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Sun S, Sun Y, Huang J, Zou P, Rao J, Xu W, Liu Q. The V-shaped double-layer patch technique for complete atrioventricular septal defect: A novel surgical technique. J Thorac Cardiovasc Surg 2023; 165:1237-1243. [PMID: 35933186 DOI: 10.1016/j.jtcvs.2022.04.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/14/2022] [Accepted: 04/28/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Several surgical techniques for repair of a complete atrioventricular septal defect have been developed. However, the postoperative complications with these methods may lead to reoperation during follow-up. The aim of this report is to share our experience with a modified surgical technique for complete atrioventricular septal defect that has anatomic advantages postoperatively and could reduce the reoperation rate. METHODS Twenty-nine patients who underwent repair of complete atrioventricular septal defect using a V-shaped double-layer patch between April 2011 and September 2019 were retrospectively investigated. RESULTS There were no deaths (0%) and only 1 reoperation (3.4%) in the series. The aortic crossclamp and cardiopulmonary bypass times were 62.7 ± 16.0 minutes and 113.9 ± 25.9 minutes, respectively. The median follow-up duration was 5.1 years. To date, no significant residual ventricular septal defects have been detected and no left ventricular outflow tract obstruction has been seen on echocardiography in any patient. During follow-up, the left atrioventricular valve status was assessed as no incompetence in 9 patients (31.0%), trivial in 18 patients (62.1%), and mild in 2 patients (6.9%). CONCLUSIONS The V-shaped double-layer patch technique is a valuable surgical option for patients with complete atrioventricular septal defects. The midterm results in our series document excellent performance of this technique, which augments the area of the anterior valve of the left atrioventricular valve to make it closer to a normal mitral valve and may also reduce the need for reoperation.
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Affiliation(s)
- Shanquan Sun
- Cardiac Center of Guangdong Women and Children Hospital, Guangzhou, Guangdong, P.R. China.
| | - Yangxue Sun
- Department of Pediatric Cardiac Surgery, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, P.R. China
| | - Jingsi Huang
- Cardiac Center of Guangdong Women and Children Hospital, Guangzhou, Guangdong, P.R. China
| | - Peng Zou
- Cardiac Center of Guangdong Women and Children Hospital, Guangzhou, Guangdong, P.R. China
| | - Jiao Rao
- Cardiac Center of Guangdong Women and Children Hospital, Guangzhou, Guangdong, P.R. China
| | - Weibin Xu
- Cardiac Center of Guangdong Women and Children Hospital, Guangzhou, Guangdong, P.R. China
| | - Qin Liu
- Cardiac Center of Guangdong Women and Children Hospital, Guangzhou, Guangdong, P.R. China
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2
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Ohuchi H, Kawata M, Uemura H, Akagi T, Yao A, Senzaki H, Kasahara S, Ichikawa H, Motoki H, Syoda M, Sugiyama H, Tsutsui H, Inai K, Suzuki T, Sakamoto K, Tatebe S, Ishizu T, Shiina Y, Tateno S, Miyazaki A, Toh N, Sakamoto I, Izumi C, Mizuno Y, Kato A, Sagawa K, Ochiai R, Ichida F, Kimura T, Matsuda H, Niwa K. JCS 2022 Guideline on Management and Re-Interventional Therapy in Patients With Congenital Heart Disease Long-Term After Initial Repair. Circ J 2022; 86:1591-1690. [DOI: 10.1253/circj.cj-22-0134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hideo Ohuchi
- Department of Pediatric Cardiology and Adult Congenital Heart Disease, National Cerebral and Cardiovascular Center
| | - Masaaki Kawata
- Division of Pediatric and Congenital Cardiovascular Surgery, Jichi Children’s Medical Center Tochigi
| | - Hideki Uemura
- Congenital Heart Disease Center, Nara Medical University
| | - Teiji Akagi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences
| | - Atsushi Yao
- Division for Health Service Promotion, University of Tokyo
| | - Hideaki Senzaki
- Department of Pediatrics, International University of Health and Welfare
| | - Shingo Kasahara
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences
| | - Hajime Ichikawa
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Hirohiko Motoki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Morio Syoda
- Department of Cardiology, Tokyo Women’s Medical University
| | - Hisashi Sugiyama
- Department of Pediatric Cardiology, Seirei Hamamatsu General Hospital
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | - Kei Inai
- Department of Pediatric Cardiology and Adult Congenital Cardiology, Tokyo Women’s Medical University
| | - Takaaki Suzuki
- Department of Pediatric Cardiac Surgery, Saitama Medical University
| | | | - Syunsuke Tatebe
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Tomoko Ishizu
