Pulmonary valve reconstruction by allograft replacement of underdeveloped anterior leaflet in case of late combined pulmonary restenosis after early primary repair

Abstract

Introduction The native pulmonary valve (PV) reconstruction is an attractive alternative to a replacement but is challenging due to the systematic underdevelopment of the valve structures in congenital heart diseases. The partial replacement of underdeveloped parts of the valve and saving of well-developed may have advantages versus replacing the whole valve in terms of durability and patient outgrowth of the prosthesis. Case presentation This report describes a case of the PV reconstruction by allograft replacement of an underdeveloped anterior leaflet in an adolescent patient who previously corrected pulmonary stenosis during the first year of her life. The normal anatomy of the right and left leaflets was revealed. The rudimental anterior leaflet determined the annular restenosis. The monocusp with the related supporting aortic wall was sewn instead of the anterior leaflet. The Z-score of the pulmonary annulus changed from minus 3, 9 before to +0.8 after the procedure. The excellent function of the PV was observed in 1-year follow-up. Discussion Valve deterioration over time will have a less negative impact on the function when it occurs in a limited area. The annular dilatation becomes unlikely if the annulus predominantly consists of natural tissues. The procedural effectiveness allows the transcatheter valve-in-valve therapy in case of late dysfunction. The expected feature of the procedure described is that the growth of the PV remains possible. Conclusion If allograft replacement of the PV is scheduled and allograft is available, the partial replacement may be superior to replacement of the whole valve in terms of durability and patient outgrowth of the prosthesis.