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Complete common atrioventricular canal in infancy--surgical repair and postoperative hemodynamics
Insights
Surgical repair of complete common atrioventricular canal (CCAVC) in infants is feasible, leading to improved cardiac function and size. Early intervention within the first year is crucial to prevent complications from pulmonary vascular obstruction.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
- Cardiovascular Physiology
Background:
- Complete common atrioventricular canal (CCAVC) is a complex congenital heart defect requiring surgical intervention.
- Early surgical repair is often recommended, but outcomes and long-term effects need further elucidation.
Purpose of the Study:
- To evaluate the early postoperative hemodynamics and cardiac function in infants following surgical repair of CCAVC.
- To assess the impact of surgical timing on outcomes, particularly concerning pulmonary vascular resistance.
Main Methods:
- Retrospective analysis of 14 infants undergoing open heart surgery for CCAVC.
- Deep hypothermia and circulatory arrest were employed during surgery.
- Postoperative echocardiography and hemodynamic assessments were performed on survivors.
Main Results:
- Three operative and two late deaths occurred. Nine infants survived.
- Seven survivors showed near-normal hemodynamics post-surgery, with no residual shunts and excellent mitral valve function in six.
- Left and right ventricular end-diastolic volumes normalized significantly post-repair (P<0.01 and P<0.025, respectively).
- Pulmonary artery pressures and resistances were generally normal, except in one patient with pre-existing severe pulmonary vascular obstructive disease.
Conclusions:
- Surgical repair of CCAVC during the first year of life is associated with favorable cardiac remodeling and functional recovery.
- Delayed surgical intervention beyond the first year may lead to irreversible pulmonary vascular changes and poorer outcomes.
Abstract:
Fourteen infants with complete common atrioventricular canal (CCAVC) underwent open heart surgery under deep hypothermia and circulatory arrest. There were three operative deaths and two late deaths. Postoperative studies performed in seven of the nine survivors revealed nearly normal hemodynamics. There were no residual shunts, and excellent mitral valve function was observed in six patients. In one patient, residual mitral regurgitation was noted. The pulmonary artery pressures and pulmonary vascular resistances were normal except in one who had severe pulmonary vascular obstructive disease before surgery. The mean left ventricular end-diastolic volume changed from 175 +/- 24% (SEM) before surgery to 106 +/- 7% after surgery (P less than 0.01). The corresponding right ventricular end-diastolic volume changed from 166 +/- 16% to 102 +/- 19% (P less than 0.025). Left ventricular ejection fraction was mildly decreased before and after surgery (0.63 +/- 0.02). Surgical repair of CCAVC is possible during the first year of life, with likely normalization of cardiac size and function. Unsatisfactory results related to pulmonary vascular obstruction may be anticipated if repair is delayed much beyond the first year.