Melody valve to replace the mitral valve in small children: Lessons learned.
Melody valve to replace the mitral valve in small children: Lessons learned.
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DOI：
10.4103/apc.apc_74_20
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发表时间：
2021-01
影响因子：
0.7
通讯作者：
Dave H
中科院分区：
文献类型：
--
作者：
Dranseika V;Pretre R;Kretschmar O;Dave H
需要二尖瓣置换术的婴儿几乎没有可行的选择。最近，支架牛颈静脉移植物（旋律）已手术植入在这种情况下。在此，我们报告了我们的经验，详细阐述了植入技术的演变、缺陷以及长期结局（包括晚期可切除性）。植入了7枚Melody瓣膜（2013-2019年）。中位患者年龄和体重分别为6.7（1.8-30.5）个月和5.8（4.6-9.5）kg。植入适应症为房室间隔缺损（AVSD）修复术后二尖瓣狭窄和/或返流（5例）、先天性二尖瓣发育不良（1例）和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）交界处创建新缝合环。植入后进行术中球囊扩张。5/7例患者在围手术期存活（1例死于技术故障，另1例死于心肺转流术后急性呼吸窘迫综合征）。五分之二的中期存活者接受了移植（1）或死于急性髓性白血病（1）。未更换瓣膜。出院时的平均超声梯度中位数为4（2-6）mmHg。所有患者均未出现左心室流出道或肺静脉阻塞。2枚Melody瓣膜在晚期（术后5个月和3年）扩张，导致平均压差从6 mmHg降至1 mmHg，从17 mmHg降至4 mmHg。末次随访时，存活的Melody的平均压差为4（1-9）mmHg。在婴儿中使用Melody瓣膜进行二尖瓣置换是可行的，具有可重复性，显示出良好的即时结果，并提供了后期扩张的可能性。与需要人工二尖瓣的婴儿的现有替代方案相比，该技术提供了更好的解决方案。
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.