Takaya Hoashi, Akinori Hirano, Ryusuke Hosoda, Haruhiro Nagase, Yuji Fuchigami, Yukino Iijima, Takaaki Suzuki
Saitama Medical University International Medical Center.
Japan
Pediatric Cardiology
Pediatr Cardiol 2024;
DOI: 10.1007/s00246-024-03707-2
Abstract
This study aimed to investigate left-sided atrioventricular valve outcome after the repair of complete atrioventricular septal defect from single-institutional retrospective chart review. From 1998 to 2022, 55 patients with complete atrioventricular septal defect and balanced 2 ventricles underwent biventricular repair. Median age and weight at repair were 5.5 months old [interquartile range, 3.4-9.1] and 4.6 kg [3.9-5.9]. Analyzed possible risk factors were Rastelli classification, low birth weight < 2.5 kg, preterm < 37 weeks, proceeding pulmonary artery banding, Down syndrome, persistent left superior vena cava, tetralogy of Fallot, early surgical era < 2010, preoperative left-sided atrioventricular valve regurgitation > mild, modified single-patch repair, small left mural leaflet, and complete left-sided atrioventricular valve cleft closure. No patients underwent left-sided atrioventricular valve replacement at the timing of repair. No patient required subsequent single ventricular conversion. The median follow-up period in survivors was 11.0 years. The survival rate at 15 years from repair was 96.4%. Freedom from moderate or greater left-sided atrioventricular valve regurgitation rate at 10 years was 58.4%. After elimination of 3 patients undergone complete closure then experienced tone of closed cleft, complete cleft closure was significant inhibitor for moderate or greater left-sided atrioventricular valve regurgitation (p = 0.034, Odds ratio: 0.36, 95% Confidence intervals: 0.14-0.93). Twelve patients underwent 15 reoperations for left-sided atrioventricular valve. All 4 patients who developed left-sided atrioventricular valve stenosis and backward pulmonary hypertension required prosthetic valve replacement. Incomplete cleft closure was the only risk factor for significant postoperative left-sided atrioventricular valve regurgitation. Already small left-sided atrioventricular valve by previous repair developed significant regurgitation, it is no longer repairable therefore required to be replaced.
Category
Class II. Pulmonary Hypertension Associated with Valvular Disease of the Left Side of the Heart
Age Focus: Pediatric Pulmonary Vascular Disease
Fresh or Filed Publication: Fresh (PHresh). Less than 1-2 years since publication
Article Access
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