日本小児循環器学会雑誌 Pediatric Cardiology and Cardiac Surgery

Background: Left atrioventricular valve regurgitation (LAVVR) is the main indication for reoperation in patients after repair of complete atrioventricular septal defects (CAVSD). In order to prevent postoperative LAVVR, we use a ventricular septal defect (VSD) patch for CAVSD repair of width 31.1∗BSA^0.56 (i.e., equal to the normal tricuspid valve annular diameter)+4 mm.

Methods: We evaluated the surgical outcome in 27 patients with CAVSD who underwent surgical repair at our institution between January 1995 and December 2011.

Results: The maximum follow-up duration after surgical correction was 18.5 years (median, 8.2 years). One early death (due to pulmonary embolism) and one late death (due to idiopathic pulmonary vein stenosis) occurred after the surgery. At discharge, 24 patients had less than moderate LAVVR and 2 patients had moderate LAVVR. Left atrioventricular valve stenosis was not observed. At mid-term follow-up, 23 patients had less than moderate LAVVR and 3 patients had moderate LAVVR. There was no case of severe LAVVR, and cardiac function was preserved in all patients. Only 1 patient required reoperation for LAVVR although valve replacement was not necessary. Freedom from reoperation was 96.2% at 5, 10, and 15 years.

Conclusion: Standardizing the patch width (normal tricuspid valve annular size+4 mm) led to good intermediate to long-term results in patients with CAVSD.