An alternative valve for mitral valve replacement in young children: using an NO-REACT(R) INJECTABLE BIOPULMONIC (TM) prosthesis as a mitral valve replacement in a 14-month-old child

The challenge of mitral valve replacement in a child is finding a valve that is flexible and malleable allowing for a comfortable insertion without causing obstruction, yet has the potential to expand in a growing child. Mitral valve replacement in infants is challenging and there are limited alternative valves available. Since the Boston group published their first report on alternative valves for mitral valve replacement in infants, there has been a growth in the literature on the topic, mostly based on the use of a stented bovine jugular vein graft (Melody(R) valve). The challenges of the Melody valve are firstly in its length of 28 mm unexpanded, which has the potential to cause left ventricular outflow tract obstruction, and secondly, the valve needs mechanical dilatation, which is laborious. A modified No-React(R) Injectable Biopulmonic (TM) Prosthesis (Bio Integral Surgical, Inc., Mississauga, ON, Canada) which is shorter (19 mm) and simpler in that it is self-expanding was implanted in a 14-month-old child to replace her mitral valve. The operation was successful and the short-term function of the prosthesis is good.