Surgical management with mitral valve replacement in young infants with congenital mitral valve diseases and complete atrioventricular septal defect

Objectives: The mechanical valve replacement may be the only option if the failing mitral valve cannot be repaired in complete AV septal defect (CAVSD), or congenital mitral valve stenosis and regurgitation in infants. In young infants the small mitral annulus - prothesis mismatch is a big problem. Aim: To assess the possibility of the left AV orifice repair and the necessity of mechanical valve replacement in CAVSD in young infants. Methods: Single center, retrospective study of 82 infants (13 pts under 3 months) who underwent complete repair of CAVSD between 2001 and 2007. Mechanical (bileaflet) valve replacement was required in 7 pts (5 weeks-7 months, 3.5-5 kg). The time interval between the two operations was 0-7 days, but the smallest baby spent 38 days in the intensive care unit waiting for increasing of his mitral annulus size from 11 to 15 mm. (Types of implanted valves: 2 Carbomedics 16 mm, 3 ATS 16 mm, 1 Sorin 17 mm, 1 Sorin 19 mm.) ATS 16 mm valves were implanted in 2 infants each with congenital mitral valve stenosis and regurgutation. Results: Early mortality (30 days) was 0, but 2 pts died in sepsis on the 46th and 71st postoperative day, respectively. In the follow-up period of 1-6 (mean 3) years 1 child (18 months later) needed reoperation (pannus removal), now all pts are doing well. Anticoagulation therapy was difficult in some cases without complication. Conclusions: The surgical repair of congenital mitral valve diseases and CAVSD can be performed successfully in very young infants. If the anatomic characteristics of the mitral valve is not suitable for repair, only mechanical mitral valve replacement can be performed successfully even in sometimes hopeless situation (one of our pts of 3.5 kg weight, is the smallest baby mentioned in the literature). Our early and mid-time results are good, but the re-replacement will be an unavoidable problem in the future.