Transapical Mitral Valve-in-Valve Implantation in Less than 10 kg Children.

The Melody valve, surgically implanted in mitral position, is used in infants as an initial “off-label” procedure towards mechanical valve, to avoid anticoagulation and allow balloon dilations. Hybrid transapical mitral valve-in-valve implantation is an alternative to reoperation when balloon dilation is unsuccessful. We report 2 paediatric cases ≤ 10Kg, with Melody valve stenosis in one, and with severe regurgitation and left ventricular outflow obstruction in the other. The first case was performed in emergency, following acute obstruction after balloon dilation of the Melody valve. The second case was complicated by an ischemic stroke after stopping anticoagulation for gastrointestinal bleeding, necessitating emergency neurosurgery, with residual right hemiplegia. Both patients had a favourable outcome with excellent function of the Melody valve, aside from a moderate left ventricle outflow obstruction in the second patient. Although feasible and effective, transapical mitral valve-in-valve implantation in small children is a high-risk procedure.