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DOI: 10.1055/s-0034-1394079
Novel method of mitral annular enlargement for implantation of an oversized mitral valve prosthesis
Background: Despite excellent results in mitral valve (MV) repair, a significant number of children require mitral valve replacement. With mitral annular hypoplasia, placement of adequate size mechanical prostethis is challenging, especially in young children.
Methods: Surgical implantation of mechanical prostethis and clinical course of five consecutive patients operated between 5/2013 and 1/2014 in our unit is described.
Results: Mean age and weight at operations were 6.0ys and 16.8 kg (range 1.3 - 13.3y, 7.3 - 44.5 kg). Indication was MV stenosis with hammock (n=2) parachute (n=1) type MV, due to prostethis outgrowth in (1) and moderate mitral regurgitation after Ross-Konno operation (1). Mitral valve was operated before in all patient (range 1- 3). Associated procedures were aortic (3), tricuspid (2) valvuloplasty, relief of subaortic stenosis (2) conduit change (1). Mean cross clamp (132±15min) bypass(209±28min), ventilation time (65±35h) and hospital stay were (17±3d). No postoperative block was associated with this surgery. After a median follow-up interval of 8 mo (range 4-11.4) 4 patients are alive an in NYHA I, with normal function of the mitral prostethis. One sudden death occured 4 months after implantation at home with normal valve function on last follow-up.
Conclusions: Supraannular implantation using a patch and allows efficient mitral annular enlargement for the implantation of a larger prosthesis, without the drawbacks seen with atrial implantation such as heart block, left ventricular outflow or pulmonary venous obstruction.