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Modified single patch: are we still worried about subaortic stenosis?

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Summary

The modified single-patch technique for atrioventricular septal defect (AVSD) repair shows low risk for late left ventricular outflow tract obstruction (LVOTO). Prior coarctation of the aorta repair is a key predictor of LVOTO.

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Area of Science:

  • Pediatric Cardiology
  • Congenital Heart Surgery

Background:

  • The modified single-patch technique for atrioventricular septal defect (AVSD) repair was introduced with concerns about potential late left ventricular outflow tract obstruction (LVOTO).
  • This study aimed to evaluate the incidence of LVOTO in patients who underwent this modified AVSD repair technique.

Purpose of the Study:

  • To assess the risk of postoperative left ventricular outflow tract obstruction (LVOTO) following the modified single-patch repair of atrioventricular septal defects (AVSD).
  • To identify predictors of late LVOTO in this patient population.

Main Methods:

  • A review of 77 infants undergoing modified single-patch AVSD repair between January 2000 and 2013.
  • Analysis of postoperative outcomes, focusing on the development of LVOTO and need for reoperation.
  • Comparison of outcomes between patients with and without a history of coarctation of the aorta repair.

Main Results:

  • Only 2.5% of patients (2 out of 77) required reoperation for LVOTO.
  • Both patients requiring reoperation had a history of prior coarctation of the aorta repair (p = 0.01).
  • One patient developed a subaortic membrane, and the other had LVOTO from accessory chordae requiring mitral valve replacement.

Conclusions:

  • The modified single-patch technique for AVSD repair is associated with a low risk of intermediate-term LVOTO.
  • A history of coarctation of the aorta repair is the most significant predictor of late LVOTO after this AVSD repair method.