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Aly S, Qattea I, Othman H, Nguyen HH, Aly HZ. Outcomes of atrioventricular septal defects with and without down syndrome: analysis of the national inpatient database. Cardiol Young 2024; 34:614-623. [PMID: 37667895 DOI: 10.1017/s1047951123003116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
BACKGROUND Controversial data exist about the impact of Down syndrome on outcomes after surgical repair of atrioventricular septal defect. AIMS (A) assess trends and outcomes of atrioventricular septal defect with and without Down syndrome and (B) determine risk factors associated with adverse outcomes after atrioventricular septal defect repair. METHODS We queried The National Inpatient Sample using International Classification of Disease codes for patients with atrioventricular septal defect < 1 year of age from 2000 to 2018. Patients' characteristics, co-morbidities, mortality, and healthcare utilisation were evaluated by comparing those with versus without Down syndrome. RESULTS In total, 2,318,706 patients with CHD were examined; of them, 61,101 (2.6%) had atrioventricular septal defect. The incidence of hospitalisation in infants with atrioventricular septal defect ranged from 4.5 to 7.5% of all infants hospitalised with CHD per year. A total of 33,453 (54.7%) patients were associated with Down syndrome. Double outlet right ventricle, coarctation of the aorta, and tetralogy of Fallot were the most commonly associated with CHD in 6.9, 5.7, and 4.3% of patients, respectively. Overall atrioventricular septal defect mortality was 6.3%. Multivariate analysis revealed that prematurity, low birth weight, pulmonary hypertension, and heart block were associated with mortality. Down syndrome was associated with a higher incidence of pulmonary hypertension (4.3 versus 2.8%, p < 0.001), less arrhythmia (6.6 versus 11.2%, p < 0.001), shorter duration for mechanical ventilation, shorter hospital stay, and less perioperative mortality (2.4 versus 11.1%, p < 0.001). CONCLUSION Trends in atrioventricular septal defect hospitalisation had been stable over time. Perioperative mortality in atrioventricular septal defect was associated with prematurity, low birth weight, pulmonary hypertension, heart block, acute kidney injury, and septicaemia. Down syndrome was present in more than half of atrioventricular septal defect patients and was associated with a higher incidence of pulmonary hypertension but less arrhythmia, lower mortality, shorter hospital stay, and less resource utilisation.
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Affiliation(s)
- Safwat Aly
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Ibrahim Qattea
- Department of Neonatology, Cleveland Clinic Children's, Cleveland, OH, USA
| | - Hasan Othman
- Department of Neonatology, Cleveland Clinic Children's, Cleveland, OH, USA
| | - Hoang H Nguyen
- Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, USA
| | - Hany Z Aly
- Department of Neonatology, Cleveland Clinic Children's, Cleveland, OH, USA
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Krishna MR, Raju V, Anderson RH. Atrioventricular Septal Defect With Tetralogy of Fallot and Exclusive Shunting at the Ventricular Level. World J Pediatr Congenit Heart Surg 2024; 15:126-127. [PMID: 37713667 DOI: 10.1177/21501351231189271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
Atrioventricular septal defect (AVSD) with shunting restricted to the ventricular level is a rare form of AVSD. To our knowledge, this shunting pattern has not been reported in AVSD with tetralogy of Fallot. We report a child with this unusual combination who underwent a successful single-stage repair at two years of age.
