Abstract
Atrioventricular valve replacement in small children is associated with high morbidity and mortality. There are no prostheses available with a diameter ˂15 mm. This study reports our initial experience with a cylinder valve for mitral and tricuspid valve replacement in infants and small children. Our cylinder valve was hand-made for patients requiring atrioventricuclar valve replacement with an annulus of <15 mm. a 12-mm contegra valve was prepared and placed inside a 14-mm gore-tex tube graft and sutured on both extremities. eight patients were included, with a median age of 6.9 months (range 1 day to 38 months). four had mitral and 4 had tricuspid valve replacement. all implants were technically successful, with no significant regurgitation, no stenosis and no left ventricular outflow tract obstruction. there were 3 early deaths from low cardiac output, in patients with significant associated lesions (severe neonatal ebstein's, pulmonary artery-intact ventricular septum, biventricular conversion from norwood stage 1). two patients required early reintervention: 1 for balloon dilatation for stenosis and 1 for reoperation for paravalvular leak. during follow-up, 2 patients had mitral valve replacement with a 16-mm mechanical valve at 9 and 20 months from the cylinder valve implantation. the remaining 2 patients are alive and well 2 years and 2 months after the procedure. cylinder valve replacement of atrioventricular valves was feasible without any technical issues. it was successful in getting out of a difficult situation and allows for somatic growth and implantation of a reasonably-sized mechanical prosthesis on the annulus.>
