Konno Aortoventriculoplasty and Mitral Valve Replacement in a Child With Atrioventricular Septal Defect
Pediatric patients with atrioventricular (AV) septal defects represent a congenital population that may require repeat operations on the AV valves over time. The authors present a previously repaired patient who also required left AV valve replacement after failed left AV valve repair and discuss Konno aortoventriculoplasty in conjunction with mitral re-replacement as a fourth reoperation to demonstrate feasibility and results.
An eight-year-old girl who had prior repair of atrioventricular septal defect underwent multiple prior reoperations, including repair and subsequent mechanical left AV valve replacement. Her current problem was shortness of breath with patient prosthesis mismatch, severe aortic regurgitation with left ventricular fibromuscular outflow tract obstruction, and severe tricuspid regurgitation. Through a fourth-time redo sternotomy, the authors performed a left AV valve re-replacement with a 19 mm St Jude mechanical valve, a Konno aortoventriculoplasty using a 19 mm Onyx mechanical valve, and an eccentric banded tricuspid annuloplasty. Separation from bypass was uneventful, with normal hemodynamics and sinus rhythm.
The patient was extubated the night of surgery and was discharged on postoperative day seven without complications. A predismissal echocardiogram revealed a mean gradient of 17 mm Hg across the aortic prosthesis, and a mean gradient of 7 mm Hg across the mitral prosthesis. Her heart rate was 106 beats/min and hemoglobin was 9.4 g/dL. The mean diastolic gradient across the tricuspid valve was 4 mm Hg with trivial regurgitation.
In pediatric patients with AV septal defects who develop recurrent valve problems and left ventricular outflow tract obstruction not amenable to conventional repair techniques, Konno aortoventriculoplasty with a mechanical valve and concomitant left AV valve (mitral) replacement with a mechanical valve can be performed safely and with good long-term results.
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