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

Background: Left atrioventricular valve regurgitation (LAVVR) is the most frequent indication for reoperation following complete atrioventricular septal defect (c-AVSD) repair.

Methods: Between January 2000 and December 2012, 17 of 29 patients with c-AVSD underwent the two-patch method (T group), whereas the remaining 12 patients underwent the simplified single-patch method (S group). The preoperative parameters and LAVVR of these groups were evaluated and compared.

Results: Ventricular septal defect (VSD) depth was shallower in the S group than that in the T group, but no significant differences were evident between the groups in any of the other parameters. Actuarial freedom from reoperation for LAVVR at 10 years was 75% in the T group and 68% in the S group (p=0.93). Two cases in the T group were converted from the simplified single-patch method. One of these cases had a 7-mm VSD as measured from the crest of the VSD to the level of the common atrioventricular valve and a bi-bridging leaflet that was positioned at the crest of the VSD and that did not allow coaptation with the left mural leaflet after the simplified single-patch method. The other case had a free-floating superior bridging leaflet and anterosuperior extension of the VSD, and left ventricular outflow tract obstruction (LVOTO) appeared after the simplified single-patch method.

Conclusions: No differences were observed in the mid- to long-term results between these two methods. Not only the scoop depth but also the anterosuperior extension of the VSD should be considered when determining the operating method because this could lead to asymmetric configuration of the valve leaflet and LVOTO.