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International Society For Minimally Invasive Cardiothoracic Surgery

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Melody Mitral Valve Replacement - Hybrid Surgical Use In Children With Critical Valve Destruction In Infective Endocarditis
Konrad Paczkowski1, Maciej Chojnicki1, Mariusz Steffens1, Anna Romanowicz-Sołtyszewska1, Marta Paśko-Majewska1, Monika Opacian-Bojanowska1, Paweł Macko1, Julia Haponiuk1, Katarzyna Gierat-Haponiuk2, Ireneusz Haponiuk3.
1Department of Pediatric Cardiac Surgery, St. Adalbertus Hospital Gdansk, COPERNICUS Ltd, Gdansk, Poland, 2Chair of Health and Biological Sciences, Gdansk Academy of Physical Education and Sport, Gdansk, Poland; Department of Rehabilitation, Gdansk Medical University, Gdansk, Poland., Gdansk, Poland, 3Department of Rehabilitation, Medical University of Gdańsk, Gdansk, Poland.

BACKGROUND Infective endocarditis, while is rare disease in children, but often difficult to treat, especially for extensive damage of heart structures. Valve repair or replacement in emergency settings is a great challenge, due to the lack of commercially available artificial or biological prostheses designed for pediatric implantations. Melody valve, originally designed for transcutaneous implantation in the pulmonary position, may be an attractive solution in cases of hopeless mitral valve damage. METHODS We present two cases of emergency mitral valve replacements with the Melody expandable stented bioprostheses implantation in children suffering from infective endocarditis. Both children presented huge bicuspid valve incompetence in the course of aggressive infective destruction with the symptoms of critical multiorgan failure and hemodynamic compromise. RESULTS Both patients were presented with a history of rapid deterioration after 2-3-weeks-long septicemia and pyorrhea in the course of acute endocarditis. The children aged 23 months-old and 15 months-old were operated on directly after an initial preoperative antibiotic treatment because of large mitral incompetence and deteriorating vegetations into mitral valve apparatus, with echocardiographic view of leaflets disruption and chordae discontinuation. After initial attempts for mitral plasty the hybrid methods of self-modified Melody valves implantation into the mitral positions (Melody-MVR) were used with good early, and mid-term results. CONCLUSION With regard to actual knowledge concerning heart valves reconstructions and institutional experience we conclude that infected mitral valves in children should be primary repaired, nevertheless self-modified Melody valve could be reasonable considered as mitral prosthesis in non-reparable mitral insufficiency.


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