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Bicuspidisation of unicuspid stenotic pulmonary valve in a nine-year-old male

Published online by Cambridge University Press:  26 March 2024

Florin Anghel Open the ORCID record for Florin Anghel [Opens in a new window] ,
Catalin Constantin Badiu  and
Alain J. Poncelet
Florin Anghel*
Affiliation:
Department of Cardiovascular Surgery, University Emergency Hospital Bucharest, Bucharest, Romania Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Catalin Constantin Badiu
Affiliation:
Department of Cardiovascular Surgery, University Emergency Hospital Bucharest, Bucharest, Romania Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Alain J. Poncelet
Affiliation:
Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium Department of Cardiovascular and Thoracic Surgery, Université catholique de Louvain, Brussels, Belgium
*
Corresponding author: F. Anghel; Email: florin.anghel@rez.umfcd.ro
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Abstract

We report the case of a 9-year-old male with severe congenital pulmonary valve stenosis referred to our centre for percutaneous valvotomy. On admission, trans-thoracic echocardiogram confirmed a unicuspid pulmonary valve with a peak/mean pulmonary valve gradient of 91/53 mmHg and a pulmonary annulus of 13.8 mm (−0.8 Z Score). It also showed an enlarged RV (RV/LV ratio 0,9). During cardiac catheterisation, an additional atrial septal defect (secundum) with significant left to right shunt (Qp/Qs > 2) was diagnosed, which was not amenable to percutaneous closure. The patient was referred for surgical repair.

The atrial septal defect was closed by a direct running suture. The repair of the unicuspid valve consisted in bicuspidisation by a large commissurotomy to the left anterior wall of the pulmonary artery. The neo-commissure was created with two separate patches of autologous pericardium secured to the wall of the pulmonary root. The adjustment of the effective height of the pulmonary valve leaflets was done by trimming the patches and a triangular plication of the newly created posterior leaflet. Perioperative echocardiogram showed a peak gradient of 15 mm Hg and trivial pulmonary regurgitation. The total cross-clamp time was 92 min and the bypass time 123 min with a favourable evolution after the surgery.

The particularity of the case is represented by the complexity of the bicuspidisation procedure. Using this technique, a tailored approach is needed for every patient.

Keywords

Pulmonary valve stenosisbicuspidisationpulmonary valve repairCHDunicuspid pulmonary valve
Type
Brief Report
Information
Cardiology in the Young , First View , pp. 1 - 3
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Copyright
© The Author(s), 2024. Published by Cambridge University Press

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References

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