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Predisposing factors of valve regurgitation in complete atrioventricular septal defect
K Suzuki1, K Tatsuno, T Kikuchi
1Department of Pediatrics, The Sakakibara Heart Institute, Tokyo, Japan. ksuzuki@shi.heart.or.jp
Insights
Early surgical repair of complete atrioventricular septal defect is key to preventing valve regurgitation. Patients with Rastelli type C defects show slower regurgitation progression, but existing regurgitation often persists post-surgery.
Area of Science:
- Congenital heart disease
- Pediatric cardiology
- Cardiac surgery
Background:
- Complete atrioventricular septal defect (CAVD) can lead to valve regurgitation.
- The progression of regurgitation is variable, influenced by the common atrioventricular valve's structure.
Purpose of the Study:
- To identify intrinsic risk factors for valve regurgitation in patients with complete atrioventricular septal defect.
- To evaluate the impact of different anatomical subtypes and surgical timing on regurgitation.
Main Methods:
- Retrospective analysis of 90 patients undergoing surgical repair for CAVD.
- Evaluation of preoperative/postoperative regurgitation, valve morphology, age at surgery, and associated anomalies.
- Echocardiographic assessment of regurgitation severity.
Main Results:
- Rastelli type C defects with an undivided inferior leaflet showed less preoperative regurgitation progression.
- Regurgitation was present in 21-49% of Rastelli type A/divided leaflet patients by age 2.
- Postoperative regurgitation occurred in 52% of those with preoperative regurgitation and developed in 28% of those without.
Conclusions:
- Rastelli type C anatomy is associated with slower regurgitation progression.
- Pre-existing regurgitation often persists after surgical repair.
- Early surgical intervention before regurgitation advances is crucial for optimal valve function.
Objectives:
We sought to determine the intrinsic risk factors of valve regurgitation in complete atrioventricular septal defect.
Background:
Progression of regurgitation varies in each case, although the structure of the common atrioventricular valve itself is a predisposing factor.
Methods:
In 90 consecutive patients undergoing surgical repair, we evaluated the preoperative and postoperative regurgitation, valve morphology, age at surgery and associated anomalies. A regurgitation jet with a high velocity reaching the deep left atrial wall by echocardiography was estimated as marked regurgitation.
Results:
None of the 40 patients with Rastelli type C and an undivided inferior bridging leaflet had preoperative regurgitation in the first year of life, and 12% of them (95% confidence intervals [CI]: 0% to 28%) showed regurgitation at the age of 2. Of the remaining 50 with Rastelli type A and/or a divided inferior leaflet, regurgitation was determined in 21% (95% CI: 6% to 35%) of those 1 year old and in 49% (95% CI: 29%7 to 69%) of those 2 years old (p < 0.01). All patients underwent corrective surgery using the double-patch technique, with the "cleft" being sutured adequately. Irrespective of the valve morphology, regurgitation remained in 52% (12 of 23) of those with preoperative regurgitation, whereas regurgitation developed postoperatively in 28% (16 of 58) of those without regurgitation (p < 0.001).
Conclusions:
Those with Rastelli type C and an undivided inferior leaflet had a lesser degree of progression of preoperative regurgitation. However, regurgitation was likely to exist even after adequate repair once regurgitation had already advanced. Therefore, early primary repair before progression of the regurgitation may be the key to maintaining better competence of the atrioventricular valve.