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Technical Features of Biventricular Repair for Unbalanced Transitional AVSD With LVOTO
Laszlo Kiraly1,2, Nishant Ch Shah3, Christopher Duke3
1Pediatric Cardiac Surgery, Cardiac Sciences, 37532Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates.
Summary
Surgical repair of complex left ventricle outflow tract obstruction in infants with unbalanced atrioventricular septal defect can be challenging. This case demonstrates a successful biventricular repair technique improving both inflow and outflow tracts.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
- Cardiac Anatomy
Background:
- Left ventricle outflow tract obstruction (LVOTO) in infants with right-dominant unbalanced atrioventricular septal defect (AVSD) presents surgical complexities.
- Accurate diagnosis and tailored surgical strategies are crucial for managing these complex congenital heart defects.
Observation:
- A two-month-old infant with transitional AVSD and severe LVOTO presented with cardiogenic shock.
- The defect involved a right-dominant unbalanced atrial and ventricular septal defect with significant outflow tract obstruction.
Findings:
- Successful biventricular repair was achieved using a novel surgical approach.
- Key steps included detachment and resection of the anterior bridging leaflet, septal myectomy, creation of an interventricular communication, and patch augmentation of the LVOT and anterior leaflet.
- Closure of the apposition zone between leaflets ensured effective repair.
Implications:
- This surgical technique offers a viable solution for complex LVOTO in infants with unbalanced AVSD.
- The described method effectively augments both left ventricular inflow and outflow tracts, potentially improving long-term outcomes.
- Further studies are warranted to evaluate the long-term efficacy and applicability of this repair strategy.
