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Fong LS, Betts K, Ayer J, Andrews D, Nicholson IA, Winlaw DS, Orr Y. Predictors of reoperation and mortality after complete atrioventricular septal defect repair. Eur J Cardiothorac Surg 2021; 61:45-53. [PMID: 34002204 DOI: 10.1093/ejcts/ezab221] [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: 07/31/2020] [Revised: 03/15/2021] [Accepted: 03/30/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Previous studies investigating risk factors associated with reoperation or mortality after repair of complete atrioventricular septal defect (CAVSD) often have not included sizeable cohorts undergoing modified single-patch repair. Both double patch and modified single-patch techniques have been widely used in Australia since the 1990s. Using a large multi-institutional cohort, we aimed to identify risk factors associated with reoperation or mortality following CAVSD repair. METHODS Between January 1990 and December 2015, a total of 829 patients underwent biventricular surgical repair of CAVSD in Australia at 4 centres. Patients with associated tetralogy of Fallot and other conotruncal abnormalities were excluded. Demographic details, postoperative outcomes including reoperation and survival, and associated risk factors were analysed. RESULTS Fifty-six patients (6.8%) required early reoperation (≤30 days) for significant left atrioventricular valve regurgitation or residual septal defects. Freedom from reoperation at 10, 15 and 20 years was 82.7%, 81.1% and 77%, respectively. Patients without Down syndrome and moderate left atrioventricular valve regurgitation on postoperative echocardiogram were found to be independent risk factors for reoperation. Operative mortality was 3.3%. Overall survival at 10, 15 and 20 years was 91.7%, 90.7% and 88.7%, respectively. Prior pulmonary artery banding was a predictor for mortality, while later surgical era (2010-2015) was associated with a reduction in mortality risk. CONCLUSIONS Improved survival in the contemporary era is in keeping with improvements in surgical management and higher rates of primary CAVSD repair over time. The presence of residual moderate left atrioventricular valve regurgitation on postoperative echocardiography is an important factor associated with reoperation and close surveillance is essential to allow timely reintervention. Primary CAVSD repair at age <3 months should be preferenced to palliation with pulmonary artery banding due to the association of pulmonary artery banding with mortality in the long-term.
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Affiliation(s)
- Laura S Fong
- The University of Sydney Children's Hospital Westmead Clinical School, Sydney, NSW, Australia.,Heart Centre for Children, Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Kim Betts
- School of Public Health, Curtin University, Perth, WA, Australia
| | - Julian Ayer
- The University of Sydney Children's Hospital Westmead Clinical School, Sydney, NSW, Australia.,Heart Centre for Children, Children's Hospital at Westmead, Sydney, NSW, Australia
| | - David Andrews
- Department of Cardiothoracic Surgery, The Perth Children's Hospital, Perth, WA, Australia
| | - Ian A Nicholson
- Heart Centre for Children, Children's Hospital at Westmead, Sydney, NSW, Australia
| | - David S Winlaw
- The University of Sydney Children's Hospital Westmead Clinical School, Sydney, NSW, Australia.,Heart Centre for Children, Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Yishay Orr
- The University of Sydney Children's Hospital Westmead Clinical School, Sydney, NSW, Australia.,Heart Centre for Children, Children's Hospital at Westmead, Sydney, NSW, Australia
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Delany DR, Gaydos SS, Romeo DA, Henderson HT, Fogg KL, McKeta AS, Kavarana MN, Costello JM. Down syndrome and congenital heart disease: perioperative planning and management. JOURNAL OF CONGENITAL CARDIOLOGY 2021. [PMCID: PMC8056195 DOI: 10.1186/s40949-021-00061-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Approximately 50% of newborns with Down syndrome have congenital heart disease. Non-cardiac comorbidities may also be present. Many of the principles and strategies of perioperative evaluation and management for patients with congenital heart disease apply to those with Down syndrome. Nevertheless, careful planning for cardiac surgery is required, evaluating for both cardiac and noncardiac disease, with careful consideration of the risk for pulmonary hypertension. In this manuscript, for children with Down syndrome and hemodynamically significant congenital heart disease, we will summarize the epidemiology of heart defects that warrant intervention. We will review perioperative planning for this unique population, including anesthetic considerations, common postoperative issues, nutritional strategies, and discharge planning. Special considerations for single ventricle palliation and heart transplantation evaluation will also be discussed. Overall, the risk of mortality with cardiac surgery in pediatric patients with Down syndrome is no more than the general population, except for those with functional single ventricle heart defects. Underlying comorbidities may contribute to postoperative complications and increased length of stay. A strong understanding of cardiac and non-cardiac considerations in children with Down syndrome will help clinicians optimize perioperative care and long-term outcomes.
