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Ann Thorac Surg 1996;62:524-525
© 1996 The Society of Thoracic Surgeons

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Invited Commentary

Invited Commentary

Department of Cardiac and Thoracic Surgery, Vanderbilt University Hospital, 2986 The Vanderbilt Clinic, 1301-22nd Ave, S, Nashville, TN 37232-5734

See also page 519.

Complete repair of atrioventricular septal defects has clearly moved to younger patients in recent years with generally improved operative results. This being accomplished with no clear evidence as to the superiority of either a single-patch or double-patch technique. As I follow the development of reparative procedures for this defect, the factors that seem to be important in achieving good results are (1) the timing of operation so that it can be carried out before the development of fixed pulmonary vascular changes, (2) the precise placement of sutures in the ventricular portion of the patch to avoid the conduction system and to avoid narrowing of the left ventricular outflow tract, and (3) repairing the mitral valve so that the patient is left with a competent left-sided atrioventricular valve at the completion of the operative procedure.

It seems clear that this can be accomplished using either a two-patch technique or a single-patch technique, and the surgeon's comfort with the technique is probably more important than the actual selection of one patch or two patches to be used in the repair. I agree completely with Alexi-Meskishvili and associates' decision to repair the cleft in the mitral valve. The risk of distortion of this valve with repair using either a single or double patch is too high to leave the valve cleft unrepaired. In my institution we have continued to use a single-patch technique, changed very little from the original description from the Mayo Clinic. Since the most recent report of our data, we have operated on an additional 36 patients, 33 being less than 1 year of age. There were no deaths among the 3 patients more than 1 year of age. There were three operative deaths among the 33 infants, resulting in a 9% operative mortality, which is comparable with the data presented in this article.

Even if the two deaths occurring in the first 30 postoperative days are included as operative deaths, the data presented by Alexi-Meskishvili and associates represent very good results, particularly when you recognize that a number of the patients in the series came to Alexi-Meskishvili and associates late and had pulmonary vascular disease. Alexi-Meskishvili and associates are to be congratulated on their results, as it is encouraging to see continued steady improvement in the management of infants with this complex congenital anomaly.

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Correction of Complete Atrioventricular Septal Defects With the Double-Patch Technique and Cleft Closure

Vladimir Alexi-Meskishvili, Kozo Ishino, Ingo Dähnert, Frank Uhlemann, Yuguo Weng, Peter E. Lange, and Roland Hetzer
Ann. Thorac. Surg. 1996 62: 519-524. [Abstract] [Full Text]

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				F. A. Crawford Jr and M. R. Stroud Surgical repair of complete atrioventricular septal defect Ann. Thorac. Surg., November 1, 2001; 72(5): 1621 - 1629. [Abstract] [Full Text] [PDF]

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Harvey W. Bender, Jr Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Bender, H. W. Search for Related Content PubMed Articles by Bender, H. W., Jr Related Collections Related Article