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Affiliation(s)
- Mani Ram Krishna
- Department of Pediatric Cardiology, Tiny Hearts Fetal and Pediatric Cardiac Clinic, Thanjavur, India
| | - Vijaykumar Raju
- Department of Cardiovascular and Thoracic Surgery, GKNM Hospital, Coimbatore, India
| | - Robert H Anderson
- Institute of Genetic Medicine, Newcastle University, Newcastle Upon Tyne, UK
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3
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Mayr B, Burri M, Strbad M, Cleuziou J, Hager A, Ewert P, Hörer J, Lange R, Ono M. Common atrioventricular valve surgery in children with functional single ventricle. Eur J Cardiothorac Surg 2021; 60:1419-1427. [PMID: 34008032 DOI: 10.1093/ejcts/ezab220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 03/11/2021] [Accepted: 03/24/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES A common atrioventricular valve (CAVV) is considered to be a risk factor for early and late deaths in patients with functional single ventricle (FSV). CAVV surgery in patients with FSV is challenging and there is limited knowledge of the outcomes of CAVV repair with univentricular physiology. METHODS We reviewed all CAVV surgical procedures in patients with FSV who underwent univentricular palliation. End points of the study were survival after CAVV surgery and cumulative incidence of reoperation. RESULTS Between 1984 and 2019, 66 children with CAVV and FSV underwent single-ventricle palliation, of whom 45.5% (30/66) required CAVV surgery. Indication for surgery was moderate CAVV regurgitation in 40% (12/30) and severe CAVV regurgitation in 60% (18/30). CAVV repair was performed in 93.3% (28/30) and CAVV replacement in 6.7% (2/30). The median age and weight at surgery were 0.9 years (interquartile range 0.3-1.8) and 6.5 kg (interquartile range 3.9-8.7), respectively. Operative and late mortality were 23.3% and 8.7%, respectively. Survival and cumulative incidence of reoperation at 4 years after CAVV surgery were 68.9% [standard deviation (SD): 8.7] and 35.8% (SD: 9.1), respectively. Fontan completion was achieved in 60% (18/30). Survival at 4 years after birth was 69.7% (SD: 8.5) in 30 patients with CAVV surgery, whereas it was 83% (SD: 6.3) in 36 patients without CAVV surgery (P = 0.32). CONCLUSIONS CAVV surgery in patients with FSV is associated with substantial mortality and a high incidence of reoperation.
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Affiliation(s)
- Benedikt Mayr
- Department of Cardiovascular Surgery, German Heart Center Munich at the Technical University of Munich, Munich, Germany.,Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Insure (Institute for Translational Cardiac Surgery), Munich, Germany
| | - Melchior Burri
- Department of Cardiovascular Surgery, German Heart Center Munich at the Technical University of Munich, Munich, Germany.,Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Insure (Institute for Translational Cardiac Surgery), Munich, Germany
| | - Martina Strbad
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Insure (Institute for Translational Cardiac Surgery), Munich, Germany.,Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany.,Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany
| | - Julie Cleuziou
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Insure (Institute for Translational Cardiac Surgery), Munich, Germany.,Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany.,Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany
| | - Alfred Hager
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich at the Technical University of Munich, Munich, Germany
| | - Peter Ewert
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich at the Technical University of Munich, Munich, Germany
| | - Jürgen Hörer
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Insure (Institute for Translational Cardiac Surgery), Munich, Germany.,Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany.,Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany
| | - Rüdiger Lange
- Department of Cardiovascular Surgery, German Heart Center Munich at the Technical University of Munich, Munich, Germany.,Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Insure (Institute for Translational Cardiac Surgery), Munich, Germany.,DZHK (German Center for Cardiovascular Research) - partner site Munich Heart Alliance, Munich, Germany
| | - Masamichi Ono
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Insure (Institute for Translational Cardiac Surgery), Munich, Germany.,Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany.,Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany
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Hofbeck M, Wiegand G, Michel J, Schlensak C. Ventriculoatrial malalignment in atrioventricular septal defect resulting in uniatrial biventricular connection: surgical options. J Cardiothorac Surg 2020; 15:59. [PMID: 32295626 PMCID: PMC7161119 DOI: 10.1186/s13019-020-01099-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 03/25/2020] [Indexed: 11/25/2022] Open
