title: Extra-aortic commissuroplasty concomitant with fenestrated Fontan operation for neoaortic valve regurgitation after Norwood reconstruction.
abstract: We introduce a simple, less invasive surgical technique for treating neoaortic valve regurgitation (neoAR) after the Norwood procedure, with the aim of delaying reoperation for neoAR. A 31-month-old girl, with hypoplastic left heart syndrome, previously underwent 4 median sternotomies and was admitted to our hospital for a fenestrated Fontan operation. She presented with moderate neoAR, originating from a tricuspid neoaortic valve (neoAV), with the regurgitation oriented from the centre. Her neoAV annulus was dilated to twice its normal size. With the aim of delaying future neoAV intervention and minimizing the surgical invasiveness, we performed extra-aortic commissuroplasties on the 2 commissures that could be approached from the front during the Fontan operation, without inducing cardiac arrest. We used direct echocardiography and transoesophageal echocardiography to confirm the feasibility before applying this procedure. Her postoperative course was uneventful, and the postoperative echocardiography did not reveal any residual neoAR 5 months postoperatively. We believe that this technique is a useful surgical option for patients with moderate neoAR oriented from its centre and well-balanced tricuspid native pulmonary valves, and it might help to delay future neoAV interventions, with minimal surgical risk.
authors.affiliation: Division of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, Shizuoka, Japan Division of Thoracic and Cardiovascular Surgery, Niigatta University Graduate School of Medical and Dental Sciences, Niigata, Japan.
authors.forename: Ai
authors.initials: A
authors.lastname: Sugimoto
authors.affiliation: Division of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, Shizuoka, Japan.
authors.forename: Noritaka
authors.initials: N
authors.lastname: Ota
authors.affiliation: Division of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, Shizuoka, Japan.
authors.forename: Masaya
authors.initials: M
authors.lastname: Murata
authors.affiliation: Division of Cardiovascular Surgery, Mt. Fuji Shizuoka Children's Hospital, Shizuoka, Japan k-sakamoto@i.shizuoka-pho.jp.
authors.forename: Kisaburo
authors.initials: K
authors.lastname: Sakamoto
mesh_terms: D000328:Adult; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D058385:Cardiac Valve Annuloplasty; D017548:Echocardiography, Transesophageal; D005260:Female; D018729:Fontan Procedure; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000175:diagnosis / Q000601:surgery*; D058327:Norwood Procedures / Q000009:adverse effects*; D012086:Reoperation; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Commissuroplasty; Hypoplastic left heart syndrome; Neoaortic valve regurgitation; Norwood procedure