Pulmonary Valve Reconstruction Using the Ozaki Leaflet Reconstructive Techniques

The aortic valve neocuspidization, or Ozaki procedure, has been shown to be technically reproducible and have acceptable results in the position adult pediatric patients. We report a case which innovative techniques were utilized create three-leaflet pulmonary using modified neocuspidization technique. Dr Baird discloses financial relationship with JOMDD. Pulmonary replacement remains challenging population, despite number of options being available, functional limitations arise over time leading earlier re-replacement.1Balasubramany S. Zurakowski D. Borisuk M. et al.Right ventricular outflow tract re-intervention after primary tetralogy Fallot repair neonates young infants.J Thorac Cardiovasc Surg. 2018; 155: 726-734Abstract Full Text PDF Scopus (15) Google Scholar In addition, there are often anatomic challenges within right such as small annulus, shortened main artery, early takeoff artery limiting options. single leaflet monocusp including polytetrafluoroethylene homograft2Kumar Turrentine M.W. Rodefeld M.D. Bell T. Brown J.W. Right reconstruction valve: 20-year experience.Semin 2016; 8: 463-470Abstract (21) Scholar,3Nath D.S. Nussbaum D.P. Yurko C. al.Pulmonary homograft tract: outcomes intermediate term.Ann 2010; 90: 42-49Abstract PubMed (10) bileaflet trileaflet valves4Quintessenz J.A. Polytetrafluoroethylene bicuspid implantation.Oper Tech 13: 244-249Abstract (9) described but generally not broadly had limited long-term competence. procedure is stentless three leaflets autologous donor pericardium excellent midterm adults.5Ozaki Kawase I. Yamashita H. Uchida Takatoh Kiyohara N. Midterm glutaraldehyde-treated pericardium.J 2379-2387Abstract (105) also demonstrated annular growth children.6Baird CW, Sefton B, Chavez M, Sleeper LA, Marx GR, del Nido PJ. Congenital truncal utilizing technique: short-term clinical [e-pub ahead print]. J https://doi.org/10.1016/j.jtcvs.2020.01.087, accessed April 13, 2020.Google Extrapolating from this experience, we technique an infant. A 16-month-old, 7.5 kg male infant Alagille’s syndrome congenital stenosis undergone neonatal balloon dilation, followed by surgical bilateral branch plasty valvectomy at 6 months old. He then distress setting upper respiratory infection increasing abdominal girth, for he was admitted hospital evidence dilation dysfunction. cardiac catheterization showed severely dilated without valvar tissue, free regurgitation, mildly stenotic acute angulation proximal left origin. hypertensive changes (right greater than left) distal vasculature. Serial dilations performed, resulting severe regurgitation residual end-diastolic pressure 35 mm Hg. presented recurrent stenosis, progressive biventricular diastolic patient liver dysfunction cholestasis, subglottic failure thrive gastro tube dependence, vitamin K deficiency, heart requiring extracorporeal membrane oxygenation support preoperatively. taken operating room, where reconstructed underwent arterioplasty valve. intercommissural edges measured original sizing device (JOMDD, Tokyo, Japan), giving appropriate tension reproduce annulus during diastole. Three cusps measuring 15 created template (JOMDD) CardioCel (Admedus, Fremantle, Australia) bovine pericardium. Each sewn place running 5-0 polypropylene suture, commissures typical fashion. Part ventriculotomy up suture make each sinotubular junction areas similar dimension. Pledgets used on outside, fashioned. carried our patch sewed together 6-0 (Figure 1). Postoperative transesophageal echocardiogram trivial maximum instantaneous gradient across 20 Epicardial imaging good excursion leaflets. function improved compared preoperative imaging. Discharge postoperative day 30 (gradient Hg) ventricle qualitatively systolic 2). Eighteen-month follow-up revealed mild stenosis. obstruction common problem surgery. Conduit availability problematic some countries, therefore nonvalved transannular patches frequently used. They can lead insufficiency, volume overload dysfunction, exercise intolerance, arrhythmias, possibly sudden death. Conversely, valved conduits prone due lack potential.7Levine A.J. Miller P.A. Stumper O.S. al.Early ventricular-pulmonary patients under 1 year age.Eur Cardiothorac 2001; 19: 122-126Crossref (45) Custom made, nonstandardized led variable results. However, standardized templated guides, colleagues,8Ozaki al.A total 404 cases 2014; 1: 301-306Abstract (120) measure allow more reproducibility. Leaving two thirds posterior native growth, sizer equal-size optimize cooptation height distribute equal throughout Although technical success operation position, optimal material continues question. Furthermore, anticoagulation regimens yet fully established limit microthrombosis failure. Currently, recommend undergoing any receiving aspirin, warfarin considered. This research project internally sponsored authors’ own department Boston Children's Hospital. Illustrations credited Kai-Ou Tang.