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Management of systemic atrioventricular valve regurgitation in infants and children
J J Lamberti1, R D Mainwaring, L George
1Division of Cardiology, Children's Hospital and Health Center, San Diego, California.
Insights
Surgical repair of systemic atrioventricular valve regurgitation in children is effective. Valve repair offers good-to-excellent long-term outcomes, avoiding complications associated with valve replacement.
Area of Science:
- Pediatric Cardiology
- Cardiac Surgery
- Valvular Heart Disease
Background:
- Systemic atrioventricular valve regurgitation affects pediatric patients with various underlying conditions.
- Surgical intervention is necessary for significant atrioventricular valve regurgitation in children.
Purpose of the Study:
- To evaluate the outcomes of surgical repair versus replacement for systemic atrioventricular valve regurgitation in pediatric patients.
- To assess the long-term efficacy and safety of valve repair techniques.
Main Methods:
- Retrospective review of 53 pediatric patients undergoing surgery for systemic atrioventricular valve regurgitation.
- Analysis of repair techniques including leaflet resection, annuloplasty, and chordal shortening.
- Comparison of outcomes between valve repair and valve replacement groups.
Main Results:
- 31 patients underwent valve repair, while 24 had valve replacement.
- Operative mortality was 12.5% in the replacement group versus 0% in the repair group.
- Long-term follow-up showed good-to-excellent status in 38 patients, with better outcomes for repaired valves.
Conclusions:
- Surgical repair is a viable and effective option for pediatric systemic atrioventricular valve regurgitation.
- Valve repair offers superior long-term results and avoids the risks associated with prosthetic valve replacement.
- Current techniques allow for successful repair in a significant number of pediatric cases.
Abstract:
Since September 1979, 53 patients have required operation for systemic atrioventricular valve regurgitation at Children's Hospital and Health Center of San Diego. (Primary repairs of atrioventricular canal defects are excluded from this report.) Diagnoses include single ventricle, cardiomyopathy, congenital mitral insufficiency , Marfan's disease, rheumatic heart disease, and a history of prior repair of atrioventricular canal defect. Ages ranged from 4 months to 19 years; median age is 5 years. In 31 patients, the atrioventricular valve could be repaired. In 24 patients, the valve was replaced (including two patients previously repaired). There were four operative deaths, all in the valve replacement group: three following valve replacement, and one following emergency thrombectomy. Two early failures in the repair group required valve replacement. Techniques for repair included leaflet resection, commissural annuloplasty, ring annuloplasty, and chordal shortening. Follow-up reveals good-to-excellent status in 38 patients. There were seven late deaths: six following valve replacement (one death valve related). Current surgical technique permits repair of the systemic atrioventricular valve in many infants and children requiring operation for regurgitation. The long-term results of valve repair are good to excellent. Repair avoids the morbidity and mortality of valve replacement, e.g., anticoagulation, fixed orifice size, and catastrophic mechanical valve malfunction.