Obstruction of right ventricle-pulmonary artery bioprosthetic valved conduits can result from valvular degeneration and calcification or neointimal peel formation. From 1968 through 1989, 38 patients underwent repair of congenital heart malformation with a porcine xenograft extracardiac valved conduits from right ventricle to pulmonary artery. Of 27 patients who survived after initial repair, 14 patients (8 males and 6 females) were reoperated for conduit obstructions. Ages of patients at the reoperation ranged 5 to 20yr (mean age 11.8±3.6yr) and the interval between initial repair and reoperation ranged 3 to 9yr (mean 6.6±1.7yr). The obstructed conduits were replaced with mechanical valved conduits (4 patients), nonvalved conduits (7 patients) or outflow patches (3 patients). In a half of patients, obstructions occured at multiple levels within the conduits. Obstructions mainly resulted from valvular degeneration, neointimal peel formation and anastomotic narrowings. There was no operative death but one late death due to the infective endocarditis. The systolic pressure ratio of right ventricle to left ventricle (or aorta) decreased from 0.81±0.13 preoperatively to 0.48±0.10 postoperatively. From our experience, it is recommended to use adequate sized bioprosthetic valued conduits for patients' body weight at the initial repair and replace obstructed conduits to the large sized nonvalved conduit at reoperation if possible.

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A case of xenograft valve dysfunction presenting with musical cooing murmur is reported. The patient was a 47-year-old woman and had received mitral valve replacement with porcine xenograft (Carpentier-Edwards 31-M) 10 years before Preoperative echocardiogram showed vibration of a leaflet outside the stent of the bioprosthetic valve. Cardiac catheterization revealed stenosis as well as regurgitation of the bioprosthetic valve. The resected xenograft valve showed a tear which produced regurgitation and musical cooing murmur in one of three pliable leaflets and it also showed pannus formation which caused stenosis.

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Blood transfusion is usually required to perform open cardiac surgical repair in small infants, but the use of blood might be rejected by parents on religious grounds. We operated on a 1.4 years old boy with ventricular septal defect (VSD) and severe (grade 3/4) mitral regurgitation (MR) due to elongated anterior chordae, whose mother was a “Jehovah's witness” sympathizer, initially rejecting any blood transfusion. In view of the deteriorating condition of the infant, and the inadequacy of the pulmonary artery banding alone as therapeutic modality, the mother was persuaded to ultimately consent to controlled cross-circulation between her and the child. The arterial blood was pumped with a roller pump from the mother's femoral artery to the infant's ascending aorta; caval venous return of the infant was drained by gravity into a reservoir and then pumped into the femoral vein of the mother by a second roller pump. A large membranous ventricular septal defect and the mitral regurgitation were repaired (patch closure of the VSD, and shortening of the elongated anterior papillary muscle chordae in conjunction with Kay's type mitral annuloplasty for the MR) during a cross-circulation time of 212min. 2.2 years after the operation, both, the infant and the mother, enjoy good health.

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