Simplified surgical-hybrid Melody® valve implantation for paediatric mitral valve disease: Figure 1:

Abstract

Children suffering from left atrioventricular valve (LAVV) disease not amenable to repair represent a significant challenge. The results of surgical reconstruction are not optimal. Valve replacement as an alternative is associated with poor results. The surgical-hybrid approach with implantation of a stented biological valve (bovine jugular vein graft, Melody valve) seems to represent a new therapeutic option. Here we demonstrate our case, the consideration and the approach to extreme clinical findings in a small child. We describe a simplified surgical-hybrid Melody valve implantation in a LAVV position. The technique of implantation is relatively simple and the immediate postoperative result very good.

Surgical Atrioventricular Valve Replacement With Melody Valve in Infants and Children

“…For atrioventricular valve replacement, the technique for implantation has been described previously. [15][16][17][18][19][20] In most of the patients, a circumferential skirt of bovine pericardium was sewn externally to the stent at its midsection to facilitate fixation to the valve annulus. The circumferential skirt was sutured to the annulus with either interrupted or continuous sutures.…”

“…Initial experience demonstrated the feasibility of MVR with the Melody valve in patients with annuli <15 mm. [15][16][17][18] Importantly, these studies demonstrated the valve could be expanded in the catheterization laboratory after somatic growth, thus avoiding early reoperation.…”

Implantacja zastawki Melody w pozycję mitralną — u dziecka z nienaprawialnym uszkodzeniem zastawki w przebiegu infekcyjnego zapalenia wsierdzia

“…There was no need for reoperation caused by Melody dysfunction or its local infection in mitral position. Perivalvular leaks or Melody-related LVOTO were casually reported, with a potential for transcatheter interventions [3].…”

“…In spite of the fact that mitral Melody replacement procedures (Melody-MVR) are still reported casually, the authors consecutively show reliable techniques and promising short-term results [2]. The main arguments to reach for Melody-MVR in selected patients were previously well defined advantages of Melody valve implanted in pulmonary position: perfect hemodynamics, favorable effective orifice area (EOA) index, low transannular gradient and an unique potential for percutaneous transcatheter balloon dilation of expandable stented valve following the growth of the child [3,4].…”

Incremental extension of a paradigm shift

“…We have even less data available on the durability of the prosthesis after catheter-based dilation. 6 Other important technical questions to resolve include the benefits or drawbacks of the use of a sewing ring for implantation, 6,9 the extent of resection of the subvalvular apparatus, 6,9 or the application of a left ventricular fixation suture to maintain alignment. 6 Nevertheless, we witness another step forward to solve a troublesome clinical problem when mitral valve repair is not possible in very small patients.…”