Hostname: page-component-cd9895bd7-jkksz Total loading time: 0 Render date: 2024-12-22T23:32:34.791Z Has data issue: false hasContentIssue false

Surgery of the left atrioventricular valve and of the left ventricular outflow tract in atrioventricular septal defect

Published online by Cambridge University Press:  19 August 2008

Tjark Ebles*
Affiliation:
From the Department of Cardiothoracic Surgery, University of Groningen, Groningen
*
Dr. Tjark Ebels, Thorax Center, Academic Hospital Oostersingel 59, 9713 EZ Groningen, The Netherlands

Summary

Malfunctioning of the left atrioventricular valve has always been, and remains, the major incremental risk factor in the repair of atrioventricular septal defect. Now that the cardiac surgeon has ample time to assess the anatomy and function of the left valve, results have improved, but are still less than ideal. On the presumption that the anterior leaflet of the mitral valve is “cleft” in this anomaly, it used to be common practice to close the “cleft”. Currently, a substantial number of surgeons employ this technique, often irrespective of the individual anatomy, and in the majority of cases with success.

Type
The World Forum for Pediatric Cardiology Symposium on Atrioventricular Septal Defect
Copyright
Copyright © Cambridge University Press 1991

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bailey, CP, Nichols, HT, Bolton, HE, Jamison, WL, Gómez-Almelda, M.Surgical treatment of forty-six interatrial septal defects by atrioseptopexy. Ann Surg 1954; 40: 805820.CrossRefGoogle Scholar
Gross, RE, Watkins, E Jr. Surgical closure of atrial septal defects. Arch Surg 1953; 67: 670685.CrossRefGoogle ScholarPubMed
Kirklin, JW, DuShane, JW, Patrick, RT, Donald, DE, Hetzel, PS, Harshbarger, HG, Wood, EH.Intracardiac surgery with the aid of a mechanical pump-oxygenator system (Gibbon type): Report of eight cases. Proc Staff Mayo Clin 1955; 30: 201206.Google ScholarPubMed
Lillehei, CW, Cohen, M, Warden, HE, Varco, RL.The direct-vision intracardiac correction of congenital anomalies by controlled cross circulation. Results in thirty-two patients with ventricular septal defects, tetralogy of Fallot, and atrio-ventricularis communis defects. Surgery 1955; 38: 1129.Google Scholar
Rastelli, GC, Kirklin, JW, Titus, JL.Anatomic observations on complete form of persistent common atrioventricular canal with special reference to atrioventricular valves. Mayo Clin Proc 1966; 41: 296308.Google ScholarPubMed
Castañeda, AR, Nicoloff, DM, Moller, JH, Lucas, RV.Surgical correction of complete atrioventricular canal utilizing ball-valve replacement of the mitral valve. Technical consider-ations and results. J Thorac Cardiovasc Surg 1971; 62: 926931.CrossRefGoogle Scholar
Sakakibara, S, Yokoyama, M, Konno, S, Kudo, T, Hatsune, K. Aconsideration of operative methods for correction of endocar-dial cushion defect. Ann Thorac Surg 1971; 12: 419427.CrossRefGoogle ScholarPubMed
Somerville, J.Atrioventricular defects. Mod Cone Cardiovasc Dis 1971; 40: 3338.Google ScholarPubMed
Abbruzzese, PA, Livermore, J, Sunderland, CO, Nunley, DL, Issenberg, H, Khonsari, S, Garcia, CE, Starr, A.Mitral repair in complete atrioventricular canal. Ease of correction in early Infancy. J Thorac Cardiovasc Surg 1983; 85: 388395.CrossRefGoogle ScholarPubMed
Kirklin, JW, Blackstone, EH, Bargeron, LM Jr, Pacifico, AD, Kirklin, JK.The repair of atrioventricular septal defects in infancy. Int J Cardiol 1986; 13: 333351.CrossRefGoogle ScholarPubMed
