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Related Concept Videos

Mitral Stenosis III: Medical Management01:26

Mitral Stenosis III: Medical Management

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Mitral stenosis, a condition marked by the narrowing of the mitral valve, necessitates an integrated approach for effective management. This approach includes preventative measures, medical therapy, and surgical interventions to reduce symptoms and prevent complications.PreventionPrevention of mitral stenosis primarily focuses on reducing the incidence of bacterial infections, particularly streptococcal infections, which can lead to rheumatic fever and subsequent valvular damage. Timely...
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Mitral regurgitation (MR) is characterized by retrograde blood circulation from the left ventricle into the left atrium due to inadequate mitral valve closure. The severity of the condition, symptoms, and underlying cause determine treatment strategies.Monitoring and Pharmacological TreatmentPatients with mild to moderate MR typically do not need immediate intervention but regular monitoring to assess progression and guide treatment. Patients with mild MR should have an echocardiogram every 3-5...
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Updated: Mar 20, 2026

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Successful Atrioventricular Valve Repair Modifies Clinical Outcomes in Single-Ventricle Patients: Multistate Model

Sachiko Kadowaki1, Chun-Po Steve Fan2, Maelys Venet3

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Successful atrioventricular valve repair (AVVR) in single ventricle patients significantly reduces death/transplant risk, achieving survival comparable to those without AVVR. Timing of repair, especially after bidirectional cavopulmonary shunt, is critical for long-term outcomes.

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Area of Science:

  • Cardiology
  • Pediatric Cardiac Surgery
  • Congenital Heart Disease

Background:

  • Single ventricle (SV) physiology presents complex challenges, with atrioventricular valve regurgitation (AVVR) impacting patient outcomes.
  • Understanding the influence of AVVR onset and subsequent atrioventricular valve repair (AVVrep) is crucial for managing SV patients.

Purpose of the Study:

  • To evaluate the impact of AVVR and AVVrep on survival in SV patients.
  • To analyze how successful AVVrep influences clinical course and long-term outcomes.

Main Methods:

  • Retrospective review of 716 SV patients undergoing surgical palliation (1998-2022).
  • Classification based on AVVR onset, AVVrep timing, and bidirectional cavopulmonary shunt (BCPS).
  • Multistate model analysis for clinical trajectories and Kaplan-Meier/competing risk analyses for transplant-free survival.

Main Results:

  • 195/716 patients developed AVVR; 155 underwent AVVrep, with 69 successful repairs.
  • Successful AVVrep significantly reduced death/heart transplant risk (HR 0.16) and yielded survival comparable to patients without AVVR (p=0.94).
  • AVVrep performed at or after BCPS improved outcomes; early AVVrep before BCPS carried higher risk unless successful. Ventricular dysfunction was linked to poor survival.

Conclusions:

  • Successful AVVrep dramatically improves survival in SV patients with AVVR, reducing death/heart transplant risk by 84%.
  • Optimal timing for AVVrep is at or after BCPS, achieving outcomes similar to patients without AVVR.
  • The success and timing of AVVrep are paramount for favorable long-term survival in SV patients.