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Ann Thorac Surg 1998;66:1389-1393
© 1998 The Society of Thoracic Surgeons

Original articles: cardiovascular

Interventricular communication in complete atrioventricular septal defect

Kiyoshi Suzuki, MD, PhDa, Siew Yen Ho, PhDa,b, Robert H. Anderson, MDb, Anton E. Becker, MD, PhDc, William H. Neches, MDd, Katsuhiko Tatsuno, MD, PhDa, Shigekazu Mimori, MD, PhDa

a Department of Pediatrics, The Sakakibara Heart Institute, Tokyo, Japan
b Department of Pediatrics, The National Heart & Lung Institute, London, United Kingdom
c Department of Cardiovascular Pathology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
d Department of Pediatrics, The Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania USA

Accepted for publication April 27, 1998.

Address reprint requests to Dr Suzuki, Department of Pediatrics, The Sakakibara Heart Institute, 2-5-4 Yoyogi, Shibuya-ku, Tokyo 151-0053 Japan
e-mail: (ksuzuki{at}shi.heart.or.jp)

Background. Little attention has been paid to whether the interventricular communication in complete atrioventricular septal defect is different beneath the superior and inferior bridging leaflets, a feature of obvious surgical significance.

Methods. We searched for a defect under the bridging leaflets and examined the valve morphologies in 98 autopsied and 86 surgical patients. Of the overall specimens, 27 were associated with Fallot’s tetralogy, and a further 20 had subaortic stenosis, aortic coarctation, or both. In the autopsied specimens, we also measured the degree of deficiency of the ventricular septum.

Results. No communication was found under the inferior bridging leaflet in 30% (29 of 98) of the specimens. All 29 hearts except two without such communications showed an undivided inferior leaflet. In contrast, all patients undergoing operation except 1 had a communication beneath both bridging leaflets (p < 0.001). The absence of a communication beneath the inferior leaflet was observed more in hearts with Fallot’s tetralogy (seven of 14) or those with subaortic stenosis, aortic coarctation, or both (eight of 18) than in those without associated anomalies (14 of 66; p < 0.01). Those with a communication under the inferior leaflet showed a greater deficiency of the inlet ventricular septum than did those without it (p < 0.001).

Conclusions. In a certain percentage of patients with complete atrioventricular septal defect, there will be no communication under the inferior bridging leaflet. Surgeons should be aware of this possibility, particularly when confronted with a patient with obstruction in either ventricular outlet.






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