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Intermediate and complete forms of atrioventricular canal
Insights
Surgical repair of complete atrioventricular canal has shifted to early infancy. Long-term outcomes now focus on mitral valve function and survival, with low early mortality.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Disease Management
- Atrioventricular Canal Repair
Background:
- Complete atrioventricular canal (CAVC) surgical management has evolved significantly over two decades.
- The historical staged approach is largely replaced by complete repair in early infancy.
- Early mortality, once high, is now low and mainly linked to pulmonary hypertension from delayed diagnosis.
Purpose of the Study:
- To review the evolution of CAVC surgical management.
- To emphasize current outcome evaluation focusing on long-term mitral valve function and survival.
- To detail the single-patch repair technique and atrioventricular valve management.
Main Methods:
- Review of surgical management evolution for CAVC over 20 years.
- Description of the single-patch technique for CAVC repair.
- Analysis of factors influencing long-term outcomes.
Main Results:
- Shift from staged repair to complete repair in early infancy.
- Low early mortality, with pulmonary hypertension as a key complication in delayed cases.
- Focus on long-term mitral valve function and overall survival as primary outcome measures.
Conclusions:
- Complete atrioventricular canal repair is now safely performed in early infancy.
- Long-term evaluation should prioritize mitral valve function and patient survival.
- The single-patch technique offers a viable approach to CAVC management.
Abstract:
The surgical management of patients with complete atrioventricular canal has evolved over the past 20 years from a staged approach with preliminary pulmonary artery banding and eventual definitive repair, to an era of complete repair in early infancy. Although once considered high risk, the early mortality is now low and is primarily related to pulmonary hypertension secondary to a prolonged delay in diagnosis and referral. While controversy still exists over the techniques of repair, evaluation of outcome of atrioventricular canal should now be focused on the long-term function of the mitral valve, and the overall long-term survival. A detailed description of the single-patch technique and management of the atrioventricular valve, as well as an indepth discussion of outcome is presented.