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Huang SY, Chang CC, Lin CS, Yeh CC, Lin JA, Cherng YG, Chen TL, Liao CC. Adverse outcomes after major surgery in children with intellectual disability. Dev Med Child Neurol 2021; 63:211-217. [PMID: 33131081 DOI: 10.1111/dmcn.14715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2020] [Indexed: 11/28/2022]
Abstract
AIM To evaluate outcomes after major surgery in children and adolescents with intellectual disability. METHOD We used 2004 to 2013 claims data from Taiwan's National Health Insurance programme to conduct a nested cohort study, which included 220 292 surgical patients aged 6 to 17 years. A propensity score matching procedure was used to select 2173 children with intellectual disability and 21 730 children without intellectual disability for comparison. Logistic regression was used to calculate the adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of the postoperative complications and 30-day mortality associated with intellectual disability. RESULTS Children with intellectual disability had a higher risk of postoperative pneumonia (OR 2.16, 95% CI 1.48-3.15; p<0.001), sepsis (OR 1.67, 95% CI 1.28-2.18; p<0.001), and 30-day mortality (OR 2.04, 95% CI 1.05-3.93; p=0.013) compared with children without intellectual disability. Children with intellectual disability also had longer lengths of hospital stay (p<0.001) and higher medical expenditure (p<0.001) when compared with children with no intellectual disability. INTERPRETATION Children with intellectual disability experienced more complications and higher 30-day mortality after surgery when compared with children without intellectual disability. There is an urgent need to revise the protocols for the perioperative care of this specific population. WHAT THIS PAPER ADDS Surgical patients with intellectual disability are at increased risk of postoperative pneumonia, sepsis, and 30-day mortality. Intellectual disability is associated with higher medical expenditure and increased length of stay in hospital after surgical procedures. The influence of intellectual disability on postoperative outcomes is consistent in both sexes and those aged 10 to 17 years. Low income and a history of fractures significantly impacts postoperative adverse events for patients with intellectual disability.
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Affiliation(s)
- Shih-Yu Huang
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chuen-Chau Chang
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan.,Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chao-Shun Lin
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan.,Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chun-Chieh Yeh
- Department of Surgery, China Medical University Hospital, Taichung, Taiwan.,Department of Surgery, University of Illinois, Chicago, IL, USA
| | - Jui-An Lin
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Center of Regional Anesthesia and Pain Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yih-Giun Cherng
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ta-Liang Chen
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan.,Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chien-Chang Liao
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan.,Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan.,Center of Regional Anesthesia and Pain Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
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4
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de Menezes LDC, da Silva TD, Capelini CM, Tonks J, Watson S, de Moraes ÍAP, Malheiros SRP, Mustacchi Z, Monteiro CBDM. Can individuals with down syndrome improve their performance after practicing a game on a mobile phone?—A new insight study. LEARNING AND MOTIVATION 2020. [DOI: 10.1016/j.lmot.2020.101685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Mimmo L, Woolfenden S, Travaglia J, Harrison R. Creating equitable healthcare quality and safety for children with intellectual disability in hospital. Child Care Health Dev 2020; 46:644-649. [PMID: 32468634 PMCID: PMC7496444 DOI: 10.1111/cch.12787] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/25/2020] [Accepted: 04/02/2020] [Indexed: 11/26/2022]
Abstract
Children with intellectual disability are susceptible to poor experiences of care and treatment outcomes, and this may compound existing health inequities. Evidence to date indicates three priority areas that must be addressed in order to reduce these inequities in the safety and quality of care for children with intellectual disability. Firstly, we need reliable methods to identify children with intellectual disability so that healthcare organizations understand their needs. Secondly, we need to develop quality metrics that can assess care quality and unwarranted care variation for children with intellectual disability in hospital. Finally, for a comprehensive understanding of the safety and quality of care for these children, and how to improve, it is critical that healthcare organizations partner with parents/carers and enable children with intellectual disability to voice their experiences of care. Children with intellectual disability have higher healthcare utilization than their peers; yet, their voice is rarely sought to optimize the safety and quality of their healthcare experience. Patient experience narratives enhance our understanding of the genesis of adverse events. By addressing these priorities, children with intellectual disability will be identified, and health services will measure and understand the problematic and beneficial variations in care delivery and can then effectively partner with children and their parents/carers to address the inequities in care quality and create safer healthcare.
