Re-replacement of the atrioventricular valve for the systemic circulation in children

Background and aim of the study: The study aim was to determine whether re- replacement of the systemic atrioventricular (AV) valve can be achieved eff iciently in children. Methods: The systemic AV valve was re-replaced in 10 children. Initial repl acement was needed for regurgitation in nine cases and congenital mitral st enosis in one case at a mean age of 3.7 +/- 3.1 years (range: 0.7-10.2 year s). The initial prosthesis chosen was a mechanical valve in all cases; pros thesis size ranged from 16 mm to 27 mm. Reoperation was indicated at a mean age of 9.7 +/- 3.6 years (range: 3.5-14.8 years) because of non-structural dysfunction in five cases, prosthetic valve endocarditis in two, thrombose d valve in two, and progressive obstruction of the left ventricular outflow tract in one case. Fibrous tissues were extensively resected to enlarge th e valvular orifice. A translocation maneuver was employed in five cases. Results: Re-replacement using a bileaflet mechanical valve was successful, with no operative or late deaths. Up-sizing was feasible in six cases with the initial valve less than or equal to 25 mm, the alternative prosthesis b eing 2-8 mm (mean 4.5 mm) larger than the initial one. Consecutive echocard iography demonstrated improved peak flow velocity across the AV valve (from 2.3 +/- 0.6 to 1.6 +/- 0.3 m/s). Catheterization showed improved mean pulm onary arterial pressure (from 32 +/- 13 to 21 +/- 3 mmHg). No change was se en in cardiac index (3.4 +/- 0.6 and 3.5 +/- 0.6 l/min/m(2)) or systemic ve ntricular ejection fraction (55 +/- 14% and 49 +/- 23%). Conclusions: Re-replacement of the systemic AV valve can be achieved effici ently, even in children, with up-sizing feasible by appropriate surgical ma neuvers.