Sharef Sadik, Coleman Ryan, Rivenes Shannon, Wilmot Ivan, Altman Carolyn, Madden-Fuentes Ramiro, Salazar Jorge
Division of Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas 77030, USA.
Tex Heart Inst J. 2010;37(3):347-9.
Disease or dysfunction of the aortic valve in pediatric patients presents a substantial challenge. Valve preservation, even if not the definitive solution, is always optimal. Successful repair will enable somatic growth and avoid repeated valve replacement and the need for systemic anticoagulation. When repair of the aortic valve is not possible in pediatric patients, replacement of the valve requires the most suitable (or, often, the least unsuitable) choice for each patient. The limitations of the typical replacement options (pulmonary autografts, mechanical valves, stented bioprostheses, and homografts) have led us to explore the use of stentless xenografts. Herein, we present a case of aortic valve replacement with a stentless porcine xenograft in one of the youngest and smallest patients reported to date. Use of the xenograft enabled a proper fit with a small aortic annulus, precluded the need for subsequent systemic anticoagulation, and averted a transvalvular gradient and the creation of 2-valve disease. We believe that the stentless porcine xenograft is feasible for use in pediatric patients who require aortic valve replacement.
小儿患者的主动脉瓣疾病或功能障碍是一项重大挑战。瓣膜保留即便不是最终解决方案，也始终是最佳选择。成功修复可促进身体生长，并避免反复进行瓣膜置换以及全身性抗凝的需求。当小儿患者无法进行主动脉瓣修复时，瓣膜置换需要为每位患者做出最合适（或者通常是最不合适程度最低）的选择。典型置换选项（自体肺动脉瓣、机械瓣膜、带支架生物假体和同种异体移植物）的局限性促使我们探索使用无支架异种移植物。在此，我们报告了迄今为止所报道的最年幼且体型最小的患者之一使用无支架猪异种移植物进行主动脉瓣置换的病例。使用异种移植物能够与小主动脉瓣环良好适配，无需后续全身性抗凝，避免了跨瓣压差以及双瓣疾病的产生。我们认为无支架猪异种移植物可用于需要进行主动脉瓣置换的小儿患者。
