Management of Complete Atrioventricular Canal Defect With Aortic Arch Obstruction

Hraška, Viktor; Walters, Henry L.

doi:10.1177/2150135110371136

Cited by 3 publications

(2 citation statements)

References 44 publications

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“…In 2010, Hraska et al recommended a two-stage approach for patients less than two months of age with competent AV valves. They reserved the one-stage surgical approach for patients (< 2 months of age) with significant AV valve insufficiency in whom medical management with or without relief of arch obstruction by a trans-catheter approach was not feasible or did not relieve symptoms [ 6 ]. Two months of age was arbitrarily chosen as a distinguishing time point highlighting the challenge of repairing friable young AV valve tissue.…”

Section: Discussionmentioning

confidence: 99%

“…Repair of AVSD in early infancy is challenging due to the fragility of the AV valve tissue and closing the cleft in the neonatal period would lead to left AV valve stenosis. The durability of left atrioventricular valve (AVV) function after early repair, and the associated morbidity and mortality has been questioned [ 6 , 7 ]. Importantly however, patients with either complete or partial atrioventricular septal defect and aortic arch obstruction frequently have a single, or nearly single left ventricular papillary muscle.…”

Section: Introductionmentioning

confidence: 99%

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Single-Stage Surgical Management of Atrioventricular Septal Defects with Coarctation of the Aorta

et al. 2022

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Surgical options for coarctation of aorta (CoA) with atrioventricular septal defect (AVSD) include single-stage repair vs. staged approach with neonatal CoA repair and delayed AVSD repair. The durability of left atrioventricular valve (LAVV) function after neonatal repair is questioned, and the optimal approach remains controversial. Eighteen CoA-AVSD patients who underwent single-stage repair 2005–2015 by a single surgeon were retrospectively analyzed. Fifteen patients had complete and three had partial AVSD. Birth weight was 3.19 kg (2.17–4.08). Age at surgery was 16 days (6–127). One- and ten-year survival were 80% and 69%. Freedom from reintervention was 60% and 40% at one and ten-year respectively. Reinterventions included relief of left ventricular outflow tract obstruction (LVOTO) ( n = 4), repair of cleft LAVV ( n = 3), and LAVV and aortic valve replacement ( n = 1). Freedom from LAVV reintervention was 85.6% and 66% at 1 and 10 years respectively. There were four deaths: two post-operative and two following hospital discharge. Mortality was due to sepsis in three patients, and heart failure related to LVOTO and LAVV insufficiency in one. At 68-month (0.6–144) follow-up the majority had mild or less LAVV regurgitation, and all had normal LV dimension and systolic function. There was no recurrent arch obstruction. Single-stage surgical repair of CoA-AVSD is feasible and reasonable. Survival and freedom from reintervention in our cohort approximate those outcomes of two-stage repair with durable left AV valve function and no recurrent arch obstruction. These patients are frequently syndromic and demonstrate mortality risk from non-cardiac causes. Consideration of a single-staged approach is warranted for appropriate patients with CoA-AVSD.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Single-Stage Surgical Management of Atrioventricular Septal Defects with Coarctation of the Aorta

et al. 2022

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Preoperative Clinical and Echocardiographic Factors Associated with Surgical Timing and Outcomes in Primary Repair of Common Atrioventricular Canal Defect

et al. 2019

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Correction of the aortic arch hypoplasia in newborn babies, suffering complete form of atrio-ventricular septal defect

Truba

Dovhaliuk

Dzyurii

et al. 2020

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Objective. Tactics of treatment and results of the hypoplasia of the aortic arch correction in newborn babies with complete form of atrio-ventricular septal defect were studied. Маterials and methods. During period from 2011 tо 2019 yrs in 21 patients correction of hypoplasia of aortic arch and atrio-ventricular septal defect were performed. The investigated group consisted of patients with a two-ventricular physiology. The patients, suffering imbalanced form of atrio-ventricular septal defect and with variants of hypoplasia in left parts of the heart, were excluded from the investigation. There were 9 (42.9%) boys and 12 (57.1%) girls. Average age of the patients have constituted (2.3 ± 1.1) mo (from 0.06 до 7.7 mo). Average body mass of the patients have constituted (3.8 ± 1.0) kg (from 2.0 до 5.9 kg). The aortic arch segment was considered a hypoplastic one if a Z-score (Standard Score - standard estimation) shift have constituted lesser than 2.0. Results. Hospital lethality have constituted 14.2%. Three newborn babies died: 2 - after first stage of correction, and 1 - after second stage of correction. All the patients, to whom a one-staged correction was done, have survived. The causes of lethality were not connected with method of the aortic arch reconstruction. While performance of echocardiography before discharge from the hospital the pressure gradient on place of the aortic arch plasty have constituted (13.6 ± 6.8) mm Hg at average. Average follow-up period have constituted (2.6 ± 2.1) yrs (from 2 mo tо 8.1 yr). In late follow-up period lethality was absent. In 2 (9.5%) patients in postoperative period reoperations on aortic arch and mitral valve were performed. Tracheal compression as well as the main bronchi compression, neurological complications in late follow-up period were absent. Conclusion. For the patients, suffering complete form of atrio-ventricular septal defect in conjunction with hypoplasia of aortic arch the staged correction constitutes a more favorable option, owing good immediate and late results. A staged approach in the treatment is indicated for newborn babies, suffering hypoplasia of distal aortic arch and competent atrio-venticular valves or with small regurgitation. Оne-stage correction is indicated in hypoplasia of aortic arch, pronounced regurgitation on common atrio-ventricular valve and pronounced heart failure.

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Management of Complete Atrioventricular Canal Defect With Aortic Arch Obstruction

Cited by 3 publications

References 44 publications

Single-Stage Surgical Management of Atrioventricular Septal Defects with Coarctation of the Aorta

Single-Stage Surgical Management of Atrioventricular Septal Defects with Coarctation of the Aorta

Preoperative Clinical and Echocardiographic Factors Associated with Surgical Timing and Outcomes in Primary Repair of Common Atrioventricular Canal Defect

Correction of the aortic arch hypoplasia in newborn babies, suffering complete form of atrio-ventricular septal defect

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