Abstract
Background Uniatrial biventricular connection (UBC) is a rare cardiovascular anomaly characterized by absence of one atrioventricular connection and drainage of the other atrium via a solitary atrioventricular valve into both ventricles. The absent atrioventricular connection may affect either the left or right atrium. Because of the absence of one atrioventricular connection hearts with UBC have been classified among functionally univentricular hearts requiring palliative treatment according to the Fontan principle. Aims/objective We report two further patients with UBC. In one of these patients careful echocardiographic examination of the atrioventricular junction in early infancy revealed the possibility of biventricular repair based on the favorable anatomy of the atrioventricular valve and balanced ventricles in the presence of an inlet ventricular septal defect (VSD). Case presentations Both patients presented in the neonatal period for evaluation of complex congenital heart disease. The anatomy of the atrioventricular valves in our patients was indistinguishable from atrioventricular septal defects exhibiting the morphology of a common valve with superior and inferior bridging leaflets. The common atrioventricular valve was connected exclusively to the right atrium draining into both ventricles while the left atrium drained into the right atrium via a secundum atrial septal defect. In one of our patients biventricular repair with good longterm-result was performed by reseptation of the atria, patch repair of the VSD and septation of the atrioventricular valve. The second patient underwent univentricular palliation according to the Fontan principle. Discussion/conclusion The echocardiographic findings in our patients suggest that at least some patients with UBC represent a variant of atrioventricular septal defects associated with extreme ventriculoatrial malalignment resulting in fusion of the deviated primary atrial septum with the lateral aspect of the atrioventricular junction. This offers the option of septation of the common atrioventricular valve and biventricular repair in patients with adequate size of both ventricles. Exact echocardiographic analysis of the morphology of the atrioventricular valve is essential to distinguish these patients with a morphologically common atrioventricular valve in early infancy from other variants of absent atrioventricular connection and to select those who are suitable for biventricular repair.
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Affiliation(s)
- Michael Hofbeck
- Department of Paediatric Cardiology, University Children's Hospital, Hoppe-Seyler-Str. 1, 72076, Tuebingen, Germany.
| | - Gesa Wiegand
- Department of Paediatric Cardiology, University Children's Hospital, Hoppe-Seyler-Str. 1, 72076, Tuebingen, Germany
| | - Jörg Michel
- Department of Paediatric Cardiology, University Children's Hospital, Hoppe-Seyler-Str. 1, 72076, Tuebingen, Germany
| | - Christian Schlensak
- Department of Thoracic and Cardiovascular Surgery, University Hospital, Hoppe-Seyler-Str. 1, 72076, Tuebingen, Germany
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He F, Jiao Y, Ma K, Hua Z, Zhang H, Yan J, Yang K, Pang K, Zhang S, Qi L, Wang G, Feng Z, Li S. Outcomes of Common Atrioventricular Valve Repair in Patients With Single-Ventricle Physiology - Indication, Timing and Repair Techniques. Circ J 2019; 83:647-653. [PMID: 30745490 DOI: 10.1253/circj.cj-18-0916] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Common atrioventricular valve (CAVV) repair in patients with a single ventricle remains a great challenge and a refractory issue for pediatric cardiac surgeons. Methods and Results: From January 2007 to April 2018, 37 consecutive patients with a single ventricle who underwent CAVV repair were included in the study group. Patients were divided into 2 groups based on the repair technique: patients in Group A were treated using the bivalvation technique, and patients in Group B underwent conventional repair techniques; baseline data were similar between groups. The inhospital and follow-up mortality were 5.4% (2/37) and 11.4% (4/35), respectively. After a follow-up of 65.5±29.3 months, the estimated 1-, 5-, and 10-year overall survival rates were 94.6%, 83.4%, and 77.0%, respectively. The rates of freedom from CAVV failure were 94.3%, 72.7%, and 62.9% after 1, 5, and 10 years, respectively. In the multivariate analysis, the independent factors for CAVV repair failure were repair technique (P=0.004) and heterotaxy syndrome (P=0.003). A total of 30 patients (81.1%) completed total cavopulmonary connection (TCPC); 3 patients required re-intervention; 24 of 31 patients (77.4%) were in New York Heart Association classes II and I at the latest follow-up. CONCLUSIONS Outcomes of CAVV repair in patients palliated by single-ventricular surgery are acceptable. The bivalvation technique is a simple and effective technique.
