Left atrioventricular valve after surgical repair in atrioventricular septal defect with separate valve orifices (“ostium primum atrial septal defect”): An Echo-Doppler study

AbstractLong-term left atrioventricular valvar function was evaluated in 95 of 110 survivors following surgical repair of atrioventricular septal defect between 1975 and 1984. A common or complete form was present in 40 and a partitioned or partial form in 55 patients. The patients have been followed for three to 13 years with a mean of 8.3 years. Pulmonary arterial banding was performed in 17 patients with a common atrioventricular valve prior to complete repair. The left atrioventricular valvar regurgitation was evaluated by clinical examination, Doppler and/or angiography. Three patients required valvar replacement postoperatively. Previous pulmonary arterial banding, pulmonary hypertension or pulmonary-to-systemic flow ratio did not affect the incidence or severity of left atrioventricular valvar regurgitation postoperatively. In this series left atrioventricular valvar regurgitation increased in the early postoperative period but rarely progressed at late follow-up.

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Surgical repair of atrioventricular septal defect with common atrioventricular valve in early infancy

Cardiology in the Young ◽

10.1017/s104795110600076x ◽

2006 ◽

Vol 16 (S3) ◽

pp. 52-58 ◽

Cited By ~ 29

Author(s):

François Lacour-Gayet ◽

David N. Campbell ◽

Max Mitchell ◽

Sunil Malhotra ◽

Robert H. Anderson

Keyword(s):

Pulmonary Hypertension ◽

Septal Defect ◽

Surgical Repair ◽

Surgical Techniques ◽

Clinical Results ◽

Atrioventricular Septal Defect ◽

Atrioventricular Valve ◽

The Past ◽

Cardiac Surgeons ◽

Common Atrioventricular Valve

The repair of atrioventricular septal defect with a common atrioventricular valve is reconstructive surgery at its best, and hence one of the favourite operations performed by paediatric cardiac surgeons. In the past, the post-operative course from such patients was dominated by the occurrence of pulmonary hypertension crises, which were responsible for significant morbidity and mortality. Nowadays, repair is generally undertaken early in infancy, and this approach has mitigated the problems emanating from pulmonary hypertension. Coupled with a better understanding of the anatomy, and adaptation of the surgical techniques, repair can now be achieved safely at around 2 to 4 months of life, without increasing the risk of postoperative regurgitation across the reconstructed left atrioventricular valve. In this review, we discuss the surgical techniques required for, and clinical results of, such early repair.

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Specific issues after surgical repair of partial atrioventricular septal defect: Actuarial survival, freedom from reoperation, fate of the left atrioventricular valve, prevalence of left ventricular outflow tract obstruction, and other events

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2008.04.035 ◽

2009 ◽

Vol 137 (3) ◽

pp. 548-555.e2 ◽

Cited By ~ 26

Author(s):

Ujjwal K. Chowdhury ◽

Balram Airan ◽

Amber Malhotra ◽

Akshay K. Bisoi ◽

Mani Kalaivani ◽

...

Keyword(s):

Septal Defect ◽

Left Ventricular Outflow Tract ◽

Surgical Repair ◽

Ventricular Outflow Tract ◽

Atrioventricular Septal Defect ◽

Left Ventricular ◽

Outflow Tract ◽

Atrioventricular Valve ◽

Actuarial Survival ◽

Left Ventricular Outflow

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Symptomatic partial and transitional atrioventricular septal defect repaired in infancy

Heart ◽

10.1136/heartjnl-2017-312195 ◽

2017 ◽

Vol 104 (17) ◽

pp. 1411-1416 ◽

Cited By ~ 4

Author(s):

Sylvia Krupickova ◽

Gareth J Morgan ◽

Mun Hong Cheang ◽

Michael L Rigby ◽

Rodney C Franklin ◽

...

Keyword(s):

Septal Defect ◽

Surgical Repair ◽

Primary Repair ◽

Nyha Class ◽

Multivariable Analysis ◽

Heart Association ◽

Reoperation Rate ◽

Atrioventricular Septal Defect ◽

Atrioventricular Valve ◽

Atrioventricular Valve Regurgitation

ObjectivesInfants with symptomatic partial and transitional atrioventricular septal defect undergoing early surgical repair are thought to be at greater risk. However, the outcome and risk profile of this cohort of patients are poorly defined. The aim of this study was to investigate the outcome of symptomatic infants undergoing early repair and to identify risk factors which may predict mortality and reoperation.MethodsThis multicentre study recruited 51 patients (24 female) in three tertiary centres between 2000 and 2015. The inclusion criteria were as follows: (1) partial and transitional atrioventricular septal defect, (2) heart failure unresponsive to treatment, (3) biventricular repair during the first year of life.ResultsMedian age at definitive surgery was 179 (range 0–357) days. Sixteen patients (31%) had unfavourable anatomy of the left atrioventricular valve: dysplastic (n=7), double orifice (n=3), severely deficient valve leaflets (n=1), hypoplastic left atrioventricular orifice and/or mural leaflet (n=3), short/poorly defined chords (n=2). There were three inhospital deaths (5.9%) after primary repair. Eleven patients (22%) were reoperated at a median interval of 40 days (4 days to 5.1 years) for severe left atrioventricular valve regurgitation and/or stenosis. One patient required mechanical replacement of the left atrioventricular valve. After median follow-up of 3.8 years (0.1–11.4 years), all patients were in New York Heart Association (NYHA) class I. In multivariable analysis, unfavourable anatomy of the left atrioventricular valve was the only risk factor associated with left atrioventricular valve reoperation.ConclusionsAlthough surgical repair is successful in the majority of the cases, patients with partial and transitional atrioventricular septal defect undergoing surgical repair during infancy experience significant morbidity and mortality. The reoperation rate is high with unfavourable left atrioventricular valve anatomy.

