Routine leaflet augmentation of left atrioventricular valve in the repair of atrioventricular septal defect.

INTRODUCTION

A better understanding of the morphology of complete atrioventricular septal defects (CAVSD) has impacted on surgical techniques and results. On some occasions the leaflet tissue is deficient and repair becomes difficult which leads to atrioventricular valve (AVV) regurgitation following the surgical repair of the AVSD.

OBJECTIVES

This study was conducted to evaluate a modified technique in which two patches where used to close the complete atrioventricular septal defect (CAVSD) with augmentation of the left atrioventricular valve (AVV) with the ventricular septal defect (VSD) patch.

METHODS

The technique was performed on 105 infants with CAVSD at a mean age of 11.7 ± 23 months (median 5.7, range 1-135). Both superior and inferior bridging leaflets are divided routinely to expose the VSD. An autologous pericardial patch, sized precisely, is sutured to the ventricular septum. A 3-4 mm of extra patch is fashioned beyond the plane of the annulus and sutured to the divided leaflet of the left AVV. A second autologous pericardial atrial patch is attached to the body of the VSD patch at the plane of the annulus allowing 3-4 mm of the VSD patch to augment the left AV valve.

RESULTS

There was one early death among these infants. At early postoperative echo all infants had no significant residual lesions. The contribution of the patch-augmented left AV valve to competency is clearly seen by two-dimensional echocardiography. At a mean follow up of 27 ± 10 months there were two late deaths with normal last echocardiography. There were only two children who progressed to severe left AV valve regurgitation needing reoperations.

CONCLUSIONS

This modified technique yields good anatomical repair. Allowing reconstruction of both AV valves independent of the other and is in particular helpful in cases of deficient left AVV tissue.