Abstract 17965: Echocardiographic Assessment of Surgically Placed Melody Valves in the Mitral Position in Young Children
Introduction: Mitral valve replacement (MVR) in young children is limited by lack of small prostheses, resulting in high re-intervention rates and mortality. Therefore, in 2010, we began performing MVR with modified, surgically placed, stented jugular vein grafts (Melody valve) to allow for tailoring to small annular dimensions as well as subsequent expansion in the catheterization lab. We aimed to analyze key pre- and post-operative (op) echo variables to refine surgical planning for this novel procedure.
Methods: We included 17 patients who underwent surgically placed Melody MVR. The pre- and post-op echoes before discharge were retrospectively reviewed for anatomic and physiologic variables. On the pre-op echo, we performed “potential” mitral annular measurements in orthogonal planes to estimate the maximum intra-op balloon sizing. Given concern for left ventricular outflow tract obstruction (LVOTO), a ratio of the narrowest subaortic region in systole to the actual mitral annular dimension (SubA:MV) was assessed in the parasternal long axis view. Values are presented as median (range), where applicable.
Results: Melody MVR was performed at 8 months of age (weight 5.2 kg) for stenosis (5), regurgitation (1), and mixed disease (11). On pre-op echo, the potential mitral measurement in the lateral dimension correlated well with the intra-op balloon size selected by the surgeon (ρ=0.58, p=0.01). The Melody valve was expanded to 1.0 times the potential lateral dimension (median 14 mm). The SubA:MV measured >0.5 in all patients. By post-op day 10 (5-35), the mean mitral gradient improved by 9 mm Hg (1-16), and right ventricular pressure was <½ systemic in 76% (vs. 12% pre-op, p<0.001). Only 2 patients had mild regurgitation and 1 had a mild perivalvar leak. The internal diameter of the Melody valve measured 3.4 mm (1-6) less than the intra-op balloon size. No patient had LVOTO >25 mm Hg or pulmonary vein obstruction.
Conclusion: Intra-op balloon sizing of Melody MVR may be guided by pre-op echo indices to achieve adequate mitral valve function without significant LVOTO. The post-op Melody valve diameter was found to measure less than the intra-op balloon size, which should be considered as experience with the Melody in native, non-conduit positions evolves.
Author Disclosures: L.R. Freud: None. S.M. Emani: None. A.C. Marshall: None. G.R. Marx: None. W. Tworetzky: None.
- © 2014 by American Heart Association, Inc.