Atrioventricular valve regurgitation in patients undergoing total cavopulmonary connection: Impact of valve morphology and underlying mechanisms on survival and reintervention

AbstractObjective: Despite the broadened indications for Fontan procedure, there are patients who could not proceed to Fontan procedure because of the strict Fontan criteria during the early period. Some patients suffer from post-Glenn complications such as hypoxia, arrhythmia, or fatigue with exertion long after the Glenn procedure. We explored the possibility of Fontan completion for those patients.Methods: Between 2004 and 2010, five consecutive patients aged between 13 and 31 years (median 21) underwent Fontan completion. These patients had been followed up for more than 10 years (10 to 13, median 11) after Glenn procedure as non-Fontan candidates. We summarise these patients retrospectively in terms of their pre-operative physiological condition, surgical strategy, and problems that these patients hold.Results: Pre-operative catheterisation showed pulmonary vascular resistance ranging from 0.9 to 3.7 (median 2.2), pulmonary to systemic flow ratio of 0.3 to 1.6 (median 0.9), and two patients had significant aortopulmonary collaterals. Extracardiac total cavopulmonary connections were performed in three patients, lateral tunnel total cavopulmonary connection in one patient, and intracardiac total cavopulmonary connection in one patient, without a surgical fenestration. Concomitant surgeries were required including valve surgeries – atrioventricular valve plasty in three patients and tricuspid valve replacement in one patient; systemic outflow tract obstruction release – Damus–Kaye–Stansel procedure in two patients and subaortic stenosis resection in one patient; and anti-arrhythmic therapies – maze procedure in two patients, cryoablation in two patients, and pacemaker implantation in two patients. All patients are now in New York Heart Association category I.Conclusion:Patients often suffer from post-Glenn complications. Of those, if they are re-examined carefully, some may have a chance to undergo Fontan completion and benefit from it. Multiple lesions such as atrioventricular valve regurgitation, systemic outflow obstruction, or arrhythmia should be surgically repaired concomitantly.

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The comparative role of echocardiography and MRI for identifying critical lesions in patients with single-ventricle physiology, before bidirectional cavopulmonary connection

Cardiology in the Young ◽

10.1017/s1047951115002693 ◽

2016 ◽

Vol 26 (7) ◽

pp. 1373-1382 ◽

Cited By ~ 2

Author(s):

Sylvia Krupickova ◽

Michael A. Quail ◽

Robert Yates ◽

Roman Gebauer ◽

Marina Hughes ◽

...

Keyword(s):

Pulmonary Artery ◽

Odds Ratio ◽

Single Ventricle ◽

Pulmonary Arteries ◽

Left Pulmonary Artery ◽

Atrioventricular Valve ◽

Valve Regurgitation ◽

Atrioventricular Valve Regurgitation ◽

Cavopulmonary Connection ◽

Bidirectional Cavopulmonary Connection

AbstractBackgroundIn the era of multi-modality imaging, this study compared contemporary, pre-operative echocardiography and cardiac MRI in predicting the need for intervention on additional lesions before surgical bidirectional cavopulmonary connection.MethodsA total of 72 patients undergoing bidirectional cavopulmonary connection for single-ventricle palliation between 2007 and 2012, who underwent pre-operative assessment using both echocardiography and MRI, were included. The pre-determined outcome measure was any additional surgical or catheter-based intervention within 6 months of bidirectional cavopulmonary connection. Indices assessed were as follows: indexed dimensions of right and left pulmonary arteries, coarctation of the aorta, adequacy of interatrial communication, and degree of atrioventricular valve regurgitation.ResultsMedian age at bidirectional cavopulmonary connection was 160 days (interquartile range 121–284). The following MRI parameters predicted intervention: Z score for right pulmonary artery (odds ratio 1.77 (95% confidence interval 1.12–2.79, p=0.014)) and left pulmonary artery dimensions (odds ratio 1.45 (1.04–2.00, p=0.027)) and left pulmonary artery report conclusion (odds ratio 1.57 (1.06–2.33)). The magnetic resonance report predicted aortic arch intervention (odds ratio 11.5 (3.5–37.7, p=0.00006)). The need for atrioventricular valve repair was associated only with magnetic resonance regurgitation fraction score (odds ratio 22.4 (1.7–295.1, p=0.018)). Echocardiography assessment was superior to MRI for predicting intervention on interatrial septum (odds ratio 27.7 (6.3–121.6, p=0.00001)).ConclusionFor branch pulmonary arteries, aortic arch, and atrioventricular valve regurgitation, MRI parameters more reliably predict the need for intervention; however, echocardiography more accurately identified the adequacy of interatrial communication. Approaching bidirectional cavopulmonary connection, the diagnostic strengths of MRI and echocardiography should be acknowledged when considering intervention.

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Bridging annuloplasty for common atrioventricular valve regurgitation

The Annals of Thoracic Surgery ◽

10.1016/0003-4975(94)00776-4 ◽

1995 ◽

Vol 59 (4) ◽

pp. 1003-1005 ◽

Cited By ~ 10

Author(s):

Tetsuro Takayama ◽

Nobuhiro Nagata ◽

Takeshi Miyairi ◽

Masakazu Abe ◽

Kenji Koseni ◽

...