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba
| | - Yumi Shiina
- Cardiovascular Center, St. Luke’s International Hospital
| | - Shigeru Tateno
- Department of Pediatrics, Chiba Kaihin Municipal Hospital
| | - Aya Miyazaki
- Division of Congenital Heart Disease, Department of Transition Medicine, Shizuoka General Hospital
| | - Norihisa Toh
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences
| | - Ichiro Sakamoto
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yoshiko Mizuno
- Faculty of Nursing, Tokyo University of Information Sciences
| | - Atsuko Kato
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
| | - Koichi Sagawa
- Department of Pediatric Cardiology, Fukuoka Children’s Hospital
| | - Ryota Ochiai
- Department of Adult Nursing, Yokohama City University
| | - Fukiko Ichida
- Department of Pediatrics, International University of Health and Welfare
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | | | - Koichiro Niwa
- Department of Cardiology, St. Luke’s International Hospital
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Ivanov Y, Buratto E, Naimo P, Lui A, Hu T, d'Udekem Y, Brizard CP, Konstantinov IE. Incidence and management of the left ventricular outflow obstruction in patients with atrioventricular septal defects. Interact Cardiovasc Thorac Surg 2021; 34:604-610. [PMID: 34751750 PMCID: PMC8972236 DOI: 10.1093/icvts/ivab303] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 08/10/2021] [Accepted: 09/26/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Yaroslav Ivanov
- Cardiac Surgery Unit, The Royal Children's Hospital, Parkville, VIC, Australia
| | - Edward Buratto
- Cardiac Surgery Unit, The Royal Children's Hospital, Parkville, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Phillip Naimo
- Cardiac Surgery Unit, The Royal Children's Hospital, Parkville, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Adrienne Lui
- Cardiac Surgery Unit, The Royal Children's Hospital, Parkville, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Thomas Hu
- Cardiac Surgery Unit, The Royal Children's Hospital, Parkville, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Yves d'Udekem
- Cardiac Surgery Unit, The Royal Children's Hospital, Parkville, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Melbourne Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne, VIC, Australia
| | - Christian P Brizard
- Cardiac Surgery Unit, The Royal Children's Hospital, Parkville, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Igor E Konstantinov
- Cardiac Surgery Unit, The Royal Children's Hospital, Parkville, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Melbourne Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne, VIC, Australia
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4
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Buratto E, Lui A, Hu T, Naimo P, Ivanov Y, d'Udekem Y, Brizard CP, Konstantinov IE. Propensity score matched analysis of cleft closure in complete atrioventricular septal defect repair. Ann Thorac Surg 2021; 113:1553-1561. [PMID: 34487709 DOI: 10.1016/j.athoracsur.2021.07.096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 07/02/2021] [Accepted: 07/12/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Repair of complete atrioventricular septal defect (cAVSD) is achieved with low mortality. However, there is a high rate of reoperation on the left atrioventricular valve (LAVV), which is often attributed to non-closure of the cleft. Although non-closure of the cleft has been reported to be a risk factor for reoperation, no randomized-controlled or propensity-matched trials have ever been performed. We investigated the effect of cleft closure on outcomes following cAVSD repair. METHODS We reviewed 455 patients who underwent cAVSD repair between 1990 and 2019. To determine the effect of cleft closure, propensity score matching was performed on risk factors for reoperation following cAVSD repair. RESULTS Median age was 3.6 months (mean 9.6±20.4), median weight was 4.3 kg (mean 4.7±4.3kg) and 41.9% (191/455) were male. Early mortality was 2.9% (13/455), and survival was 89.8±1.9% at 20 years. Early reoperation was a risk factor for mortality (p=0.004). Freedom from reoperation was 72.5±4.0% at 20 years. Freedom from LAVV reoperation was 74.1±4.0% at 20 years. Preoperative severe LAVV regurgitation (p<0.001) and early postoperative moderate or greater LAVV regurgitation (p=0.007) were risk factors for reoperation, while trisomy 21 (p=0.03) and recent era of surgery (p=0.02) were protective. Propensity score matching yielded 106 pairs. There were no differences in long-term survival (p=0.71) or reoperation (p=0.26) between the two groups. CONCLUSIONS Repair of cAVSD can be achieved with low mortality and good long-term survival, however, the reoperation rate remains high. Similar freedom from reoperation can be achieved with or without closure of the LAVV cleft.
