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The Journal of Thoracic and Cardiovascular Surgery, Vol 99, 320-326, Copyright © 1990 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
RG Weintraub, WJ Brawn, AW Venables and RB Mee
Before January 1987, 62 infants underwent two-patch repair of complete (51)
or intermediate (11) atrioventricular septal defect at the Royal Children's
Hospital, Melbourne. Median age at repair was 4.3 months and median weight
was 4.4 kg. Early deaths (3%) were confined to two infants with
preoperative respiratory tract infections; a further two patients died
during follow-up (late mortality rate 3%). Reoperation for severe
postoperative mitral regurgitation was necessary in 10 infants (16%), two
of whom subsequently required mitral valve replacement with a prosthesis.
Preoperative atrioventricular valve regurgitation was assessed
retrospectively in 49 patients from angiography or Doppler echocardiography
and was found to be absent or mild in 33 (68%), moderate in 9 (18%), and
severe in 7 (14%). At the time of latest review (at a mean of 2.4 years
after repair), judged from a combination of clinical and echocardiographic
criteria, mitral regurgitation was absent or mild in 49 (84%) of the 58
survivors; none of them had symptomatic regurgitation or were requiring
continuing medical treatment. Analysis of sequential atrioventricular valve
function in 46 of the 49 patients in whom objective preoperative data were
available showed no relationship between the degree of preoperative and
postoperative atrioventricular valve regurgitation. Infants without Down's
syndrome, however, had a significantly higher reoperation rate for severe
postoperative mitral valve regurgitation (50%) than those with Down's
syndrome (10%) (p = 0.007). Complete atrioventricular septal defect can be
repaired in early infancy with a low mortality rate and good intermediate
term results.
ARTICLES
Two-patch repair of complete atrioventricular septal defect in the first year of life. Results and sequential assessment of atrioventricular valve function
Department of Cardiology, Royal Children's Hospital, Melbourne, Australia.
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