Original articlePediatric cardiacEarly Surgical Correction of Atrioventricular Valvular Regurgitation in Single-Ventricle Patients
Section snippets
Patients and Methods
We retrospectively reviewed the medical records of 39 single-ventricle patients who underwent atrioventricular repair or replacement more than once between 1996 and 2008. We compared the grade of AVVR before and after the valvular surgery according to when the valve surgery was performed and the grade of preoperative AVVR. Because of the long study period, 13 years, there were some different descriptions for echocardiographic findings among the physicians, especially for grade of valvular
Patient Characteristics and Operations
The diagnoses included the heterotaxy syndrome (n = 11, right isomerism in 9 cases, left isomerism in 2), right ventricular type functional univentricular heart (n = 11), congenitally corrected transposition of the great arteries (cc-TGA) with pulmonary stenosis or atresia (n = 5), double-outlet right ventricle with unbalanced complete atrioventricular septal defect (n = 3), Taussig-Bing anomaly with left ventricular outflow tract obstruction (n = 2), hypoplastic left heart syndrome (n = 2),
Comment
The adequate timing of AV repair or replacement for regurgitation is very important in valvular heart disease, because prolonged exposure to the regurgitant flow induces irreversible pulmonary vascular disease, arrhythmia, and intractable congestive heart failure. Also, the postoperative course of a late operation is difficult to manage. In single-ventricle physiology, especially before BCPC or Fontan completion, the AV valve is in charge of excessive volume loading, which causes rapid
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Cited by (18)
Effect of Atrioventricular Valve Repair on Multistage Palliation Results of Single-Ventricle Defects
2021, Annals of Thoracic SurgeryCitation Excerpt :When AVV morphology was mitral, repair techniques were commonly simpler and involved mainly cleft closure and Kay-type annuloplasty, and postrepair AVV regurgitation was mild or less in 83% of patients. The common AVV morphology is the most difficult to address, and several techniques are commonly needed, including cleft closure, edge-to-edge repair, commissuroplasty, and partial annuloplasty.2,5,16,17,19-22 Several groups have reported improved experience with common AVV repair, and in our current study, postrepair AVV regurgitation mild or less was achieved in 65% of those patients.16-22
Atrioventricular valve regurgitation in patients undergoing total cavopulmonary connection: Impact of valve morphology and underlying mechanisms on survival and reintervention
2018, Journal of Thoracic and Cardiovascular SurgeryInfluence of bidirectional cavopulmonary anastomosis and concomitant valve repair on atrioventricular valve annulus and function
2014, Annals of Thoracic SurgeryCitation Excerpt :Indeed, some authors have suggested that early surgical intervention with valvuloplasty might improve outcomes in this patient population [2, 6, 7]. Kwak and colleagues [16] reported that atrioventricular valve function tends to be better at midterm follow-up for patients who undergo an early valve operation to treat AVVR [16]. However, atrioventricular valve operations for patients with single ventricles are fraught with technical difficulties because most of these valves are morphologically common atrioventricular or tricuspid valves that fail under systemic arterial pressure.
Long-term outcomes after atrioventricular valve operations in patients undergoing single-ventricle palliation
2012, Annals of Thoracic SurgeryCitation Excerpt :We were similarly disappointed by the edge-to-edge repair and restrict its indication to common AV valves when restoring central apposition of the superior and inferior bridging leaflets seems mandatory. There has been debate on the best timing for operation in AV regurgitation especially in relation to the Fontan completion [18–21]. Although the present study could not bring forward any argument on this debate, we tend today to proceed with the valve repair as a procedure separate from the Fontan completion.
Atrioventricular Valve Repair for Patient With Heterotaxy Syndrome and a Functional Single Ventricle
2012, Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery AnnualCitation Excerpt :Edge-to-edge repair is one of the preferred techniques at our institute. Some authors have reported good results in patients who underwent edge-to-edge repair against CAVV or tricuspid regurgitation.50-54 Ando et al51 described that postoperative CAVV regurgitation was lesser in patients who underwent edge-to-edge repair than in patients who did not.