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Prosthetic mitral valve replacement after atrioventricular septal defect repair: a technique for small children
1Section of Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston 77030, USA.
Insights
A novel mitral annulus enlargement technique successfully treated severe mitral regurgitation in an infant, avoiding heart transplantation. This surgical innovation offers a promising solution for complex congenital heart disease.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Complete atrioventricular septal defect repair is a common pediatric cardiac surgery.
- Postoperative complications can include severe mitral regurgitation, pulmonary hypertension, and heart failure.
- Small atrioventricular valve annulus size can complicate surgical repair.
Observation:
- An 11-month-old infant presented with severe mitral regurgitation, pulmonary hypertension, and heart failure post-atrioventricular septal defect repair.
- The left atrioventricular valve annulus was deemed irreparable due to its small size (11 mm).
Findings:
- A surgical technique to enlarge the mitral annulus was employed.
- A 17-mm prosthetic valve was successfully implanted.
- The patient experienced an unremarkable postoperative course.
Implications:
- Mitral annulus enlargement offers a viable alternative to cardiac transplantation in select pediatric cases.
- This technique can improve outcomes for infants with complex congenital heart defects and severe valve dysfunction.
- Successful valve implantation demonstrates the potential for long-term recovery and improved quality of life.
Abstract:
An 11-month-old girl was transferred for consideration of cardiac transplantation. She had previously undergone repair of complete atrioventricular septal defect at another institution. Her postoperative course was notable for severe mitral regurgitation, pulmonary hypertension, and heart failure. At reoperation, the left atrioventricular valve was considered irreparable with a very small (11 mm) annulus. Using a technique to enlarge the mitral annulus, a 17-mm prosthetic valve was placed. Her postoperative course was unremarkable and she is doing very well at 3 years follow-up.