Keyword(s):

Atrioventricular Valve ◽

Valve Regurgitation ◽

Atrioventricular Valve Regurgitation ◽

Common Atrioventricular Valve

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Abstract 17543: The Chicken or the Eggs? Examining the Causal Relationship Between the Development of Atrioventricular Valve Regurgitation and Ventricular Dysfunction in Patients With Functionally Single-Ventricle Physiology

Circulation ◽

10.1161/circ.132.suppl_3.17543 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Yasuhiro Kotani ◽

Devin Chetan ◽

Selvi Senthilnathan ◽

Arezou Saedi ◽

Christopher A Caldarone ◽

...

Keyword(s):

Causal Relationship ◽

Single Ventricle ◽

Ventricular Dysfunction ◽

Stage I ◽

Stage Ii ◽

Atrioventricular Valve ◽

Valve Regurgitation ◽

Ventricular Dilation ◽

Atrioventricular Valve Regurgitation ◽

Annular Dilation

Introduction: Development of atrioventricular valve regurgitation (AVVR) with or without ventricular dysfunction (VD) often occurs during the first 6 months of life and has a significant impact on outcomes for single-ventricle patients. Yet, it is not well known whether AVVR causes VD or vice versa. Thus, we sought to identify the timing and causal relationship between AVVR and VD. Methods: Among 156 consecutive single-ventricle patients who had staged palliation (2005- 2012), 28 who had AVV repair at the time of stage II (n=24, 86%) or inter-stage (n=4, 14%) were reviewed. Diagnosis included HLHS in 17 (61%) patients, tricuspid atresia in 2 (7%), and others in 9 (32%). Ventricular morphology was left-dominant in 6 (21%) patients and right-dominant in 22 (79%). AVV morphology included mitral in 6 (21%) patients, tricuspid in 18 (64%), and common in 4 (14%). Serial echocardiograms were reviewed to identify the timing of development of AVVR and/or VD. Results: After stage I palliation, ventricular end-diastolic dimension (VEDD) z-score significantly increased from 4.01 to 5.69 (p<0.01) AVVR (Figure). By the time of stage II palliation, VEDD further increased and subsequent AVV annular dilation occurred, resulting in 23 patients with significant AVVR. None of the patients, however, had significant VD before stage II palliation/AVV repair, but 9 patients developed significant VD after AVV repair. Conclusions: Ventricular dilation occurred immediately after stage I palliation and continued until stage II palliation. Secondary annular dilation occurred inter-stage and this further triggered the development of AVVR. Tangible ventricular dysfunction was not seen before AVV repair, however, important ventricular dysfunction was unmasked after volume unloading surgery. Heart failure management and early intervention to significant AVVR may reduce the incidence of ventricular dysfunction following AVV repair.

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A Twenty-Month Experience Comparing Conventional Pulsed-Doppler Echocardiography and Color-Coded Digital Multigate Doppler, for Detection of Atrioventricular Valve Regurgitation, and Its Severity

Developments in Cardiovascular Medicine - Echocardiology ◽

10.1007/978-94-009-8299-4_44 ◽

1981 ◽

pp. 399-407 ◽

Cited By ~ 10

Author(s):

J. Geoffrey Stevenson ◽

Isamu Kawabori ◽

Marco A. Brandestini

Keyword(s):

Doppler Echocardiography ◽

Atrioventricular Valve ◽

Pulsed Doppler ◽

Valve Regurgitation ◽

Pulsed Doppler Echocardiography ◽

Atrioventricular Valve Regurgitation

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Survival and predictors of mortality in patients after the Fontan operation

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492320949655 ◽

2020 ◽

Vol 28 (9) ◽

pp. 572-576

Author(s):

Saviga Sethasathien ◽

Suchaya Silvilairat ◽

Hathaiporn Kraikruan ◽

Rekwan Sittiwangkul ◽

Krit Makonkawkeyoon ◽

...

Keyword(s):

Pulmonary Artery ◽

Pulmonary Artery Pressure ◽

Fontan Operation ◽

Hazard Ratio ◽

Early Mortality ◽

Atrioventricular Valve ◽

Valve Regurgitation ◽

Artery Pressure ◽

Mean Pulmonary Artery Pressure ◽

Atrioventricular Valve Regurgitation

Background As a result of the surgical techniques now being employed, the survival rate in patients after undergoing the Fontan operation has improved. The aims of this study were focused on determining the survival rate and predictors of early mortality. Methods In a retrospective cohort study, 117 consecutive patients who underwent the Fontan operation were recruited. Multivariate Cox proportional regression analysis was used to assess the predictors of early mortality, defined as death within 30 days after the Fontan operation. Results The median follow-up time was 6.1 years. The median age at the time of the Fontan operation was 5.7 years. Survival rates in the patients at 5, 10, and 15 years postoperatively were 92%, 87% and 84%, respectively. Using univariate Cox regression analysis, the predictors of early mortality were found to be postoperative mean pulmonary artery pressure ≥23 mm Hg (hazard ratio 26.0), renal failure (hazard ratio 9.5), heterotaxy syndrome (hazard ratio 5.3), and uncorrected moderate or severe atrioventricular valve regurgitation (hazard ratio 9.4). After adjusting for confounding factors using multivariate Cox regression analysis, the predictors of early mortality were found to be postoperative mean pulmonary artery pressure ≥23 mm Hg (hazard ratio 23.2) and uncorrected moderate or severe atrioventricular valve regurgitation (hazard ratio 8.2). Conclusions Uncorrected moderate or severe atrioventricular valve regurgitation and postoperative mean pulmonary artery pressure ≥23 mm Hg are independent predictors of early mortality after the Fontan operation. Patients with these factors should undergo aggressive management to minimize morbidity and mortality.

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