Surgical Repair of Complete Atrioventricular Septal Defect

Between January 1988 and March 1996, 40 patients underwent repair of complete atrioventricular septal defect with a two-patch technique and routine atrioventricular valve cleft closure. The mean age of the patients was 10.8 ± 6.9 months and the mean weight was 6.6 ± 2.6 kg. Twenty-three had Down's syndrome and 13 had coexisting cardiac anomalies. Preoperative angiography and echocardiography revealed mild atrioventricular valve regurgitation in 22 patients, moderate regurgitation in 16, and severe regurgitation in the other 2. The mortality was 12.5% (4 early and 1 late deaths). The major cause of death was pulmonary hypertensive crisis. Reoperation was necessary in 3 patients; 2 had atrioventricular valve annuloplasty and one had prosthetic valve replacement. All 3 survived reoperation. Echocardiography at a mean of 32 ± 20 months postoperatively showed mild left atrioventricular valve regurgitation in 32 patients and moderate regurgitation in 3. Management of postoperative pulmonary hypertensive crisis and repair of complete atrioventricular septal defect before the development of high pulmonary vascular resistance may reduce the mortality of this surgical procedure.