A mitralis billentyű sebészete atrioventricularis septumdefektusban

Összefoglaló. A veleszületett szívbetegségek egyik gyakori formáját jelentő atrioventricularis septumdefektus korrekciós műtétjének kritikus pontja a közös atrioventricularis szájadék elválasztásával a mitralis billentyű kialakítása. A korrekció sikere számos anatómiai variáns függvénye, ezért nem lehet minden esetben a tökéletes anatómiai viszonyokat kialakítani. A fennmaradó billentyűstenosisok, regurgitatiók a későbbi életkorban progressziót mutatva olyan hemodinamikai kórképeket, keringési elégtelenséget okozhatnak, melyek további beavatkozásokat igényelhetnek. A mitralis billentyűnek az atrioventricularis septumdefektushoz társuló betegsége koraszülöttkortól aggkorig minden életkorban előfordul, más-más műtéti megoldást igényelve. A szerzők részletezik a különböző életkorokra vonatkozóan a napjainkban lehetséges és szükséges műtéti megoldásokat, sebészi kihívásokat. A mitralis billentyű műbillentyűre történő cseréjében a klasszikus sebészi megoldások mellett napjainkban új beavatkozásokként jelentős számban jelentkeznek a katéteres intervenciós és hibrid megoldások. A felnőttkort egyre nagyobb számban megélő betegek fokozott odafigyelést, speciális ellátást igényelnek a kardiológusoktól, szívsebészektől. Orv Hetil. 2021; 162(35): 1397–1401. Summary. The critical point of the atrioventricular septal defect correction is to separate the common atrioventricular orifice, which results in the reconstruction of the mitral valve. The success of the correction depends on many anatomical aspects, therefore a perfect anatomical outcome is not always possible. The remaining valvular stenoses and regurgitations, showing progression at a later age, may result in hemodynamic disorders and circulatory insufficiency that may require further interventions. Mitral valve disease associated with atrioventricular septal defect occurs at all ages from preterm to adulthood, requiring different surgical solutions. The authors detail the possible and necessary surgical solutions and surgical challenges at different ages. In addition to the classic surgical solutions, a significant number of catheter interventional and hybrid solutions are emerging as new interventions in the replacement of the mitral valve with an artificial valve. An increasing number of patients living in adulthood require increased attention and special care from cardiologists and cardiac surgeons. Orv Hetil. 2021; 162(35): 1397–1401.

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Atrioventricular Septal Defect: What Is in a Name?

Journal of Cardiovascular Development and Disease ◽

10.3390/jcdd8020019 ◽

2021 ◽

Vol 8 (2) ◽

pp. 19

Author(s):

Michael Rigby

Keyword(s):

Mitral Valve ◽

Septal Defect ◽

Adult Congenital Heart Disease ◽

Atrioventricular Septal Defect ◽

Atrioventricular Canal ◽

Aortic Leaflet ◽

Adult Congenital ◽

The Right ◽

Cardiac Surgeons ◽

Almost All

Robert Anderson has made a huge contribution to almost all aspects of morphology and understanding of congenital cardiac malformations, none more so than the group of anomalies that many of those in the practice of paediatric cardiology and adult congenital heart disease now call ‘Atrioventricular Septal Defect’ (AVSD). In 1982, with Anton Becker working in Amsterdam, their hallmark ‘What’s in a name?’ editorial was published in the Journal of Thoracic and Cardiovascular Surgery. At that time most described the group of lesions as ‘atrioventricular canal malformation’ or ‘endocardial cushion defect’. Perhaps more significantly, the so-called ostium primum defect was thought to represent a partial variant. It was also universally thought, at that time, that the left atrioventricular valve was no more than a mitral valve with a cleft in the aortic leaflet. In addition to this, lesions such as isolated cleft of the mitral valve, large ventricular septal defects opening to the inlet of the right and hearts with straddling or overriding tricuspid valve were variations of the atrioventricular canal malformation. Anderson and Becker emphasised the differences between the atrioventricular junction in the normal heart and those with a common junction for which they recommended the generic name, ‘atrioventricular septal defect’. As I will discuss, over many years, they continued to work with clinical cardiologists and cardiac surgeons to refine diagnostic criteria and transform the classification and understanding of this complex group of anomalies. Their emphasis was always on accurate diagnosis and communication, which is conveyed in this review.

