RESULTS OF LEFT ATRIOVENTRICULAR VALVE RECONSTRUCTION AFTER PREVIOUS CORRECTION OF ATRIOVENTRICULAR SEPTAL-DEFECTS

Objective: The objective of this study was to determine causes of seve re left atrioventricular (AV) incompetence and the factors leading to the success of valve repair later after correction of atrioventricular septal defects (AVSD). Methods: a total of 28 patients aged 5 months to 38 years (mean age 6.7 years) were operated for significant (grade II-III) left AV valve incompetence (LAVVI), two months to twenty-five years (median 1.5 years) after correction of complete (ii patients) or partial atrioventricular septal defects. Fourteen patients had initia lly undergone surgery during infancy. Results: At reoperation a comple tely open or partially sutured cleft was found in 16 patients combined with dysplastic valve tissue in four cases, with a fibrotic valve in three cases, with posterior leaflet prolapse in two cases, with a doub le orifice valve in three cases, and a parachute valve in two cases. P artial or complete reopening of a previously sutured cleft caused by s uture dehiscence was found in 12 cases combined with a fibrotic valve in five cases, with a dysplastic valve in one case and with seven defo rmity of valve in one case. A combination of these anomalies was obser ved in seven patients in both groups. Left atrioventricular valve repa ir including cleft closure combined with annuloplasty and other surgic al procedures resulted in the disappearance or significant diminishing of LAVI in 18 patients (64%). Seven SAVI persisted in six patients, f ive of them exhibiting a combination of several additional left AV val ve anomalies (fibrotic or dysplastic valve, parachute valve). Five of these six patients underwent successful left AV valve replacement with a mechanical prosthesis 7 days to 2 years after reoperation. The pres ence of additional left AV valve anomalies was the single statisticall y significant factor for recurrent major LAVVI after reoperation (P = 0.0106). There were two postoperative deaths in patients with mild LAV VI after surgery, and no late deaths. Conclusion: An open cleft is the major factor of late severe SAVVI after correction of AVSD. Although suturing the cleft in conjunction with performing annuloplasty improve d valvular function in most of the cases, the presence of severe left, AV valve anomalies increased the risk of recurrent LAVVI and the need for valve replacement, thus playing a major role in determining the o utcome of valve reconstruction in patients after reoperation. (C) 1997 Elsevier Science B.V.