CARDIOVASCULAR
ENGINEERING
Journal for Extracorporeal Circulation, Assist Devices,Transplantation and Artificial Organs
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CARDIOVASCULAR
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Volume 2, 1997, No 4 |
Abstract:
Residual regurgitation of the left atrioventricular (AV) valve
represents an important factor influencing outcome after repair
of atrioventricular septal defect (AVSD). Out of 310 patients
with AVSD corrected between 1978-1997, redo for the left AV valve
regurgitation was indicated in 27 (8.7%) patients. In 5 (1.6%)
patients it was required early and in 22 (7.1%) patients, late
post-operatively. The redo was performed 3 days to 10.4 years
after the repair (median 1.2 yrs). Re-operation was necessary in
8 (6.8%) out of 118 patients with a common orifice and in 19
(9.9%) out of 192 patients with two orifices. Most often,
residual or recurrent regurgitation was caused by a combination
of unfavourable valvar morphology, valve dehiscence and/or
incomplete suture of the "cleft". Unfavourable valvar
morphology as dysplastic valve, double-orifice valve and
inadequate amount of the valvar tissue, represented an important
factor of regurgitation in at least 15 patients. In 12 (44.4%)
re-operated patients, plastic repair was possible: suture of the
"cleft" in 6, suture of the "cleft" and one
or two commissuroplasties in 4, and more complex repair in 2
patients. In the remaining 15 (55.6%) patients unfavourable
congenital malformation of the left AV orifice required valve
replacement. At the time of re-operation, a residual atrial
septal defect was closed in 7 patients, a membranous left
ventricular outflow tract obstruction was excised in 1 and an
annuloplasty of the right AV valve was performed in 1 patient.
Three (60.0%) out of 5 patients were re-operated early, and 2
(9.1%) out of 22 patients re-operated late, died. Redo for the
left AV valve insufficiency was required especially in AVSD with
severe preoperative (p=0.0132), and early postoperative
(p=0.0016) regurgitation in presence of a stenotic valvar
morphology and after incomplete "cleft" closure. In
about 50% of patients repeated plastic repair is successful, but
in patients with stenotic valvar morphology it is usually
necessary to replace the valve. The risk of death after
re-operation is higher during the early post-operative period,
after valve replacement and in presence of a common orifice.
Keywords:
Heart defects, congenital, atrioventricular septal defect, mitral
valve repair, re-operation, valve replacement, heart surgery
Address for Correspondence:
Reference:
(CVE. 1997; 2 (4): 250-256)
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