<div>Title page</div><div>Multiple replacements for recurrent stuck mechanical valve in a patient
with Fontan circulation</div><div>Kota Agematsu, Mitsugi Nagashima, Yoshiharu Nishimura</div><div>Department of Cardiovascular Surgery, Wakayama Medical University</div><div>The data that support the findings of this case report are available on
request from corresponding author [K.A]</div><div>This case report has been approved by the institutional review board of
our university.</div><div>Informed consent was obtained from the patient for publication of this
case report.</div><div>Funding: none</div><div>Conflict of interest: none</div><div>Corresponding author: Kota Agematsu, Department of Cardiovascular
Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama city,
641-8510, Japan (E-mail:<i>agematsukouta@yahoo.co.jp</i>)</div><div>Abstract</div><div>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.</div>