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Surgery of atrioventricular septal defects. Review of the first 100 cases
1Department of Cardiac Surgery, Vall d'Hebrón Hospital for Children, Barcelona, Spain.
Insights
Surgical correction of atrio-ventricular septal defects in 100 children improved survival rates significantly. Long-term outcomes show good quality of life, with survival linked to left valvular insufficiency severity.
Area of Science:
- Cardiology
- Pediatric Surgery
Background:
- Atrio-ventricular septal defects (AVSD) are congenital heart conditions requiring surgical intervention.
- This study reviews the initial cohort of pediatric patients undergoing AVSD correction.
Purpose of the Study:
- To evaluate the surgical outcomes and long-term survival of children with atrio-ventricular septal defects.
- To identify factors influencing survival and quality of life post-correction.
Main Methods:
- Retrospective analysis of 100 children who underwent surgical correction for AVSD between 1972 and 1985.
- Data collected included defect type, patient demographics, surgical procedures, complications, and long-term follow-up.
Main Results:
- Overall mortality decreased from 20% before 1980 to 3.3% from 1981-1985.
- 9% of patients required reoperation for complications like residual shunts or mitral incompetence.
- Long-term survival was 86.7%, with most survivors in NYHA Class I or II.
Conclusions:
- Surgical correction of AVSD in children has evolved, leading to improved survival rates.
- Left valvular insufficiency is a key factor in long-term prognosis.
- Most surviving children achieve a good quality of life post-surgery.
Abstract:
From 1972 to 1985, the first 100 children suffering from some form of atrio-ventricular septal defect underwent surgical correction. In all cases, corrective surgery was carried out primarily except in 3 children who presented with a total defect and first underwent palliative surgery. In 48 children, a complete form was present, in 5 an intermediate form, and in 47 a partial form. There were 43 males and 57 females. Thirty-eight percent of patients suffered from Down's syndrome. The mean age at operation was 42 (range 2-143) months. A prosthesis was implanted in the left atrio-ventricular valve at primary correction in 9 patients. Up to 1980, the overall mortality was 20% and from 1981 to 1985 it was 3.3%. There was late mortality in 3 children (2 with a complete form and 1 partial). In 32 cases, postoperative cardiac catheterization was performed. Nine patients were reoperated upon (9%), 2 due to a residual shunt, 4 due to serious mitral incompetence (in all cases a prosthesis was used), and 3 due to valvular thrombosis. In this series, only 2 patients remained in complete atrio-ventricular block (1 affected by the complete form and the other partial). Long term survival is related to the severity of left valvular insufficiency. In this series with a mean follow-up of 3.83 +/- 2.78 years, we had an a cumulative survival of 86.7% +/- 3.43%. At the last control, most of the survivors had a good quality of life: 91% were in class I and 9% in class II according to the NYHA scale.