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Isabella Rosa Nanini

Mr. Speice

Independent Study and Mentorship II- 3B

26 February 2018

Research: Mitral Valvuloplasty and Mitral Valve Replacements in Infants Less Than One Year

Old

Final Product Proposal

Introduction and Statement of Purpose

Since pediatric cardiothoracic surgery is a fairly new and specific medical subspecialty,

limited research can be found on more rare congenital heart malformations. The mitral valve

consists of the annulus which is C shaped like a saddle, and of two leaflets the anterior (A1, A2,

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

anterolateral and posteromedial lines of commissure.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 can also cause mitral valve stenosis, which is the

narrowing of the mitral valve. If stenosis is severe enough operation is required. 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
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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 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 and high risk, 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 final product is to, alongside my

mentor and a fellow, to create a prospective research where we review the charts and life of past

patients who have undergone mitral valvuloplasty and mitral valve replacements when less than

one year old at Children’s Health Medical Center Dallas, and use my original work to assist me

in writing this publication to prove that although rare and high risk there can be a positive

prognosis of living for these patients.. 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.

Review of Skills and Research

My original work consisted of extensive research to increase my background knowledge

of congenital mitral valve malformation, mitral valvuloplasty, mitral valve replacements, and

medical research. This allows me to have a handbook of information to look back at when
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writing my research. The articles used in my research for my original work project will also

become references for my research and will add to the credibility of our information and to the

introduction and discussion sections of our publication.

Methodology

For this research I have chosen to follow the method of writing proposed in:

Kallestinova, Elena D. “How to Write Your First Research Paper.” ​The Yale Journal of Biology

and Medicine

This method includes the following steps:

1. Start with an outline

a. Level 1

b. Level 2

i. Get feedback

2. Continue with drafts, copy outline into separate file and expand on each of the

points, adding data and elaborating on the details.

a. Get feedback

3. Start with materials and methods section

a. Get feedback

4. Write results section

a. Get feedback

5. Re-read methods and results section and change your outline to match your

research focus

6. Write introduction
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a. Get feedback

7. Write discussion of results

8. Revise research

9. Submit for publication

Materials

Materials needed for this research is the chart/excel sheet being made by the fellow to

obtain all the information needed to conduct our prospective research. We will also meet with a

statistics professional to help build our graphs and tables for the results and discussion section,

and a cardiologist has been asked to assist in the review of each patient’s echocardiograms.

Conclusions

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 built 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

getting it published.

Calendar/Timeline
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❖ Feb. 12 to Feb. 16

➢ Finish proposal

➢ Revise calendar with Dr. Pirolli

❖ Feb. 19 to Feb. 23

➢ Level 1 outline

■ What is the topic of my paper?

■ Why is this topic important?

■ How could I formulate my hypothesis?

■ What are my results (include visuals)?

■ What is my major finding?

➢ Get feedback

❖ Feb. 26 to March 2

➢ Level 1 outline

■ What is the topic of my paper?

■ Why is this topic important?

■ How could I formulate my hypothesis?

■ What are my results (include visuals)?

■ What is my major finding?

➢ Get feedback

➢ Level 2 outline

■ Introduction

● Why is your research important?

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● What is known about the topic?

● What are your hypotheses?

● What are your objectives?

■ Materials and Methods

● What materials did you use?

● Who were the subjects of your study?

● What was the design of your research?

● What procedure did you follow?

➢ Get feedback

❖ March 5 to March 9

➢ Complete level 2 outline

➢ Begin drafts: copy outline into separate file and expand on each of the points,

adding data and elaborating on the details

❖ March 12 to March 16 (Spring Break)

➢ Expand on drafts

➢ Get feedback

❖ March 19 to March 23

➢ Write material and methods

❖ March 26 to March 30

➢ Finish materials and methods

➢ Get feedback

❖ April 2 to April 6
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➢ Write results section

■ Organized into different segments:

● Purpose

● Experimental approach

● Data

● Data Commentary

■ Exclude data interpretation (leave that for discussion)

❖ April 9 to April 13

➢ Finish results

➢ Get feedback

❖ April 16 to April 20

➢ Begin introduction

■ Establish research territory: show that the general research area is

important, central, interesting, and problematic in some way.

■ Find a niche: indicate a gap in the previous research or extend previous

knowledge in some way.

■ Occupy the niche:

● Outline the purposes/state the nature of the present research

● List research questions or hypotheses

● Announce principle findings

● State the value of present research

● Indicate the structure of the research paper

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❖ April 23 to April 27

➢ Finish introduction

➢ Get feedback

❖ April 30 to May 4

➢ Begin discussion section

■ The study’s major findings

● State the studies major findings

● Explain importance and meaning

● Consider alternative explanations

■ Research context

● Compare and contrast your findings with those of other published

results

● Explain any discrepancies and unexpected findings

● State the limitations, weaknesses, and assumptions of your study

■ Closing the paper

● Summarize the answers to the research questions

● Indicate the importance of the work by stating applications,

recommendations, and implications

❖ May 7 to May 11

➢ Finish discussion

➢ Get feedback

❖ May 14 to May 18
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➢ Begin revision process

■ Take bird’s eye view of the whole paper. Outline will allow you to see if

ideas in paper are coherently structured, if your results are logically built,

and if the discussion is linked to the research question in the introduction

■ Revise each section from the beginning

❖ May 21 to May 25

➢ Complete revision process

➢ Begin submission process