INDIVIDUALIZED REPAIR OF THE LEFT ATRIOVENTRICULAR VALVE IN SPECTRUM OF ATRIOVENTRICULAR SEPTAL-DEFECT

From September 1977 to October 1995, 287 patients with atrioventricula r septal defect (AVSD) aged from 2 months to 21 years underwent total repair in Kardiocentrum in Prague. In 97 patients complete, in 20 tran sitional and in 170 patients partial form of AVSD was present. The rep air consisted of closure of the defect and individually modified recon struction of tno atrioventricular (AV) orifices. In cases with a commo n orifice a two-patch technique was used. Fixation of undivided anteri or and posterior common leaflets to patches in an appropriate level wa s essential in combination with complete closure of the cleft. Incompl ete closure of the cleft was performed if potentially stenotic morphol ogy was present. Commissuroplasty with pladgeted mattress stitches was done in patients with dilated annulus and commissuroplasty with a sin gle stitch was performed if the annulus was not dilated. The methods w ere similar incases with two AV orifices. The AV valve repair was diff icult in the presence of severe regurgitation in valves with potential ly stenotic morphology. Of the 287 operated patients 26 (9.1%) died du ring the early postoperative period. Mortality was 19.6% in the com pl ete form and 3.7% in the partial and transitional forms. The mortality depended on morphology of the left atrioventricular valve. Potentiall y stenotic valvar morphology represented an important risk factor for death and reoperation. It was necessary to reoperate on 18 (6.3%) pati ents for significant ''mitral'' valve regurgitation. Reconstruction of a competent left AV valve is the most important step of AVSD repair w hich must always be modified according to individual morphological and functional abnormalities.