# Modified Melody Valve Surgical Implantation in Atrioventricular Position in Four Children Under Two Years of Age

## TL;DR

A modified Melody valve was successfully implanted in four young children under two years old to replace their atrioventricular valves when other options were unavailable.

## Contribution

The study demonstrates the viability of modified Melody valves in the atrioventricular position for infants with limited surgical options.

## Key findings

- Modified Melody valves were implanted in four children under two years old in either mitral or tricuspid positions.
- Two patients survived with a maximum follow-up of three years after the implantation.
- The procedure was used palliatively when no other surgical alternatives were available.

## Abstract

Mitral and tricuspid valve replacement options have traditionally been limited to mechanical valves, bioprostheses, and the mitral Ross procedure. In recent years, the Melody valve (Medtronic, Minneapolis, MN) has emerged as a viable alternative for infants and young children. We present four patients under two years of age who underwent surgical implantation of a modified Melody valve 22 mm in the atrioventricular position. The valve was placed in the mitral position in three patients and the tricuspid position in one. The procedure was performed with palliative intent in all patients, as no alternative surgical options were available. At the time of valve implantation, two patients were supported with venoarterial extracorporeal membrane oxygenation. At the time of this report, two patients remain alive, with a maximum follow-up of three years in one case following valve implantation. We describe the experience of using a modified Melody valve in the tricuspid or mitral position with palliative intent in four patients, supporting its viability as an option in children under two years of age with limited therapeutic alternatives.

The online version contains supplementary material available at 10.1007/s00246-025-03972-9.