Pediatric Cardiology and Cardiac Surgery
Vol.25 No.2 2009 (133-138)
Shintaro Nemoto,1) Tomoyasu Sasaki,1) Hideki Ozawa,1) Mari Kakita,1) Yoshihiro Katsumada,1) Kanta Kishi,2) Kenichi Okumura,2) and Yasuhiko Mori2)
Departments of 1)Cardiovascular Surgery and 2)Pediatric Cardiology, Osaka Medical College, Osaka, Japan
Purpose: Repair of the left atrioventricular valve (LAVV) is a mainstay of surgical repair for complete atrioventricular septal defect (AVSD). We have used modified conventional two-patch repair to reconstruct a coaptation between the anterior and posterior bridging leaflets, a so-called “cleft”, as a new septal commissure. Early and midterm results of our surgical modification were assessed.
Patients and Methods: Twenty-six infants (24- isolated AVSD, 2- AVSD with Tetralogy of Fallot) were reviewed retrospectively. The mean age at surgery was 7 months (range, 1 to 39 months). Preoperative LAVV morphology: 6- hypoplastic mural leaflet, 2- small annulus, and 5- LAVV regurgitation. Opposing edges of both bridging leaflets were introduced into a small vertical incision in the upper border of the interventricular patch (VSD patch) and sutured into place to make a new commissure with adequate apposition. The “cleft” was left open- in 8 cases, partially closed in 13, and completely closed- in 5. Ten additional valve repair procedures were performed.
Results: There was no surgical atrioventricular block or surgical death, but one hospital death occurred due to necrotizing enterocolitis. In-hospital re-operation (repair) was performed for severe LAVV regurgitation in 2 cases (POD 1 & 12). There was no death in follow-up (mean 36.2 months, range 14-39). Asymptomatic LAVV regurgitation (> moderate) was noted in 5 cases.
Conclusions: Long-term follow-up is required to determine the effectiveness of our modification for complete AVSD, but this method may be an alternative to achieve adequate LAVV competency, particularly in infants with hypoplastic leaflets or small annulus of the LAVV.