Leaflet tissue was not divided, and a trileaflet mitral valve was left in each patient. Complete atrioventricular canal defect cavc american. Results with the two patch technique for repair of complete atrioventricular septal defect. The assessment of modified single patch and two patch techniques in complete atrioventricular septal defects and our shortterm results. Surgical management of pediatric patients with the diagnosis of complete atrioventricular canal cavc is accomplished by using one of three procedures.
The modified singlepatch technique was conceived simultaneously by two separate groups, one in the united states and one in australia. Between january 2000 and june 2006, 55 infants underwent cavc repair. Congenital heart valve program mitral valve boston. Contemporary outcomes of complete atrioventricular septal defect repair. Although both the onepatch and twopatch techniques of complete avc repair yield acceptable results, these approaches are neither simple nor flexible, particularly in the smallest infants. The valves open and close to keep blood flowing forward through the heart. After cardiopulmonary bypass cpb the o 2 sat was 80% fio 2 100%, no 20 ppm. This defect is also called a complete common av canal.
Next article congenital heart disease after surgery. Pediatric unbalanced atrioventricular septal defects. Complete atrioventricular canal defects require surgery, usually within the first two or three months of life. Medications may be helpful and improve symptoms until the operation is performed. Atrioventricular septal defect avsd or atrioventricular canal defect avcd, also known as common atrioventricular canal cavc or endocardial cushion defect ecd, is characterized by a deficiency of the atrioventricular septum of the heart. Dr ranjith mp senior resident department of cardiologygovernment medical college kozhikode 2. Correspondence should be typed doublespaced including references with conventional margins. Methods between december 2001 and october 2011, 98 infants underwent complete avsd primary repair. Results of simplified singlepatch repair for complete. This is our current technique of choice at childrens memorial hospital in chicago, illinois. Doublepatch technique for correction of complete atrioventricular. Mitral regurgitation was absent in 2 patients, mild in 3, moderate in 2, and severe in 2. These lesions are divided into partial and complete forms.
Carpentier technique for repair of complete avsd with the double patch technique. Repair of complete atrioventricular septal defect with tetralogy of fallot the association of the tetralogy of fallot tof with a complete atrioventricular septal defect cavsd is a wellrecognized congenital heart malformation occurring in 510% of hearts with cavsd and in 1. Methodsfourteen patients underwent traditional av canal repair with the single patch technique group 1 and 11 patients underwent repair with the australian technique group 2. Also known as atrioventricular canal defects or endocardial cushion defects, they account for about 5 percent of all congenital heart disease, and are most common in infants with down syndrome. The purpose of this study was to compare the modified singlepatch technique to the twopatch technique for infants with complete atrioventricular canal cavc defects.
This is 1 advantage of utilizing a 2patch technique over a sin glepatch technique for repair of tof with an av canal defect. A complete atrioventricular septal defect see figure atrioventricular septal defect consists of a large ostium primum atrial septal defect asd in the anteroinferior aspect of the septum, a nonrestrictive inlet ventricular septal defect, and a common av valve orifice. Repair of complete atrioventricular defect using twopatch technique. Although no patch repair was the first surgical treatment for complete atrioventricular canal, patch repairs are currently more widely used. Direct closure was the first described surgical treatment for complete atrioventricular canal cavc 1. Pdf the assessment of modified singlepatch and two. One patient had the right ventricular dominant form of complete av septal defect. Tetralogy of fallot with atrioventricular canal defect. Repair of complete av septal defect is facilitated by using separate patches for the ventricular and atrial components of the defect.
Complete repair in total atrioventricular canal defect. Utilization of these techniques have resulted in a current operative mortality of 2 4% and. Of these, the modified singlepatch is currently the best technique available for repair of cavc. Comparison of modified single patch technique with two patch technique. This is the portion of the atrial septum located between the anteriorinferior margin of the fossa ovalis and the common avv. Robert anderson, reported in 1997, a technique where 12 patients with complete atrioventricular av septal defect had direct closure of the ventricular element.
Correction of complete atrioventricular septal defects with two patch. Current procedural terminology repair of incomplete or. Atrial component of the atrioventricular septum or canal portion of the atrial septum. Abstract this technique involves the use of a crescentshaped teflon patch to close the ventricular. A simplified method for the repair of complete atrioventricular canal. Open lung biopsy was made in the third postoperative day pod when the thorax was closed and revealed heathedwards grade iii of pulmonary hypertension. Two patch, single patch, and modified single patch repairs are accepted techniques for repair of complete atrioventricular av canal defects. Repair of complete atrioventricular septal defect with. Complete repair was made with two patch technique and a small persistent foramen ovale pfo was maintained opened. We report our comparative results of repairing complete av canal defects between 1998 and 2006 using the traditional single patch and the australian techniques. Pediatric complete atrioventricular septal defects. Techniques for repair of complete atrioventricular septal defect avsd have. For infants with complete atrioventricular canal defect, repair using the twopatch technique with routine mitral valve cleft closure at 4 to 6 months of age results in a low operative mortality, a low incidence of permanent heart block, and a low reoperation rate for mitral insufficiency.
Repair of partial atrioventricular canal without atrioventricular valve repair. Atrioventricular septal defects avsd are a relatively common family of congenital heart defects. The purpose of this study was to compare the modified single. Surgical repair of complete atrioventricular defect nunn technique.