McGoon, DC, Rastelli, GC. Operation for persistent atrioven-tricular canal. In: Feldt, RH (ed). Atrioventricular Canal Defects. WB Saunders, Philadelphia, 1976, pp 119138.Google Scholar
Braunwald, NS, Morrow, AG.Incomplete persistent atrioventricular canal operative methods and the results of pre- and postoperative hemodynamic assessments. J Thorac Cardiovasc Surg 1966; 51: 7180.CrossRefGoogle ScholarPubMed
Lindesmith, GG, Meyer, BW, Chapman, N, Santon, RE, Jones, JC.The surgical repair of endocardial cushion defects. Ann Thorac Surg 1966; 2: 399415.CrossRefGoogle ScholarPubMed
Gerbode, F, Sanchez, PA, Arguero, R, Kerth, WJ, Hill, JD, DeVries, PA, Selzer, A, Robinson, SJ.Endocardial cushion defects. Ann Surg 1967; 166: 486495.CrossRefGoogle ScholarPubMed
Griffiths, SP, Ellis, K, Burris, JO, Bumenthal, S, Bowman, FO, Malm, JR. Postoperative evaluation of mitral valve function in ostium primum defect with cleft mitral valve (partial form of atrioventricular canal). Circulation 1969; 40: 2129.CrossRefGoogle ScholarPubMed
Wanderman, KL, Shahin, W, Levy, MJ.Persistent common atrioventricular canal: results following operation. J Cardio-vasc Surg 1972; 13: 548553.Google ScholarPubMed
Reichart, B, Klinner, W.Zur Korrektur der Endokardkissende-fekte (Ostium-primum-Defekt, AV-Kanal). Munch Med Wschr 1973; 115: 254258.Google Scholar
Mair, DD, McGoon, DC.Surgical correction of atrioventricu-lar canal during the first year of life. Am J Cardiol 1977; 40: 6669.CrossRefGoogle ScholarPubMed
Cooper, DKC, De Leval, MR, Stark, J.Results of surgical correction of persistent complete atrioventricular canal. J Thorac Cardiovasc Surg 1979; 27: 111115.CrossRefGoogle ScholarPubMed
Goldfaden, DM, Jones, M, Morrow, AG.Long-term results of repair of incomplete persistent atrioventricular canal. J Thorac Cardiovasc Surg 1981; 82: 669673.CrossRefGoogle ScholarPubMed
Chin, AJ, Keane, JF, Norwood, WI, Castañeda, AR.Repair of complete common atrioventricular canal in infancy. J Thorac Cardiovasc Surg 1982; 85: 437446.CrossRefGoogle Scholar
King, RM, Puga, FJ, Danielson, GK, Schaff, HV, Julsrud, PR, Feldt, RH.Prognostic factors and surgical treatment of partial atrioventricular canal. Circulation 1986; 74(Suppl Iyes): I 42I 46.Google ScholarPubMed
Stewart, S, Alexson, C, Manning, J.Partial atrioventricular canal defect: the early and late results of operation. Ann Thorac Surg 1987; 43: 527529.CrossRefGoogle ScholarPubMed
Weintraub, RG, Brawn, WJ, Venables, AW, Mee, RBB.Two-patch repair of complete atrioventricular septal defect in the first year of life. J Thorac Cardiovasc Surg 1990; 99: 320326.CrossRefGoogle ScholarPubMed
Dubost, C, Blondeau, P.Canal atrio-ventriculaire et ostium primum. Cure chirurgicale, d'apres 25 observations. J Chir 1959; 78: 241258.Google Scholar
Edwards, JE.The problem of mitral insufficiency caused by accessory chordae tendineae in persistent common atrioven-tricular canal. Proc Staff Meet Mayo 1960; 35: 299306.Google ScholarPubMed
Schlesinger, Z, Deutsch, V, Yahini, JH, Neufeld, HN.Deformed anterior mitral valve leaflet without mitral insufficiency in persistent common atrioventricular canal. Anatomic and angiocardiographic correlations. Am Heart J 1967; 73: 742751.CrossRefGoogle ScholarPubMed
Vaysse, J.Traitement chirurgical du canal atrioventriculaire. Ann Chir Thorac Cardiovasc 1963; 2: 280292.Google Scholar
Soulié, P, Pauly-Laubry, C.Resultats de la chirurgie du canal atrio-ventriculaire. Arch Mal Coeur 1970; 63: 15051525.Google Scholar
Lévy, S, Blondeau, P, Dubost, C.Long-term follow-up after surgical correction of the partial form of common atrioventricular canal. J Thorac Cardiovasc Surg 1974; 67: 353363.CrossRefGoogle ScholarPubMed
