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The Commando Procedure For Pediatric Patients - A Case Series
Hiroo Kinami, David Kalfa, David Solowiejczyk, Emile Bacha.
NYP Morgan Stanley Children's Hospital, New York, NY, USA.

Objective(s): The Commando procedure includes division of the Intervalvular fibrous body (IFB), Mitral valve replacement (MVR), and Aortic valve replacement. It is considered a technically challenging procedure with a high mortality. It has rarely been employed in pediatric patients. We reviewed the patients undergoing a Commando procedure and describe our results with follow-up echocardiograms.
Results: Five patients with combined left ventricular (LV) inflow and outflow obstruction were included (see table for clinical details). The mean follow up was 15.3 20.7 months. The mean age at surgery was 10.75.7 years old, body weight 31.4 14.4kg, Cardiopulmonary bypass time was 211.6 51.5 minutes, and cross-clamp time 161.8 45.1 minutes. There were no early and late deaths during follow-up. No pacemaker implantation were required. One patient had junctional rhythm with right bundle branch block. Freedom from reoperation during follow-up was 100%. By follow-up echo, all patients have no clinically significant gradient across mitral and aortic valves. One patient who has been followed up long term for 5 years had a mean gradient of 13mmHg at the mitral level with no gradient across the aortic.
Conclusions:While technically challenging, the Commando procedure can be done safely and provides good mid-term results for patients with combined LV inflow and outflow problems.


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