Results of surgical repair of atrioventricular septal defect with double-orifice left atrioventricular valve
Received 26 June 2008; received in revised form 13 March 2009; accepted 15 May 2009. published online 29 June 2009.
Objective
The outcome of surgical correction of atrioventricular septal defect with double-orifice left atrioventricular valve has improved in recent years but is still reported to be associated with high mortality and reoperation rates. Controversy exists about the management of the accessory orifice. We evaluated our results with correction of atrioventricular septal defect with double-orifice left atrioventricular valve.
Methods
Between 1975 and 2006, 21 patients underwent correction of atrioventricular septal defect with double-orifice left atrioventricular valve. Clinical data were obtained by means of retrospectively reviewing inpatient and outpatient medical records. To evaluate the influence of double-orifice left atrioventricular valve on mortality and the need for reoperation, a comparison was made with 291 consecutive patients who, during the same period, underwent correction of atrioventricular septal defect without double-orifice left atrioventricular valve.
Results
None of the 21 patients with double-orifice left atrioventricular valve had undergone a previous operation. The accessory orifice was managed with different techniques depending on the severity of the regurgitation. There was no in-hospital mortality, and there were 3 late deaths. Seven patients required 12 reoperations, 7 for left atrioventricular valve insufficiency. Double-orifice left atrioventricular valve had no influence on mortality but was a significant predictor for reoperation compared with repair of atrioventricular septal defect without double-orifice left atrioventricular valve. At the latest follow-up, all 18 survivors were in New York Heart Association functional class І without medication. Only 1 patient showed residual mild left atrioventricular valve insufficiency.
Conclusion
Atrioventricular septal defect with double-orifice left atrioventricular valve can be repaired with low mortality. However, double-orifice left atrioventricular valve is a predictor for reoperation. The accessory orifice is often competent and should then be left untouched. If regurgitation of the accessory orifice is present, this is best managed with suture or patch closure.
aDepartment of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
bDepartment of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands
cDepartment of Anatomy, Leiden University Medical Center, Leiden, The Netherlands
Address for reprints: Gerard J. F. Hoohenkerk, MD, Department of Cardio-Thoracic Surgery, Hagaziekenhuis location Leyenburg, The Hague, PO Box 40551, 2504 LN The Hague, The Netherlands.
ABSTRACT