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Ann Thorac Surg 1995;60:530-537
© 1995 The Society of Thoracic Surgeons
Divisions of Cardiovascular-Thoracic Surgery and Cardiology, The Children's Memorial Hospital, and Departments of Surgery and Pediatrics and the Feinberg Cardiovascular Research Institute, Northwestern University Medical School, Chicago, Illinois
Background. Between 1983 and 1994, 115 infants and children underwent repair of a complete atrioventricular canal defect with the two-patch technique and routine mitral valve ``cleft'' closure.
Methods. A retrospective review of these 115 patients was performed. Age at the time of repair ranged from 1 month to 108 months (mean age, 14.2 ± 16.5 months; median age, 8 months). Preoperative cardiac catheterization in 113 patients revealed a mean pulmonary to systemic flow ratio of 3.37 ± 1.8, a mean pulmonary artery systolic pressure of 71.1 ± 15.7 mm Hg, and a mean pulmonary vascular resistance of 4.9 ± 3.3 units. Associated anomalies included Down's syndrome (99 patients), patent ductus arteriosus (47), and coarctation of the aorta (4). Rastelli classification was A (76 patients), B (10), C (24), and unknown (5). Twenty-four patients had intraoperative epicardial or transesophageal echocardiography.
Results. Although there was a trend toward increasing mean preoperative pulmonary vascular resistance with age from 2.1 ± 0.9 units (0 to 3 months) to 4.0 ± 2.6 units (4 to 6 months) to 5.7 ± 3.0 units (7 to 12 months), the mean pulmonary vascular resistance of each age group was not significantly different from that of the main group. The operative survival rate was 94% (seven early deaths) and the overall survival rate, 91% (three late deaths). Intraoperative echocardiography altered the surgical therapy for 1 patient. No patient has required reoperation for a residual ventricular septal defect. Four patients (3.5%) had heart block requiring permanent pacemakers. Eight patients (7%) required reoperation for mitral insufficiency; 6 of whom had successful repair of a residual cleft.
Conclusions. For infants with complete atrioventricular canal defect, repair using the two-patch technique with routine mitral valve cleft closure at 4 to 6 months of age results in a low operative mortality, a low incidence of permanent heart block, and a low reoperation rate for mitral insufficiency.
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