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Reconstructed aortic valve and creation of 3 new valves in a six-year-old child

Lis Berisha is a 6-year-old child who came for the first time to us for a surgery. He was born with congenital heart defect – aortic stenosis, which is a narrowed opening of the aorta – a large blood vessel coming out of the left ventricle carrying oxygenated blood to the whole body.
Immediately after birth, a systolic murmur was noticed, and due to eating disorders and poor weight gain, the patient was kept in the Prishtina hospital where severe aortic stenosis was identified on an echocardiogram.

– At the age of two months, due to the inability to undergo a surgery, a balloon dilatation of the aortic valve was performed at the University Children’s Clinic in Belgrade, which widened the aortic opening by reducing the pressure gradient. The following regular echocardiographic results showed increased pressure gradient, left ventricular hypertrophy, aortic valve insufficiency with a risk of further heart failure, explained Dr. Jordanka Madjoska, our paediatrician.

It was clear that this child’s condition required surgical treatment that would be a permanent solution without the need for resurgery.
The literature describes three surgery options – replacement of the aortic valve with a mechanical prosthesis, which is a safe and long-lasting solution but requires prevention of thromboembolic complications and prohibition of physical activity or other procedures that cause bleeding; treatment was postponed until the patient comes to a certain age when the biggest prosthesis could be implanted with the greatest risk of re-implantation due to patient’s growth. The second option is to replace the valve with a biological prosthesis that does not last long enough and again requires anticoagulant therapy.

The third option is the Ross procedure – autotransplantation of the pulmonary valve at the aortic position. Of all the possibilities, none was the solution because of the patient’s age.

Our expert team guided by Dr. Zan Mitrev reviewed the case and decided that Lis should be admitted to our clinic and operated. The narrowed aortic part was extended, and Dr. Zan Mitrev designed aortic valves with pericardial matrix material. Immediately after the operation, the follow-ups showed excellent function of the valve and the extended part of the narrowed aorta.

– We provided a permanent solution for the patient because of the material’s ability to grow together with the patient growth and it does not require further surgery, chronic therapy and the patient can practice sports, explained Dr. Madjoska.
The patient had stable vital parameters after surgery and today, one week after the surgery, he is leaving home.
We would define the whole case as an excellent operative and postoperative course of a specific heart defect that was resolved in a way that we can say is new, unique, not yet applied in paediatric cardiac surgery, which will create new protocols in the treatment of aortic stenosis! – concluded the doctor.

Lis and his mother are preparing to leave home today.

– As a mother, I have no words to express the gratitude to the whole team at this clinic, especially to Dr. Zan Mitrev. Thanks for everything you did for my child. All the staff I met at the Zan Mitrev Clinic are extremely professional, with a friendly approach. Now, we go home where our family and especially Lis’ twin brother Malj are expecting us – said Mrs. Berisha.

Dear Lis, be healthy, strong and happy … life is in front of you.

With love,
Zan Mitrev Clinic.