A third Melody valve-in-valve implantation in the mitral position using a hybrid transapical approach to facilitate transfemoral delivery was feasible and resulted in good hemodynamics.
Case Report (n=1)
Demonstrates the feasibility of a third Melody valve-in-valve implantation in the mitral position using a hybrid approach in a pediatric patient.
BACKGROUND: Severe congenital mitral valve disease is difficult to manage in infants and small children. Off-label use of a Melody valve in the mitral position (MiM) has emerged as an important bridge to definitive valve replacement, with the potential to reintervene. CASE SUMMARY: A 6-year-old boy with Shone's complex and multiple left-sided interventions, including surgical MiM implantation at age 3 months (Melody #1) and transapical MiM valve-in-valve at age 2 years (Melody #2), presented 4 years later with progressive mixed MiM dysfunction. In a hybrid catheterization laboratory, balloon dilation of the existing MiM improved expansion but resulted in worsening regurgitation, necessitating valve replacement. A limited left anterior thoracotomy was performed to facilitate a venoarterial rail, enabling controlled transfemoral advancement and deployment of Melody #3 within the prior MiMs, with good hemodynamic result. CONCLUSIONS: Our case demonstrates the feasibility of repeat MiM valve-in-valve therapy, including a third MiM implantation, using a hybrid transapical approach to facilitate transfemoral delivery.
Hassan et al. (Mon,) conducted a case report in Shone's complex with progressive mixed mitral valve dysfunction (n=1). Repeat Melody valve-in-valve implantation (third valve) using a hybrid transapical approach was evaluated on Hemodynamic result and feasibility. A third Melody valve-in-valve implantation in the mitral position using a hybrid transapical approach to facilitate transfemoral delivery was feasible and resulted in good hemodynamics.