Comparison of Two Surgical Techniques for Complete Atrioventricular Septal Defect Repair Using Two- and Three-Dimensional Echocardiography

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• 作者：Khalfan S. Al Senaidi (1)
  David B. Ross (2)
  Ivan M. Rebeyka (2)
  Joyce Harder (3)
  Ashok P. Kakadekar (4)
  Daniel Garros (2)
  Andrew S. Mackie (2)
  Jeffrey Smallhorn (2)
  
• 关键词：Atrioventricular septal defect ; Modified single ; patch technique ; Double ; patch technique ; Three ; dimensional echocardiography
• 刊名：Pediatric Cardiology
• 出版年：2014
• 出版时间：March 2014
• 年：2014
• 卷：35
• 期：3
• 页码：393-398
• 全文大小：352 KB
• 参考文献：1. Alexi-Meskishvili V, Ishino K, D?hnert I, Uhlemann F, Weng Y, Lange PE et al (1996) Correction of complete atrioventricular septal defects with the double-patch technique and cleft closure. Ann Thorac Surg 62:519-24 (discussion 524-15) CrossRef
  2. Backer CL, Stewart RD, Bailliard F, Kelle AM, Webb CL, Mavroudis C (2007) Complete atrioventricular canal: comparison of modified single-patch technique with two-patch technique. Ann Thorac Surg 84:2038-046 (discussion 2038-046) CrossRef
  3. Bando K, Turrentine MW, Sun K, Sharp TG, Ensing GJ, Miller AP et al (1995) Surgical management of complete atrioventricular septal defects. A twenty-year experience. J Thorac Cardiovasc Surg 110:1543-552 (discussion 1552-544) CrossRef
  4. Bogers AJ, Akkersdijk GP, de Jong PL, Henrich AH, Takkenberg JJ, van Domburg RT et al (2000) Results of primary two-patch repair of complete atrioventricular septal defect. Eur J Cardiothorac Surg 18:473-79 CrossRef
  5. Fortuna RS, Ashburn DA, Carias De Oliveira N, Burkhart HM, Konstantinov IE et al (2004) Atrioventricular septal defects: effect of bridging leaflet division on early valve function. Ann Thorac Surg 77:895-02 (discussion 902) CrossRef
  6. Hanley FL, Fenton KN, Jonas RA, Mayer JE, Cook NR, Wernovsky G et al (1993) Surgical repair of complete atrioventricular canal defects in infancy. Twenty-year trends. J Thorac Cardiovasc Surg 106:387-94 (discussion 394-87)
  7. Jeong IS, Lee CH, Lee C, Lim HG, Kim IS, Youn HC et al (2009) Surgical outcomes of the modified single-patch technique in complete atrioventricular septal defect. Interact Cardiovasc Thorac Surg 8:435-37 (discussion 437-38) CrossRef
  8. Lillehei CW, Cohen M, Warden HE, Varco RL (1955) The direct-vision intracardiac correction of congenital anomalies by controlled cross circulation: results in thirty-two patients with ventricular septal defects, tetralogy of Fallot, and atrioventricularis communis defects. Surgery 38:11-9
  9. Moran AM, Daebritz S, Keane JF, Mayer JE (2000) Surgical management of mitral regurgitation after repair of endocardial cushion defects: early and midterm results. Circulation 102:III160–III165 CrossRef
  10. Nicholson IA, Nunn GR, Sholler GF, Hawker RE, Cooper SG, Lau KC et al (1999) Simplified single patch technique for the repair of atrioventricular septal defect. J Thorac Cardiovasc Surg 118:642-46 CrossRef
  11. Nunn GR (2007) Atrioventricular canal: modified single patch technique. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 28-1
  12. Prifti E, Bonacchi M, Bernabei M, Crucean A, Murzi B, Bartolozzi F et al (2004) Repair of complete atrioventricular septal defects in patients weighing less than 5?kg. Ann Thorac Surg 77:1717-726 CrossRef
  13. Reddy VM, McElhinney DB, Brook MM, Parry AJ, Hanley FL (1998) Atrioventricular valve function after single patch repair of complete atrioventricular septal defect in infancy: how early should repair be attempted? J Thorac Cardiovasc Surg 115:1032-040 CrossRef
  14. Stellin G, Vida VL, Milanesi O, Rizzoli G, Rubino M, Padalino MA et al (2003) Surgical treatment of complete A-V canal defects in children before 3?months of age. Eur J Cardiothorac Surg 23:187-93 CrossRef
  15. Tweddell JS, Litwin SB, Berger S, Friedberg DZ, Thomas JP, Frommelt PC et al (1996) Twenty-year experience with repair of complete atrioventricular septal defects. Ann Thorac Surg 62:419-24 CrossRef
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• 作者单位：Khalfan S. Al Senaidi (1)
  David B. Ross (2)
  Ivan M. Rebeyka (2)
  Joyce Harder (3)
  Ashok P. Kakadekar (4)
  Daniel Garros (2)
  Andrew S. Mackie (2)
  Jeffrey Smallhorn (2)
  
  1. Division of Pediatric Cardiology, Sultan Qaboos University Hospital, Al Khod, P O Box 35, Muscat, 123, Oman
  2. Stollery Children’s Hospital, Edmonton, AB, Canada
  3. Alberta Children’s Hospital, Calgary, AB, Canada
  4. Royal University Hospital, Saskatoon, SK, Canada
  
• ISSN：1432-1971

文摘

Different surgical techniques for complete atrioventricular septal defect (CAVSD) repair have been described, with the double-patch technique being most frequently employed. More recently a newer technique using a modified single-patch repair has been advocated. We hypothesized that the modified single-patch technique would result in an increased incidence of the two major post-repair comorbidities, namely, distortion of the left AV valve (LAVV) leaflets and narrowing of the left-ventricular outflow tract (LVOT). We studied 14 patients with CAVSD who underwent either traditional double-patch technique [group 1 (n?=?7)] or modified single-patch technique [group 2 (n?=?7)]. Preoperative and immediate postoperative two-dimensional (2D) echocardiograms, as well as follow-up 2D and three-dimensional (3D) studies, were reviewed. For group 1, the median age at repair was 4.1?months with a median duration from surgical repair and last echocardiogram of 44?months. For group 2, the median age at repair was 3?months with a median duration from surgical repair and last echocardiogram of 28?months. The two groups had similar demographics and ventricular septal defect size before surgery. For the LAVV, no significant difference was observed with respect to LAVV annulus size, tenting height, and the size of the vena contracta. Furthermore, there was no significant difference in the 2D echocardiographic areas and volumes of the LVOT between pre-repair and immediate post-repair studies for both groups. At the last evaluation, although there had been growth of the LVOT in both groups, no significant difference between areas and volumes were observed. Areas of the LVOT measured by 3D echocardiography on the final study showed no significant statistical difference between both groups. There was good correlation of the areas measured by 2D and 3D echocardiography within each group. In this small group, modified single-patch technique does not appear to tether the LAVV or promote an increase in regurgitation. In the short term, LVOT growth is unaffected, and the repair does not promote LVOT obstruction. 3D echocardiography is useful for area measurements of the LVOT and showed good correlation with areas measured by assumption of the LVOT shape as determined using 2D techniques.