Biventricular repair of right-dominant complete atrioventricular canal defect

Complete atrioventricular (AV) canal defects usually have right and left valve components of approximately equal size, although unbalanced forms do occur. Optimal management of unbalanced AV canal defects is controversial, with no proven guidelines for choosing between biventricular repair and univentricular palliation. We describe successful biventricular repair of a right-dominant unbalanced AV canal with severe left AV valve stenosis. This case illustrates that severely unbalanced AV canal defects can be repaired successfully by tailoring the AV valve to distribute it equally between the ventricles, The increase in left ventricular volume after surgery exceeded prediction based on conformational change alone.