Long - term results of tricuspid reconstruction with pericardium in an infant
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CASE REPORT
Long‑term results of tricuspid reconstruction with pericardium in an infant Hajime Sakurai1 · Toshimichi Nonaka1 · Takahisa Sakurai1 · Motoshi Kozakai1 · Naoki Ohashi2 · Hiroshi Nishikawa2 Received: 14 July 2020 / Accepted: 4 September 2020 © The Japanese Association for Thoracic Surgery 2020
Abstract We report the long-term clinical outcome of an 8-month-old infant who underwent tricuspid reconstruction using fresh autologous pericardium for severe tricuspid regurgitation due to defects in the leaflets of the tricuspid valve after ventricular septal defect closure and ablation. Ten years after surgery, the tricuspid function is good with mild regurgitation and mild stenosis. From the age of 8 months to 11 years, the patient’s body weight and height increased fourfold and twofold, respectively. Thus, a fresh autologous pericardial patch could be the material of choice for tricuspid leaflet repair in pediatric patients. Keywords Tricuspid valve reconstruction · Fresh autologous pericardium · Long-term result · Infant
Introduction Valvular surgery in children must be planned after considering the impact of surgery on their growth. Some cases of valvuloplasty need a large patch for leaflet augmentation. However, the patch materials currently used are neither durable in the long term nor do they allow growth [1–5]. Here, we report the long-term clinical course of an infant who underwent tricuspid reconstruction using fresh autologous pericardium for severe tricuspid regurgitation due to defects in the anterior and posterior leaflets of the tricuspid valve after ventricular septal defect (VSD) closure and ablation.
Case A 10-day-old boy was diagnosed with subarterial VSD and Wolff–Parkinson–White syndrome at an outpatient clinic. Diuretics and flecainide were administered to control tachycardia. Because of progression of heart failure and aortic
* Hajime Sakurai [email protected] 1
Department of Cardiovascular Surgery, Japan Community Healthcare Organization Chukyo Hospital, 1‑1‑10 Sanjo, Minami‑ku, Nagoya 457‑8510, Japan
Department of Pediatric Cardiology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
2
regurgitation, he was referred to our hospital for surgical treatment at 3 months of age (body weight, 6.2 kg). While the patient was undergoing cardiopulmonary bypass, we performed VSD patch closure via pulmonary arteriotomy and intraoperative cryoablation of the right free wall accessory pathway via right atriotomy (1st operation, Fig. 1). After declamping the aorta, sustained atrial tachycardia at 250 beats per minute occurred, and he could not be weaned off the cardiopulmonary bypass machine. Therefore, we selected radiofrequency ablation as another mechanism of ablation and ablated a large region of the tricuspid annulus. Subsequently, the delta wave, which existed preoperatively in the electrocardiogram, disappeared, and a normal sinus rhythm was maintained. He was successfully weaned off the bypass machine and was discharged without medication on postoperati
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