Complete atrioventricular septal defect with absent or diminutive primum component: Incidence, anatomic characteristics, and outcomes
| Autor: | Lester C. Permut, Michael H. Kwon, Muhammad K. Nuri, D. Michael McMullan, Amy H. Schultz, Madonna Lee |
|---|---|
| Rok vydání: | 2022 |
| Předmět: |
Reoperation
Pulmonary and Respiratory Medicine congenital hereditary and neonatal diseases and abnormalities medicine.medical_specialty Time Factors Databases Factual Regurgitation (circulation) 030204 cardiovascular system & hematology Transesophageal echocardiogram Risk Assessment 03 medical and health sciences 0302 clinical medicine Risk Factors Internal medicine medicine Operative report Humans cardiovascular diseases Atrioventricular Septal Defect Cardiac Surgical Procedures Atrium (heart) Retrospective Studies Atrioventricular valve medicine.diagnostic_test business.industry Heart Septal Defects Incidence Mitral Valve Insufficiency Recovery of Function medicine.disease Tricuspid Valve Insufficiency Treatment Outcome medicine.anatomical_structure 030228 respiratory system cardiovascular system Patent foramen ovale Cardiology Surgery Transthoracic echocardiogram Cardiology and Cardiovascular Medicine business |
| Zdroj: | The Journal of Thoracic and Cardiovascular Surgery. 163:1156-1162 |
| ISSN: | 0022-5223 |
| Popis: | Background Repair of complete atrioventricular septal defect with absent or diminutive primum defect is challenging because of atrial septal malposition and abnormal anatomy of the left atrioventricular valve. We sought to define the incidence, anatomy, and surgical outcomes of this entity. Methods We identified all patients in our institutional database presenting for complete atrioventricular septal defect repair from 2006 to 2018. Operative reports and echocardiograms were reviewed to determine the presence and size of the primum defect, atrioventricular valve anatomy, degree of atrioventricular valve regurgitation, repair method, and complications, including reoperation for atrioventricular valve regurgitation. Functionally univentricular patients and those receiving repair at an outside institution were excluded. Results Of 183 patients with complete atrioventricular septal defect, absent/diminutive primum defect occurred in 16 patients (8.7%; 10 absent, 6 diminutive). Six patients (38%) had leftward malposition of the atrium septum on the common atrioventricular valve. The rate of reoperation for left atrioventricular valve regurgitation was 31% (3 early, 2 late), for which preoperative predictors included leftward malposition of the atrial septum onto the common atrioventricular valve (4/6 patients with malposition required reoperation, P = .036, Fisher exact test). One patient exhibiting this risk factor died. The overall rate of moderate or greater left atrioventricular valve regurgitation on the most recent postoperative echocardiogram was 13% (2/16 patients; median follow-up, 141 days; range, 3-2236 days). Conclusions Complete atrioventricular septal defect with absent or diminutive primum defect is a unique variant of complete atrioventricular septal defect for which the risk of reoperation for left atrioventricular valve regurgitation after complete repair is high and risk factors include leftward malposition of the atrial septum on the common atrioventricular valve. |
| Databáze: | OpenAIRE |
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