Mitral implantation of a (Melody) pulmonary valve. A report of the first pediatric case in Colombia

Congenital mitral valve disease is complex, entails a significant challenge from a clinical, hemodynamic, and surgical point of view, and has high rates of morbidity and mortality. Surgical valvuloplasty has a high failure and reoperation rate, especially in neonates and infants due to the presence of dysplastic valves and special anatomical characteristics. Mitral valve replacement presents limitations in this age group given the lack of available prostheses for rings smaller than 15 mm. Melody valve implantation in mitral position is a management alternative in these patients with important potential benefits in the short- and medium-term. We present the case of a 6-month-old girl with a congenital heart disease consisting in severe mitral valve stenosis, severe aortic coarctation and hypoplasia of the transverse aorta and the isthmus. She was taken to surgery at 4-months of age for a reconstruction of the aortic arch, mitral valvuloplasty, and creation of a calibrated 5 – mm interatrial communication. She developed early failure of the valvuloplasty with stenosis and severe residual mitral regurgitation, and progressed to severe acute heart failure. It was decided to implant a pulmonary Medtronic Melody 22 mm valve in the mitral position by a hybrid approach in collaboration with the pediatric hemodynamics group and cardiovascular surgery.