Left atrioventricular valve repair technique in partial atrioventricular septal defects

Background. The aim of our study was to evaluate the effect of chordal tran sfer around the cleft on left atrioventricular valve competence in the late postoperative period. Methods. Forty-four adult patients underwent surgical correction of partial atrioventricular septal defect between 1983 and 1997. Fenestration was fou nd in 8 patients (18.2%) and cleft, in 35 (79.5%). There was no chordal sup port of the free edges of the left superior and left inferior leaflets arou nd the cleft in 18 patients. Two chordae were mobilized from the left later al leaflet and reimplanted into the tip of the left superior and left infer ior leaflets around the cleft. Results. At 5 years postoperatively, left atrioventricular valve insufficie ncy was severe in 5 patients and moderate in 11 patients who had had cleft closure alone. In contrast, severe valvular insufficiency was present in on ly 1 patient in the group with chordal transfer (p < 0.05). Reoperation was done in 5 patients with isolated cleft closure. Left AV valve replacement was performed in 1 patient. Conclusions. Chordal transfer plus cleft closure with interrupted sutures s ignificantly reduces early and late left atrioventricular valve incompetenc e and also decreases the rate of reoperation. (C) 1999 by The Society of Th oracic Surgeons.