MP07. Bioprosthetic Mitral Valve Replacement Post Mitral Valve Repair in a Pediatric Patient: A Case Report
Presented During: Moderated E-Posters
University of North Carolina at Chapel Hill
Chapel Hill, NC
United States - Contact Me
Native of Greece. Currently working as a PGY-1 resident physician at the University of North Carolina, Cardiothoracic surgery (Intergrated Thoracic Surgery program). Fully invested in pursuing an academic career in the field of cardiothoracic surgery.
Thursday, May 4, 2023: 6:30 PM - Saturday, May 6, 2023: 2:29 AM
New York Hilton Midtown
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Description
Objective: Report a case of mitral valve replacement (MVR) with tissue valve in a pediatric patient with Loey's Dietz syndrome in the setting of a previous mitral valve repair.
Methods: A 12-year-old female patient with a past medical history of mitral valve valvuloplasty in the setting of mixed mitral valve stenosis and regurgitation was admitted for MVR due to the reemergence of mixed mitral valve stenosis and regurgitation.
Results: The patient underwent a MVR with a 25 millimeters Edwards Mitris Resilia valve. Completion echocardiogram revealed good biventricular function with no left ventricular outflow tract obstruction, no prosthetic valve insufficiency or stenosis and no periprosthetic valve leak. The mean gradient was 5 mmHg.
Conclusions: There are several dilemmas that need to be addressed when performing MVR in pediatric patients. The small size of the native valve annulus and the limited growth potential of the available prostheses often demand intentional oversizing of the prosthesis to meet the patient's somatic growth. Nevertheless, utilization of a large prosthesis is associated with increased intraoperative and early postoperative mortality rates due to adverse events related with left ventricular outflow tract obstruction, myocardial ischemia due to nearby coronary artery compression, and electrical conduction block. The optimal type of prosthesis in this age group is unclear. Mechanical valves, although credited to be more durable, require lifelong anticoagulation which is problematic in pediatric patients. Lifelong anticoagulation with Vitamin K antagonists (VKA) is inherently associated with several diet restrictions and poor-compliance increases the risk of both thromboembolic and hemorrhagic events. VKA medications require abstinence from several everyday activities and have a direct impact on the quality of life of these patients. Moreover, VKA are associated with menstruation related complications raising extra concerns in female patients. Edwards Mitris Resilia prosthesis is a bioprosthetic valve credited to offer better postoperative hemodynamic profile as well as longer valve longevity with decreased structural valve deterioration rates compared to other bioprostheses. The notion behind opting for this valve in our patient was to offer her a good hemodynamic profile that will protect her from future cardio- and cerebro-vascular events as well as to avoid the need to subject her to lifelong anticoagulation.
Methods: A 12-year-old female patient with a past medical history of mitral valve valvuloplasty in the setting of mixed mitral valve stenosis and regurgitation was admitted for MVR due to the reemergence of mixed mitral valve stenosis and regurgitation.
Results: The patient underwent a MVR with a 25 millimeters Edwards Mitris Resilia valve. Completion echocardiogram revealed good biventricular function with no left ventricular outflow tract obstruction, no prosthetic valve insufficiency or stenosis and no periprosthetic valve leak. The mean gradient was 5 mmHg.
Conclusions: There are several dilemmas that need to be addressed when performing MVR in pediatric patients. The small size of the native valve annulus and the limited growth potential of the available prostheses often demand intentional oversizing of the prosthesis to meet the patient's somatic growth. Nevertheless, utilization of a large prosthesis is associated with increased intraoperative and early postoperative mortality rates due to adverse events related with left ventricular outflow tract obstruction, myocardial ischemia due to nearby coronary artery compression, and electrical conduction block. The optimal type of prosthesis in this age group is unclear. Mechanical valves, although credited to be more durable, require lifelong anticoagulation which is problematic in pediatric patients. Lifelong anticoagulation with Vitamin K antagonists (VKA) is inherently associated with several diet restrictions and poor-compliance increases the risk of both thromboembolic and hemorrhagic events. VKA medications require abstinence from several everyday activities and have a direct impact on the quality of life of these patients. Moreover, VKA are associated with menstruation related complications raising extra concerns in female patients. Edwards Mitris Resilia prosthesis is a bioprosthetic valve credited to offer better postoperative hemodynamic profile as well as longer valve longevity with decreased structural valve deterioration rates compared to other bioprostheses. The notion behind opting for this valve in our patient was to offer her a good hemodynamic profile that will protect her from future cardio- and cerebro-vascular events as well as to avoid the need to subject her to lifelong anticoagulation.