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[Surgical treatment of complete atrioventricular canal in early infancy]
Insights
Surgical outcomes for complete atrioventricular canal in children varied significantly based on initial treatment. Pulmonary artery banding in infants with severe pulmonary hypertension showed high mortality, while immediate complete correction had lower mortality in select cases.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
- Medical History
Background:
- Complete atrioventricular canal (CAVC) is a complex congenital heart defect.
- Surgical management strategies have evolved over time.
- Outcomes can be influenced by associated conditions like trisomy 21 and pulmonary hypertension.
Purpose of the Study:
- To evaluate the surgical outcomes of CAVC repair in children between 1973 and 1982.
- To compare the results of two distinct surgical approaches: pulmonary artery banding followed by later correction versus immediate complete correction.
Main Methods:
- Retrospective analysis of 90 children with CAVC undergoing surgery.
- Group 1: 26 infants with severe pulmonary hypertension treated with pulmonary artery banding.
- Group 2: 64 children who underwent immediate complete correction.
Main Results:
- Pulmonary artery banding in infants (Group 1) had a high mortality (38%), especially in those under 6 months (50%).
- Immediate complete correction (Group 2) had an overall operative mortality of 28%, significantly lower (7%) when pulmonary atrial pressure was not severe.
- Long-term results for Group 1 showed 27% good outcomes, 19% average outcomes, and 42% mortality, with residual mitral regurgitation a concern.
Conclusions:
- Early surgical management of CAVC in infants with severe pulmonary hypertension via banding had poor outcomes.
- Immediate complete correction appears more favorable, particularly in patients without severe pulmonary hypertension.
- The timing and approach to CAVC repair significantly impact surgical results and survival rates.
Abstract:
Ninety children with complete atrioventricular canal without any significant associated abnormality underwent surgery between 1973 and 1982. The first group of 26 infants, including 7 with trisomy 21 (average age 5.3 +/- 3.8 months) had severe pulmonary hypertension and underwent pulmonary artery banding: 10 died in the immediate or early postoperative period (38 p. 100). The mortality was 50 p. 100 in children under 6 months of age. In two cases, the banding was a failure because it was ineffective or "vicious" and both patients had to undergo reoperation 2 to 6 months later for total correction which resulted in 1 death and 1 poor result; the surviving 14 patients were improved: 3 are waiting for total correction under good conditions and 11 underwent open heart surgery 36 +/- 16 months after banding with 7 good results and 4 average results because of residual significant mitral regurgitation associated in one case with atrioventricular block requiring pacing. The overall results of this group were 42 p. 100 mortality, 19 p. 100 average results and 27 p. 100 good results; 12 p. 100 are waiting for surgery. The second group included 64 children, with 34 with trisomy 21 (average age 17.4 +/- 16.7 months) who underwent complete correction straight away (before 2 years in 50 cases, before 1 year in 30 cases). The operative mortality was 28 p. 100, but only 7 p. 100 in the 15 cases in which pulmonary atrial pressure did not exceed 2/3 of the systemic pressure and 35 p. 100 in the other 49 cases with severe pulmonary hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)