Left atrioventricular valve regurgitation after repair of incomplete atrioventricular septal defect

Murashita, Takashi; Kubota, Takehiro; Oba, Jane; Aoki, Toshihide; Matano, J; Yasuda, Keishu

doi:10.1016/j.athoracsur.2003.12.019

Cited by 60 publications

(41 citation statements)

References 17 publications

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“…Previous clinical studies have reported that the key to competence of the trifoliate LAV valve is the zone of apposition (cleft) between its bridging leaflets 2,7,9. The findings from this study confirm these clinical observations and provide novel insights into the interaction between the degree of cleft opening and annular size after primary valve repair in AVC defects.…”

Section: Discussionsupporting

confidence: 84%

“…Unlike repair for other valve lesions, surgical guidelines for LAV valve reconstruction in AVC defects are unclear, resulting in evolution of a variety of unsuccessful repair procedures that often result in valve replacement 2,6,7. Long-term follow-up studies on these patients are scarce, so that it is impossible to assess the surgical techniques or understand the failure mechanisms.…”

mentioning

confidence: 99%

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Cleft closure and undersizing annuloplasty improve mitral repair in atrioventricular canal defects

Padala

Vasilyev

Owen

et al. 2008

The Journal of Thoracic and Cardiovascular Surgery

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Objective Reoperation rates to correct left atrioventricular valve regurgitation after primary repair of atrioventricular canal defects remain relatively high. The causes of valvular regurgitation are likely multifactorial, and simple cleft closure is often insufficient to prevent recurrence. Methods To elucidate the mechanisms leading to regurgitation, we conducted hemodynamic studies using isolated native mitral valves. Anatomy of these valves was altered to mimic atrioventricular canal type valves and studied under pediatric hemodynamic conditions. The impact of subvalvular geometry, cleft closure, annular dilatation, and annular undersizing on regurgitation were investigated. Results Papillary muscle position did not have a significant effect on regurgitation. Cleft closure had a significant impact on valvular competence, with reduction in regurgitation volume with increased cleft closure. Regurgitation volume decreased from 12.5 ± 2.4 mL/beat for an open cleft to 4.9 ± 1.9 mL/beat for a partially closed cleft and to 1.4 ± 1.6 mL/beat when the cleft was completely closed. Annular dilatation had a significant impact on regurgitation even after cleft closure. A 40% increase in annular size increased regurgitation by 59% for a partially closed cleft and by 84% for a fully closed cleft. Reducing the annular size by 20% from the physiologic level decreased the regurgitation volume by 12% for a fully open cleft and by 58% for the partially closed cleft case. Conclusions Annular dilatation after primary repair has a potentially significant role in the recurrence of atrioventricular valve regurgitation. Reducing the annular size and restricting dilatation as an adjunct to cleft closure is a promising surgical approach in such valve anatomies.

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Section: Discussionsupporting

confidence: 84%

mentioning

confidence: 99%

Cleft closure and undersizing annuloplasty improve mitral repair in atrioventricular canal defects

Padala

Vasilyev

Owen

et al. 2008

The Journal of Thoracic and Cardiovascular Surgery

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“…Left-sided AV valve (LAVV) regurgitation is the major cause of late morbidity after surgical repair of atrioventricular septal defect (AVSD) [1,2]. Past studies have indicated that up to 40% of the patients ultimately require reoperation [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Real-time transthoracic three-dimensional echocardiography provides additional information of left-sided AV valve morphology after AVSD repair

Bosch

Dijk

McGhie

et al. 2006

International Journal of Cardiology

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“…However, these techniques may have limitations in children, particularly those with congenital heart disease. Residual MR is an important complication after surgical repair of atrioventricular septal defect (AVSD) [3, 4, 15, 18]. Both qualitative and quantitative methods of evaluating the severity of MR in these children may be compromised by the presence of multiple jets, a noncircular cross-sectional jet profile, eccentric direction of flow into the left atrium with marked Coanda effect, and dynamic regurgitant orifice.…”

Section: Introductionmentioning

confidence: 99%

Challenges in Echocardiographic Assessment of Mitral Regurgitation in Children After Repair of Atrioventricular Septal Defect

et al. 2011

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The validity and reproducibility of echocardiographic methods used to quantify mitral regurgitation (MR) in children with congenital heart disease are unknown. We evaluated the usefulness of methods used to quantify MR in children enrolled in a multicenter trial of enalapril 6 months after surgical repair of an atrioventricular septal defect (AVSD). MR severity in this trial was assessed using body surface area (BSA)-adjusted vena contracta lateral (i-VCWlat) and anterior-posterior (i-VCWap) dimensions and cross-sectional area (i-VCA), regurgitant volume/BSA, regurgitant fraction, and qualitative MR grade. For each method, association with left ventricular end-diastolic volume (LVEDVz) and end-diastolic dimension (LVEDDz) z-scores and interobserver agreement were assessed. In 149 children (median age 1 year), i-VCWlat, i-VCWap, and i-VCA were best associated with LVEDVz (r2 = 0.54, r2 = 0.24, and r2 = 0.46, respectively; p < 0.001 for all) and showed the highest interobserver agreement (intraclass correlation coefficient = 0.62, 0.73, and 0.68, respectively). Qualitative MR grade was also associated with LVEDVz (r2 = 0.31, p < 0.001) and showed modest interobserver agreement (kappa 0.56). Regurgitant volume/BSA and regurgitant fraction were associated with LVEDVz (r2 = 0.45 and r2 = 0.45, p < 0.001 for both) but showed poor interobserver agreement [ICC = 0.28 (n = 91) and ICC = 0.17 (n = 76), respectively], and their values were negative in 75% of subjects. In conclusion, echocardiographic assessment of MR severity after AVSD remains challenging. Among the quantitative methods used in this trial, i-VCW and i-VCA performed the best but offered little advantage compared with qualitative MR grade. The utility of regurgitant volume and fraction was severely limited by poor interobserver agreement and frequently negative values.

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Left atrioventricular valve regurgitation after repair of incomplete atrioventricular septal defect

Cited by 60 publications

References 17 publications

Cleft closure and undersizing annuloplasty improve mitral repair in atrioventricular canal defects

Cleft closure and undersizing annuloplasty improve mitral repair in atrioventricular canal defects

Real-time transthoracic three-dimensional echocardiography provides additional information of left-sided AV valve morphology after AVSD repair

Challenges in Echocardiographic Assessment of Mitral Regurgitation in Children After Repair of Atrioventricular Septal Defect

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