Common atrioventricular valve failure during single ventricle palliation†

Abstract

Patients with single ventricle physiology and common atrioventricular valve experience a continuous decline in valve function. The majority of patients experience valve failure in the first 30 years of life.

Management of the bad atrioventricular valve in Fontan…time for a change

“…In a study by Buratto and colleagues 17 of unbalanced atrioventricular septal defects undergoing single-ventricle palliation, 32% needed valve repair and had an early mortality of 18%, and 32% needed further valve intervention. King and colleagues 18 reported on 114 patients with Fontan circulation with common atrioventricular valves and found that 28 patients required valve intervention, and 24 of those patients underwent repair at the first intervention. Of the patients who underwent repair, 67% experienced valve repair failure that was defined as the need for reintervention for moderate or more regurgitation.…”

“…Of the patients who underwent repair, 67% experienced valve repair failure that was defined as the need for reintervention for moderate or more regurgitation. 18 The 4-year freedom from repair failure was a disappointing 50%. 18 Similarly in the study of King and colleagues, 1 common atrioventricular valve was a factor for valve repair failure on univariate analysis, with 68% failing as compared with 14% of mitral valve repairs.…”

“…18 The 4-year freedom from repair failure was a disappointing 50%. 18 Similarly in the study of King and colleagues, 1 common atrioventricular valve was a factor for valve repair failure on univariate analysis, with 68% failing as compared with 14% of mitral valve repairs. Ota and colleagues 19 studied valve repair in single-ventricle patients with heterotaxia presenting with moderate-to-severe or greater regurgitation and found 44% had a durable initial repair with a median follow-up of 6.2 years.…”

Partition of Common Atrioventricular Valve in a Patient With Dextrocardia and Univentricular Circulation

“…Moderate-to-severe AVV regurgitation is an independent predictor of mortality and reoperation after single-ventricle palliation. 3 Patients with single-ventricle physiology and common AVV are at risk of progressive AVV insufficiency after Fontan operation, 2 as occurred in the patient described herein. We have previously demonstrated that AVV repair is especially difficult in unbalanced AVSD 3 and dextrocardia 4 using conventional techniques.…”

“…1 Common atrioventricular valves (AVV) often become insufficient in patients with univentricular physiology, leading to heart failure. 1,2 We have recently observed that outcomes of children with AVSD who reach Fontan circulation are not as bad as previously thought, provided that the AVV remains competent. 1 Common AVV surgery is associated with substantial mortality and reoperation rates.…”