日本小児循環器学会雑誌 Pediatric Cardiology and Cardiac Surgery

Objective: The purpose of this study was to evaluate the indications and surgical outcomes of aortic valve repair (AVP) using glutaraldehyde-treated autologous pericardial patch in children with aortic valve disease.

Patients and Methods: From September 2004 to December 2012, five children underwent AVP using glutaraldehyde treated autologous pericardium at our institution. The median age at surgery was 5.0 years (range: 2.6 to 11.6 years). The primary diagnoses were truncus arteriosus, ventricular septal defect, coarctation complex, complete transposition of the great arteries, and congenital aortic valve insufficiency. The criteria for this procedure included aortic insufficiency (AI), tricuspid aortic valve, cusp dysplasia limited to one or two cusps, and truncal valve insufficiency. The median follow-up time was 5.0 years (range: 2.0 to 6.6 years).

Results: There were no early or late deaths. Preoperatively, the degree of AI was severe in four patients and moderate in one patient. After AVP, AI was improved to mild in four and mild to moderate in one patient. One patient, who had undergone two previous surgeries, underwent the Ross-Konno operation 4 years and 11 months after AVP because of progression of AI and aortic valve stenosis. Except this case, the degree of AI was mild in two and moderate in two patients, and the flow velocity of the aortic valve was less than 2.5 m/s at the latest follow-up. During follow up, the diameters of the aortic annulus had grown in all patients along the normal average curve (mean diameter was 18.8±4.3 mm preoperatively and 21.2±2.6 mm at the latest follow up).

Conclusion: AVP using a glutaraldehyde-treated autologous pericardial patch is an effective surgical option that can postpone aortic valve replacement or Ross procedure in patients with aortic or truncal valve insufficiency. Careful follow-up is necessary, particularly in patients with multiple previous surgeries.