Closure of the zone of apposition at correction of complete atrioventricular septal defect improves outcome

Abstract

This study demonstrates the advantage of closing the zone of apposition ('cleft') as part of repair of complete atrioventricular septal defect. Survival, freedom from reoperation for left atrioventricular valve incompetence and over-all outcome were more favourable in patients of group II. The zone of apposition should be surgically addressed whenever the morphology of the left atrioventricular valve allows for closure without producing stenosis.

Current options and outcomes for the management of atrioventricular septal defect

“…Chronic left AV valve insufficiency worsens with time and results in considerable morbidity, more often noted in cases with partial AVSD than those with complete AVSD. Re-operation in this group is more likely when the cleft was not repaired at the original operation [47]. Contemporary clinical practice usually recommends surgical closure over a zone of apposition between the superior and inferior bridging leaflets in most cases [40].…”

Surgical validation of real-time transthoracic 3D echocardiographic assessment of atrioventricular septal defects

“…Rastelli classification) as well as anatomically (i.c. chordae attachment) [17,18]. The great advantage of RT-3DE is that a single Fen face_ view can be created in which the entire AV valve apparatus is visualized.…”

“…This study shows that we could correctly identify the variability of the superior bridging leaflet in all patients. This is of great importance, because many patients with a small bridging leaflet and large left mural leaflet have significant regurgitation at the zone of apposition between these leaflets that require surgical repair [5,18,19].…”

Subaortic Area at Risk for Development of Obstruction After Surgical Repair of Atrioventricular Septal Defect

“…The cleft was directly and entirely (or as much as possible) closed. 8 Although in recent experience some secondary attachments of the bridging leaflets were divided in order to optimize the leaflet mobility, no additional gesture was employed in order to prevent possible subsequent left ventricular outflow tract obstruction (LVOTO).…”