Repair of complete atrioventricular canal defects: results with the two-patch technique

Ann Thorac Surg. 1995 Sep;60(3):530-7. doi: 10.1016/0003-4975(95)00468-Z.

Abstract

Background: Between 1983 and 1994, 115 infants and children underwent repair of a complete atrioventricular canal defect with the two-patch technique and routine mitral valve "cleft" closure.

Methods: A retrospective review of these 115 patients was performed. Age at the time of repair ranged from 1 month to 108 months (mean age, 14.2 +/- 16.5 months; median age, 8 months). Preoperative cardiac catheterization in 113 patients revealed a mean pulmonary to systemic flow ratio of 3.37 +/- 1.8, a mean pulmonary artery systolic pressure of 71.1 +/- 15.7 mm Hg, and a mean pulmonary vascular resistance of 4.9 +/- 3.3 units. Associated anomalies included Down's syndrome (99 patients), patent ductus arteriosus (47), and coarctation of the aorta (4). Rastelli classification was A (76 patients), B (10), C (24), and unknown (5). Twenty-four patients had intraoperative epicardial or transesophageal echocardiography.

Results: Although there was a trend toward increasing mean preoperative pulmonary vascular resistance with age from 2.1 +/- 0.9 units (0 to 3 months) to 4.0 +/- 2.6 units (4 to 6 months) to 5.7 +/- 3.0 units (7 to 12 months), the mean pulmonary vascular resistance of each age group was not significantly different from that of the main group. The operative survival rate was 94% (seven early deaths) and the overall survival rate, 91% (three late deaths). Intraoperative echocardiography altered the surgical therapy for 1 patient. No patient has required reoperation for a residual ventricular septal defect. Four patients (3.5%) had heart block requiring permanent pacemakers. Eight patients (7%) required reoperation for mitral insufficiency; 6 of whom had successful repair of a residual cleft.

Conclusions: For infants with complete atrioventricular canal defect, repair using the two-patch technique with routine mitral valve cleft closure at 4 to 6 months of age results in a low operative mortality, a low incidence of permanent heart block, and a low reoperation rate for mitral insufficiency.

MeSH terms

  • Age Factors
  • Aortic Coarctation / complications
  • Blood Pressure
  • Cardiac Catheterization
  • Cardiac Output
  • Child
  • Child, Preschool
  • Down Syndrome / complications
  • Ductus Arteriosus, Patent / complications
  • Echocardiography
  • Echocardiography, Transesophageal
  • Endocardial Cushion Defects / diagnostic imaging
  • Endocardial Cushion Defects / surgery*
  • Heart Block / etiology
  • Heart Block / therapy
  • Humans
  • Infant
  • Intraoperative Care
  • Mitral Valve / abnormalities
  • Mitral Valve / surgery
  • Mitral Valve Insufficiency / etiology
  • Mitral Valve Insufficiency / surgery
  • Pacemaker, Artificial
  • Postoperative Complications
  • Prostheses and Implants
  • Pulmonary Artery / physiopathology
  • Reoperation
  • Retrospective Studies
  • Survival Rate
  • Vascular Resistance