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Routine cleft closure in repair of complete atrioventricular septal defects
1Department of Cardiothoracic & Vascular Surgery, All India Institute of Medical Sciences, New Delhi.
Insights
Complete closure of the left atrioventricular valve cleft in complete atrioventricular septal defects is recommended. This approach may prevent late-onset atrioventricular valve regurgitation, improving long-term outcomes.
Area of Science:
- Cardiology
- Pediatric Cardiac Surgery
- Congenital Heart Disease
Background:
- Complete atrioventricular septal defect (CAVD) is a complex congenital heart anomaly.
- Patients often present with severe pulmonary arterial hypertension and atrioventricular valve regurgitation.
- Associated conditions like Down's syndrome are common in CAVD patients.
Purpose of the Study:
- To evaluate the long-term outcomes of surgical repair for complete atrioventricular septal defects.
- To determine the impact of left atrioventricular valve cleft management on post-operative valve function.
- To assess the incidence of late atrioventricular valve regurgitation after CAVD repair.
Main Methods:
- Retrospective analysis of 30 patients with CAVD operated between 1989 and 1996.
- Surgical intervention involved closure of the left atrioventricular valve cleft in most patients.
- Post-operative evaluation included serial 2D echocardiography for up to eight years.
Main Results:
- Five in-hospital deaths (16.66%) occurred, including two cases where the cleft was not closed.
- Late deterioration of left atrioventricular valve regurgitation was observed in two patients, both with unrepaired clefts.
- The majority of patients with closed clefts maintained stable, mild, or trivial atrioventricular valve regurgitation.
Conclusions:
- Complete closure of the left atrioventricular valve cleft is crucial in complete atrioventricular septal defect repair.
- Leaving the cleft open is associated with a higher risk of late atrioventricular valve regurgitation.
- This surgical strategy may improve long-term valve function and patient outcomes.
Abstract:
Thirty patients with complete atrioventricular septal defect were operated upon between 1989 and 1996 at our institute. Their ages ranged from two months to 24 years (mean age 2.81 years). All patients had severe pulmonary arterial hypertension except one who had associated pulmonic stenosis. Four patients had severe atrioventricular valve regurgitation and another six had moderate regurgitation. Five patients had Down's syndrome. The cleft in the left atrioventricular valve was closed in all but seven patients. There were five (16.66%) in-hospital deaths which included two patients in whom the cleft was left open. Follow-up ranged from three months to eight years. All patients were evaluated by 2D echocardiography in the immediate post-operative period and three to six monthly subsequently. One patient progressed to moderate and another to severe left atrioventricular valve regurgitation during follow-up. In both the patients the cleft had been left open. All other patients continue to have stable left atrioventricular valve status, that is, none or trivial to mild regurgitation. In view of late deterioration of the left atrioventricular valve regurgitation only in those patients where the cleft was left open, we suggest complete closure of the cleft in all complete atrioventricular canal defects.