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Rheumatic mitral valve repair: the Score procedure

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492320935251 ◽

2020 ◽

Vol 28 (7) ◽

pp. 377-380

Author(s):

Tiange Luo ◽

Xu Meng

Keyword(s):

Quality Of Life ◽

Mitral Valve ◽

Mitral Valve Repair ◽

Mitral Valve Disease ◽

Surgical Procedure ◽

Valve Repair ◽

Simple Operation ◽

Number Of Patients ◽

Cardiac Surgeons

We have defined a standard surgical procedure for rheumatic mitral valve repair (the Score procedure) including four steps: shaving, checking, commissurotomy, and relaxing. Here, we summarize the clinical pathological classification for making a decision on repair or replacement. Given the large number of patients in China, we consider it the responsibility of Chinese cardiac surgeons to adopt a therapeutic schedule for rheumatic mitral valve disease, which includes a simple operation with reliable effects and easy to promote. This schedule would ensure that millions of patients get the best treatment to extend survival and improve their quality of life.

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Systematic cutting of selected secondary mitral valve chordae, in association with a shallow myectomy, in obstructive hypertrophic cardiomyopathy:impact on mitral valve function and patient management

European Heart Journal ◽

10.1093/ehjci/ehaa946.2076 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

D Margonato ◽

R Abete ◽

A Zyrianov ◽

A Sorropago ◽

M Chioffi ◽

...

Keyword(s):

Mitral Valve ◽

Septal Defect ◽

Left Ventricular ◽

Outflow Tract ◽

Anterior Leaflet ◽

Mitral Leaflet ◽

Access To Treatment ◽

Anterior Mitral Leaflet ◽

Septal Myectomy ◽

Number Of Patients

Abstract Introduction Few centers worldwide have large experience with performing an extended septal myectomy in patients with obstructive hypertrophic cardiomyopathy (HCM). Therefore, many HCM patients eligible for surgical relief of left ventricular (LV) outflow gradient do not have access to treatment. In a previous study, cutting fibrotic anterior mitral leaflet secondary chordae, in association with only a shallow myectomy, proved highly effective in moving the mitral valve (MV) apparatus away from the LV outflow tract and relieving the outflow gradient in our HCM patients with mild hypertrophy (<19 mm), a surgical approach that simplifies the operation. Purpose To assess whether chordal cutting is equally effective in improving MV geometry and relieving LV outflow gradient and heart failure symptoms in HCM patients with more marked hypertrophy. Methods Surgical outcome and MV geometry and function were assessed in 226 consecutive HCM patients who underwent systematic cutting of fibrotic anterior mitral leaflet secondary chordae, in association with a shallow myectomy and independently of magnitude of septal thickness, at our center from January 2015 to December 2018. Results Of 226 study patients, 1 (0.4%) died perioperatively. None had iatrogenic septal defect. Postoperatively, LV outflow gradient at rest decreased from 70±36 to 10±2 mmHg (P<0.001). In the 77 patients in whom data on the outflow gradient provoked with physiologic maneuvers after surgery were available, the provocable gradient was 16±10 mmHg. NYHA functional class improved significantly (P<0.001), with the number of patients in class III-IV decreasing from 178 (79%) to 2 (0.9%). No patient had residual severe MV regurgitation and only 4 (1.7%) had moderate-to-severe regurgitation. Quality of the echocardiogram allowed assessment of MV geometry in 212 (94%) patients. In the 62 patients with mild hypertrophy, anterior leaflet-annulus ratio increased 27% postoperatively, from 0.43+0.06 to 0.55+0.06 and MV tenting area decreased 34% from 2.9+0.6 to 1.9+0.4 cm2 (P<0.001), indicating repositioning of MV coaptation away from the outflow tract (with increased outflow tract dimension). Similarly, in 150 patients with marked hypertrophy, anterior leaflet-annulus ratio increased 27% from 0.43+0.05 to 0.55+0.06 and tenting area decreased 28% from 2.9+0.6 to 2.1+0.4 cm2 (P<0.001). Conclusions Our results show that cutting fibrotic anterior mitral leaflet secondary chordae, by moving the MV apparatus away from the LV outflow tract and independently of the magnitude of septal hypertrophy, contributes to improve the results of septal myectomy and reduces the need for a deep septal excision (and associated risk of iatrogenic septal defect) in patients with obstructive HCM. Therefore, chordal cutting could make the myectomy operation more accessible to surgeons, increasing the availability of surgical treatment for HCM patients eligible for invasive abolition of LV outflow obstruction. Funding Acknowledgement Type of funding source: None

