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

Copyright © 2009 EDIZIONI MINERVA MEDICA

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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