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Abstract
Introduction A male infant was diagnosed and treated for Group B Streptococcus meningitis from day 10 of life after uncomplicated pregnancy and delivery. During this intravenous antibiotic treatment he presented with symptoms of heart failure. The diagnosis of infective endocarditis of the mitral valve with mixed pathology and impaired LV function was established on day 26 of life. His weight was 4kg at that time. On day 34 of life attempt of valve repair failed and 17mm mechanical prosthesis was implanted into mitral position. 2 subsequent bypass surgeries followed this initial operation on day 79 and 82 due to partially blocked prosthesis including re-do mitral valve replacement. Despite otherwise good clinical progression conversion from iv Heparin to Warfarin remained unsuccessful requiring several courses of thrombolysis due to repeated blockage of one leaflet of the prosthesis.
Treatment and Complication: The mechanical prosthesis was replaced with Melody valve 6 months after the initial and 4 months after the last surgery at a body weight of 7.4kg. The Melody valve was implanted by dilating it to 14mm under direct vision. Post bypass transoesophageal echocardiography showed a 4mm significant paravalvular leak (figure 1).
Cardiopulmonary bypass (CPB) was reinstituted and with fibrillated heart on normothermia re-dilatation of the Melody valve via left atrial purse string was performed. The balloon was re-inflated up to 16mm this time. CPB was weaned off in sinus rhythm.
Lesson to be learned: Intraoperative re-dilatation of the stented Melody valve in mitral position is feasible without reopening the left atrium and further cardioplegic arrest.
Result No significant leak after repeat balloon dilatation of the valve was detected (figure 2).