[Reconstructive valve surgery in congenital heart disease]

Area of Science:

• Cardiology
• Pediatric Cardiac Surgery
• Biomaterials in Medicine

Context:

• Valvular lesions are common and challenging defects in congenital heart disease.
• Recent advancements focus on improving surgical outcomes and long-term results of valve repair and replacement.
• Specific congenital conditions discussed include congenital aortic stenosis, supracristed ventricular septal defect (VSD) with aortic regurgitation, tetralogy of Fallot, and atrioventricular canal defects.

Purpose:

• To review recent advances in the management of valvular lesions in congenital heart disease.
• To report on the late results of surgical repair and valve replacement procedures.
• To highlight the efficacy of various surgical techniques and biomaterials used in pediatric cardiac surgery.

Summary:

• Congenital aortic stenosis often requires valvotomy, with some patients needing reoperation and valve replacement in childhood.
• For supracristed VSD with aortic regurgitation, 70% of patients remained free of diastolic murmur at 10 years post-surgery.
• Tetralogy of Fallot repair utilizes composite pericardial patches to minimize pulmonary regurgitation, with glutaraldehyde treatment preventing shrinkage. Homografts and xenografts show comparable late results as external conduits.
• Atrioventricular canal defects are managed with endocardial cushion prosthesis, incorporating modified glutaraldehyde-treated pericardium wings.

Impact:

• Improved surgical strategies are leading to better long-term functional outcomes for children with congenital heart defects.
• The use of autologous pericardium and advancements in graft materials enhance durability and reduce reoperation rates.
• These findings contribute to optimizing treatment protocols for complex pediatric valvular heart disease, potentially improving quality of life and survival rates.