Abstract
A 6-year-old girl with a diagnosis of aortic regurgitation with stenosis and mitral regurgitation because of short chordae was referred to us for surgery. Echocardiography revealed that the aortic and the mitral annular diameters were 16 and 23 mm, respectively. The Ross procedure and mitral valvuloplasty were scheduled. During the procedure, we were concerned that aggressive mitral valvuloplasty might result in mitral stenosis. We therefore converted the procedure to double-valve replacement using the Manouguian technique because it was necessary to enlarge both the aortic and mitral annuli. In children, the mitral prosthetic valve in Manouguian technique may override aortic annulus resulting in left ventricular outflow tract obstruction (LVOTO). Thus, it is important to decide the mitral prosthetic valve size. Measurements of both annuli showed 15 and 21 mm in aortic and mitral positions, respectively. Size #18 ATS AP mechanical valve (ATS Medical, Inc., Minneapolis, MN, USA) and size #23 ATS mechanical valve were implanted. We successfully performed two sizes up in the aortic position and one size up in the mitral position avoiding complications such as coronary orifice obstruction and LVOTO. To our knowledge, this is the youngest patient who underwent double-valve replacement by the Manouguian technique.
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Manouguian S, Seybold-Epting W. Patch enlargement of the aortic valve ring by extending the aortic incision into the anterior mitral leaflet. New operative technique. J Thorac Cardiovasc Surg. 1979;78:402–12.
Imanaka K, Takamoto S, Furuse A. Mitral regurgitation late after Manouguian’s annulus enlargement and aortic valve replacement. J Thorac Cardiovasc Surg. 1998;115:727–9.
Okuyama H, Hashimoto K, Kurosawa H, Tanaka K, Sakamoto Y, Shirtatori K. Midterm results of Manouguian double valve replacement: comparison with standard double valve replacement. J Thorac Cardiovasc Surg. 2005;129:869–74.
Harada Y, Terada M, Ishihara K, Kurosawa H, Imai Y. Aortic valve replacement in children associated with enlargement of aortic annulus. Nippon Geka Gakkai Zasshi. 1988;89:1903–7.
Kersten TE, Bessinger FB, Stone FM, Nicoloff DM. Combined techniques for double valve replacement in the infant. Ann Thorac Surg. 1985;39:180–4.
Nicks R, Cartmill T, Bernstein L. Hypoplasia of the aortic root. Thorax. 1970;25:339–46.
Konno S, Imai Y, Iida Y, Nakajima M, Tatsuno K. A new method for prosthetic valve replacement in congenital aortic stenosis associated with hypoplasia of the aortic valve ring. J Thorac Cardiovasc Surg. 1975;70:909–17.
Sakamoto T, Matsumura G, Kosaka Y, Iwata Y, Yamamoto N, Saito S, et al. Long-term results of Konno procedure for complex left ventricular outflow tract obstruction. Eur J Cardiothorac Surg. 2008;34:37–41.
Masuda M, Kado H, Ando Y, Shiose A, Nakano T, Fukae K, et al. Intermediate-term results after the aortic valve replacement using bileaflet mechanical prosthetic valve in children. Eur J Cardiothorac Surg. 2008;34:42–7.
SelametTierney ES, Pigula FA, Berul Cl, Lock JE, del Nido PJ, McElhinney DB. Mitral valve replacement in infants and children 5 years of age or younger: evolution in practice and outcome over three decades with a focus on supra-annular prosthesis implantation. J Thorac Cardiovasc Surg. 2008;136:954–61.
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Sugiura, T., Hiramatsu, T., Iwata, Y. et al. Manouguian double-valve replacement in a 6-year-old girl. Gen Thorac Cardiovasc Surg 60, 760–763 (2012). https://doi.org/10.1007/s11748-012-0069-4
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DOI: https://doi.org/10.1007/s11748-012-0069-4