Mitral valve replacement in the neonate: A report of two cases
Mitral valve replacement was performed in two critically ill neonates with severe mitral stenosis and regurgitation. Both patients had coexisting severe aortic stenosis previously treated by transventricular aortic valve dilatation.
Preoperative echocardiography showed a mitral annulus measuring between 11 and 12 mm in diameter—too small for any of the commercially available free-standing valve prostheses. Accordingly, the porcine valve from a commercially available 12-mm external-valved conduit was removed and sutured into position. The function of the valve was satisfactory in both cases and cardiopulmonary bypass was discontinued easily with a good cardiac output established in both.
Both patients died—one at 20 h and one 36 h after surgery. In each case, the immediate cause of death was acute bleeding secondary to preexisting hepatic failure and depletion of coagulation factors.
At autopsy, both prostheses had been correctly placed and were competent. Left ventricular outflow tract obstruction secondary to strut imposition was not evident.
Both patients were very ill preoperatively. Although neither patient survived mitral valve replacement, we were encouraged by the relative hemodynamic improvement in the immediate postoperative period. We believe that prosthetic valve replacement could become a viable therapy for the neonate with severe mitral valve abnormalities.
Key wordsNeonatal mitral obstruction Mitral valve replacement
Attie F, Kuri J, Zanoniani C, Renteria V, Buendia A, Ovseyevitz J, Lopez-Soriano F, Garcia-Cornejo M, Martinez-Rios U (1981) Mitral valve replacement in children with rheumatic heart disease.Circulation 64
Benmimoun EG, Friedli B, Rutishauer W, Faidutti B (1982) Mitral valve replacement in children: comparative study of pre- and postoperative haemodynamics and left ventricular function.Br Heart J 48
Berry BE, Ritter DG, Wallace RB, McGoon DC, Danielson GK (1974) Cardiac valve replacement in children.J Thorac Cardiovasc Surg 68
Braunwald NS, Brais M, Castaneda A (1976) Considerations in the development of artificial heart valve substitutes for use in infants and small children.J Thorac Cardiovasc Surg 72
Crawford FA, Selby JH, Joransen JA (1978) Mitral valve replacement with a porcine heterograft in an infant.J Thorac Cardiovasc Surg 78
Gardner TJ, Roland JMA, Neill CA, Donahoo JS (1982) Valve replacement in children.J Thorac Cardiovasc Surg 83
Human DG, Joffe HS, Fraser CB, Barnard CM (1982) Mitral valve replacement in children.J Thorac Cardiovasc Surg 83
Laks HL, Hellenbrand WE, Kleinman C, Talner N (1980) Left atrial-left ventricular conduit for relief of congenital mitral stenosis in infancy.J Thorac Cardiovasc Surg 80
Ruckman RN, Van Praagh R (1978) Anatomic types of congenital mitral stenosis: report of 49 autopsy cases with consideration of diagnosis and surgical implications.Am J Cardiol 42
Silver MM, Pollock J, Silver MD, Williams WG, Trusler GA (1980) Calcification in porcine xenograft valves in children.Am J Cardiol 45
Williams WG, Pollock JC, Geiss DM, Trussler GA, Fowler RS (1981) Experience with aortic and mitral valve replacement in children.J Thorac Cardiovasc Surg 81
Young D, Robinson G (1964) Successful valve replacement in an infant with congenital mitral stenosis.N Engl J Med 270