REPAIR OF SUBAORTIC STENOSIS IN ATRIOVENTRICULAR-CANAL WITH ABSENT ORRESTRICTIVE INTERVENTRICULAR COMMUNICATION BY PATCH AUGMENTATION OF VENTRICULAR SEPTUM, RESUSPENSION OF ATRIOVENTRICULAR VALVES, AND SEPTALMYECTOMY

Objective: To describe a modification of a surgical technique for reli ef of subaortic stenosis in patients with atrioventricular canal, Mate rial and Methods: We report an etiology-oriented modified technique of repair of subaortic stenosis after previous repair of atrioventricula r canal, without (N = 2) or with (N = 1) a restrictive interventricula r communication, Results: In addition to a generous myectomy of the le ft ventricular septum, the technique consists of complete detachment o f the left and right atrioventricular valves from the ventricular cres t, patch augmentation of the concavity of the ventricular crest, and a ttachment of both atrioventricular valves at the superior aspect of th e ventricular septal patch; thus, the septal leaflet of the left atrio ventricular valve-in particular, its superior component-is lifted away from the elongated left ventricular outflow tract, Conclusion: This m odification (as opposed to detachment of only the superior component o f the septal leaflet of the left atrioventricular valve, as performed in previously proposed techniques) may be a valuable adjunctive techni que to relieve subaortic obstruction associated with atrioventricular canal, In addition, this modification allows a secure anchoring of the patch to the right of the ventricular septum and therefore is associa ted with minimal risk of damaging the conduction tissue and of causing regurgitation of the left atrioventricular valve.