The first repair of a complete atrioventricular septal defect was performed in 1954 by lillehei using a single patch technique and controlled cross circulation. This technique is particularly suited for patients with large rastelli a defects, as it allows for excellent exposure of the ventricular crest, while maintaining the physiologic height of the atrioventricular av valve tissue above the ventricular crest. The truth about mobile phone and wireless radiation dr devra davis duration. A v canal defect repair can be done by single patch and double patch technique. Atrioventricular septal defects avsd are a group of anomalies that share a defect of the atrioventricular septum and abnormalities of the atrioventricular valves.
A pericardial patch sewn to upper edge of patch for ventricular septal defect. We assessed the safety of forgoing a patch during the correction of complete atrioventricular canal in 8 consecutive patients. Atrioventricular canal avc defects childrens hospital. A five leaflet valve that guards the common av orifice. At the expense of increasing complexity, doublepatch repair was introduced to minimize the risk of left ventricular outflow tract lvot obstruction and heart block due to a repair under tension. The patches are stitched into the heart muscle, and as the child grows, the tissue grows over the patches. Repair of complete atrioventricular septal defects single. It is caused by an abnormal or inadequate fusion of the superior and inferior endocardial cushions with the mid portion of the atrial septum and the. Seventysix patients left the intensive care within 2 days. For the central patch technique, the superior and inferior bridging leaflets are attached with simple sutures. A novel technique for repair of complete atrioventricular canal defect. Specific treatments for atrioventricular canal defect av canal depend on the extent of the disease which can range from a single defect to a full combination of defects complete. T1 two patch repair of atrioventricular canal 7 au tedziagolska, m. Repair of congenital defect between both upper and lower heart chambers.
Previous article two patch technique for av canal defect repair. Repair of complete atrioventricular septal defects single patch technique. For the central patch technique, the superior and inferior bridging leaflets are attached with simple sutures to the right and left. The twopatch technique for complete atrioventricular canal. Repair of complete atrioventricular septal defects single patch technique repair of complete atrioventricular septal defects single patch technique crawford, fred a. Atrioventricular septal av canal defects in children. Backer cl, stewart rd, bailliard f, kelle am, webb cl, mavroudis c. For many years at childrens memorial hospital we utilized the twopatch technique for repair of complete atrioventricular canal cavc defect as originally described by george trusler in the article by mills and colleagues 1.
As the patch is sutured to the atrial surface of the superior and inferior bridging lea. The central patch technique is an alternative to other accepted techniques for the complete repair of atrioventricular septal defects asd. Congenital heart valve program at boston childrens hospital mitral valve. A variety of operative techniques has been used to repair complete atrioventricular av canal defects and satisfactory outcomes after single patch repairs have been reported. The surgical strategy with regard to complete atrioventricular septal defect cavsd. The traditional singlepatch technique for repair of complete atrioventricular av canal requires surgical division of the superior and inferior common leaflets. The american heart association explains the congenital heart defect complete atrioventricular, av, canal, complete av canal, complete common av canal, and endocardial cushion defect in children and adults.
The risk of hospital death for repair is 3% determinants of hospital. The surgeon will close the large hole with one or two patches. Rastelli onepatch procedure for complete atrioventricular. During the last 10 years in almost 160 patients undergoing surgery for complete avsd we have. Traditional single patch versus the australian technique. When your child has an atrioventricular av canal defect. Results of primary twopatch repair of complete atrioventricular. Lillehei and colleagues 1955 reported one of the earliest repair of a complete avsd using cross circulation 2. The onepatch technique involves closure of both the atrial and ventricular defects, as well as division and resuspension of the bridging leaflets, using a single patch. No ventricular septal defect patch atrioventricular septal defect. Primary repair of cavsd with a twopatch technique, including cleft closure. Essentially, they all describe a similar heart problem.
To report the mid and longterm results of the simplified single patch technique for complete avsd repair. The terms atrioventricular canal defects or endocardial cushion defects also describe these lesions. Nopatch technique for complete atrioventricular canal. Less distortion is created, and a more accurate reconstruction of a competent trileaflet mitral valve can be done. Correction of complete atrioventricular septal defects with the double patch technique and cleft closure. Atrioventricular septal defects are characterized by complete absence of av septum.
Repair of complete atrioventricular septal defects single patch. Repair of the complete atrioventricular septal defect, as with many other congenital heart defects, has changed with time from the one patch technique rastelli to the two patch technique and then to the modified one patch technique. A novel technique for repair of complete atrioventricular canal. In the neonate and young infant, subsequent resuspension of very delicate av valve tissue on the pericardial patch can be problematic. Infants are usually diagnosed with a complete av canal defect in utero or. This technique can be performed without splitting the avvalve leaflet tissue. Using an inverted singlepatch technique, direct asd closure has been. Nopatch repair of complete atrioventricular canal defects. The twopatch technique uses a prosthetic patch for the ventricular septal defect, a pericardial patch for the atrial septal defect, and suture closure of the anterior mitral cleft. Concept of a trileaflet left atrioventricular valve 52 53. Echocardiographic evaluation of common atrioventricular. Av canal is almost always treated by surgical repair of the defects.
Repair of partial atrioventricular canal with atrioventricular valve repair. The best technique for repair of complete atrioventricular av canal is the modified singlepatch technique. In all instances, repair was done using separate ventricular and atrial patches. Since wilcoxs description of the simplified single patch technique for atrioventricular septal defect avsd repair in 1997, several studies have compared that technique with the two patch technique. Nopatch repair of complete atrioventricular canal defects ctsnet.
1140 1590 1552 626 94 1236 1530 918 982 1429 1212 74 974 510 37 1025 1008 466 737 578 1011 1502 1207 427 271 891 762 622 1168 781 796 239 460 303 1098