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Primary repair of complete atrioventricular septal defect in infancy
W R Thies1, T Breymann, W Matthies
1Department of Pediatric Cardiology, Ruhr University of Bochum, Bad Oeynhausen, FRG.
Insights
Primary repair of complete atrioventricular septal defects in infants is effective, with most survivors showing good functional class and reduced pulmonary artery pressure. Early surgical intervention is recommended, especially if pulmonary arteriolar resistance is high.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
- Cardiac Surgery
Background:
- Complete atrioventricular septal defect (CAVSD) is a complex congenital heart condition.
- Primary surgical repair in infancy is the standard treatment for CAVSD.
- Optimizing surgical timing and technique is crucial for favorable outcomes.
Purpose of the Study:
- To evaluate the outcomes of primary surgical repair for CAVSD in infants.
- To assess the impact of early surgical intervention on functional status and hemodynamics.
- To identify factors influencing postoperative complications and long-term results.
Main Methods:
- Retrospective analysis of 40 infants undergoing primary CAVSD repair within the first year of life.
- Surgical techniques included one- or two-patch repair methods.
- Follow-up included clinical assessment, echocardiography, and cardiac catheterization.
Main Results:
- The mean age at surgery was 4 months. Mortality was 10% (4/40), with no late deaths.
- Postoperative complications included atrioventricular block, right bundle branch block, and residual defects.
- Survivors demonstrated significant improvement in functional class (83% NYHA I) and reduced pulmonary to systemic artery pressure ratio (0.42).
- 53% had no detectable atrioventricular valve regurgitation, and 36% had mild mitral incompetence.
Conclusions:
- Primary repair of CAVSD in infancy yields favorable short- and long-term outcomes.
- Early surgical intervention, ideally between 5-6 months or sooner if pulmonary resistance is elevated, is recommended.
- Careful surgical technique and patient selection are key to minimizing complications and optimizing functional recovery.
Abstract:
Forty infants with complete atrioventricular septal defect have undergone primary repair within their 1st year of life. The mean age at time of surgery was 4 months (range 1-12 months) and the mean weight 4.2 kg (range 2.9-7.0 kg). Either the one- or the two-patch method was used. Four patients died (10%). There were no late deaths. Three patients needed reoperation due to mitral valve insufficiency. Postoperative complications were: 1 total atrioventricular block in an infant with an absent ventricular septum 3 weeks after surgery, 9 complete right bundle branch blocks, 3 small residual ventricular septal defects. Mean follow-up of the 36 survivors is 22 months (3-46 months). Thirty (83%) are in NYHA functional class I, 4 (11%) in NYHA class II and 2 (6%) in NYHA class III. No atrioventricular valve regurgitation is detectable by the color Doppler technique in 19 (53%) patients. Mitral incompetence is mild in 13 cases (36%) and moderate in 4 (11%). In ten recatheterized patients the average systolic pulmonary to systemic artery pressure ratio dropped from 1.0 to 0.42 and the average pulmonary arteriolar resistance was reduced from 5.5 to 3.9 U/m2. All but one patient gained weight and underwent adequate statomotoric development. Primary repair should be performed at the age of 5-6 months or even earlier, if pulmonary arteriolar resistance exceeds 5 U/m2.