Dr. Novick reports on complex surgery

Originally, the Belarusians performed a VSD closure and pulmonary valvotomy on a six month old girl, noting that the tricuspid valve was a little small. Postoperatively she did not do well and a bedside echo revealed moderate to severe tricuspid valve regurgitation. The Institute Chief performed a tricuspid valve repair the next day. He succeeded in reducing the regurgitation to moderate, but made the valve stenotic in the process, leaving her with an 8 mm mean gradient. She was eventually discharged from the hospital, but over then next year the regurgitation increased and as she grew the stenosis got worse.

I saw the girl first in February 2007 and told them that I did not think a re-repair would be possible, that she would need a tricuspid valve replacement. In April 2007, the Chief "repaired" her valve again. He used some xeno-pericardium and tried to perform leaflet extensions. I saw her in May 2007. She had severe regurgitation, and a mean gradient of 16 across the tricuspid valve.

We performed her re-operation on this December 2007 trip. Although it was a 4th time sternotomy, we were able to repeat the sternotomy without incident by placing her on Fem-Fem bypass prior to opening the sternum. I removed the tricuspid valve, the orifice would only allow for passage of a 6 mm Hegar dilator, and replaced it with a 19 mm Biocor SJM while the heart was beating. She returned to the ICU in sinus rhythm, she had been in junctional pre-operatively, and she was extubated about 6 hours later.

When the preoperative echo was performed her annulus measured 14 mm, and we were all concerned that we would not be able to place anything but a 17 mm mechanical SJM, but we were fortunate and with some creative annulus enlargement able to get the 19 mm in on this operation.

Needless to say she will need another re-op to replace the 19, but for the time being she is in excellent shape for the first time in her short (2.5) life and can live like a normal child without coumadin for what we hope will be several years.

Thank you to all of those at St Jude's Medical that made this possible. 

Surgical and educational teams go to Minsk

During the first week, these medical team members performed operations:

During the second week, these education team members trained the local medical team: