Journal of Pediatric Cardiology and Cardiac Surgery

Numerous studies have substantiated the viability of aortic valve neocuspidization (AVNeo) in the pediatric demographics; however, the potential complications associated with this technique remain inadequately elucidated. A 12-year-old female patient presented with aortic regurgitation following the unroofing procedure 10 months earlier for the anomalous origin of the left coronary artery from the right coronary cusp exhibiting an intramural course. She underwent AVNeo this time. It appeared there had been a constriction at the sino-tubular junction, despite the absence of a notable pressure gradient. During the surgical procedure, all three leaets were replaced with patches of the glutaraldehyde-treated autologous pericardium that had degenerated and thickened due to prior surgery. During the weaning process from cardiopulmonary bypass, episodes of ventricular fibrillation recurrently occurred, coinciding with significant aortic stenosis (AS) indicated on intraoperative transesophageal echocardiography. Consequently, a decision was made to proceed with mechanical valve replacement in conjunction with annular enlargement. Following this revision, weaning from cardiopulmonary bypass was successfully achieved, culminating in patient’s discharge on the postoperative day 25. AVNeo was performed in an adolescent, necessitating intraoperative conversion to mechanical valve replacement. It is conceivable that both supra-aortic stenosis, clinically insignificant but morphologically significant, and the pericardium inadequately flexible limited opening of the reconstructed leaflets.