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Case Report: Using Medtronic AP360 mechanical prosthesis in mitral valve replacement for patients with mitral insufficiency after primum atrial septal defect repair to reduce left ventricular outflow tract obstruction risk



Case Reports


doi: 10.3389/fsurg.2022.1008444.


eCollection 2022.

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Case Reports

Lei Guo et al.


Front Surg.


.

Abstract


Background:

Atrial septal defect is one of the most common congenital heart diseases in adults. Primum atrial septal defect (PASD) accounts for 4%-5% of congenital heart defects. Patients with PASD frequently suffer mitral insufficiency (MI), and thus, mitral valvuloplasty (MVP) or mitral valve replacement (MVR) is often required at the time of PASD repair. Unfortunately, recurrent unrepairable severe mitral regurgitation can develop in many patients undergoing PASD repair plus MVP in either short- or long-term after the repair surgery, requiring a re-do MVR. In those patients, the risk of left ventricular outflow tract obstruction (LVOTO) has increased.


Case presentation:

We present five such cases, ranging in age from 24 to 47 years, who had a PASD repair plus MVP or MVR for 14-40 years while suffering moderate to severe mitral regurgitation. Using Medtronic AP360 mechanical mitral prostheses, only one patient experienced mild LVOTO.


Conclusions:

The use of Medtronic AP360 mechanical mitral prostheses to perform MVR in patients with MI who had a history of PASD repair can potentially reduce the risk of LVOTO. Long-term follow-up is required to further confirm this clinical benefit associated with AP360 implantation in patients with PASD.


Keywords:

LVOTO; MVR; PASD repair; case report; congenital heart disease.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures



Figure 1

(A) Preoperative echocardiography showed and (B) intraoperative findings of Case 1. The black arrow indicates the protruding mitral annulus tissue.


Figure 2


Figure 2

(A) Cartoon showing an implanted ATS mechanical mitral valve (left) and AP360 (right) after MVR, and (B) photos of an ATS mechanical mitral valve (left) and AP360 (right). Panel A shows that after the implantation, ATS valve will subside more substantially into the LVOT than an AP360, resulting in a higher risk of LVOTO. Panel B shows that with the sewing cuff in the same plane, the ATS is approximately 3 mm lower than the AP360. MVR, mitral valve replacement; LVOT, left ventricular outflow tract; LVOTO, left ventricular outflow tract obstruction.

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