Use of expanded polytetrafluoroethylene sutures as artificial tendinous cords in children with congenital mitral regurgitation

Objective: To determine the efficacy in the intermediate term of artificial cords inserted in children with congenital mitral regurgitation. Methods: We reconstructed the tendinous cords using expanded polytetrafluoroethylene (ePTFE) sutures in 11 children with severe mitral regurgitation. In these patients, the aortic (anterior) leaflet of the mitral valve had been marked ly prolapsed, the tendinous cords being partially lacking in seven, and elo ngated in the remaining four. In addition, one of the papillary muscles was hypoplastic in five and absent in three. The number of artificial cords co nstructed varied from two to six. Conventional annuloplasty was performed i n all to plicate the dilated annular attachment of the valve. Ventricular s eptal defect was present in four patients, and other associated malformatio ns in another two. Age at operation ranged from 9 months to 9 years old wit h a mean of 4.5 years. Results: All patients survived the operation. No reo peration has been needed thus far. No complications were encountered relate d to the use of the prosthetic materials or anticoagulation. As judged by e chocardiography, regurgitation became trivial or slight immediately after t he repair. In two patients, however, regurgitation recurred within 1 year o f the operation. Coaptation between the leaflets was maintained by a compen satory growth at the site of attachment of the artificial cords. Catheteriz ation demonstrated significant improvements in the end-diastolic volume of the left ventricle. Conclusion: Expanded polytetrafluoroethylene sutures ca n be used as artificial cords when attempting to repair the malformed mitra l valve in children, providing excellent results in the short- and the inte rmediate-term after the surgical procedure. (C) 1999 Elsevier Science B.V. All rights reserved.