PREDISPOSING FACTORS OF VALVE REGURGITATION IN COMPLETE ATRIOVENTRICULAR SEPTAL-DEFECT

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 struct ure of the common atrioventricular valve itself is a predisposing fact or, Methods. In 90 consecutive patients undergoing surgical repair, we evaluated the preoperative and postoperative regurgitation, valve mor phology, age at surgery and associated anomalies. A regurgitation jet with a high velocity reaching the deep left atrial wall by echocardiog raphy was estimated as marked regurgitation. Results. None of the 40 p atients with Rastelli type C and an undivided inferior bridging leafle t 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 div ided inferior leaflet, regurgitation was determined in 21% (95% CI: 6% to 35%) of those 1 year old and in 49% (95% CI: 29% to 69%) of those 2 years old (p < 0.01). All patients underwent corrective surgery usin g the double-patch technique, with the ''cleft'' being sutured adequat ely. Irrespective of the valve morphology, regurgitation remained in 5 2% (12 of 23) of those with preoperative regurgitation, whereas regurg itation developed postoperatively in 28% (16 of 58) of those without r egurgitation (p < 0.001). Conclusions. Those with Rastelli type C and an undivided inferior leaflet had a lesser degree of progression of pr eoperative regurgitation. However, regurgitation was likely to exist e ven after adequate repair once regurgitation had already advanced. The refore, early primary repair before progression of the regurgitation m ag be the key to maintaining better competence of the atrioventricular valve. (C) 1998 by the American College of Cardiology.