Bicuspidization using autologous pericardium for neonatal quadricuspid truncal valve

Background: Neonatal truncal valve plasty remains a significant challenge. Several surgical techniques have been reported, but there is no standard procedure. We herein report a novel operative technique for the quadricuspid truncal valve with axisymmetric morphology.

Case presentation: A 17-day-old neonate with severe truncal valve insufficiency developed persistent congestive heart failure and underwent urgent truncal valve plasty. The truncal valve was quadricuspid with four equal sinuses, and all four cusps were hypoplastic, resulting in a complete lack of coaptation. We performed bicuspidization valvuloplasty with leaflet reconstruction using autologous pericardium for this valve. The patient had an uneventful recovery and was free from recurrent truncal valve insufficiency for 10 months.

Conclusions: Bicuspidization with leaflet reconstruction is a suitable surgical option for overcoming neonatal truncal valve insufficiency in cases with quadricuspid truncal valves with axisymmetric morphologies. Although the durability of a bicuspid neo-leaflet using glutaraldehyde-treated autologous pericardium is unknown, this technique is expected to postpone subsequent truncal valve replacement in such neonates.