Insertion of an aortic and pulmonary homograft for simultaneous reconstruction of the left and right ventricular outflow tracts. A case report.

We present the case of the successful reconstruction in a child of a congenital cardiac malformation (tetralogy of Fallot) complicated by acquired aortic regurgitation and aneurysm formation of the left pulmonary artery due to previous endocarditis, by using an aortic homograft for reconstruction of the left ventricular outflow tract and a pulmonary homograft for reconstruction of the right ventricular outflow tract. Regarding the excellent results recently obtained with cryopreserved homografts, the many advantages of these valves compared to mechanical prostheses, we feel that aortic and or pulmonary homografts might constitute ideal biological valves for reconstruction of left and or right ventricular outflow tract in children when the presence of a congenital anomaly of the pulmonary valve renders an autograft impossible.

[Conservative surgery of rheumatic mitral insufficiency in children. Remote results]. / Chirurgie conservatrice de l'insuffisance mitrale rhumatismale de l'enfant. Résultats à distance.

Between 1977 and 1986, 38 children aged from 3.8 to 16.4 years underwent mitral valvuloplasty for symptomatic mitral valve incompetence of rheumatic origin. Two children (5.3 per cent) died in the immediate post-operative period, and 6 were lost sight of. Among the 30 children followed up for a mean period of 3.3 years, 6 were reoperated upon within 5 months of the valvuloplasty, 5 still present with a significant residual mitral valve incompetence and 9 have satisfactory clinical and echocardiographic results. Survival rate and survival rate without reoperation at 4 years were 93.8 per cent and 76.1 per cent respectively. Factors that correlated with the quality of long-term results were pre-operative left ventricular myocardial fibre shortening rate and surgical technique (poor results were obtained in children who had only one annuloplasty or none).

Treatment of ruptured or elongated anterior mitral valve chordae by partial transposition of the posterior leaflet: experience with 29 patients.

We report a series of 29 patients, 5 to 75 years of age (mean age, 31.8 +/- 21.4 [SD] years), with pure mitral regurgitation caused by ruptured or elongated chordae of the anterior mitral leaflet. These patients underwent mitral valve repair by segmental transposition of the posterior leaflet with its attached chordae sutured to the free edge of the flail anterior leaflet. There were 2 hospital deaths. Follow-up ranged from 1 to 35 months (mean follow-up, 14.9 +/- 8.5 months). One patient is lost to follow-up. Two patients are in New York Heart Association Functional Class II; all others are in Class I. In 17 patients there is no detectable murmur; in 5 patients a mild to moderate systolic murmur can be detected, while 4 have a marked systolic murmur. The adequacy of the repair could be confirmed by Doppler echocardiography, which has shown no evidence of prolapse in 22 patients. A mild regurgitation jet is present in 4 patients, and a marked jet, in 3. Postoperative cardiac catheterization performed in 5 patients has confirmed the Doppler echocardiographic findings. Although longer follow-up is necessary, this technique appears adequate for repairing a major prolapse of the anterior leaflet caused by multiple ruptured or elongated chordae, therefore obviating the need for a prosthetic valve substitute.