Surgery of the left atrioventricular valve and of the left ventricular outflow tract in atrioventricular septal defect

Abstract

SummaryMalfunctioning of the left atrioventricular valve has always been, and remains, the major incremental risk factor in the repair of atrioventricular septal defect. Now that the cardiac surgeon has ample time to assess the anatomy and function of the left valve, results have improved, but are still less than ideal. On the presumption that the anterior leaflet of the mitral valve is “cleft” in this anomaly, it used to be common practice to close the “cleft”. Currently, a substantial number of surgeons employ this technique, often irrespective of the individual anatomy, and in the majority of cases with success.

Atrioventricular valve function after single patch repair of complete atrioventricular septal defect in infancy: How early should repair be attempted?

“…Technical factors have been a primary focus in a number of recent reports on AVSD repair. [1][2][3][4][5][6][7][8] In neonates and very young infants the question of single versus double patch repair of AVSD is unresolved. [1][2][3][4][5][6] Excellent results have been demonstrated with both techniques, [1][2][3][4][5][6][7][8] and we think that the choice primarily comes down to personal preference.…”

“…[1][2][3][4][5][6][7][8] In neonates and very young infants the question of single versus double patch repair of AVSD is unresolved. [1][2][3][4][5][6] Excellent results have been demonstrated with both techniques, [1][2][3][4][5][6][7][8] and we think that the choice primarily comes down to personal preference. It has been our policy to perform single patch repair, with complete closure of the left AV valve cleft except when this will restrict left ventricular inflow.…”

“…In this context, the advantages and drawbacks of various surgical techniques, such as closure of the "cleft" of the left AV valve, and single versus double patch repair have been debated in the literature. [1][2][3][4][5][6][7][8] There has been little focus on the relationship between age at repair in infancy and outcomes. 5 Although repair before 6 months of age is common, medical therapy is generally used with neonates, very young infants, and low birth weight babies, primarily because of technical concerns about the fragility of the AV valve tissue.…”

Surgical anatomy of the atrioventricular septum and atrioventricular septal defects

“…Although uncommon, the coronary sinus can vary in location in hearts with defects of the atrioventricular septum; for example, the coronary sinus has been shown to terminate in the left atrium ( Figure 8). 3 ' 4 More extensive comments regarding the placement of the patch(es) in the repair of such defects are found in the papers in this issue by Laks et al, 5 Ebels, 6 and Merrill et al 7 The penetrating bundle courses through the apex of this nodal triangle to run beneath the inferior bridging leaflet as a long non-branching bundle. The left bundle Figure 7.…”