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Affiliation(s)
- Fengpu He
- Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College
| | - Yiping Jiao
- Psychological Teaching and Research Department, Hangzhou Armed Police Officer School
| | - Kai Ma
- Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College
| | - Zhongdong Hua
- Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College
| | - Hao Zhang
- Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College
| | - Jun Yan
- Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College
| | - Keming Yang
- Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College
| | - Kunjing Pang
- Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College
| | - Sen Zhang
- Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College
| | - Lei Qi
- Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College
| | - Guanxi Wang
- Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College
| | - Zicong Feng
- Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College
| | - Shoujun Li
- Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College
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Jacobs JP, Tchervenkov CI, Stellin G, Kurosawa H, Mavroudis C, Jatene MB, Al-Halees Z, Cicek SM, Sandoval NF, Backer CL, Cervantes J, Dearani JA, Ebels T, Edwin F, Finucane K, Fragata J, Iyer KS, Kinsley RH, Kirklin JK, Kreutzer C, Liu J, Maruszewski B, St Louis JD, Sarris GE, Jonas RA. History of the World Society for Pediatric and Congenital Heart Surgery: The First Decade. World J Pediatr Congenit Heart Surg 2018; 9:392-406. [PMID: 29945512 DOI: 10.1177/2150135118775962] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The World Society for Pediatric and Congenital Heart Surgery (WSPCHS) is the largest professional organization in the world dedicated to pediatric and congenital heart surgery. The purpose of this article is to document the first decade of the history of WSPCHS from its formation in 2006, to summarize the current status of WSPCHS, and to consider the future of WSPCHS. The WSPCHS was incorporated in Canada on April 7, 2011, with a head office in Montreal, Canada. The vision of the WSPCHS is that every child born anywhere in the world with a congenital heart defect should have access to appropriate medical and surgical care. The mission of the WSPCHS is to promote the highest quality comprehensive cardiac care to all patients with congenital heart disease, from the fetus to the adult, regardless of the patient's economic means, with an emphasis on excellence in teaching, research, and community service.
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Affiliation(s)
- Jeffrey P Jacobs
- 1 Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,2 Division of Cardiovascular Surgery, Department of Surgery, Johns Hopkins All Children's Heart Institute, Johns Hopkins All Children's Hospital and Florida Hospital for Children, St Petersburg, Tampa, and Orlando, FL, USA
| | - Christo I Tchervenkov
- 3 Division of Pediatric Cardiovascular Surgery, The Montreal Children's Hospital of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Giovanni Stellin
- 4 Pediatric and Congenital Cardiac Surgical Unit, University of Padova Medical School, Padova, Italy
| | - Hiromi Kurosawa
- 5 Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan
| | - Constantine Mavroudis
- 1 Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,2 Division of Cardiovascular Surgery, Department of Surgery, Johns Hopkins All Children's Heart Institute, Johns Hopkins All Children's Hospital and Florida Hospital for Children, St Petersburg, Tampa, and Orlando, FL, USA
| | - Marcelo B Jatene
- 6 Department of Pediatric Cardiac Surgery and Pediatric Cardiology, Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
| | - Zohair Al-Halees
- 7 Heart Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Sertac M Cicek
- 8 Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Nestor F Sandoval
- 9 Instituto de Cardiopatías Congénitas, Fundación Cardioinfantil-IC, Universidad del Rosario, Bogota, Colombia
| | - Carl L Backer
- 10 Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, CA, USA
| | - Jorge Cervantes
- 11 Department of Cardiac Surgery and Congenital Heart Diseases, Instituto Nacional de Cardiologıa "Ignacio Chavez" (National Institute of Cardiology "Ignacio Chavez"), Mexico City, Mexico
| | | | - Tjark Ebels
- 13 Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Frank Edwin
- 14 National Cardiothoracic Center, Korle Bu Teaching Hospital, Accra, Ghana.,15 Department of Surgery, University of Health and Allied Sciences, Ho, Ghana
| | - Kirsten Finucane
- 16 Green Lane Paediatric and Congenital Cardiac Services, Starship Children's Hospital, Auckland, New Zealand
| | - Jose Fragata
