The surgical management of total atrioventricular canal lesions.

Between 1969 and 1976 sixteen children have had surgery for total atrioventricular canal lesions at the Royal Children's Hospital, Melbourne. Twelve infants had palliative banding of the main pulmonary artery to control heart failure and prevent the development of pulmonary hypertension, with two hospital deaths (17%) and one late death. One other patient has been lost to follow-up and may also have died. Nine patients have undergone complete repair, with three hospital deaths (33%), and one later death at reoperation for residual mitral incompetence. Five of these had previously had banding of the main pulmonary artery, and the mortality has occurred exclusively in this group. The techniques of repair are discussed, and reasons advanced in favour of early primary repair of the defect in preference to palliative banding and later secondary repair.