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Affiliation(s)
- Edward Buratto
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne; Department of Paediatrics, University of Melbourne, Melbourne; Heart Research Group, Murdoch Children's Research Institute, Melbourne
| | - Adrienne Lui
- Department of Paediatrics, University of Melbourne, Melbourne
| | - Thomas Hu
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne; Department of Paediatrics, University of Melbourne, Melbourne
| | - Phillip Naimo
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne; Department of Paediatrics, University of Melbourne, Melbourne; Heart Research Group, Murdoch Children's Research Institute, Melbourne
| | - Yaroslav Ivanov
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne; Department of Paediatrics, University of Melbourne, Melbourne
| | - Yves d'Udekem
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne; Department of Paediatrics, University of Melbourne, Melbourne; Heart Research Group, Murdoch Children's Research Institute, Melbourne; Melbourne Children's Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne
| | - Christian P Brizard
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne; Department of Paediatrics, University of Melbourne, Melbourne; Heart Research Group, Murdoch Children's Research Institute, Melbourne; Melbourne Children's Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne
| | - Igor E Konstantinov
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne; Department of Paediatrics, University of Melbourne, Melbourne; Heart Research Group, Murdoch Children's Research Institute, Melbourne; Melbourne Children's Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne.
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5
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Wang WT, Chen OD, Li X, Cen JZ, Wu JL, Ma QY, Jian XH. A Modified Technique for Valve Regurgitation after Partial Atrioventricular Septal Defect Repair. Ann Thorac Surg 2021; 113:e385-e387. [PMID: 34453925 DOI: 10.1016/j.athoracsur.2021.07.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/16/2021] [Accepted: 07/19/2021] [Indexed: 11/25/2022]
Abstract
Given its complex pathological anatomy, recurrent left atrioventricular valve regurgitation after partial atrioventricular septal defect repair remains a challenge for surgical correction. Here, we introduce a modified bridging technique by shortening the anteroposterior leaflet distance in selected patients with inadequate coaptation to compensate for the short leaflet height, specifically that of the anterior leaflet.
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Affiliation(s)
- Wei-Teng Wang
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ou-Di Chen
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xin Li
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jian-Zheng Cen
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jin-Lin Wu
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Qing-Yan Ma
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xu-Hua Jian
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
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6
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Kumar TKS. Commentary: Partial Atrioventricular Septal Defects in Adults: A Different Beast! Semin Thorac Cardiovasc Surg 2020; 33:479-480. [PMID: 33223154 DOI: 10.1053/j.semtcvs.2020.09.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 09/26/2020] [Indexed: 11/11/2022]
Affiliation(s)
- T K Susheel Kumar
- Division of Congenital Cardiothoracic Surgery, Hassenfeld Children's Hospital at NYU Langone Health, New York, New York.
