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Melody valve to replace the mitral valve in small children: Lessons learned
Vilius Dranseika1, Rene Pretre1, Oliver Kretschmar1
1Children's Heart Centre and Children's Research Centre, University Children's Hospital, Zurich, Switzerland.
Annals of Pediatric Cardiology
|March 8, 2021
Summary
Melody valve implantation is a feasible and reproducible option for infants needing mitral valve replacement, offering good initial results and potential for later dilation. This technique provides a superior alternative for pediatric patients requiring prosthetic mitral valves.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Biomedical Engineering
Background:
- Infants requiring mitral valve replacement have limited treatment options.
- The stented bovine jugular vein graft (Melody valve) has emerged as a surgical option for these infants.
Purpose of the Study:
- To report the experience with Melody valve implantation in infants.
- To elaborate on the implantation technique, identify potential pitfalls, and assess long-term outcomes, including late dilatability.
Main Methods:
- Seven Melody valves were implanted between 2013 and 2019 in infants with a median age of 6.7 months.
- Indications included post-AVSD repair mitral stenosis/regurgitation, congenital mitral valve dysplasia, and Shone's complex.
- The technique involved valve shortening, creating a neo-sewing ring, and intraoperative balloon dilatation.
Main Results:
- Five of seven patients survived the perioperative period; two survivors later underwent transplantation or died from other causes.
- No valves required replacement, and no patients showed left ventricular outflow tract or pulmonary venous obstruction.
- Two valves underwent late dilatation, significantly reducing mean gradients; surviving valves maintained a mean gradient of 4 mmHg at follow-up.
Conclusions:
- Mitral valve replacement with the Melody valve is feasible, reproducible, and yields good immediate results in infants.
- The Melody valve offers the potential for later dilatation, addressing a key limitation of prosthetic valves in growing children.
- This technique represents an improved solution for infants needing prosthetic mitral valves compared to existing alternatives.
Keywords:
BioprosthesisMelody valvecomplete atrioventricular septal defectcongenital valvular diseasemitral valve replacement in infants and childrenMore Related Videos
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