- 17 Hospital de Santa Marta, NOVA Medical School, Lisbon, Portugal
| | - Krishna S Iyer
- 18 Fortis Escorts Heart Institute and Research Centre, New Delhi, Delhi, India
| | - Robin H Kinsley
- 19 The Paediatric Cardiac Centre for Africa, Sunninghill Hospital, Johannesburg, South Africa
| | | | - Christian Kreutzer
- 21 Division of Congenital Heart Surgery, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Jinfen Liu
- 22 Department of Pediatric Thoracic and Cardiovascular Surgery, Xinhua Hospital, Shanghai Children's Medical Center, Shanghai Second Medical University, Shanghai, China
| | - Bohdan Maruszewski
- 23 Department of Pediatric and Congenital Heart Surgery, Children's Memorial Health Institute, Warsaw, Poland
| | - James D St Louis
- 24 Department of Surgery, University of Missouri-Kansas City School of Medicine, Kansas City, MI, USA
| | - George E Sarris
- 25 Athens Heart Surgery Institute and Department of Pediatric, Congenital Heart Surgery at IASO Children's Hospital, Athens, Greece
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Hosny H, AbdelSalam S, Wally H, Yacoub M. Double outlet right atrium with three atrioventricular valves. Glob Cardiol Sci Pract 2014; 2014:117-22. [PMID: 25419523 PMCID: PMC4220441 DOI: 10.5339/gcsp.2014.32] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 06/30/2014] [Indexed: 11/03/2022] Open
Abstract
The atrioventricular (AV) valves are complex anatomical structures which perform sophisticated functions.(1) A wide spectrum of malformations of these valves can occur in patients with AV septal defects. We here describe the anatomic and functional abnormalities of a rare form of the disease, where two valves connected the right atrium to both the right and left ventricles, in addition to a third valve that connected the left atrium to the left ventricle, with no evidence of regurgitation or cyanosis in spite of the relatively large communication between the right atrium and the left ventricle. In addition, the patient had severe subaortic stenosis. The pathophysiology, hemodynamics and method of repair of the condition are discussed.
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Misumi Y, Hoashi T, Kagisaki K, Kitano M, Kurosaki K, Shiraishi I, Yagihara T, Ichikawa H. Long-term outcomes of common atrioventricular valve plasty in patients with functional single ventricle. Interact Cardiovasc Thorac Surg 2013; 18:259-65. [PMID: 24336698 DOI: 10.1093/icvts/ivt508] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Common atrioventricular valve (CAVV) regurgitation is widely known as a risk factor for mortality and Fontan completion in patients with functional single ventricle. Hence, we reviewed our surgical experience with CAVV plasty in Fontan candidates. METHODS Staged Fontan strategy and extracardiac total cavopulmonary connection as Fontan modification were our principal approaches in 1995. Since then, 38 consecutive Fontan candidates (21 males, median weight at operation was 7.0 kg and median age was 17 months old) underwent CAVV plasty. Right atrial isomerism was associated with 24 patients. The initial CAVV plasty was performed before inter-stage bidirectional Glenn (BDG) in 3 patients, at BDG in 23, before Fontan in 4 and during Fontan in 8. Since 1995, the modified Alfieri technique with a tailed, expanded, polytetrafluoroethylene tube as a bridging strip was the procedure for repair and 27 patients underwent the procedure. The mean follow-up period was 7.1 years (range 0-17 years). RESULTS Actuarial survival and freedom from CAVV replacement rates at 1, 5 and 10 years were 81, 70 and 67% and 89, 85 and 75%, respectively. Seven patients ultimately underwent CAVV replacement with one death. Twenty-three of the 38 patients completed Fontan operation (61%). Association with total anomalous pulmonary venous connection (P= 0.01) and CAVV plasty before BDG (P= 0.05) were risk factors for mortality. CONCLUSIONS CAVV plasty for patients with functional single ventricle is still challenging; however, the aggressive and repeated surgical intervention may contribute to provide better life-prognosis. The ventricular volume unloading effect of BDG without additional pulmonary blood flow or Fontan operation did not contribute to maintain CAVV function. Therefore, there would not be any hesitation for CAVV replacement to control CAVVR in the setting of systemic ventricular failure. Although the statistically significant therapeutic superiority of the modified Alfieri technique was not shown so far, further follow-up may reveal the advantage of this easy and simple technique.
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Affiliation(s)
- Yusuke Misumi
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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