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Systemic atrioventricular conduit for extracardiac bypass of hypoplastic systemic atrioventricular valve
A Amodeo1, R Di Donato, A Corno
1Department of Pediatric Cardiology and Cardiac Surgery, Ospedale Bambino Gesù, Rome, Italy.
Insights
Systemic atrioventricular extracardiac conduits offer a reliable surgical option for infants with hypoplastic atrioventricular valves. This approach effectively reduces transmitral gradients, though long-term valve efficacy requires further investigation.
Area of Science:
- Cardiology
- Pediatric Surgery
- Biomedical Engineering
Background:
- Severe congenital mitral stenosis in pediatric patients presents complex management challenges.
- Conventional surgical interventions are often unsuitable for infants with hypoplastic systemic atrioventricular valves.
Observation:
- A systemic atrioventricular (SAV) extracardiac conduit was utilized in six pediatric patients to bypass hypoplastic atrioventricular valves.
- The conduit was implanted between the left atrium and left ventricle in five patients and the right atrium and right ventricle in one.
Findings:
- Postoperative cardiac catheterization demonstrated a significant reduction in the mean transmitral gradient from 16 mmHg to 5 mmHg.
- One hospital death occurred due to mediastinitis; two late deaths were attributed to progressive subaortic stenosis and arrhythmia.
- Bioprosthetic valve calcification was observed in two patients, necessitating further intervention or replacement.
Implications:
- The SAV extracardiac conduit represents a viable surgical strategy for complex congenital mitral stenosis in infants.
- While effective in gradient reduction, long-term durability and potential complications like calcification warrant ongoing monitoring and research.
Abstract:
The management of severe congenital mitral stenosis in infants and children is still controversial. We describe our experience with the use of a systemic atrioventricular (SAV) extracardiac conduit to bypass a hypoplastic systemic atrioventricular valve. An SAV extracardiac conduit has been used in six patients (left atrium--left ventricle in five, right atrium--right ventricle in one). One hospital death occurred due to mediastinitis and there were two late deaths, one due to progressive subaortic stenosis and one sudden, possibly due to arrhythmia. Postoperative cardiac catheterization performed in five patients showed reduction of the transmitral gradient from a mean of 16 mmHg to a mean of 5 mmHg. Calcification of the bioprosthetic valve occurred in two patients 3 1/2 years and 2 years respectively after the operation; one died from concomitant subaortic stenosis and one underwent conduit replacement. Although its long-term efficacy is limited, the SAV conduit seems the most reliable surgical option for infants and children with hypoplastic systemic atrioventricular valves unsuited to conventional surgery.