Carpentier, A. Surgical anatomy and management of the mitral component of atrioventricular canal defects. In: Anderson, RH and Shinebourne, EA (eds). Paediatric Cardiology 1977. Churchill Livingstone, Edinburgh, 1978, pp 477490.Google Scholar
Villain, E, Kachaner, J, Sidi, D, Lebidois, J, Piechaud, JF.Surgical management of complete atrioventricular defect in infancy. Pediatr Cardiol 1984; 5: 231234.Google Scholar
Van Mierop, LHS, Alley, RD.The management of the cleft mitral valve in endocardial cushion defect. Ann Thorac Surg 1966; 2: 416423.CrossRefGoogle Scholar
Kanazawa, H, Eguchi, S, Miyamura, H, Imaizumi, K, Yamazaki, Y.Total circular annuloplasty with absorbable suture of the repair of mitral regurgitation of endocardial cushion defect in growing children. Nippon Kyobu Geka Gakkai Zasshi 1987; 35: 799803.Google ScholarPubMed
Ebels, T, Anderson, RH, Devine, WA, Debich, DE, Penkoske, PA, Zuberbuhler, JR.Anomalies of the left atrioventricular valve and related ventricular septal morphology in atrioventricular septal defects. J Thorac Cardiovasc Surg 1990; 99: 299307.CrossRefGoogle ScholarPubMed
Meijboom, EJ, Ebels, T., Anderson, RH, Schasfoort-van Leeuwen, M, Deanfield, JE, Eijgelaar, A, Homan van der Heide, JN.Left atrioventricular valve after surgical repair in atrioventricular septal defect with separate valve orifices (“Ostium primum atrial septal defect”) an echo-Doppler study. Am J Cardiol 1986; 57: 433436.CrossRefGoogle Scholar
Ebels, T, Anderson, RH, Devine, WA, Debich, DE, Penkoske, PA, Zuberbuhler, JR.Anomalies of the left atrioventricular valve and related ventricular septal morphology in atrioventricular septal defects. J Thorac Cardiovasc Surg 1990: 99: 299307.CrossRefGoogle ScholarPubMed
Abbruzzese, PA, Livermore, J, Sunderland, CO, Nunley, DL, Issenberg, H, Khonsari, S, Garcia, CE, Starr, A.Mitral repair in complete atrioventricular canal. Ease of correction in early infancy. J Thorac Cardiovasc Surg 1983; 85: 388395.CrossRefGoogle ScholarPubMed
Abbruzzese, PA, Napoleone, A, Bini, RM, Annecchino, FP, Merlo, M, Parenzan, L.Late left atrioventricular valve insufficiency after repair of partial atrioventricular septal defects: anatomical and surgical determinants. Ann Thorac Surg 1990; 49: 111114.CrossRefGoogle ScholarPubMed
Saito, A, Ueda, K, Nakano, H.Quantitative evaluation of complete endocardial cushion defect using two-dimensional echocardiography. J Cardiogr 1987 17: 169178.Google ScholarPubMed
McGrath, LB, González-Lavin, L.Actuarial survival, freedom from reoperation, and other events after repair of atrioventricular septal defects. J Thorac Cardiovasc Surg 1987; 94: 582590.CrossRefGoogle ScholarPubMed
Abbate, M, Lomeo, A, Patane, L, Urso, E, Gentile, M, Bianca, I, Sciuto, G, Greco, G, Calvi, V.Risultati immediati e a distanza della correzione chirurgica del canale atrioventricolare parziale in eta'adulta. II Cuore 1989: 6: 587590.Google Scholar
Champsaur, G, Ninet, J, Rizk, M, Vigneron, M, Cochet, P, Jarolin, J, Bozio, A, Sassolas, F, Neidecker, J.Traitement chirurgical des canaux atrio-ventriculaires complets. Intérêt de la technique de la “double piece composite”. Arch Mal Coeur 1989: 82:715718.Google Scholar
Yasui, H, Nakamura, Y, Kado, H, Yonenaga, K, Shiokawa, Y, Fusazaki, N, Sunagawa, H, Tokunaga, K.Primary repair for complete atrioventricular canal: recommendation for early primary repair. J Cardiovasc Surg 1990: 31: 498504.Google ScholarPubMed