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Affiliation(s)
- Laurel Mimmo
- Health Management, School of Public Health and Community Medicine, Faculty of MedicineUniversity of New South WalesSydneyNew South WalesAustralia,Clinical Governance UnitSydney Children's Hospitals NetworkSydneyNew South WalesAustralia
| | - Susan Woolfenden
- School of Women’s and Children’s Health, Faculty of MedicineUniversity of New South WalesSydneyNew South WalesAustralia,Community Child HealthSydney Children's HospitalRandwickNew South WalesAustralia
| | - Joanne Travaglia
- Health Services Management, Centre for Health Services Management, Faculty of HealthUniversity of Technology SydneySydneyNew South WalesAustralia
| | - Reema Harrison
- Health Management, School of Public Health and Community Medicine, Faculty of MedicineUniversity of New South WalesSydneyNew South WalesAustralia
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6
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Bartz-Kurycki MA, Anderson KT, Austin MT, Kao LS, Tsao K, Lally KP, Kawaguchi AL. Increased complications in pediatric surgery are associated with comorbidities and not with Down syndrome itself. J Surg Res 2018; 230:125-130. [DOI: 10.1016/j.jss.2018.04.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 03/02/2018] [Accepted: 04/03/2018] [Indexed: 10/16/2022]
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Abstract
OBJECTIVES To assess if morphine pharmacokinetics are different in children with Down syndrome when compared with children without Down syndrome. DESIGN Prospective single-center study including subjects with Down syndrome undergoing cardiac surgery (neonate to 18 yr old) matched by age and cardiac lesion with non-Down syndrome controls. Subjects were placed on a postoperative morphine infusion that was adjusted as clinically necessary, and blood was sampled to measure morphine and its metabolites concentrations. Morphine bolus dosing was used as needed, and total dose was tracked. Infusions were continued for 24 hours or until patients were extubated, whichever came first. Postinfusion, blood samples were continued for 24 hours for further evaluation of kinetics. If patients continued to require opioid, a nonmorphine alternative was used. Morphine concentrations were determined using a unique validated liquid chromatography tandem-mass spectrometry assay using dried blood spotting as opposed to large whole blood samples. Morphine concentration versus time data was modeled using population pharmacokinetics. SETTING A 16-bed cardiac ICU at an university-affiliated hospital. PATIENTS Forty-two patients (20 Down syndrome, 22 controls) were enrolled. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The pharmacokinetics of morphine in pediatric patients with and without Down syndrome following cardiac surgery were analyzed. No significant difference was found in the patient characteristics or variables assessed including morphine total dose or time on infusion. Time mechanically ventilated was longer in children with Down syndrome, and regarding morphine pharmacokinetics, the covariates analyzed were age, weight, presence of Down syndrome, and gender. Only age was found to be significant. CONCLUSIONS This study did not detect a significant difference in morphine pharmacokinetics between Down syndrome and non-Down syndrome children with congenital heart disease.