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7
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Pontailler M, Haidar M, Méot M, Moreau de Bellaing A, Gaudin R, Houyel L, Metton O, Moceri P, Bonnet D, Vouhé P, Raisky O. Double orifice and atrioventricular septal defect: dealing with the zone of apposition†. Eur J Cardiothorac Surg 2020; 56:541-548. [PMID: 30897200 DOI: 10.1093/ejcts/ezz085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 01/13/2019] [Accepted: 01/30/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES A double orifice of the left atrioventricular valve (LAVV) associated with atrioventricular septal defects (AVSD) can significantly complicate surgical repair. This study reports our experience of AVSD repair over 3 decades, with special attention to the zone of apposition (ZoA) of the main orifice, and presents a technique of hemivalve pericardial extension in specific situations. METHODS We performed a retrospective study from 1987 to 2016 on 1067 patients with AVSD of whom 43 (4%) had a double orifice, plus 2 additional patients who required LAVV pericardial enlargement. Median age at repair was 1.3 years. Mean follow-up was 8.2 years (1 month-32 years). RESULTS Associated abnormalities of the LAVV subvalvular apparatus were found in 7 patients (5 parachute LAVV and 2 absence of LAVV subvalvular apparatus). ZoA was noted in 4 patients (9%): partially closed in 15 (35%) and completely closed in 24 (56%). Four patients required, either at first repair or secondarily, a hemivalve enlargement using a pericardial patch without closure of the ZoA. The early mortality rate was 7% (n = 3), all before 2000. Two patients had unbalanced ventricles and the third had a single papillary muscle. There were no late deaths. Six patients (14%) required 7 reoperations (3 early and 4 late reoperations) for LAVV regurgitation and/or dysfunction, of whom 4 (9%) required mechanical LAVV replacement (all before 2000). Freedom from late LAVV reoperation was 97% at 1 year, 94% at 5 years and 87% at 10, 20 and 30 years. Unbalanced ventricles (P = 0.045), subvalvular abnormalities (P = 0.0037) and grade >2 LAVV postoperative regurgitation (P = 0.017) were identified as risk factors for LAVV reoperations. Freedom from LAVV mechanical valve replacement was 95% at 1 year, 90% at 5 years and 85% at 10, 20 and 30 years. An anomalous LAVV subvalvular apparatus was identified as a risk factor for mechanical valve replacement (P = 0.010). None of the patients who underwent LAVV pericardial extension had significant LAVV regurgitation at the last follow-up examination. CONCLUSIONS Repair of AVSD and double orifice can be tricky. Preoperative LAVV regurgitation was not identified as an independent predictor of surgical outcome. LAVV hemivalve extension appears to be a useful and effective alternate surgical strategy when the ZoA cannot be closed.
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Affiliation(s)
- Margaux Pontailler
- Department of Pediatric Cardiac Surgery, Necker Sick Children Hospital-M3C, University Paris Descartes, Paris, France
| | - Moussa Haidar
- Department of Pediatric Cardiac Surgery, Necker Sick Children Hospital-M3C, University Paris Descartes, Paris, France
| | - Mathilde Méot
- Department of Pediatric Cardiology, Necker Sick Children Hospital-M3C, University Paris Descartes, Paris, France
| | - Anne Moreau de Bellaing
- Department of Pediatric Cardiology, Necker Sick Children Hospital-M3C, University Paris Descartes, Paris, France
| | - Régis Gaudin
- Department of Pediatric Cardiac Surgery, Necker Sick Children Hospital-M3C, University Paris Descartes, Paris, France
| | - Lucile Houyel
- Department of Pediatric Cardiology, Necker Sick Children Hospital-M3C, University Paris Descartes, Paris, France
| | - Olivier Metton
- Cardio-Pediatric and Congenital Medico-Surgical Department C, Cardiologic Hospital Louis Pradel, Lyon, France
| | - Pamela Moceri
- Department of Cardiology, Hôpital Pasteur, CHU de Nice, Nice, France
| | - Damien Bonnet
- Department of Pediatric Cardiology, Necker Sick Children Hospital-M3C, University Paris Descartes, Paris, France
| | - Pascal Vouhé
- Department of Pediatric Cardiac Surgery, Necker Sick Children Hospital-M3C, University Paris Descartes, Paris, France
| | - Olivier Raisky
- Department of Pediatric Cardiac Surgery, Necker Sick Children Hospital-M3C, University Paris Descartes, Paris, France
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Konstantinov IE, Buratto E. Repair of partial atrioventricular septal defects in infancy: a paradigm shift or a road block? Heart 2018; 104:1388-1389. [PMID: 29472292 DOI: 10.1136/heartjnl-2017-312817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Igor E Konstantinov
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Edward Buratto
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
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Buratto E, Ye XT, Bullock A, Kelly A, d'Udekem Y, Brizard CP, Konstantinov IE. Long-term outcomes of reoperations following repair of partial atrioventricular septal defect. Eur J Cardiothorac Surg 2016; 50:293-7. [DOI: 10.1093/ejcts/ezw018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 01/08/2016] [Indexed: 11/12/2022] Open
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