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[Reoperation for pediatric valvular diseases]
1Department of Cardiovascular Surgery Jikei University, Tokyo, Japan.
Insights
For grown-up children with valvular heart disease, valve repair is preferred over artificial valves. When replacement is necessary, the Ross operation or homograft is superior to the Konno operation for these complex pediatric cardiac surgery cases.
Area of Science:
- Pediatric Cardiac Surgery
- Valvular Heart Disease
- Congenital Heart Defects
Context:
- Managing valvular heart disease in grown-up children (GUCH) presents unique surgical challenges.
- Adequate artificial valve sizing can be difficult without annular enlargement in pediatric patients.
- Complex anomalies like univentricular atrioventricular connections often necessitate valve repair over prosthetic implantation.
Purpose:
- To review surgical strategies for atrioventricular valve management in grown-up children with valvular diseases.
- To highlight the importance of considering the atrioventricular conduction system during valve interventions, especially reoperations.
- To compare the efficacy of different valve replacement techniques in GUCH.
Summary:
- Atrioventricular valve repair is preferred in GUCH, particularly for complex congenital heart defects, to avoid prosthetic complications.
- Valve replacement in GUCH may be required initially or during reoperation, demanding careful attention to cardiac anatomy.
- The Ross operation or homograft demonstrates better outcomes than the Konno operation or artificial valve replacement in GUCH.
Impact:
- Informs surgical decision-making for grown-up children with congenital and acquired valvular heart disease.
- Emphasizes the need for specialized approaches in pediatric cardiac reoperations involving the atrioventricular valve.
- Suggests improved long-term outcomes by favoring specific valve replacement strategies in GUCH.
Abstract:
Grown-up children (GUCH) are one of the major concerns in the field of cardiac surgery in children with valvular diseases. In particular, an artificial valve of adequate size is sometimes difficult to insert without annular enlargement. In cases with complex anomalies such as an univentricular atrioventricular connection, the atrioventricular valve should be repaired without the use of an artificial valve as often as possible. However, those patients occasionally require valve replacement at the initial operation or redo. The specific anatomy of the atrioventricular conduction system should be taken into account during valve replacement or plasty, particularly during reoperation. In the setting of valve replacement in GUCH, the Ross operation or homograft is better than the Konno operation or artificial valve replacement.