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Emergency redo mitral valve replacement and caesarean section in a patient with previous atrioventricular septal defect repair in childhood

Interactive Cardiovascular and Thoracic Surgery ◽

10.1510/icvts.2008.183095 ◽

2008 ◽

Vol 8 (1) ◽

pp. 164-165

Author(s):

M. P. Devbhandari ◽

R. Jeeji ◽

M. Bewsher ◽

N. Odom

Keyword(s):

Mitral Valve ◽

Caesarean Section ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Septal Defect ◽

Atrioventricular Septal Defect ◽

Defect Repair

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The Angle of the Components of the Common Atrioventricular Valve Predicts the Outcome of Surgical Correction in Patients With Atrioventricular Septal Defect and Common Atrioventricular Junction

Journal of the American Society of Echocardiography ◽

10.1016/j.echo.2008.05.006 ◽

2008 ◽

Vol 21 (10) ◽

pp. 1099-1104 ◽

Cited By ~ 14

Author(s):

Tara Bharucha ◽

Muthukumaran C. Sivaprakasam ◽

Marcus P. Haw ◽

Robert H. Anderson ◽

Joseph J. Vettukattil

Keyword(s):

Septal Defect ◽

Atrioventricular Septal Defect ◽

Surgical Correction ◽

Atrioventricular Valve ◽

Atrioventricular Junction ◽

The Common ◽

Common Atrioventricular Valve

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Surgical management with mitral valve replacement in young infants with congenital mitral valve diseases and complete atrioventricular septal defect

Orvosi Hetilap ◽

10.1556/oh.2008.28417 ◽

2008 ◽

Vol 149 (40) ◽

pp. 1891-1894

Author(s):

István Hartyánszky ◽

Sándor Mihályi ◽

Gábor Bodor

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Surgical Management ◽

Septal Defect ◽

Atrioventricular Septal Defect ◽

Young Infants ◽

Complete Atrioventricular Septal Defect ◽

Valve Diseases ◽

Complete Atrioventricular

A szerzők célja volt csecsemőkorban vizsgálni a veleszületett mitralisbillentyű-szűkület és -elégtelenség sebészi kezelését, valamint a komplett atrioventricularis septumdefektus (CAVD) teljes korrekciója során a mitralis billentyű kialakításának, pótlásának lehetőségét. Betegek: 2001 és 2007 között 82, egy évnél fiatalabb csecsemőn a korrekciós műtétet követően 7 betegben (5 hét–7 hónap, 3,5–5 kg) mitralis (bileaflet) műbillentyű korai beültetése vált szükségessé. A két műtét közti idő 0–7 nap, de a legkisebb csecsemőnél intenzív kezelés mellett 38 napot kellett várni az annulus feltágulására, hogy a legkisebb műbillentyű beültethető lehessen. A műbillentyűk típusa: 16 mm-es Carbomedics 2, 16 mm-es ATS 3, 17 mm-es Sorin 1, 19 mm-es Sorin 1. Congenitalis mitralis stenosis, illetve insufficientia miatt 2-2 csecsemőbe kellett 16 mm-es ATS billentyűt beültetni. Eredmény: 30 napos mortalitás 0. Egy-egy csecsemő a 46., illetve a 71. posztoperatív napon szepszisben meghalt. 1–6 (átlag 3) éves utánkövetés: 1 betegben kellett pannust eltávolítani, a betegek panaszmentesek. Az antikoaguláns terápia helyes beállítása nehézséget jelentett. Összefoglalás: Congenitalis mitralis stenosis és elégtelenség, valamint a CAVD sebészi korrekciója már kis súlyú újszülötteken is sikerrel elvégezhető. Kedvezőtlen anatómiai helyzetben a mitralis billentyű kialakításának lehetetlensége esetén csak a műbillentyű-beültetés a megoldás. Ez kilátástalannak tűnő helyzetben (kis mitralis annulus) is elvégezhető jó eredménnyel. (Tudomásunk szerint 3500 g súlyú betegünk a legkisebb, sikeresen operált eset.) Ezt igazolják eseteink korai és középtávú eredményei.

