[Atrioventricular discordance. Results of a series of 34 operations]

From 1968 to 1980, 34 patients with atrioventricular discordance underwent intracardiac repair. Thirty three patients had a ventriculoarterial discordance (corrected transposition) and one patient had a double outlet right ventricle. The age at operation ranged from 12 months to 59 years (mean 19 years). The lesions were ventricular septal defect (26 cases), pulmonary stenosis (22 cases), atrioventricular valve anomalies (20 cases). Lesions were associated in 80% of the cases. Ventricular septal defect and pulmonary stenosis were combined in eleven patients. Seven patients had had palliative operations. Pulmonary stenosis was mostly of subvalvular type and treated with a conduit. A patient with double outlet right ventricle and pulmonary atresia had a conduit on the left pulmonary artery because the right one was non-functional. Ventricular septal defects were closed through the right A-V valve, and the stitches placed on the free edge of the defect. The tricuspid valve (systemic) was replaced in 10 cases. Hospital mortality was 38% but only 3 out of 14 (21,4%) patients operated upon since 1975 have died. Late mortality was 24% (5 patients) related to conduction problems in 3 patients. Three patients were reoperated with good results. Out of twelve patients with a long-term follow-up, eleven have a good functional result. 7 patients with preoperative A-V block and 3 patients with atrial fibrillation had pacemakers implanted. 16 patients had postoperative A-V block. The incidence of conduction problems is now reduced with the use of conduit for subvalvular pulmonary stenosis.