Mitral Valve Insufficiency Clinical Trial
Official title:
The Effect of Posterior Annulus Elevation Technique in Reducing Residual Regurgitation During Mitral Valve Repair in Children
The main problem in mitral valve repair surgery in children is the high number of postoperative residual lesions (49% of the total cases). Residual lesions after mitral valve repair are associated with morbidity and complications in the form of hemolysis and could affect the postoperative reverse remodeling process. Surgery techniques for mitral valve repair in children have fewer choices than adult patients because of the smaller and thinner valve structure. Besides, the weakness of the mitral valve repair technique that often occurs in large left ventricles with severe mitral regurgitation, after repairing with ring annuloplasty, there is usually a mild residual regurgitation due to posterior mitral leaflet that tends to become restrictive due to being attracted by the left ventricular wall that remains big. No technique has been found to overcome the problem of mitral regurgitation residuals that occur postoperatively. Therefore, by analyzing postoperative mitral valve structural abnormalities with conventional techniques, an additional posterior mitral valve elevation technique was designed to increase the area of coaptation between two leaves of the mitral valve so that the incidence of postoperative regurgitation lesions can be reduced.
The main problem in mitral valve repair surgery in children is the high number of
postoperative residual lesions (49% of the total cases). Residual lesions after mitral valve
repair are associated with morbidity and complications in the form of hemolysis and could
affect the postoperative reverse remodeling process. Surgery techniques for mitral valve
repair in children have fewer choices than adult patients because of the smaller and thinner
valve structure. Besides, the weakness of the mitral valve repair technique that often occurs
in large left ventricles with severe mitral regurgitation, after repairing with ring
annuloplasty, there is usually a mild residual regurgitation due to posterior mitral leaflet
that tends to become restrictive due to being attracted by the left ventricular wall that
remains big. No technique has been found to overcome the problem of mitral regurgitation
residuals that occur postoperatively.
Therefore, by analyzing postoperative mitral valve structural abnormalities with conventional
techniques, an additional posterior mitral valve elevation technique was designed. The
posterior annulus elevation technique is a technique that is carried by lifting the posterior
mitral annulus towards the cranial so that the posterior mitral leaflet can meet perfectly
with the anterior mitral leaflet indicated by a larger coaptation area. This technique can be
applied after repair with conventional techniques done optimally to reduce the possibility of
postoperative residual lesions.
The hypothesis in this study is that pediatric patients with mitral regurgitation who undergo
mitral valve repair surgery with posterior annulus elevation techniques can reduce residual
mitral regurgitation, improve clinical and metabolic outcomes of postoperative heart failure,
and reduce the risk of postoperative hemolysis.
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