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Imperforate Ebstein's malformation in atrioventricular septal defect

Cardiology in the Young ◽

10.1017/s1047951100000287 ◽

1991 ◽

Vol 1 (2) ◽

pp. 152-154 ◽

Cited By ~ 1

Author(s):

Jeong-Wook Seo ◽

Woo Hee Jung ◽

Yong Won Park

Keyword(s):

Left Ventricle ◽

Septal Defect ◽

Lateral Wall ◽

Atrioventricular Septal Defect ◽

Left Hand ◽

Left Lateral Wall ◽

Right Isomerism ◽

The Common ◽

The Right ◽

Double Inlet Left Ventricle

SummaryAnatomic data are presented of a female abortus with the unusual combination of Ebstein's malformation and atrioventricular septal defect with right isomerism of the atrial appendages, left-hand ventricular topology and discordant ventriculoarterial connection. The common atrioventricular orifice was guarded by an effectively common valve, the right half being guarded by a well-formed three-leaflet valve, but the posterior and left lateral wall of the orifice being deficient of valvar leaflet tissue. The right ventricular inlet was a blind chamber, an imperforate dimple being seen which was surrounded by valvar remnants. The apical trabecular and outlet components of the right ventricle communicated with the left ventricle through an outlet ventricular septal defect in front of the anterosuperior leaflet of the atrioventricular valve, giving the potential clinically for the lesion to be misdiagnosed as double inlet left ventricle.

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Comparison of cleft and papillary muscle position in cleft mitral valve and atrioventricular septal defect

The American Journal of Cardiology ◽

10.1016/s0002-9149(96)90589-5 ◽

1996 ◽

Vol 77 (2) ◽

pp. 164-169 ◽

Cited By ~ 36

Author(s):

Thomas Kohl ◽

Norman H. Silverman

Keyword(s):

Mitral Valve ◽

Papillary Muscle ◽

Septal Defect ◽

Atrioventricular Septal Defect

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Challenges in the Surgical Treatment of Atrioventricular Septal Defect in Children With and Without Down Syndrome in Romania-A Developing Country

Frontiers in Pediatrics ◽

10.3389/fped.2021.612644 ◽

2021 ◽

Vol 9 ◽

Author(s):

Ioana-Cristina Olariu ◽

Anca Popoiu ◽

Andrada-Mara Ardelean ◽

Raluca Isac ◽

Ruxandra Maria Steflea ◽

...

Keyword(s):

Down Syndrome ◽

Surgical Treatment ◽

Septal Defect ◽

Surgical Intervention ◽

Atrioventricular Septal Defect ◽

Post Surgery ◽

Number Of Patients ◽

Increased Risk ◽

Complete Form ◽

Surgery Mortality

Background: Atrioventricular septal defect (AVSD) is a cardiac malformation that accounts for up to 5% of total congenital heart disease, occurring with high frequency in people with Down Syndrome (DS). We aimed to establish the surgical challenges and outcome of medical care in different types of AVSD in children with DS compared to those without DS (WDS).Methods: The study included 62 children (31 with DS) with AVSD, evaluated over a 5 year period.Results: Complete AVSD was observed in 49 (79%) children (27 with DS). Six children had partial AVSD (all WDS) and seven had intermediate types of AVSD (4 with DS). Eight children had unbalanced complete AVSD (1 DS). Median age at diagnosis and age at surgical intervention in complete AVSD was not significantly different in children with DS compared to those WDS (7.5 months vs. 8.6). Median age at surgical intervention for partial and transitional AVSDs was 10.5 months for DS and 17.8 months in those without DS. A large number of patients were not operated: 13/31 with DS and 8/31 WDS.Conclusion: The complete form of AVSD was more frequent in DS group, having worse prognosis, while unbalanced AVSD was observed predominantly in the group without DS. Children with DS required special attention due to increased risk of pulmonary hypertension. Late diagnosis was an important risk factor for poor prognosis, in the setting of suboptimal access to cardiac surgery for patients in Romania. Although post-surgery mortality was low, infant mortality before surgery remains high. Increased awareness is needed in order to provide early diagnosis of AVSD and enable optimal surgical treatment.

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