Surgically created double-orifice left atrioventricular valve: A valve-sparing repair in selected atrioventricular septal defects

AbstractObjectives: Some features of the left atrioventricular valve (large mural leaflet, dystrophic tissue) represent a challenge for repair of atrioventricular septal defects without postoperative regurgitation. A retrospective study was conducted to evaluate the results of surgically creating a double-orifice left atrioventricular valve in such circumstances. Clinical results were analyzed according to valvular and subvalvular left atrioventricular valve measurements in pathologic specimens with atrioventricular septal defects. Methods: Among 157 patients operated on for atrioventricular septal defect since October 1989, 10 patients underwent primary repair (n = 8) or reoperation (n = 2) by this procedure. Median age at repair was 3.3 years (0.1-33 years). Anatomic types were complete (n = 3), intermediate (n = 5), and partial (n = 2). Preoperative moderate to severe left atrioventricular valve regurgitation was present in 6 patients. After the repair (two-patch technique in complete atrioventricular septal defect, cleft closed in each case), these 10 patients were found to have moderate to severe residual regurgitation not amenable to repair by annuloplasty. The top edge of the mural leaflet was anchored to the facing free edge of the cleft. Results: No hospital death or morbidity was observed. Left atrioventricular valve regurgitation was absent or trivial (8 patients) and mild (2 patients). Color-coded echocardiography did not show significant left atrioventricular valve stenosis. The mean diastolic pressure gradient across the left atrioventricular valve was 3.2 ± 1.1 mm Hg (1.4-4.5 mm Hg). At a median follow-up of 72 months (6-91 months), there was 1 late death, unrelated to left atrioventricular valve malfunction, due to pulmonary vascular obstructive disease. Left atrioventricular valve regurgitation did not increase over time, except in 1 patient in whom regurgitation recently progressed from mild to moderate. At rest, the mean diastolic pressure gradient across the left atrioventricular valve was 3.8 ± 2.9 mm Hg (1.5-11.2 mm Hg). One child had an early moderate stenosis without pulmonary hypertension. Studies on pathologic specimens (n = 34) indicated that long chordal lengths and large mural leaflet size are essential independent anatomic features to assess its feasibility. Conclusions: Surgical creation of a double-orifice left atrioventricular valve is an effective additional procedure for repair of atypical cases of atrioventricular septal defect. The operation may decrease the need for reoperation or left atrioventricular valve replacement. (J Thorac Cardiovasc Surg 2001;121:352-65

Left-sided lesions after anatomic repair of transposition of the great arteries, ventricular septal defect, and coarctation: Surgical factors

AbstractObjectiveThis study was undertaken to identify potential anatomic and surgical factors creating left-sided lesions, namely recoarctation of the aorta and neoaortic regurgitation, after anatomic repair of transposition of the great arteries with ventricular septal defect and aortic coarctation.MethodsFrom 1983 to September 2002, 109 survivors out of 120 patients were studied. Two-stage repair was performed in 42 patients (group A), and single-stage repair was performed in 67 (groups B and C). Before repair, the diameters of the ascending aorta and main pulmonary artery were measured. In the patients with single-stage repair, coarctation was repaired by extended end-to-end anastomosis in 35 patients (group B) and by pulmonary homograft patch augmentation in 32 patients (group C). The ventricular septal defect was closed through the pulmonary artery in 70 patients and through the right ventricle or atrium in 39 patients. The neoaorto-aortic discrepancy was treated by V-shaped resection of the posterior sinus of Valsalva in 7 cases, pulmonary homograft patch in 32 cases, and anterior splitting of the ascending aorta in all cases. Before discharge from the hospital, neoaortic root and ascending aorta diameters and aortic regurgitation grade were recorded. Neoaortic regurgitation progression and reintervention were the end points of follow-up (97.2 ± 61.2 months).ResultsEarly and late survivals were significantly better in group C (P < .001). Risk factors for neoaortic regurgitation at discharge by univariate analysis were single-stage repair (P < .05) and ventricular septal defect closure through the pulmonary artery (P = .0076). On multivariate analysis, the latter was the only risk factor for neoaortic regurgitation at discharge and at last follow-up. Multivariate analysis showed that higher neoaortic root/ascending aorta ratio and ventricular septal defect closure through the pulmonary artery were risk factors for neoaortic regurgitation evolution at last follow-up. There were 29 reinterventions, 19 for recoarctation of the aorta and 10 for neoaortic regurgitation with or without aortic root dilatation. Group B (P < .05), high neoaortic root/ascending aorta ratio (P < .01), and progressive neoaortic regurgitation (P < .05) were risk factors for recoarctation of the aorta. Group A was a risk factor for aortic valve replacement at 10 years (P < .05).ConclusionNeonatal single-stage repair with pulmonary homograft aortic augmentation remains the optimal approach to transposition of the great arteries with ventricular septal defect and aortic coarctation. It provides better early and late survivals and freedoms from left-sided lesions. Avoidance of late recoarctation of the aorta and progressive neoaortic regurgitation requires meticulous closure of the ventricular septal defect and evenly sized reconstruction of the aorta from root to distal arch

Complications coronaires après cure de transposition des gros vaisseaux par correction anatomique

La correction anatomique (ou "switch artériel") est depuis 20 ans le traitement de choix de la transposition des gros vaisseaux (TGV) avec un bon résultat à court, moyen et long terme. Au cours de cette chirurgie, la translocation des artères coronaires est un point crucial et les complications coronaires demeurent la première cause de mortalité. L'objectif de cette étude a été tout d'abord d'établir l'incidence et les facteurs de risque des événements coronaires et des lésions coronaires survenant après switch artériel. Ensuite, cette étude a tenté de montrer l'intérêt des examens non-invasifs dans le dépistage des lésions coronaires. ???Les événements coronaires surviennent pour la majorité, précocement après le switch artériel et sont en nette diminution depuis quelques années. Une coronarographie systématique associée à une surveillance régulière par l'association d'un ECG, d'une échocardiographie et d'une scintigraphie myocardique est nécessaire pour le dépistage des lésions coronaires.NANTES-BU Médecine pharmacie (441092101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Résultats immédiats et à moyen terme de la répartition complète du tronc artériel commun dans la première année de vie (à propos de 142 cas opérés au Centre Chirurgical Marie Lannelongue (le Plessis Robinson, France) )

REIMS-BU Santé (514542104) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF