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[Surgical correction of complete atrioventricular septal defect with tetralogy of Fallot]
1Department of Thoracic and Cardiovascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China.
Insights
Surgical correction of complete atrioventricular septal defect with tetralogy of Fallot (AVSD-TOF) using a two-patch technique and combined right ventriculotomy/atriotomy approach is effective. This method leads to good postoperative function with low complication rates.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Congenital Heart Disease
Context:
- Complete atrioventricular septal defect with tetralogy of Fallot (AVSD-TOF) is a complex congenital heart defect.
- Surgical correction presents significant challenges due to the intricate anatomy.
- Effective surgical strategies are crucial for improving patient outcomes.
Purpose:
- To report the surgical correction outcomes of complete AVSD-TOF in pediatric patients.
- To evaluate the efficacy of the two-patch technique for AVSD repair combined with specific VSD closure and RVOT reconstruction.
- To assess postoperative complications, mortality, and long-term functional results.
Summary:
- Six pediatric patients with complete AVSD-TOF underwent surgical correction using a two-patch technique for the septal defect and closure via right ventriculotomy and atriotomy.
- The common atrioventricular valve commissure was routinely closed, and right ventricular outflow tract (RVOT) obstruction was addressed with a transannular patch and monocuspid valve.
- Early complications included respiratory failure, low cardiac output, and multi-organ failure (MOF) in one patient, leading to one mortality. Survivors showed good functional status (NYHA Class I/II) with minimal late regurgitation.
Impact:
- The study demonstrates the feasibility and effectiveness of the described surgical technique for complete AVSD-TOF.
- Routine commissure closure of the atrioventricular valve appears to minimize regurgitation.
- This approach offers a viable option for achieving good long-term functional results in patients with this complex defect.
Objective:
To report the surgical correction of complete atrioventricular septal defect with tetralogy of Fallot (AVSD-TOF).
Methods:
Six consecutive patients aged 3 - 9 years underwent correction of complete AVSD-TOF. The two-patch technique for atrioventricular septal defect was used. The ventricular septal defect was closed through a right ventriculotomy and right atriotomy in each case. The commissure between the superior and inferior bridging leaflets of the left portion of the common atrioventricular valve was closed in each patient. RVOT obstruction was relieved by a transannular autologous pericardium with monocuspid valve.
Results:
Postoperative complications included respiratory failure in 1 patient, low cardiac output syndrome in 1, and MOF in 1. There was one mortality because of MOF in the early postoperative period. Five survivors were followed up from 6 months to 5.5 years (mean 2.3 years). There was no late mortality and only one patient had mild left atrioventricular valve regurgitation. NYHA cardiac function was class I in 4 patients and class II in 1.
Conclusions:
AVSD-TOF can be corrected using the two-patch technique and closure of the ventricular septal defect through a combined approach using a right ventriculotomy and right atriotomy. Routine closure of the commissure of the left portion of the atrioventricular valve results in a low incidence of regurgitation. Good functional result can be achieved in most patients postoperatively.