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8
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Rao PS, Harris AD. Recent advances in managing septal defects: ventricular septal defects and atrioventricular septal defects. F1000Res 2018; 7. [PMID: 29770201 PMCID: PMC5931264 DOI: 10.12688/f1000research.14102.1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/20/2018] [Indexed: 12/18/2022] Open
Abstract
This review discusses the management of ventricular septal defects (VSDs) and atrioventricular septal defects (AVSDs). There are several types of VSDs: perimembranous, supracristal, atrioventricular septal, and muscular. The indications for closure are moderate to large VSDs with enlarged left atrium and left ventricle or elevated pulmonary artery pressure (or both) and a pulmonary-to-systemic flow ratio greater than 2:1. Surgical closure is recommended for large perimembranous VSDs, supracristal VSDs, and VSDs with aortic valve prolapse. Large muscular VSDs may be closed by percutaneous techniques. A large number of devices have been used in the past for VSD occlusion, but currently Amplatzer Muscular VSD Occluder is the only device approved by the US Food and Drug Administration for clinical use. A hybrid approach may be used for large muscular VSDs in small babies. Timely intervention to prevent pulmonary vascular obstructive disease (PVOD) is germane in the management of these babies. There are several types of AVSDs: partial, transitional, intermediate, and complete. Complete AVSDs are also classified as balanced and unbalanced. All intermediate and complete balanced AVSDs require surgical correction, and early repair is needed to prevent the onset of PVOD. Surgical correction with closure of atrial septal defect and VSD, along with repair and reconstruction of atrioventricular valves, is recommended. Palliative pulmonary artery banding may be considered in babies weighing less than 5 kg and those with significant co-morbidities. The management of unbalanced AVSDs is more complex, and staged single-ventricle palliation is the common management strategy. However, recent data suggest that achieving two-ventricle repair may be a better option in patients with suitable anatomy, particularly in patients in whom outcomes of single-ventricle palliation are less than optimal. The majority of treatment modes in the management of VSDs and AVSDs are safe and effective and prevent the development of PVOD and cardiac dysfunction.
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Affiliation(s)
- P Syamasundar Rao
- University of Texas-Houston McGovern Medical School, Children Memorial Hermann Hospital, Houston, USA
| | - Andrea D Harris
- Pediatrix Cardiology Associates of New Mexico, Albuquerque, USA
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Kharbanda RK, Blom NA, Hazekamp MG, Yildiz P, Mulder BJ, Wolterbeek R, Weijerman ME, Schalij MJ, Jongbloed MR, Roest AA. Incidence and risk factors of post-operative arrhythmias and sudden cardiac death after atrioventricular septal defect (AVSD) correction: Up to 47 years of follow-up. Int J Cardiol 2018; 252:88-93. [DOI: 10.1016/j.ijcard.2017.09.209] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 08/30/2017] [Accepted: 09/28/2017] [Indexed: 12/01/2022]
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10
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Drago F. Postoperative arrhythmias after AVSD repair: The lack of regular periodic rhythm surveillance allows you to see only the tip of the iceberg. Int J Cardiol 2018; 252:94-95. [PMID: 29249443 DOI: 10.1016/j.ijcard.2017.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 11/03/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Fabrizio Drago
- Pediatric Cardiology and Cardiac Atthythmias Complex Unit, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy
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11
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Mimmo L, Harrison R, Hinchcliff R. Patient safety vulnerabilities for children with intellectual disability in hospital: a systematic review and narrative synthesis. BMJ Paediatr Open 2018; 2:e000201. [PMID: 29637187 PMCID: PMC5843001 DOI: 10.1136/bmjpo-2017-000201] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 11/20/2017] [Accepted: 01/06/2018] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Adults and children with intellectual disability (ID) are vulnerable to preventable morbidity and mortality due to poor quality healthcare. While poor quality care has been commonly identified among children with ID, evidence of the patient safety outcomes for this group is lacking and therefore explored in this review. DATA SOURCES Systematic searches of six electronic bibliographic research databases were undertaken from January 2000 to October 2017, in addition to hand searching. STUDY SELECTION Keywords, subject headings and MeSH terms relating to the experience of iatrogenic harm during hospitalisation for children with ID were used. Potentially relevant articles were screened against the eligibility criteria. Non-English language papers were excluded. DATA EXTRACTION Data regarding: author(s), publication year, country, sample, health service setting, study design, primary focus and main findings related to measures of quality and safety performance were extracted. RESULTS OF DATA SYNTHESIS Sixteen studies met the inclusion criteria, with three themes emerging: the impact of the assumptions of healthcare workers (HCWs) about the child with ID on care quality and associated safety outcomes; reliance on parental presence during hospitalisation as a protective factor; and the need for HCWs to possess comprehensive understanding of the IDs experienced by children in their care, to scientifically deduce how hospitalisation may compromise their safety, care quality and treatment outcomes. CONCLUSION When HCWs understand and are responsive to children's individual needs and their ID, they are better placed to adjust care delivery processes to improve care quality and safety during hospitalisation for children with ID.
