[Surgical technique and results of correction of partial, transitional and total forms of atrioventricular septal...

During 1982-2001 correction of atrioventricular septal defect was performed by the author in 180 patients: 74 (41.1%) patients with partial, 11 (6.1%) with transitional and 95 (52.8%) with complete form. The age was in range from 1 month to 17 years and 7 months (mean 3.3 +/- 3.8 years). 71 (39.4%) patients were younger than 1 year. The repair consisted in closure of the defect with one or two patches and plastic reconstruction of both atrioventricular valves. In 70.0% patients the "cleft" of the left anterior leaflet was completely closed, in 17.2% commissuroplasty of one and in 6.1% commissuroplasty of both commissures was required. In two patients with stenotic and regurgitant valve mechanical prosthesis was inserted. The surgical mortality was 7.8% (5.4% in partial, 0.0% in transitional and 10.5% in complete form). Out of 115 patients operated before 1994, 14 (12.2%) patients died, but out of 65 patients (including 42 patients with complete form) operated in the period 1995-2001, no patient died. Low cardiac output represented the most common cause of death. Stenotic valvar morphology, complete form and severe clinical condition represented risk factors of death during the early period. Influence of all risk factors was, however, neutralized with time and the early mortality decreased bellow 1% even in the complete form. Surgery performed before 1995 represents the only risk factor of early mortality. After surgery long-term follow-up concentrated to early detection of severe residual or recurrent left atrioventricular valvar incompetence and serious late complications is necessary.