Re-replacement of the Atrioventricular Valve for the Systemic
Circulation in Children
Hiroyuki Nakajima MD, Hideki Uemura MD, Toshikatsu Yagihara MD, Youichi Kawahira MD, Yoshiro Yoshikawa MD, Soichiro Kitamura MD

The systemic atrioventricular (AV) valve was re-replaced in 10 children. Initial replacement was needed for regurgitation (n = 9) or congenital mitral stenosis (n = 1) at a mean age of 3.7 ± 3.1 years (range: 0.7-10.2 years). The initial prosthesis (range: 16-27 mm) was mechanical in all cases. Reoperation was performed at a mean age of 9.7 ± 3.6 years (range: 3.5-14.8 years) because of non-structural dysfunction (n = 5), prosthetic valve endocarditis (n = 2), thrombosed valve (n = 2) or progressive obstruction of the left ventricular outflow tract (n = 1). Fibrous tissues were extensively resected to enlarge the valvular orifice. A translocation maneuver was used in five cases. Re-replacement was successful, with no operative or late deaths when using a bileaflet valve. The valve was up-sized in six cases with initial valve size <25 mm; the replacement prosthesis was 2-8 mm (mean 4.5 mm) larger than the initial one. Consecutive echocardiography showed improved peak flow velocity across the AV valve (2.3 ± 0.6 versus 1.6 ± 0.3 m/s); catheterization showed improved mean pulmonary arterial pressure (32 ± 13 versus 21 ± 3 mmHg). Cardiac index (3.4 ± 0.6 and 3.5 ± 0.6 l/min/m²) and systemic ventricular ejection fraction (55 ± 14% and 49 ± 23%) were unchanged. In conclusion, re-replacement of the systemic AV valve was achieved in children, with up-sizing feasible by appropriate surgical maneuvers.