第53回日本小児循環器学会総会・学術集会

講演情報

JCK E-Oral Presentation

JCK E-Oral Presentation 2 (III-JCKEOP02)

2017年7月9日(日) 13:00 〜 14:00 E-Oral エリア (1F 展示イベントホール)

Chair:Atsuko Kato(Division of Cardiology, The Labatt Family Heart Centre, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada)
Chair:Takaya Hoashi(Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Japan)

13:00 〜 14:00

[III-JCKEOP02-06] Mitral valve replacement using stented bovine jugular vein graft (Melody valve) in infants and small children

Atsuko Kato1, Osami Honjo2 (1.Division of Cardiology, The Labatt Family Heart Centre, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada, 2.Department of Cardiovascular surgery, The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Canada)

BACKGROUND: Melody® valve (Medtronic, MN) implantation in the mitral position is a novel procedure for the small mitral valve (MV) annulus, which does not require anticoagulation. We sought to analyze our initial experience with mitral valve replacement (MVR) with Melody® valve.
METHOD: The records of patients who underwent MVR using Melody® from 2014 to 2016 were retrospectively reviewed. The Melody® (22 mm) valve was prepared by sewing a 3.5 mm Gore-Tex tube graft at the middle of the stent as a cuff and resecting one or three zigs to avoid left ventricular outflow tract (LVOT) obstruction.
RESULTS: Five patients (age, 11 months, 5 - 16 months; weight, 6.8 kg, 4.6 - 8.6 kg) were included. All patient had dysplastic MV, including severe mitral stenosis (n=3) and/or regurgitation (n=3). Three patients had Melody® valve MVR as a salvage procedure: mechanical valve thrombosis (n=2) and tissue valve dysfunction (n=1). The valve was inflated to 18 mm (n=2) or 20 mm (n=3). Intraoperative echocardiography revealed trivial or none regurgitation in all patients with mean pressure Doppler gradient across the valve of 2 mmHg (1 – 4 mmHg), and peak LVOT gradient of 5 mmHg (0 – 12 mmHg). All the patients but one were discharged home. There was one patient who had sudden death at 3 months after surgery.
CONCLUSIONS: Melody® valve MVR is a viable alternative to mechanical MVR in small children. Early functional outcome of this procedure is excellent, whereas long-term outcome is to be investigated.