A seven-year-old boy was admitted to the cardiac surgery department with a diagnosis of aortic stenosis (narrowing of the aortic orifice at the level of the aortic valve). This congenital malady progresses throughout life. The share of aortic stenosis among other congenital heart diseases is 20-25%, while in half the cases the patient needs urgent surgery.
“For help, our colleagues from the team of the corresponding member of the Russian Academy of Sciences Dmitry Shumakov turned to us. The patient received a fibrous ring with a diameter of 1 cm, the gradient on the valve was 70 mm RT. Art. Such values are an absolute indication for surgery. Otherwise, a fatal outcome cannot be avoided, ”says Roman Komarov, head of the cardiac surgery department at the Clinical Hospital No. 1 of Sechenovskiy University .
One of the options for surgical intervention is balloon dilatation, during which the valve is torn and left in this state until an older age is reached. This solution to the problem adds new difficulties in the form of constant medication and limiting the mobility of the child.
The second option is commissurotomy, i.e. expansion of the aortic valve due to the separation of adhesions on the valve. In this case, the patient is doomed to re-surgery. In some cases, a Ross operation is indicated in which the affected aortic valve is replaced with the patient’s own pulmonary valve. During this time-consuming operation, the heart is literally taken apart for parts, which increases the risks of an adverse outcome. An alternative is Ozaki’s operation, named after a Japanese doctor and actively introduced into the Russian practice of adult surgery.
“The essence of the operation is that the valves are cut out of the heart’s own membrane and sewn in place of the changed aortic valve. In pediatric surgery, such an operation, if not the only one in our country, is, of course, extremely rare, ”comments Roman Komarov. “The three – leaf valve is made taking into account the subsequent growth of the child and stretches as it grows.”
The child underwent surgery well, the gradient on the valve decreased to 10-15 mm RT. Art. On the seventh day the boy was discharged home.