Abstract

Significant atrioventricular valve insufficiency is associated with increased mortality and morbidity in patients with a single-ventricle because of the congestion associated with single-ventricle circulation. Treatment of atrioventricular valve insufficiency is mandatory for completing Fontan circulation. Although valve repair is a favorable procedure for the lesion because it preserves the valve leaflet and ventricular motion, replacement of the atrioventricular valve is the last option of treatment. The choice of a mechanical valve is often made for atrioventricular valve replacement in children. However, because children's small body size, mechanical valve implantation can cause early and late complications, including thromboembolic or hemorrhagic events, the artificial valve leaflet becoming stuck, and ventricular dysfunction. Because of these complications, valve replacement can be performed several times, and repeat surgical intervention can induce technical difficulties of artificial valve implantation as well. We present a patient who received multiple mechanical valve replacements due to repeat valve leaflet stuck after first palliation of pulmonary artery banding followed by Glenn anastomosis and Fontan completion. To overcome surgical difficulty, some technical modification was required during the repeat valve replacement.