Modified Ozaki Procedure For Truncal Valve Reconstruction In Neonate With Severe Truncal Valve Stenosis And Regurgitation
Narutoshi Hibino, MD, PhD1, Chawki El-zein, MD2, Emily Pena, PA2, Luca Vricella, MD1.
1University of Chicago, Advocate Children's Hospital, Chicago, IL, USA, 2Advocate Children's Hospital, Oak lawn, IL, USA.
Repair for the truncus arteriosus in neonate with severe truncal valve stenosis and regurgitation is challenging. This case demonstrates an alternative method of truncal valve reconstruction using modified Ozaki procedure.The patient is a 11 day old, 2.9kg full term baby with truncus arteriosus, severe truncal valve stenosis and regurgitation, and VSD.The heart was approached through a median sternotomy. Following heparinization bypass was commenced. The ascending aorta was clamped and transected. The central pulmonary artery was excised from the left side of the truncus.The truncal valve was four commissures consisting of quadro cusp, and all leaflets were quite thick, fused, and dysplastic from annulus. There was no thin part of the leaflets that could work as a valve, which was extremely difficult to repair. Therefore, we decided to perform total leaflet reconstruction using a modified Ozaki procedure.Based on annulus size (13mm), three leaflets that were created using glutaraldehyde treated autologous pericardium were sutured along with new three commissures created based on coronary artery position. The VSD was closed through RV incision. A 10 mm valved femoral vein homograft was used for RV-PA conduit. The postoperative echo 6 months after op showed mild AS and mild AR.Total leaflet reconstruction using Ozaki procedure is the useful alternative for the patient with severe truncal valve disease that cannot be repaired using conventional methods.
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