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Individualized surgical management of complete atrioventricular canal
Insights
Surgical outcomes for 46 children with complete atrioventricular canal (CAVC) show that individualized treatment based on clinical factors is key. Palliation is preferred for infants under 5 kg, while larger children undergo primary correction.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
- Pediatric Cardiac Surgery
Background:
- Complete atrioventricular canal (CAVC) is a complex congenital heart defect requiring surgical intervention.
- Management strategies for CAVC have evolved, necessitating evaluation of outcomes based on patient characteristics.
Purpose of the Study:
- To analyze the surgical outcomes of children with complete atrioventricular canal (CAVC) over a 5-year period.
- To determine the effectiveness of individualized surgical approaches, including palliation versus primary correction, in managing CAVC.
Main Methods:
- Retrospective review of 46 children with CAVC who underwent 51 operations over 5 years.
- Categorization of interventions into surgical correction and palliation.
- Analysis of patient demographics, including age, weight, and prior surgical history.
- Assessment of early and late mortality, reoperations, and overall survival.
Main Results:
- Thirty-two children underwent correction (ages 4 months-14.6 years), with no early deaths and two late deaths. Two required subsequent mitral replacement.
- Nine children received palliation (ages 8 days-1.34 years), with one early and one late death. Pulmonary artery banding was common in infants <5 kg.
- Overall survival at review was 91% (42/46 children).
Conclusions:
- Individualized surgical management of CAVC, considering clinical condition, weight, and anomalies, leads to favorable outcomes.
- Pulmonary artery banding is a suitable initial approach for infants weighing less than 4-5 kg.
- Primary correction is recommended for larger infants and children with CAVC.
Abstract:
In a 5 year interval 46 children with complete atrioventricular canal (CAVC) required 51 operations. Thirty-two children underwent correction; nine received surgical palliation. The ages of the children undergoing correction ranged from 4 months to 14.6 years (mean 4.2 years); eight were less than 1 year old. Weights ranged from 4.1 kg to 39 kg (mean 13.5 kg); 15 weighted less than 10 kg. Ten had undergone previous palliation (seven by pulmonary artery band; three by shunt). There were no early deaths and two late deaths. One infant required mitral replacement at correction; two required subsequent mitral replacement. The ages of the children undergoing palliation ranged from 8 days to 1.34 years (mean 5.8 months); 16 were less than 1 year old. Weights ranged from 2.5 kg to 8.5 kg (mean 4.4 kg); 14 weighted less than 5 kg. Operations included pulmonary artery banding in 14, shunt creation in four, and pericardial enlargement of the right ventricular outflow tract in one. One death occurred 5 days after pulmonary artery banding in an infant with unrecognized coarctation. One late death occurred several months after the creation of a second shunt in a child with severe tetralogy of Fallot and hypoplastic pulmonary arteries. Forty-two (91%) of these children were alive at the time of this review. The outcome in these 46 patients supports individualized choice of initial operation (palliation versus correction) based upon clinical condition, weight, and associated anomalies. The pulmonary artery is banded in infants less than 4 to 5 kg; larger infants and children undergo correction primarily.