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Results with the two-patch technique for repair of complete atrioventricular septal defect
Insights
Repair of complete atrioventricular septal defects using separate patches offers improved outcomes. This surgical technique facilitates accurate reconstruction of the trileaflet mitral valve, minimizing distortion and residual heart failure in pediatric patients.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Congenital Heart Defects
Background:
- Complete atrioventricular septal defect (CAVSD) is a complex congenital heart anomaly often presenting with significant shunting and pulmonary hypertension, particularly in infants.
- Surgical repair aims to close septal defects and address atrioventricular valve abnormalities, but challenges remain in achieving optimal valve function and minimizing residual issues.
Purpose of the Study:
- To evaluate the efficacy and outcomes of a specific surgical technique for repairing complete atrioventricular septal defects.
- To assess the impact of using separate ventricular and atrial patches on mitral valve competence and overall patient recovery.
Main Methods:
- Retrospective review of 9 pediatric patients undergoing complete atrioventricular septal defect repair between May 1982 and September 1983.
- Surgical approach involved using separate ventricular and atrial patches without dividing leaflet tissue, aiming for trileaflet mitral valve reconstruction.
- Patient demographics, preoperative conditions (shunting, pulmonary hypertension, mitral regurgitation), surgical details, and postoperative outcomes were analyzed.
Main Results:
- Eight of nine patients survived the operation with good clinical status at 3-17 months post-repair.
- The technique resulted in no conduction disturbances and significantly reduced or eliminated mitral regurgitation in most patients.
- One operative death occurred in a patient with the right ventricular dominant form; only one patient experienced mild residual heart failure.
Conclusions:
- Repair of complete atrioventricular septal defects using separate ventricular and atrial patches is a safe and effective surgical strategy.
- This method facilitates accurate reconstruction of a competent trileaflet mitral valve, leading to favorable long-term outcomes and reduced complications.
- The technique minimizes distortion, contributing to improved functional recovery in pediatric patients with CAVSD.
Abstract:
From May, 1982, to September, 1983, 9 patients underwent repair of complete AV septal defect. They ranged in age from 11 months to 48 months and in weight from 5.3 kg to 16.5 kg. Seven patients were 24 months old or less. Previous operations included pulmonary artery banding in 1 patient and ligation of a patent ductus arteriosus with repair of coarctation in another. All patients had large left-to-right shunts (mean pulmonary to systemic flow ratio, 3.1), and the 7 young infants had marked pulmonary hypertension. Mitral regurgitation was absent in 2 patients, mild in 3, moderate in 2, and severe in 2. One patient had the right ventricular dominant form of complete AV septal defect. In all instances, repair was done using separate ventricular and atrial patches. Leaflet tissue was not divided, and a trileaflet mitral valve was left in each patient. Eight patients survived operation and are well 3 to 17 months after repair. The single operative death occurred in the patient with right ventricular dominance. Only 1 patient has mild residual heart failure 4 months after operation. Clinically, mitral regurgitation is absent in 4 patients and, at most, mild in the other 4. No patient has a conduction disturbance. Repair of complete AV septal defect is facilitated by using separate patches for the ventricular and atrial components of the defect. Less distortion is created, and a more accurate reconstruction of a competent trileaflet mitral valve can be done.