Ungerleider, RM, Kisslo, JA, Greeley, WJ, Van Trigt, P, Sabiston, DC.Intraoperative prebypass and postbypass epicardial color flow imaging in the repair of atrioventricular septal defects. J Thorac Cardiovasc Surg 1989; 98: 90100.CrossRefGoogle ScholarPubMed
Canter, CE, Sekarski, DC, Martin, TC, Guitiérrez, FR, Spray, TL.Intraoperative evaluation of atrioventricular septal defect repair by color flow mapping echocardiography. Ann Thorac Surg 1989: 48: 544550.CrossRefGoogle ScholarPubMed
Ebels, T, Elzenga, NJ.Difference in ultrasound penetration and reflection of PTFE, plain Dacron and gelsealed Dacron intracardiac patch material. Echocardiography 1990: 7: 359364.Google Scholar
Lee, CN, Danielson, GK, Schaff, HV, Puga, FJ, Mair, DD.Surgical treatment of double-orifice mitral valve in atrioventricular canal defects. Experience in 25 patients. J Thorac Cardiovasc Surg 1985: 90: 700705.CrossRefGoogle ScholarPubMed
Warnes, C, Somerville, J.Double mitral valve orifice in atrioventricular defects. Br Heart J 1983; 49: 5964.CrossRefGoogle ScholarPubMed
Draulans-Noë, HAY, Wenink, ACG, Quaegebeur, J.Single papillary muscle (“Parachute valve”) and double-orifice left ventricle in atrioventricular septal defect convergence of cordal attachment: surgical anatomy and results of surgery. Pediatr Cardiol 1990; 11: 2935.CrossRefGoogle Scholar
Szulc, M, Poon, E, Cooper, R, Kaplovitz, H, Frenkel, M, Tranbaugh, R.Single papillary muscle and ostium primum defect. Pediatr Cardiol 1990; 11: 9697.CrossRefGoogle ScholarPubMed
Losay, J, Rosenthal, A, Castañeda, AR, Bernhard, WH, Nadas, AS.Repair of atrial septal defect primum. Results, course and prognosis. J Thorac Cardiovasc Surg 1978; 75: 248254.CrossRefGoogle ScholarPubMed
McMullan, MH, McGoon, DC, Wallace, RB.Surgical treatment of partial atrioventricular canal. Arch Surg 1978; 75: 248254.Google Scholar
Caillat, M, Leca, F, Thibert, M, Tamisier, D, Abdel-Meguid, I, Vouhe, P, Neveux, JY.Remplacement valvulaire mitral dans le canal atrio-ventriculaire. Arch Mal Coeur 1990; 83: 711715.Google Scholar
McGrath, LB, Kirklin, JW, Soto, B, Bargeron, LM.Secondary left atrioventricular valve replacement in atrioventricular septal (AV canal) defect: A method to avoid left ventricular outflow tract obstruction. J Thorac Cardiovasc Surg 1985; 89: 632635.CrossRefGoogle ScholarPubMed
Ebels, T, Ho, SY, Anderson, RH, Meijboon, EJ, Eijgelaar, A.The surgical anatomy of the left ventricular outflow tract in atrio-ventricular septal defect. Ann Thorac Surg 1986; 41: 483488.CrossRefGoogle Scholar
Metz, D, Chapoutot, L, Mauran, P, Deschildre, A, Elaerts, J, Bajolet, A.Retrétrécissement aortique sous-valvulaire découvert aproes correction d'un canal atrio-ventriculaire chez l'adulte. Arch Mal Coeur 1988; 81: 223225.Google Scholar
Taylor, NC, Somerville, J.Fixed subaortic stenosis after repair of ostium primum defects. Br Heart J 1981;45: 689697.CrossRefGoogle ScholarPubMed
Spanos, PK, Fiddler, GI, Mair, DD, McGoon, DC.Repair of atrioventricular canal associated with membranous subaortic stenosis. Mayo Clin Proc 1977; 52: 121124.Google ScholarPubMed
Piccoli, GP, Ho, SY, Wilkinson, JL, Macartney, FJ, Gerlis, LM, Anderson, RH.Left-sided obstructive lesions in atrioventricular septal defects. J Thorac Cardiovasc Surg 1982; 83: 453460.CrossRefGoogle ScholarPubMed
Heydarian, M, Griffith, BP, Zuberbuhler, JR.Partial atrioventricular canal associated with discrete subaortic stenosis. Am Heart J 1985; 109: 915917.CrossRefGoogle ScholarPubMed
Ben-Shachar, G, Moller, JH, Castafñeda-Zuniga, W, Edwards, JE.Signs of membranous subaortic stenosis appearing after correction of persistent common atrioventricular canal. Am J Cardiol 1981; 48: 340344.CrossRefGoogle Scholar
