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Repair of complete common atrioventricular canal in infancy
Insights
Surgical repair of common atrioventricular canal (CAVC) in infants significantly reduced operative mortality over time. Mitral regurgitation remains a key challenge impacting long-term outcomes in CAVC repair.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
- Cardiovascular Anatomy
Background:
- Common atrioventricular canal (CAVC) is a complex congenital heart defect requiring surgical intervention.
- Early surgical repair aims to improve survival and reduce morbidity in affected infants.
Purpose of the Study:
- To evaluate the outcomes of surgical repair for common atrioventricular canal (CAVC) in infants.
- To identify factors influencing operative mortality and long-term morbidity after CAVC repair.
Main Methods:
- Retrospective analysis of 43 infants undergoing CAVC repair between 1975 and 1980.
- Assessment of operative and late mortality rates.
- Cardiac catheterization in long-term survivors to evaluate residual shunts and mitral regurgitation.
Main Results:
- Operative mortality decreased from 62% (1975-1977) to 17% (1978-1980).
- Late mortality remained low at 6-7%.
- 29% of survivors experienced moderate to severe mitral regurgitation; mitral dysfunction is a major cause of morbidity.
Conclusions:
- Surgical techniques and management have improved outcomes for CAVC repair, significantly reducing operative mortality.
- Anatomic variations, particularly mitral valve abnormalities, are critical determinants of surgical success and long-term prognosis.
- Preoperative identification of specific anatomic features can aid in surgical planning for CAVC.
Abstract:
Forty-three infants with common atrioventricular canal (CAVC) underwent repair before 24 months of age at Children's Hospital Medical Center, Boston, between Jan. 1, 1975, and June 30, 1980. From 1975 to 1977, the operative mortality was 62% (8/13); the late mortality was 7% (1/13). From 1978 to 1980, the operative mortality was 17% (5/30) and the late mortality, was 6% (2/30). Seventeen (63%) unselected patients of the 27 long-term survivors have undergone cardiac catheterization 10 to 19 months following the operation. Five (29%) had mitral regurgitation of either moderate (four) or severe (one) degree. One had a significant residual shunt. The pulmonary/systemic resistance ratio (Rp/Rs) remained the same or decreased after repair except in the patient with severe mitral regurgitation. Anatomic features which determine outcome of reparative procedures are (1) deficiency of atrioventricular valve tissue, (2) the presence of ventricular hypoplasia, (3) malalignment of the common atrioventricular valve (CAVV) with respect to the ventricles, (4) the presence of double-orifice mitral valve, (5) the presence of solitary left ventricular papillary muscle group, and, in our experience, (6) the presence of additional muscular ventricular septal defects (VSDs). Four of these six anatomic variables can now be evaluated preoperatively by axial angiography and subxiphoid two-dimensional echocardiography. However, the architecture of the CAVV is extremely variable, so that the development of a "uniform approach" to valve reconstruction is impossible; mitral dysfunction is likely to remain the major cause of operative mortality and long-term morbidity.