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The Journal of Cardiovascular Surgery 2000 August;41(4):523-7

language: English

Placement of interatrial patch suture lines in atrioventricular canal defect repair

Aeba R., Katogi T., Kashima I., Mitsumaru A., Takeuchi S., Kawada S.

From the Divi­sion of Car­di­o­vas­cular Sur­gery Keio Uni­ver­sity, ­Tokyo, ­Japan


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Back­ground. The place­ment of the ­suture ­line for inter­atrial ­patches in com­plete and incom­plete atri­o­ven­tric­ular ­canal ­defect ­repairs ­varies ­from sur­geon to sur­geon ­despite estab­lished ana­tomic knowl­edge of the atri­o­ven­tric­ular con­duc­tion ­system. ­This ­study ­describes our tech­nique for it and ­reviews ­early and ­long-­term out­comes.
­Methods. ­Between 1980 and 1999, 64 ­infants and chil­dren under­went ­repair of ­either com­plete (n=39) or incom­plete (n=25) atri­o­ven­tric­ular ­canal ­defects. ­Thirty-­four of the chil­dren (53.1%) had ­Down’s syn­drome. The ­suture ­line for the inter­atrial ­patch orig­i­nated on ­either the arti­fi­cial or ­native ven­tric­ular ­septal ­crest and con­tinued left­ward ­above the ­annulus of the ­left infe­rior ­leaflet of the atri­o­ven­tric­ular ­valve at the pos­te­roin­ferior ­corner. All ­stitches ­were ­placed in a hor­i­zontal mat­tress or U-­shaped ­fashion.
­Results. The oper­a­tive sur­vival ­rate was 94% (4 ­early ­deaths) and the ­overall sur­vival ­rate was 85% (6 ­late ­deaths). Atri­o­ven­tric­ular ­heart ­blocks ­occurred in ­none of the ­patients. ­Although ­left-­sided atri­o­ven­tric­ular func­tion sig­nif­i­cantly ­improved ­with ­repair, two ­patients (3.1%) ­required reop­er­a­tion for ­valve replace­ment ­because of ­residual or recur­rent insuf­fi­ciency.
Con­clu­sions. ­This ­suture tech­nique for inter­atrial ­patches is straight­for­ward and ­results in a low inci­dence of ­heart ­block and a low re-oper­a­tion ­rate for ­left atri­o­ven­tric­ular ­valve insuf­fi­ciency.

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