PATCH AUGMENTATION OF REGURGITANT COMMON ATRIOVENTRICULAR VALVE IN UNIVENTRICULAR PHYSIOLOGY

Background. Regurgitation of the common atrioventricular valve in pati ents with univentricular atrioventricular connection has a negative im pact on outcome in the Fontan operation. Because severe regurgitation of the common atrioventricular valve may not be sufficiently reduced b y a volume-reducing operation alone, the addition of a valvuloplasty m ay be a necessary adjunct to achieve competence of the common atrioven tricular valve. A modified technique of valvuloplasty of the common at rioventricular valve and its medium-term results are presented. Method s. Two infants and 1 young child with isomeric right atrial appendages , complete atrioventricular canal, univentricular atrioventricular con nection with a double-inlet right ventricle through a common atriovent ricular valve, pulmonary atresia (n = 2) or pulmonary stenosis (n = 1) , and bilateral superior venae cavae presented with marked dilatation of the annulus of the common atrioventricular valve and severe regurgi tation between the bridging leaflets. All 3 patients previously had be en palliated with a generous central aortopulmonary shunt. The repair technique consisted of patch augmentation of the central bridging leaf lets with an autologous pericardial patch. In addition, bilateral bidi rectional cavopulmonary anastomoses were constructed and additional so urces of pulmonary blood flow were eliminated. Results. Intraoperative echocardiography demonstrated competence of the large central leaflet , excellent coaptation between the central leaflet and the bilateral m ural leaflets, and decrease of the anteroposterior diameter of the ann ulus of the atrioventricular valve from 24, 29, and 34 mm preoperative ly to 20, 23, and 29 mm, respectively. In all 3 patients, echocardiogr aphic follow-up at 17, 14, and 6 months showed continued competence of the atrioventricular valve. Conclusions. Pericardial patch augmentati on of the bridging leaflets may be a valuable adjunctive technique in the reconstruction of the regurgitant common atrioventricular valve in hearts with univentricular atrioventricular connection, especially if a volume-reducing operation alone does not result in competence of th e valve. (C) 1997 by The Society of Thoracic Surgeons.