MANAGEMENT OF SYSTEMIC ATRIOVENTRICULAR VALVE REGURGITATION IN INFANTS AND CHILDREN

Since September 1979, 53 patients have required operation for systemic atrioventricular valve regurgitation at Children's Hospital and Healt h Center of San Diego. (Primary repairs of atrioventricular canal defe cts are excluded from this report.) Diagnoses include single ventricle , cardiomyopathy, congenital mitral insufficiency, Marfan's disease, r heumatic heart disease, and a history of prior repair of atrioventricu lar canal defect. Ages ranged from 4 months to 19 years; median age is 5 years. In 31 patients, the atrioventricular valve could be repaired . In 24 patients, the valve was replaced (including two patients previ ously repaired). There were four operative deaths, all in the valve re placement group: three following valve replacement, and one following emergency thrombectomy. Two early failures in the repair group require d valve replacement. Techniques for repair included leaflet resection, commissural annuloplasty, ring annuloplasty, and chordal shortening. Follow-up reveals good-to-excellent status in 38 patients. There were seven late deaths: six following valve replacement (one death valve re lated). Current surgical technique permits repair of the systemic atri oventricular valve in many infants and children requiring operation fo r regurgitation. The long-term results of valve repair are good to exc ellent. Repair avoids the morbidity and mortality of valve replacement , e.g., anticoagulation, fixed orifice size, and catastrophic mechanic al valve malfunction.