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Ann Thorac Surg 2001;72:831-835
© 2001 The Society of Thoracic Surgeons

Original article: cardiovascular

Atrioventricular valve regurgitation in patients with single ventricle: impact of the bidirectional cavopulmonary anastomosis

William T. Mahle, MDa, Meryl S. Cohen, MDa, Thomas L. Spray, MDb, Jack Rychik, MDa

a Divisions of Cardiology and Cardiothoracic Surgery, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
b Departments of Pediatrics and Surgery at the University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA

Accepted for publication May 17, 2001.

Address reprint requests to Dr Mahle, Sibley Heart Center, Egleston Children’s Hospital, 1405 Clifton Rd, NE, Atlanta, GA 30322
e-mail: mahlew{at}kidsheart.com

Background. It is not known whether atrioventricular valve regurgitation (AVVR) can improve in some patients after the bidirectional cavopulmonary anastomosis (BCPA) without undertaking concomitant valvuloplasty.

Methods. We retrospectively reviewed our experience with patients who underwent the BCPA between June 1989 and June 2000 with specific attention to those patients with moderate or severe AVVR. The degree of AVVR was determined by color Doppler echocardiography. During the study period there were 576 patients who underwent BCPA at a median age of 6.8 months (range, 1.3 months to 4.8 years). The majority of subjects (66%) had a tricuspid valve as the systemic atrioventricular valve. Significant (moderate or severe) AVVR before BCPA was noted in 36 of 576 patients (6%) and was significantly more prevalent (8 of 52 patients, 15%; p = 0.01) in patients with a common atrioventricular canal.

Results. Of the 36 subjects with moderate or severe AVVR, 8 had interventions (6 valvuloplasty, 2 aortic arch dilation) at BCPA. There was 1 hospital death (2.8%). Of the remaining 27 survivors who did not undergo additional interventions at BCPA, improvement in AVVR (mild or none) was noted in 6 (22%) at intermediate follow-up (median, 2 years; range, 0.5 to 3.1 years). The presence of significant AVVR before BCPA was not significantly associated with hospital survival or intermediate-term freedom from death or transplantation.

Conclusions. We conclude that AVVR improves in some patients after BCPA and that valvuloplasty is not justified in all patients with moderate preoperative AVVR.




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