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Affiliation(s)
- Laurel Mimmo
- Clinical Governance Unit, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Reema Harrison
- School of Public Health and Community Medicine, Faculty of Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Reece Hinchcliff
- Centre for Health Services Research, University of Technology Sydney, Ultimo, New South Wales, Australia
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12
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Atrioventricular septal defect: From embryonic development to long-term follow-up. Int J Cardiol 2016; 202:784-95. [DOI: 10.1016/j.ijcard.2015.09.081] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 07/28/2015] [Accepted: 09/23/2015] [Indexed: 11/18/2022]
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Abstract
CHD is frequently associated with a genetic syndrome. These syndromes often present specific cardiovascular and non-cardiovascular co-morbidities that confer significant peri-operative risks affecting multiple organ systems. Although surgical outcomes have improved over time, these co-morbidities continue to contribute substantially to poor peri-operative mortality and morbidity outcomes. Peri-operative morbidity may have long-standing ramifications on neurodevelopment and overall health. Recognising the cardiovascular and non-cardiovascular risks associated with specific syndromic diagnoses will facilitate expectant management, early detection of clinical problems, and improved outcomes--for example, the development of syndrome-based protocols for peri-operative evaluation and prophylactic actions may improve outcomes for the more frequently encountered syndromes such as 22q11 deletion syndrome.
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14
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Kozak MF, Kozak ACLFBM, Marchi CHD, Sobrinho Junior SH, Croti UA, Moscardini AC. Factors associated with moderate or severe left atrioventricular valve regurgitation within 30 days of repair of complete atrioventricular septal defect. Braz J Cardiovasc Surg 2015; 30:304-10. [PMID: 26313720 PMCID: PMC4541776 DOI: 10.5935/1678-9741.20150036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 05/25/2015] [Indexed: 11/20/2022] Open
Abstract
Introduction Left atrioventricular valve regurgitation is the most concerning residual lesion
after surgical correction of atrioventricular septal defects. Objective To determine factors associated with moderate or severe left atrioventricular
valve regurgitation within 30 days of surgical repair of complete atrioventricular
septal defect. Methods We assessed the results of 53 consecutive patients 3 years-old and younger
presenting with complete atrioventricular septal defect that were operated on at
our practice between 2002 and 2010. The following variables were considered: age,
weight, absence of Down syndrome, grade of preoperative atrioventricular valve
regurgitation, abnormalities on the left atrioventricular valve and the use of
annuloplasty. Median age was 6.7 months; median weight was 5.3 Kg; 86.8% had Down
syndrome. At the time of preoperative evaluation, there were 26 cases with
moderate or severe left atrioventricular valve regurgitation (49.1%).
Abnormalities on the left atrioventricular valve were found in 11.3%; annuloplasty
was performed in 34% of the patients. Results At the time of postoperative evaluation, there were 21 cases with moderate or
severe left atrioventricular valve regurgitation (39.6%). After performing a
multivariate analysis, the only significant factor associated with moderate or
severe left atrioventricular valve regurgitation was the absence of Down syndrome
(P=0.03). Conclusion Absence of Down syndrome was associated with moderate or severe postoperative left
atrioventricular valve regurgitation after surgical repair of complete
atrioventricular septal defect at our practice.
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Affiliation(s)
- Marcelo Felipe Kozak
- Department of Pediatrics and Pediatric Surgery, Hospital de Base, São José do Rio Preto Medical School, São José do Rio Preto, SP, BR
| | | | - Carlos Henrique De Marchi
- Department of Pediatrics and Pediatric Surgery, Hospital de Base, São José do Rio Preto Medical School, São José do Rio Preto, SP, BR
| | - Sirio Hassem Sobrinho Junior
- Department of Cardiology, Hospital de Base, Hospital de Base, São José do Rio Preto Medical School, São José do Rio Preto, SP, BR
| | - Ulisses Alexandre Croti
- Department of Pediatrics and Pediatric Surgery, Hospital de Base, São José do Rio Preto Medical School, São José do Rio Preto, SP, BR
| | - Airton Camacho Moscardini
- Department of Pediatrics and Pediatric Surgery, Hospital de Base, São José do Rio Preto Medical School, São José do Rio Preto, SP, BR
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