An Alternative Method for Enlargement of Left Atrioventricular Valvular Annulus at Repeat Prosthetic Valve Replacement in Atrioventricular Septal Defect
10.4326/jjcvs.36.292
- VernacularTitle:完全型房室中隔欠損術後・左側房室弁再置換時における人工弁サイズアップのための弁輪拡大法
- Author:
Tomohisa Kawahito
;
Takashi Tominaga
;
Yoshiyasu Egawa
- Publication Type:Journal Article
- From:Japanese Journal of Cardiovascular Surgery
2007;36(5):292-294
- CountryJapan
- Language:Japanese
-
Abstract:
A 10-year-old girl was given a diagnosis of mitral stenosis due to a small prosthetic valve. She had undergone intra-cardiac repair operations for a complete atrioventricular septal defect by a two-patch method at 6 months after birth, and for left atrioventricular valve insufficiency by replacement with a mechanical prosthesis (SJM-HP-17mm) at 2 years of age. The cause of mitral stenosis was considered to be that the existing prosthesis was too small for her body growth. Reoperation was done with a trans-septal approach, but despite the resection of the old prosthesis and peripheral fibrous tissue her left atrioventricular annulus was not big enough to insert a larger prosthesis. We thus cut the previous VSD patch about 1cm toward the apex, and sutured a patch for annular enlargement. After this annular enlargement, we could insert a larger prosthesis (SJM-HP-21mm). Her postoperative course was uneventful. There was no left ventricular outflow obstruction and no worsening of her mild right atrioventricular regurgitation. There are few established procedures for enlargement of a left atrioventricular annulus. Our method presented here is safe and effective for left atrioventricular annular enlargement, but can only be applied to patients with atrioventricular septal defect.