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Cleft of the mitral valve in patients with Down's syndrome

Cardiology in the Young ◽

10.1017/s1047951102000057 ◽

2002 ◽

Vol 12 (1) ◽

pp. 27-31 ◽

Cited By ~ 6

Author(s):

Alain Fraisse ◽

Tony Abdel Massih ◽

Damien Bonnet ◽

Daniel Sidi ◽

Jean Kachaner

Keyword(s):

Mitral Valve ◽

Ventricular Septal Defect ◽

Atrial Septal Defect ◽

Septal Defect ◽

Surgical Repair ◽

Ductus Arteriosus ◽

Down's Syndrome ◽

Down’S Syndrome ◽

Atrioventricular Septal Defect ◽

Atrial Septal Defect Closure

Differentiation between a cleft of the mitral valve and the cleft of the left side of an atrioventricular septal defect – a lesion commonly found in patients with Down's syndrome – is surgically important since the distribution of the conduction tissue varies between the 2 lesions. We sought to determine if cleft of the mitral valve occurs also in patients with Down's syndrome. We studied 5 patients with Down's syndrome and cleft of the mitral valve followed in our institution. Echocardiography showed in all 5 patients a cleft dividing the anterior (aortic) leaflet of mitral valve with normal papillary muscle position, mural leaflet size, and ratio of the inlet/outlet dimension of the left ventricle. Associated cardiac lesions were present in all 5 patients: perimembranous ventricular septal defect in 3, ostium secundum atrial septal defect in 2 and patent ductus arteriosus in 2 patients. During the 5.6 years (0.2–11) of the follow-up period, surgical repair of the cleft was never indicated since the mitral regurgitation through the cleft remained mild or absent in all the patients. Two patients underwent closure of a ventricular septal defect, with atrial septal defect closure in one and ductal ligation in 2. One patient died suddenly at home, without evidence of a cardiac cause. In conclusion, a cleft of the mitral valve has important developmental and morphologic differences with atrioventricular septal defect and may occur in patients with Down's syndrome. If surgical repair of the cleft or of associated cardiac lesion is indicated, it is necessary to distinguish it from atrioventricular septal defect where the conduction axis is displaced posteriorly and may be exposed during surgery.

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EARLY OUTCOME AFTER AORTIC VALVE REPLACEMENT ON PATIENTS WITH REDUCED LEFT VENTRICULAR EJECTION FRACTION

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2014.1.5 ◽

2014 ◽

pp. 31-36

Author(s):

Quang Thuu Le

Keyword(s):

Septal Defect ◽

Intraoperative Complications ◽

Systolic Pressure ◽

Atrioventricular Septal Defect ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Mitral Insufficiency ◽

Atrioventricular Valve ◽

Ventricular Ejection Fraction ◽

Mitral Incompetence

Background: To evaluate the early results of operation for partial atrioventricular septal defect. Methods: Twenty-sevent patients underwent surgical correction of partial atrioventricular septal defect from 1/2011 to 12/2013 at Cardiovascular Centre of Hue Central Hospital. There were 7 (25.9%) female patients and 20 (74.1%) male patients, 18.5% of patients aged < 1 age, 55.6% of patients aged ≥ 1 to 15 years, and 25.9% of patients aged ≥ 16 to 60 years. Sevent (25.9%) had congestive heart failure. There was a primum atrial septal defect in 100% of patients. A cleft of the anterior mitral leaflet was diagnosed in 100% of patients. 92.6% of patients had either moderate or severe mitral incompetence prior to operation. The pulmonary artery systolic pressure exceeded 40 mmHg in 85,.2% of patients. Results: Atrial septal defects were closed with a pericardial patch in 100% of patients. The cleft in its anterior leaflet was closed in 100% of patients. Postoperatively, moderate mitral insufficiency developed in 14.8% of patients. 85.2% of patients have mild mitral incompetence. One patients (3.7%) needed a permanent pacemaker. There was no intraoperative mortality. At 6-9 months postoperatively, left atrioventricular valve insufficiency was moderate in 2 (7.4%) patients and mild in 25 (92.6%) patients who had had cleft closure alone. Conclusions: Repair of partial atrioventricular septal defect is safe and good. It is important to close the cleft in the left atrioventricular valve. The mitral valve should be repaired in a conservative manner. Intraoperative complications occur but are uncommon, suggesting that short-term follow is excellent.

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