Clinical Outcomes of Mitral Valve Replacement With the 16-mm ATS Advanced Performance Valve in Neonates and Infants

Long-term outcomes of mitral valve replacement in patients weighing less than 10 kg

“…Placing the prosthesis in a supra-annular position is an alternative, when a more traditional annular implantation is not possible. The prosthetic valve was implanted with interrupted pledgeted polyester sutures with the pledgets on the atrial side of the prosthesis [15]. Previous publications suggested that the early results with supra-annular MVR in children were discouraging and identi ed it as a risk factor for early mortality because of the reduction of LA volume and compliance and aneurysm formation in the ventricularized segment of LA between the prosthesis and the annulus [2].…”

Echocardiographic assessment of prosthetic mitral valves in children

“…The influence of somatic growth has primarily been explored in previous studies through peak E velocity of transprosthetic flow. The peak E velocity of transprosthetic flow and the peak PG calculated by the simplified Bernoulli equation have been found to increase in proportion to the relative reduction in PMV size due to the somatic growth of children . Vohra et al.…”

“…We adopted the PMV size z‐score based on BSA as an indicator of the relationship between PMV size and body size. Previous reports used various indices of relative PMV size including the nominal orifice area of the PMV indexed to BSA, PMV size indexed to body weight, and the ratio of PMV size to BSA‐predicted mitral valve size . As opposed to the nominal orifice area of the PMV, which varies in different products, the PMV size is easily obtained from medical charts in echocardiography laboratories.…”

“…Nonetheless, mitral valve replacement is necessary for children with acute mitral regurgitation due to ruptured chordae tendineae or infective endocarditis, residual valve regurgitation after repair of an atrioventricular septal defect or a congenital mitral insufficiency, or mitral stenosis in patients with Shone's syndrome after an unsuccessful attempt at mitral repair. [1][2][3] Serial echocardiographic examinations are essential in patients with a prosthetic mitral valve (PMV) because mechanical PMVs are subject to valve dysfunction due to thrombosis and pannus formation. 4 Echocardiographic assessment of PMV function in children remains challenging.…”

Supra-Annular Mitral Valve Replacement in an Infant With Infective Endocarditis

“…The difficulty in performing mitral valve replacement in children is primarily due to the small annulus of the mitral valve; thus, we often have to perform supraannular mitral valve replacement. Supra-annular implantation has some advantages: a larger prosthesis can be used in small children, there is reduced risk of complete atrioventricular block compared with that in standard annular mitral valve replacement, and there is minimized contact between the prosthesis and subannular structure [1,7]. Despite these advantages, the rigid mechanical valve ring must be sutured onto a friable annulus, and paravalvular leakage or other complications, such as late atrioventricular block, can occur.…”