J Thorac Cardiovasc Surg 2001;121:0352-0365
© 2001 The American Association for Thoracic Surgery
Surgery for Congenital Heart Disease |
Surgically created double-orifice left atrioventricular valve: A valve-sparing repair in selected atrioventricular septal defects
Loïc Macé, MDa,
Patrice Dervanian, MDa,
Lucile Houyel, MDb,
Evelyne Chaillon-Fracchia, MDb,
Dominique Piot, MDa,
Virginie Lambert, MDa,
Jean Losay, MDa,
Jean-Yves Neveux, MDa
From the Department of Cardiovascular and Pediatric Cardiac Surgery,a Cardiopathologic Laboratory,b Marie Lannelongue Hospital, Paris-Sud University, Paris, France.
Received for publication May 4, 2000. Revisions requested June 16, 2000; revisions received Aug 21, 2000. Accepted for publication Sept 19, 2000.
Address for reprints: Loïc Macé, MD, Département de Chirurgie Cardiovasculaire et Cardiaque Pédiatrique, Hôpital Marie Lannelongue, 133, avenue de la Résistance, 92350 Le Plessis Robinson, France (E-mail: mace{at}ccml.com).
Objectives: Some features of the left atrioventricular valve (large mural leaflet, dystrophic tissue) represent a challenge for repair of atrioventricular septal defects without postoperative regurgitation. A retrospective study was conducted to evaluate the results of surgically creating a double-orifice left atrioventricular valve in such circumstances. Clinical results were analyzed according to valvular and subvalvular left atrioventricular valve measurements in pathologic specimens with atrioventricular septal defects.
Methods: Among 157 patients operated on for atrioventricular septal defect since October 1989, 10 patients underwent primary repair (n = 8) or reoperation (n = 2) by this procedure. Median age at repair was 3.3 years (0.1-33 years). Anatomic types were complete (n = 3), intermediate (n = 5), and partial (n = 2). Preoperative moderate to severe left atrioventricular valve regurgitation was present in 6 patients. After the repair (two-patch technique in complete atrioventricular septal defect, cleft closed in each case), these 10 patients were found to have moderate to severe residual regurgitation not amenable to repair by annuloplasty. The top edge of the mural leaflet was anchored to the facing free edge of the cleft.
Results: No hospital death or morbidity was observed. Left atrioventricular valve regurgitation was absent or trivial (8 patients) and mild (2 patients). Color-coded echocardiography did not show significant left atrioventricular valve stenosis. The mean diastolic pressure gradient across the left atrioventricular valve was 3.2 ± 1.1 mm Hg (1.4-4.5 mm Hg). At a median follow-up of 72 months (6-91 months), there was 1 late death, unrelated to left atrioventricular valve malfunction, due to pulmonary vascular obstructive disease. Left atrioventricular valve regurgitation did not increase over time, except in 1 patient in whom regurgitation recently progressed from mild to moderate. At rest, the mean diastolic pressure gradient across the left atrioventricular valve was 3.8 ± 2.9 mm Hg (1.5-11.2 mm Hg). One child had an early moderate stenosis without pulmonary hypertension. Studies on pathologic specimens (n = 34) indicated that long chordal lengths and large mural leaflet size are essential independent anatomic features to assess its feasibility.
Conclusions: Surgical creation of a double-orifice left atrioventricular valve is an effective additional procedure for repair of atypical cases of atrioventricular septal defect. The operation may decrease the need for reoperation or left atrioventricular valve replacement.
Copyright © 2001 by The American Association for Thoracic Surgery.
