Placement of interatrial patch suture lines in atrioventricular canal defect repair

The placement of the suture line for interatrial patches in complete and incomplete atrioventricular canal defect repairs varies from surgeon to surgeon despite established anatomic knowledge of the atrioventricular conduction system. This study describes our technique for it and reviews early and long-term outcomes.

Between 1980 and 1999, 64 infants and children underwent repair of either complete (n=39) or incomplete (n=25) atrioventricular canal defects. Thirty-four of the children (53.1%) had Down's syndrome. The suture line for the interatrial patch originated on either the artificial or native ventricular septal crest and continued leftward above the annulus of the left inferior leaflet of the atrioventricular valve at the posteroinferior corner. All stitches were placed in a horizontal mattress or U-shaped fashion.

The operative survival rate was 94% (4 early deaths) and the overall survival rate was 85% (6 late deaths). Atrioventricular heart blocks occurred in none of the patients. Although left-sided atrioventricular function significantly improved with repair, two patients (3.1%) required reoperation for valve replacement because of residual or recurrent insufficiency.

This suture technique for interatrial patches is straightforward and results in a low incidence of heart block and a low re-operation rate for left atrioventricular valve insufficiency.