Atrioventricular Valve Failure in Fontan Palliation

Management of the bad atrioventricular valve in Fontan…time for a change

“…19 What's Ugly A subset of the single-ventricle population has atrioventricular valve pathology that is beyond salvage. As identified by King and colleagues 1 as an independent predictor of atrioventricular valve failure and valve intervention, a dominant right ventricle with a morphologic tricuspid valve has also been identified as a risk factor for Fontan failure in other studies. 20 One half of patients with a single tricuspid valve in the series of King and colleauges 1 experienced valve failure by 30 years.…”

“…In their cohort, atrioventricular valve failure more than doubled the rate of Fontan failure, with two-thirds of patients with a common atrioventricular valve and one-half with a single tricuspid valve experiencing valve failure by 30 years of age. 1 Many unanswered questions remain in this regard: at what point along the single-ventricle palliation pathway should valve repair be undertaken? When is it permissible to perform valve repair at the time of Fontan procedure and when should it be staged in advance of Fontan?…”

Hybrid trans‐apical atrioventricular valve‐in‐valve implantation in Fontan circulation

“…Nowadays trans‐catheter valve implantation is a nonsurgical alternative option in selected patients with pulmonary and aortic valve disease. In the recent years, trans‐catheter valve in valve have been performed in failing surgically implanted bio‐prosthesis in the aortic, mitral, tricuspid, and pulmonary position . Early and mid‐term results are really promising.…”

“…Early and mid‐term results are really promising. Various approaches have been used which include the trans‐caval, carotid, subclavian, and trans‐apical routes . Complex congenital heart diseases with unique anatomy may need the application of techniques used in other settings.…”

Commentary: Moderate atrioventricular valve regurgitation may be too much to bear for a single ventricle

“…In our experience, more than half of the common atrioventricular valves and tricuspid valves were regurgitant or necessitated intervention before patients reached the age of 25 years (Figure 1). 2 The existence of even moderate regurgitation was enough to more than double a patient's risk of circulatory failure, which for most meant death or transplantation. 2 Some of the opinions expressed in the review by Stephens and Dearani 1 are bold and controversial, but they should be taken seriously, because these surgeons are among the most experienced of our time, especially with valve repair in congenital heart disease.…”