Surgical treatment for large ductus arteriosus with functional mitral regurgitation in children

  Background  Patent ductus arteriosus (PDA) is usually treated with interventional closure or surgical ligation, with good results. When there is a large left to right shunt that cause the left ventricular volume overload, the left ventricle and mitral valve annulus enlarges and causes mitral valve regurgitation, which will further lead to the overload of left ventricular volume, thus aggravating mitral valve regurgitation.

  Objective  To summarize the surgical treatment strategies and follow-up results of children with congenital large patent ductus arteriosus (PDA) with mitral valve regurgitation (MR), and provide clinical evidence for the treatment of this kind of patients.

  Methods  Clinical data about 45 children with large PDA and functional MR were retrospectively analyzed in our department from January 2014 to January 2018. There were 3 kinds of surgical treatment strategy, including directly PDA ligation via posterolateral incision, traditional PDA ligation and mitral valve repair under extracorporeal circulation, and two-stage surgical treatment strategy. Then the perioperative and long-term complications, postoperative degree of MR, left ventricular end-diastolic diameter (LVEDD), and left ventricular ejection function (LVEF) were compared. Results There were 21 males and 24 females, with age ranged from 4 months to 12 years. The average diameter of ductus was (11.7 ± 3.4) mm (range: 8 − 14 mm). No case died after surgery, and the degree of MR reduced significantly or disappeared in 44 cases after surgery. One child underwent mitral valve repair and PDA ligation due to residual shunt combined with severe MR at 2 years after surgery. One child received intra-aortic balloon pump due to low cardiac low syndrome, and recovered at 5 days after surgery. In children with mitral valve regurgitation, the left ventricle decreased significantly after surgery, and the LVEF also decreased compared to preoperation; all differences were statistically significant (P＜0.05). However, the LVEF recovered at 3 months after surgery.

  Conclusion  For children with large PDA and functional mitral regurgitation, PDA ligation can reduce left ventricular volume preload effectively, improve mitral regurgitation, reduce the risk of simultaneous surgery, with a satisfied long-term effect, which can be an alternative treatment strategy.