Cleft-to-commissure conversion in atrioventricular septal defect using artificial chordae: Technical report and case...

Area of Science:

• Cardiovascular Surgery
• Pediatric Cardiology
• Congenital Heart Disease

Background:

• Complete atrioventricular septal defect (cAVSD) repair has good outcomes, but reoperations for left atrioventricular valve regurgitation (LAVVR) persist.
• Managing the LAVV cleft is controversial, with routine closure risking stenosis, particularly in single papillary muscle anatomy.
• Optimal LAVV management in single papillary muscle cases remains challenging, with limited data on artificial chordae.

Purpose of the Study:

• To describe a novel surgical technique using artificial chordae for LAVV repair in a complex pediatric case.
• To evaluate the immediate efficacy of artificial chordae in reducing LAVVR and avoiding stenosis.

Main Methods:

• A case report of an 8-year-old patient with complex congenital heart disease and severe LAVVR after prior cAVSD repair.
• Surgical technique involved creating artificial chordae to support bridging leaflets, converting the cleft into a commissure, followed by annuloplasty.
• Postoperative echocardiography assessed LAVVR and stenosis; hemodynamic stability was monitored.

Main Results:

• The artificial chordae technique successfully reduced severe LAVVR to mild residual regurgitation.
• No LAVV stenosis was observed postoperatively.
• The patient demonstrated stable hemodynamics after the procedure.

Conclusions:

• Artificial chordae show potential for optimizing LAVV repair, especially in complex anatomies like single papillary muscle.
• This technique offers a more physiologic reconstruction compared to standard cleft closure in specific cases.
• Further long-term studies in larger cohorts are needed to confirm durability and generalizability.