Padovani Paul, Jalal Zakaria, Fouilloux Virginie, Benbrik Nadir, Grunenwald Céline, Thambo Jean-Benoit, Aldebert Philippe, Tagorti Maha, Roubertie François, Baron Olivier, Ovaert Caroline, Ly Mohamedou, Baruteau Alban-Elouen
Department of Pediatric Cardiology and Pediatric Cardiac Surgery, FHU PRECICARE, Nantes Université, CHU Nantes, Nantes, France.
INSERM, Nantes Université, CHU Nantes, Nantes, France.
Interdiscip Cardiovasc Thorac Surg. 2024 Mar 29;38(4). doi: 10.1093/icvts/ivae046.
Surgical management of mitral valve disease is challenging in infants <1 year old. We aimed at reviewing the French experience with Melody mitral valve replacement in critically ill infants.
A retrospective cohort study reporting the French experience with Melody mitral valve replacement.
Seven symptomatic infants [complete atrioventricular septal defect (n = 4, Down syndrome: n = 3), hammock valve (n = 3)] underwent Melody mitral valve replacement [age: 3 months (28 days to 8 months), weight: 4.3 kg (3.2-6.4 kg)] because of severe mitral valve regurgitation (6) or mixed valve disease (1) and 14 mm (11-16 mm) mitral valve annulus. In 2 patients whose valve was felt irreparable, Melody mitral valve replacement was performed straightaway. The others underwent 2 (1-3) previous attempts of valve repair; 3 were on extracorporeal membrane oxygenation. Melody mitral valve replacement led to competent valve and low gradient [3 mmHg, (1-4 mmHg)]. One patient died 3 days post-implant from extracorporeal membrane oxygenation-related stroke. Of the 6 discharged home patients, 3 (50%) were readmitted for a definite diagnosis (1) or high suspicion (2) of infective endocarditis, of which 2 died. Over the follow-up, 1 underwent balloon expansions of the valve at 9- and 16-months post-implant, and mechanical mitral valve replacement at 2 years; another is currently planned for transcatheter Melody valve dilation.
Melody mitral valve replacement may be considered in selected infants with small mitral valve annulus as an alternative to mechanical mitral valve replacement. Our experience highlights a high-risk of late infective endocarditis that deserves further consideration.
对于1岁以下婴儿，二尖瓣疾病的外科治疗具有挑战性。我们旨在回顾法国在危重症婴儿中使用美敦力二尖瓣置换术（Melody二尖瓣置换）的经验。
一项回顾性队列研究，报告法国使用美敦力二尖瓣置换术的经验。
7例有症状的婴儿[完全性房室间隔缺损（n = 4，唐氏综合征：n = 3），吊床样瓣膜（n = 3）]因严重二尖瓣反流（6例）或混合性瓣膜病（1例）且二尖瓣瓣环为14 mm（11 - 16 mm），接受了美敦力二尖瓣置换术[年龄：3个月（28天至8个月），体重：4.3 kg（3.2 - 6.4 kg）]。在2例认为瓣膜无法修复的患者中，直接进行了美敦力二尖瓣置换术。其他患者先前进行了2次（1 - 3次）瓣膜修复尝试；3例患者接受了体外膜肺氧合。美敦力二尖瓣置换术使瓣膜功能良好且压差较低[3 mmHg，（1 - 4 mmHg）]。1例患者在植入后3天因与体外膜肺氧合相关的中风死亡。在6例出院回家的患者中，3例（50%）因确诊（1例）或高度怀疑（2例）感染性心内膜炎再次入院，其中2例死亡。在随访期间，1例患者在植入后9个月和16个月接受了瓣膜球囊扩张，并在2岁时接受了机械二尖瓣置换术；另1例目前计划进行经导管美敦力瓣膜扩张。
对于二尖瓣瓣环较小的特定婴儿，可考虑使用美敦力二尖瓣置换术作为机械二尖瓣置换术的替代方法。我们的经验凸显了晚期感染性心内膜炎的高风险，值得进一步关注。
