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Isabella Rosa Nanini

Mr. Speice

Independent Study and Mentorship II 3B

13 November 2017

A Prospective Research on Mitral Valvuloplasty and Mitral Valve Replacement in Infants Less

Than One Year Old

Original Work Proposal

Since pediatric cardiothoracic surgery is a fairly new and very specific medical

subspecialty not much research can be found on more rare congenital heart malformations. For

my original work I want to focus specifically on the mitral valve. The mitral valve consists of

the annulus which is C shaped like a saddle. The mitral valve consists of two leaflets the anterior

(A1, A2, and A3) and the posterior leaflet (P1, P2, and P3) and between the two leaflets are the

lines of commissure, anterolateral and posteromedial. The mitral valve also consists of the

chordae tendineae and papillary muscles. When all of this anatomy is working properly the

mitral valve allows blood flow from the left atrium into the left ventricle, but not the other way.

When the anatomy of the mitral valve is malformed this leads to regurgitation; which means

blood is flowing from the left atrium into the left ventricle and back into the left atrium. Severe

regurgitation can lead to atrial fibrillation and a combination of other heart diseases that require

operation. Mitral valve malformation may also come non-isolated, meaning the heart has a

congenital mitral valve malformation combined with other congenital heart malformations. For

most cases of congenital mitral valve malformations operation is required later in life, but in the

rare case where regurgitation is severe an infant less than one year old may require a mitral valve
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repair where the incorrect anatomy is repaired through different surgical techniques (mitral

valvuloplasty) or a mitral valve replacement where the mitral valve is removed and replaced with

a mechanical or bioengineered mitral valve. More often than not mitral valve repair is performed

and patients need reoperation. Since this operation is rare many pediatric cardiothoracic surgeons

perform mitral valve repairs and replacements in infants less than one year old without knowing

the likely prognosis of their patient. My goal with my original work is to alongside my mentor

and a fellow to create a prospective research where we review the past patients who have

undergone mitral valvuloplasty and mitral valve replacements when less than one year old. Our

study will focus on isolated mitral valve malformations and we will review the outcomes of these

operations and create a medical research article where the outcomes of our research can be

shared with medical professionals around the world to better understand the outcome of mitral

valvuloplasties and mitral valve replacement in infants less than one year old, and increase the

knowledge of pediatric cardiothoracic surgery and congenital mitral valve malformations.

The first step to completing this research is to build the background knowledge to

understand mitral valve anatomy, mitral valve embryology, and congenital mitral valve

malformations. By building this foundational understanding I can begin to build the knowledge

needed to understand the repairs and replacements used to correct these mitral valve

malformations. To achieve this I will create extensive research on mitral valve anatomy, mitral

valve embryology, and congenital mitral valve malformations by reading medical articles and

creating research assessments where I can collect my newly gained knowledge. To continue to

build my background knowledge I also need to research the specific aspects of surgery that will

be reviewed in patient charts and what these mean for overall heart health and this patient’s
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prognosis. Through this new extension of knowledge, I can now begin the prospective research

and understand what I will be reviewing and hopefully writing. The revision of charts is the next

step of this research. Alongside my mentor and a pediatric cardiothoracic surgery fellow I will be

reviewing the charts of the past patients who meet the specific criteria for our research (mitral

valvuloplasty or mitral valve replacement in infant less than one year old with an isolated

congenital mitral valve malformation) from the past 16 years of pediatric cardiothoracic surgery

at Children’s Health Medical Center Dallas. Since I am not a physician, patient name and other

confidential information will not be revealed to me specifically, but this will not hinder the

development of our research. There will be less than 30 patients to review and with this

information we will begin to write our publication. This publication will cause me to step outside

my comfort zone and write my first medical research article. Writing this article will require me

to learn the specific methods of writing a published medical journal.

Through this research I will be able to achieve the very goal I set for myself during my

first week of my Independent Study and Mentorship II journey which was to think big and get

specific with my topic. This research allows me to step outside of my own learning comfort zone

where I will have to build extensive background knowledge that is very specific to pediatric

cardiothoracic surgery. The knowledge I will gain will allow me to overall better understand

congenital heart malformations and the pediatric cardiothoracic surgical process. Through the

review of patient criteria and charts I will better understand pediatric cardiothoracic patient

prognosis and the overall outcome of open-heart surgery to the human body. By creating a

medical publication I will learn more about different aspects of the job of a pediatric

cardiothoracic surgery and the different processes that go into developing a medical research and
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getting it published. This original work project will hopefully allow me to overall better

understand the field of pediatric cardiothoracic surgery and what it takes to expand the medical

knowledge of pediatric cardiothoracic surgery.