Cylinder mitral and tricuspid valve replacement in neonates and small children. (26th August 2020)

• Record Type: Journal Article
• Authors: Myers, Patrick O; Dave, Hitendu; Kretschmar, Oliver; Sologashvili, Tornike; Pfister, Raymond; Prêtre, René
• Is Part Of: European journal of cardio-thoracic surgery. Volume 58:Number 5(2020)
• Page Start: 964
• Page End: 968
• Publication Date: 2020-08-26
• Subjects: Congenital mitral valve -- Congenital tricuspid valve -- Valve replacement; Heart -- Surgery -- Periodicals; Chest -- Surgery -- Periodicals; 617.54
• DOI: 10.1093/ejcts/ezaa196
• Languages: English
• ISSNs: 1010-7940

Abstract

Abstract: OBJECTIVES: Atrioventricular valve replacement in small children is associated with high morbidity and mortality. There are no prostheses available with a diameter ˂15 mm. This study reports our initial experience with a cylinder valve for mitral and tricuspid valve replacement in infants and small children. METHODS: Our cylinder valve was hand-made for patients requiring atrioventricuclar valve replacement with an annulus of <15 mm. A 12-mm Contegra valve was prepared and placed inside a 14-mm Gore-Tex tube graft and sutured on both extremities. RESULTS: Eight patients were included, with a median age of 6.9 months (range 1 day to 38 months). Four had mitral and 4 had tricuspid valve replacement. All implants were technically successful, with no significant regurgitation, no stenosis and no left ventricular outflow tract obstruction. There were 3 early deaths from low cardiac output, in patients with significant associated lesions (severe neonatal Ebstein's, pulmonary artery-intact ventricular septum, biventricular conversion from Norwood stage 1). Two patients required early reintervention: 1 for balloon dilatation for stenosis and 1 for reoperation for paravalvular leak. During follow-up, 2 patients had mitral valve replacement with a 16-mm mechanical valve at 9 and 20 months from the cylinder valve implantation. The remaining 2 patients are alive and well 2 years and 2 months after the procedure. CONCLUSIONS: Cylinder valve replacement of atrioventricular valves was feasible without any technical issues. It was successful in getting out of a difficult situation and allows for somatic growth and implantation of a reasonably-sized mechanical prosthesis on the annulus. Abstract : Mitral and tricuspid valve repair is always the first option in infants and small children, with improving outcomes [1–3].