Original articlePediatric cardiacVariations of Atrioventricular Septal Defects Predisposing to Regurgitation and Stenosis
Section snippets
Patients and Methods
The study was approved by the Institutional Review Board of Sakakibara Heart Institute, and the procedures were in accordance with institutional guidelines for protection of patient confidentiality. The need for patient consent was waived.
We reviewed 138 patients with CAVSD—including 75 female patients—undergoing complete repair between 1992 and 2008. Patients with tetralogy of Fallot or double-outlet right ventricle were excluded. Five other patients having CAVSD (with distinct two ventricles)
Overall Data
The mean age at operation was 7.6 ± 10.0 months, and the mean follow-up period was 3.4 ± 3.5 years (maximum 15.5). The AVV was Rastelli type A in 80 patients and type C in 58. The AVV cleft was completely closed in 112 patients (81.2%). The reasons for not closing the cleft were the anticipation of causing left AVV stenosis in 16 and the fragile valve tissue in 10. The mean cardiopulmonary bypass and aortic cross-clamp times were 116.1 ± 31.7 minutes and 83.9 ± 22.1 minutes, respectively. The
Comment
The surgical outcome of CAVSD has improved owing to better anatomical understanding and improved techniques. Early primary repair at 3 to 6 months of age has become common practice [3], and hence irreversible pulmonary vascular obstructive disease is rarely seen. Despite low operative mortality rates, however, left AVV regurgitation or stenosis may persist after operation and compromise patients' quality of life [6, 9]. Left AVV regurgitation is the most common indication for reoperation after
References (21)
- et al.
Surgical repair of complete atrioventricular septal defect
Ann Thorac Surg
(2001) - et al.
Long-term results after repair of complete atrioventricular septal defects: analysis of risk factors
Ann Thorac Surg
(1998) Atrioventricular canal: modified single patch technique
Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu
(2007)- et al.
Atrioventricular valve function after single patch repair of complete atrioventricular septal defect in infancy: how early should repair be attempted?
J Thorac Cardiovasc Surg
(1998) - et al.
Complete atrioventricular canal: comparison of modified single-patch technique with two-patch technique
Ann Thorac Surg
(2007) - et al.
Potentially parachute mitral valve in common atrioventricular canal: pathological anatomy and surgical importance
J Thorac Cardiovasc Surg
(1982) - et al.
Double-orifice mitral valve: a study of 27 postmortem cases with developmental, diagnostic and surgical considerations
Am J Cardiol
(1988) - et al.
Results of surgical repair of atrioventricular septal defect with double-orifice left atrioventricular valve
J Thorac Cardiovasc Surg
(2009) - et al.
Complete atrioventricular septal defect, Down syndrome, and surgical outcome: risk factors
Ann Thorac Surg
(2003) - et al.
Pulmonary vascular disease in Down's syndrome with complete atrioventricular septal defect
Am J Cardiol
(2000)
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