Kasegawa, H, Nakagawa, Y, Masuda, M, Furukawa, H, Shiihara, H, Okui, K.A case report of hypertrophic obstructive cardiomyopathy after the correction of atrioventricular septal defect. Nippon Kyobu Geka Gakkai Zasshi 1989; 37: 22232228.Google ScholarPubMed
Wright, JS, Newman, DC.Complete and intermediate atrio-ventricular canal in infants less than a year old: observations of anatomical and pathological variants in left ventricular out-flow tract. Ann Thorac Surg 1982; 33: 171173.CrossRefGoogle Scholar
Moulaert, AJ, Oppenheimer-Dekker, A.Anterolateral muscle undle of the left ventricle, bulboventricular flange and subaortic stenosis. Am J Cardiol 1976; 37: 7881.CrossRefGoogle ScholarPubMed
Wenink, ACG. The ventricular septum in hearts with an atrioventricular defect. In: Wenink, ACG, Oppenheimer-Dekker, A, Moulaert, AJ (eds). The Ventricular Septum of the Heart Martinus Nijhoff Publishers, The Hague/Boston/London, 1981, pp 131138.CrossRefGoogle Scholar
De Biase, L, Di Ciommo, V, Ballerini, L, Bevilacqua, M, Marceletti, C, Marino, B.Prevalence of left-sided obstructive lesions in patients with atrioventricular canal without Down's syndrome. J Thorac Cardiovasc Surg 1986; 91: 467469.CrossRefGoogle ScholarPubMed
Van Praagh, S, Antoniadis, S, Otero Coto, E, Leidenfrost, RD, Van Praagh, R. Common atrioventricular canal with and without conotruncal malformations. An anatomic study of 251 postmortem cases. In: Nora, JJ, Takao, A (eds). Congenital Heart Disease. Causes and Processes. Futura Publishing Co., Mount Kisco, New York, 1984, pp 599639.Google Scholar
Ebels, T, Meijboom, EJ, Anderson, RH, Schasfoort-van Leeuwen, M, Lenstra, D, Eijgelaar, A, Bossina, KK, Homan van der Heide, JN.Anatomic and functional “obstruction” of the outflow tract in atrioventricular septal defects with separate valve orifices (“ostium primum atrial septal defect”): an echocardiographic study. Am J Cardiol 1984; 54: 843847.CrossRefGoogle Scholar
Yoshida, H, Funabashi, T, Nakaya, S, Maeda, T, Taniguchi, N.Subxihoid cross-sectional echocardiographic imaging of the “goose-neck” deformity in endocardial cushion defect. Circulation 1980; 62: 13191323.CrossRefGoogle ScholarPubMed
Wenink, ACG, Ottenkamp, J, Guit, GL, Draulans-Noë, HAY, Doornbos, J.Correlation of morphology of the left ventricular outflow tract with two-dimensional Doppler echocardiography and magnetic resonance imaging in atrioventricular septal defect. Am J Cardiol 1989; 63: 11371140.CrossRefGoogle ScholarPubMed
Chang, CI, Becker, AE.Surgical anatomy of left ventricular outflow tract obstruction in complete atrioventricular septal defect. J Thorac Cardiovasc Surg 1987; 94: 897903.CrossRefGoogle ScholarPubMed
Somerville, J.Clinical assessment of the function of the mitral valve in atrioventricular defects related to the anatomy. Am Heart J 1966; 71: 701711.CrossRefGoogle ScholarPubMed
Berger, TJ, Blackstone, EH, Kirklin, JW, Bargeron, LM, Hazelrig, JB, Turner, ME.Survival and probability of cure without and with operation in complete atrioventricular canal. Ann Thorac Surg 1979; 95: 722726.Google Scholar
Bull, C, Rigby, ML, Shinebourne, EA.Should management of complete atrioventricular canal defect be influenced by coexistent Down syndrome? Lancet 1985; 11471149.CrossRefGoogle ScholarPubMed
Clapp, SK, Perry, BL, Farooki, ZQ, Jackson, WL, Karpawich, PP, Hakimi, M, Arciniegas, E, Green, EW.Surgical and medical results of complete atrioventricular canal: a ten year review. Am J Cardiol 1987; 59: 454458.CrossRefGoogle ScholarPubMed