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Early experience with the two patch technique for complete atrioventricular septal defect
I A Hamid1, M Jothi, P Premanand
1Department of Cardiac Surgery, Institute of Cardiovascular Diseases, Madras.
Insights
The two-patch technique for complete atrioventricular septal defects shows promise. This surgical repair method can achieve low early mortality in carefully selected pediatric patients.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Defects
- Surgical Techniques
Background:
- Complete atrioventricular septal defects (AVSD) are complex congenital heart abnormalities.
- Surgical repair is essential for managing these defects in infants and children.
- The two-patch technique is one approach for repairing complete AVSD.
Purpose of the Study:
- To evaluate the efficacy and early outcomes of the two-patch technique for complete atrioventricular septal defect repair.
- To assess the safety and feasibility of this surgical approach in a pediatric cohort.
Main Methods:
- Retrospective analysis of 12 pediatric patients undergoing complete AVSD repair using the two-patch technique.
- Utilized Gore-Tex and pericardial patches for ventricular and atrial septal closure, respectively.
- Four cases involved hypothermic circulatory arrest.
Main Results:
- No intra-operative deaths occurred.
- Early mortality was 16.6% (2/12 patients), attributed to pulmonary hypertensive crisis and septicemia.
- Mean ventilatory support was 62 hours and inotropic support was 57 hours.
Conclusions:
- Primary repair of complete AVSD with the two-patch technique is feasible.
- This method can be associated with low early mortality in carefully selected pediatric patients.
- Further research may explore long-term outcomes and optimal patient selection criteria.
Abstract:
A total of 12 cases underwent repair of complete atrioventricular (AV) septal defect utilising the two-patch technique. There were 4 males and 8 females. The mean age at repair was 9.6 months (range, 3 to 49 months). The average weight was 5.4 kg (range, 3.5 to 13 kg). Five had associated patent ductus arteriosus. A Gore-Tex patch and glutaraldehyde preserved pericardium was utilised for the ventricular and atrial portions of the defects respectively in all patients. Four of these were done under hypothermic circulatory arrest. There were no intra-operative deaths. Early mortality comprised of 2 patients (2/12, 16.6%). One due to a pulmonary hypertensive crisis and the other to septicemia. The mean duration of ventilatory support was 62 hours (range, 24 to 192 hours). The mean duration of inotropic support was 57 hours (range, 24 to 192 hours). Primary repair of AV septal defects using the two-path of technique can be accomplished with a low early mortality in carefully selected patients.