Atrioventricular valve regurgitation in patients undergoing total cavopulmonary connection: Impact of valve morphology and underlying mechanisms on survival and reintervention

Abstract

Atrioventricular valve regurgitation in univentricular heart is more frequently associated with a tricuspid or a common atrioventricular valve, and structural anomalies are the primary cause. Significant atrioventricular valve regurgitation requiring surgery influences survival after total cavopulmonary connection, especially when atrioventricular valve replacement was needed. Surgical management based on mechanisms of regurgitation is mandatory.

Prognostic value of the preoperative neutrophil‐lymphocyte ratio in patients undergoing the bidirectional Glenn procedure

“…Many of these patients required palliation via the bidirectional Glenn procedure. Well‐known risk factors for mortality, morbidity, or readmission are prematurity, less than 2 months of age at the time of surgery, lower weight, pulmonary vascular resistance, SV dysfunction, hypoplastic left heart syndrome (HLHS), moderate‐to‐severe atrioventricular valve regurgitation, longer CPB time, and previous aortopulmonary shunt . Some patients experienced improvement; however, for others, a better time could have been chosen for intervention.…”

Direct measurement of atrioventricular valve regurgitant jets using 4D flow cardiovascular magnetic resonance is accurate and reliable for children with congenital heart disease: a retrospective cohort study

“…The presence of atrioventricular valve regurgitation (AVVR) causes significant morbidity and mortality in patients with congenital heart disease (CHD) [1][2][3][4][5][6]. AVVR of moderate or greater degrees is a significant risk factor for unwanted outcomes, including re-operation in patients with repaired atrioventricular septal defects and death or heart transplantation in the single ventricle populations [5][6][7]. In CHD, the initial mechanism of AVVR is most likely anatomic abnormalities such as septal clefts, dysplasia, or prolapse.…”

“…In CHD, the initial mechanism of AVVR is most likely anatomic abnormalities such as septal clefts, dysplasia, or prolapse. As a result of progressive, eccentric regurgitation, a pathologic cycle develops of volume overload, annular dilation, and worsened regurgitation [5,8]. Although the standard of care for initial evaluation of AVVR is transthoracic echocardiography, accuracy and reliability is limited in distinguishing moderate from severe regurgitation-a distinction particularly important as it impacts surgical management [9][10][11][12].…”

Breaking a commandment

“…The review by Ono and colleagues 2 describes 101 patients who underwent atrioventricular (AV) valve surgery before or coincident with their Fontan procedure. 2 Comparison survival curves would indicate that after the initial slightly higher operative and early mortality, the outcomes for these patients are similar to those for patients who did not undergo an AV valve operation. Their significant number of patients with what was previously thought to be a contraindication is of substantial interest.…”