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How to save the life of this baby with CAVC and MV replacement?
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How to save the life of this baby with CAVC and MV replacement?

My friend's baby girl, born on June 6, 2009, was diagnosed CAVC (Complete Atrioventricular Canal defect) when she was 35-day old in China.  She accepted two main surgeries at the age of 3 and 6 moths respectively.  But it didn't solve her problems and her life is in danger now.  The following is her medical record:

1. Accepted CAVC radical surgery on 2009-9-21.  After the surgery the ultrasound showed that the atrial septal was repaired well without shunt.  Slight mitral stenosis, mild mitral valve and tricuspid regurgitation.
2. 2009-12-20 she had left ventricular failure and was confirmed severe mitral stenosis.  Mitral valve replacement was done on 2009-12-27.  But since the doctors cannot find the appropriate size of the artificial mitral valve, size 17 aortic valve was used . The medication after discharge: warfarin, spironolactone, capoten.
3. The follow-up ultrasound on 2010-7-4 showed severe left ventricular outflow stenosis.
4. The follow-up ultrasound on 2010-10-11 showed a narrow left ventricular outflow(severe), and left ventricular hypertrophy.

The patient baby presents clear consciousness, normal diet and activities.  Height 75cm, weight 8.5kg. Oral drugs: warfarin(1.5mg), spironolactone, Capoten, metoprolol.  Latest INR is 2.39.

The conclusions made by the local pediatricians and surgeons are:
1. LOVT is related to the replaced mitral valve extrusion.
2. Pulse pressure 84mmHg, may causes sudden death;
3. Since the patient is too young and her weight gain is not obvious, the valve ring size is estimated not to change since the MV replacement.  No smaller valve available even if accepting surgery.  Close observation is suggested.

Question:
1. Are there any artificial mitral valves smaller than size 17 available in US or Canada or Hongkong?
2. Does she need immediate surgery?  What is the consequence if the 3rd surgery is postponed?
3. Can any medication or stent solve or alleviate her current severe narrow ventricular outflow problems?
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Hello, welcome to the pediatric cardiology forum. Unfortunately, I cannot answer these questions for you. Having said that, you are free to write this question on the Expert: Pediatric Heart Forum where a pediatric specialist from CHOP will answer your questions. Another thought might be for this baby to be evaluated at a large University Hospital here in the USA. If she is not in the States, I would certainly consider bringing her here to be evaluated.
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