Percutaneous Management of a Mechanical Complication Post Mitral Valve Surgery in a Child

J INVASIVE CARDIOL 2021;33(3):E229. 

Key words: cardiac imaging, pediatric percutaneous coronary intervention

A 4-year-old girl with congenital mitral regurgitation status post mechanical mitral valve replacement (MVR) using a 16 mm Carbomedics valve (LivaNova) at the age of 5 months underwent a redo MVR using a 21 mm aortic prosthesis implanted in an inverted position for progressed increased mitral valve gradient due to pannus formation. Post operatively, echocardiogram showed good mitral valve prosthesis function with severe depressed left ventricular function (ejection fraction, 19%) and markedly segmental dyskinesia in the lateral wall. Coronary angiogram showed severe compression to the proximal dominant left circumflex artery (Figures 1A and 1B; Videos 1 and 2). Percutaneous coronary intervention was performed using a 2.0 x 18 mm Resolute Onyx drug-eluting stent (Boston Scientific) with good angiographic result and Thrombolysis in Myocardial Infarction 3 flow (Figures 1C and 1D; Videos 3 and 4). At 3-month follow-up, the patient was symptom free and the left ventricular function recovered. 

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From the ¹Heart Center, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia; and ²Department of Interventional Cardiology, University Hospital of Caen, Caen, France.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

The authors report that patient consent was provided for publication of the images used herein.

Manuscript accepted April 3, 2020.

Address for correspondence: Ziad Dahdouh, MD, Heart Center, King Faisal Specialist Hospital & Research Center, Zahrawi St, Al Maather, Al Maazer, Riyadh 12713, Saudi Arabia. Email: ziad_dahdouh@hotmail.com