Patch augmentation of regurgitant common atrioventricular valve in univentricular physiology

Regurgitation of the common atrioventricular valve in patients with univentricular atrioventricular connection has a negative impact on outcome in the Fontan operation. Because severe regurgitation of the common atrioventricular valve may not be sufficiently reduced by a volume-reducing operation alone, the addition of a valvuloplasty may be a necessary adjunct to achieve competence of the common atrioventricular valve. A modified technique of valvuloplasty of the common atrioventricular valve and its medium-term results are presented.

Two infants and 1 young child with isomeric right atrial appendages, complete atrioventricular canal, univentricular atrioventricular connection with a double-inlet right ventricle through a common atrioventricular valve, pulmonary atresia (n = 2) or pulmonary stenosis (n = 1), and bilateral superior venae cavae presented with marked dilatation of the annulus of the common atrioventricular valve and severe regurgitation between the bridging leaflets. All 3 patients previously had been palliated with a generous central aortopulmonary shunt. The repair technique consisted of patch augmentation of the central bridging leaflets with an autologous pericardial patch. In addition, bilateral bidirectional cavopulmonary anastomoses were constructed and additional sources of pulmonary blood flow were eliminated.

Intraoperative echocardiography demonstrated competence of the large central leaflet, excellent coaptation between the central leaflet and the bilateral mural leaflets, and decrease of the anteroposterior diameter of the annulus of the atrioventricular valve from 24, 29, and 34 mm preoperatively to 20, 23, and 29 mm, respectively. In all 3 patients, echocardiographic follow-up at 17, 14, and 6 months showed continued competence of the atrioventricular valve.

Pericardial patch augmentation of the bridging leaflets may be a valuable adjunctive technique in the reconstruction of the regurgitant common atrioventricular valve in hearts with univentricular atrioventricular connection, especially if a volume-reducing operation alone does not result in competence of the valve.