L. Mace et al., Surgically created double-orifice left atrioventricular valve: A valve-sparing repair in selected atrioventricular septal defects, J THOR SURG, 121(2), 2001, pp. 352-365
Citations number
33
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Objectives: Some features of the left atrioventricular valve (large mural l
eaflet, dystrophic tissue) represent a challenge for repair of atrioventric
ular septal defects without postoperative regurgitation. A retrospective st
udy was conducted to evaluate the results of surgically creating a double-o
rifice left atrioventricular valve in such circumstances. Clinical results
were analyzed according to valvular and subvalvular left atrioventricular v
alve measurements in pathologic specimens with atrioventricular septal defe
cts.
Methods: Among 157 patients operated on for atrioventricular septal defect
since October 1989, 10 patients underwent primary repair (n = 8) or reopera
tion (n = 2) by this procedure. Median age at repair was 3.3 years (0.1-33
years). Anatomic types were complete (n = 3), intermediate (n = 5), and par
tial (n = 2). Preoperative moderate to severe left atrioventricular valve r
egurgitation was present in 6 patients. After the repair (two-patch techniq
ue in complete atrioventricular septal defect, cleft closed in each case),
these 10 patients were found to have moderate to severe residual regurgitat
ion not amenable to repair by annuloplasty. The top edge of the mural leafl
et was anchored to the facing free edge of the cleft.
Results: No hospital death or morbidity was observed. Left atrioventricular
valve regurgitation was absent or trivial (8 patients) and mild (2 patient
s). Color-coded echocardiography did not show significant left atrioventric
ular valve stenosis. The mean diastolic pressure gradient across the left a
trioventricular valve was 3.2 +/- 1.1 mm Hg (1.4-4.5 mm Hg). At a median fo
llow-up of 72 months (6-91 months), there was 1 late death, unrelated to le
ft atrioventricular valve malfunction, due to pulmonary vascular obstructiv
e disease. Left atrioventricular valve regurgitation did not increase over
time, except in 1 patient in whom regurgitation recently progressed from mi
ld to moderate. At rest, the mean diastolic pressure gradient across the le
ft atrioventricular valve was 3.8 +/- 2.9 mm Hg (1.5-11.2 mm Hg). One child
had an early moderate stenosis without pulmonary hypertension. Studies on
pathologic specimens (n = 34) indicated that long chordal lengths and large
mural leaflet size are essential independent anatomic features to assess i
ts feasibility.
Conclusions: Surgical creation of a double-orifice left atrioventricular va
lve is an effective additional procedure for repair of atypical cases of at
rioventricular septal defect. The operation may decrease the need for reope
ration or left atrioventricular valve replacement.