The Annals of Thoracic Surgery, Vol 39, 180-184, Copyright © 1985 by The Society of Thoracic Surgeons
Combined techniques for double valve replacement in the infant
TE Kersten, FB Bessinger, FM Stone and DM Nicoloff
A 6-month-old female infant was seen with heart failure secondary to severe
aortic and mitral regurgitation. As a neonate the infant had undergone an
aortic valvotomy for congenital aortic stenosis. Subsequently the infant
had aortic and mitral regurgitation with an infarcted papillary muscle.
Double valve replacement was carried out with the St. Jude valve. The first
approach was by the Manouguian procedure with extension of the aortotomy
out between the left coronary cusp and the noncoronary cusp. The posterior
mitral apparatus was resected, and a 19-mm St. Jude aortic valve was sewn
into the mitral position. Because the enlarged aortic valve annulus was
still inadequate to accommodate a 19-mm St. Jude valve, a Konno procedure
was carried out to enlarge the aortic ring anteriorly. Atrial, septal, and
aortic repair and right ventricular outflow tract reconstruction were
carried out with bovine pericardium. Bypass was carried out with standard
techniques of hypothermia, aortic cross-clamping, and cardioplegia.
Postoperative anticoagulation therapy was initially with aspirin and
dipyridamole (Persantine); however, clotting of the mitral prosthesis
necessitated treatment with urokinase and heparin, which completely
resolved the clot. Sodium warfarin (Coumadin) therapy was then begun. One
year postoperatively, the child is developing normally.
