Manouguian double-valve replacement in a 6-year-old girl

A 6-year-old girl with a diagnosis of aortic regurgitation with stenosis and mitral regurgitation because of short chordae was referred to us for surgery. Echocardiography revealed that the aortic and the mitral annular diameters were 16 and 23 mm, respectively. The Ross procedure and mitral valvuloplasty were scheduled. During the procedure, we were concerned that aggressive mitral valvuloplasty might result in mitral stenosis. We therefore converted the procedure to double-valve replacement using the Manouguian technique because it was necessary to enlarge both the aortic and mitral annuli. In children, the mitral prosthetic valve in Manouguian technique may override aortic annulus resulting in left ventricular outflow tract obstruction (LVOTO). Thus, it is important to decide the mitral prosthetic valve size. Measurements of both annuli showed 15 and 21 mm in aortic and mitral positions, respectively. Size #18 ATS AP mechanical valve (ATS Medical, Inc., Minneapolis, MN, USA) and size #23 ATS mechanical valve were implanted. We successfully performed two sizes up in the aortic position and one size up in the mitral position avoiding complications such as coronary orifice obstruction and LVOTO. To our knowledge, this is the youngest patient who underwent double-valve replacement by the Manouguian technique.