Prosthesis-Free Repair of Partial Atrioventricular Septal Defect in Down Syndrome: A Valve-Sparing Technique

BACKGROUND Atrioventricular septal defects (AVSDs) are common in Down syndrome, with the complete form being more frequent. Partial AVSD with significant mitral and tricuspid regurgitation presenting in adulthood poses a complex surgical challenge. This report describes a prosthesis-free, valve-sparing repair in a 21-year-old man with Down syndrome and partial AVSD with severe dual valve regurgitation. CASE REPORT A 21-year-old man with Down syndrome presented with fatigue, dyspnea, and poor exercise tolerance. Echocardiography revealed a large primum atrial septal defect, a high membranous ventricular septal defect, severe mitral regurgitation from a cleft in the A2 segment of the anterior mitral leaflet, and severe tricuspid regurgitation from a cleft in the septal cusp. The patient underwent a prosthesis-free repair via median sternotomy. The mitral valve was repaired by cleft closure and modified suture annuloplasty, the tricuspid valve by cleft closure and modified De Vega annuloplasty, and the septal defects were closed with an autologous pericardial patch. The postoperative course was uneventful. CONCLUSIONS At 1-year follow-up, echocardiography demonstrated competent valves with no residual shunts and stable ventricular function. A prosthesis-free, valve-sparing repair is a safe and effective option for partial AVSD with dual valve involvement in adults with Down syndrome, eliminating the need for prosthetic material and lifelong anticoagulation.