Mitral and tricuspid valve repair using interannular bridging in children.

Abstract

In children, it is difficult to control mitral (MV) or tricuspid valve (TV) regurgitation with conventional procedures alone because complex factors hamper easy improvement of valve coaptation. We investigated interannular bridging in children with MV/TV regurgitation. The subjects were 9 patients who underwent interannular bridging to control TV or MV regurgitation between January 2014 and December 2021. We analyzed reintervention for the valve, progression of stenosis/regurgitation, and valve growth. The TV and MV groups included four and five patients, respectively. At operation, the median age was 5.8 (1.4 to 14) years in TV and 3.6 (0.3 to 7.0) years in MV. The median weight was 13.0 (8.4 to 41.2) kg in TV and 11.0 (4.8 to 18.3) kg in MV. The median follow-up periods were 78 (11 to 94) months for TV and 30 (4 to 34) months for MV. None of the patients in either group underwent reintervention. Moderate or greater regurgitation recurred in one TV patient but subsequently improved to mild regurgitation. Valve stenosis (mean diastolic pressure gradient >10 mmHg) was not detected. Median valve diameter (Z-score) ranged from -1.17 (-3.7 to 0.85) at discharge to -0.59 (-1.2 to 2.01) at the latest follow-up in TV patients. In MV patients, valve diameter changed from 1.14 (-1.68 to 1.46) to 0.72 (-0.23 to 1.36). After bridging, the coaptation height (CH) was maintained at the same value over time. Interannular bridging could be a useful approach for complicated TV/MV regurgitation in children.