Dranseika Vilius, Pretre Rene, Kretschmar Oliver, Dave Hitendu
Children's Heart Centre and Children's Research Centre, University Children's Hospital, Zurich, Switzerland.
Ann Pediatr Cardiol. 2021 Jan-Mar;14(1):35-41. doi: 10.4103/apc.APC_74_20. Epub 2021 Jan 4.
Infants requiring mitral valve replacement have few viable options. Recently, stented bovine jugular vein graft (Melody) has been surgically implanted in such cases. Herein, we report our experience, elaborating on evolution of implantation technique, pitfalls, as well as long-term outcome (including late dilatability).
Seven Melody valves were implanted (2013-2019). The median patient age and weight were 6.7 (1.8-30.5) months and 5.8 (4.6-9.5) kg, respectively. The indications for implantation were mitral stenosis and/or regurgitation postatrioventricular septal defect (AVSD) repair (5), congenital mitral valve dysplasia (1), and Shone's complex (1). Operative technique involved shortening the valve and creating a neo-sewing ring at 2/3 (atrial)-1/3 (ventricular) junction. Implantation was followed by intraoperative balloon dilatation.
Five out of seven patients survived the perioperative period (one death due to technical failure and the other due to acute respiratory distress syndrome postcardiopulmonary bypass). Two out of five medium-term survivors got transplanted (1) or died due to acute myeloid leukemia (1). No valves were replaced. The mean echo gradient at discharge was a median 4 (2-6) mmHg. None of the patients showed left ventricular outflow tract or pulmonary venous obstruction. Two Melody valves were dilated late (5 months and 3 years postoperatively), resulting in decreasing mean gradients from 6 to 1 and from 17 to 4 mmHg. At last follow-up, surviving Melody had a mean gradient of 4 (1-9) mmHg.
Mitral valve replacement with a Melody valve is feasible in infants, is reproducible, shows good immediate results, and offers the possibility of later dilatation. This technique offers a better solution compared to the existing alternatives for infants requiring a prosthetic mitral valve.
需要进行二尖瓣置换的婴儿可行的选择很少。最近，带支架的牛颈静脉移植物（Melody）已通过手术植入此类病例。在此，我们报告我们的经验，详细阐述植入技术的演变、陷阱以及长期结果（包括后期扩张性）。
植入了7个Melody瓣膜（2013 - 2019年）。患者的中位年龄和体重分别为6.7（1.8 - 30.5）个月和5.8（4.6 - 9.5）千克。植入的指征为房室间隔缺损（AVSD）修复术后的二尖瓣狭窄和/或反流（5例）、先天性二尖瓣发育异常（1例）以及Shone综合征（1例）。手术技术包括缩短瓣膜并在2/3（心房）- 1/3（心室）交界处创建一个新的缝合环。植入后进行术中球囊扩张。
7例患者中有5例在围手术期存活（1例因技术失败死亡，另1例因体外循环后急性呼吸窘迫综合征死亡）。5例中期存活者中有2例接受了移植（1例）或因急性髓系白血病死亡（1例）。未进行瓣膜置换。出院时的平均超声心动图梯度中位数为4（2 - 6）mmHg。所有患者均未出现左心室流出道或肺静脉梗阻。2个Melody瓣膜在后期进行了扩张（术后5个月和3年），导致平均梯度从6降至1以及从17降至4 mmHg。在最后一次随访时，存活的Melody瓣膜平均梯度为4（1 - 9）mmHg。
用Melody瓣膜进行二尖瓣置换在婴儿中是可行的，可重复，近期效果良好，并提供了后期扩张的可能性。与需要人工二尖瓣的婴儿现有的替代方案相比，该技术提供了更好的解决方案。
