Repair of Partial Atrioventricular Septal Defects in Adults: A Single Center Experience.

Published on Jun 1, 2021in Seminars in Thoracic and Cardiovascular Surgery2.133
· DOI :10.1053/J.SEMTCVS.2020.08.009
Sri Harsha Patlolla7
Estimated H-index: 7
(Mayo Clinic),
Joseph A. Dearani95
Estimated H-index: 95
(Mayo Clinic)
+ 4 AuthorsNishant Saran5
Estimated H-index: 5
(Mayo Clinic)
Sources
Abstract
Limited data are available on long-term outcome after repair of partial atrioventricular septal defects (pAVSD) in adults. We sought to review our experience. Between January 1, 1957 and December 31, 2016, 179 adult patients [median age (IQR) 34 (18, 72) years] underwent primary repair of pAVSD. The most common associated defects were secundum atrial septal defect (n = 38) and ventricular septal defect (VSD) (n = 7). Left atrioventricular valve (LAVV) zone of apposition (ZOA) was complete in 47 patients and LAVV regurgitation (≥moderate) was present in 73 patients. Autologous pericardium (n = 79, 45%) and polytetrafluoroethylene felt (n = 56, 32%) were mainly used for pAVSD closure.  Repair techniques for LAVV regurgitation included: ZOA suture closure (n =  142), suture annuloplasty (n = 10) and posterior band annuloplasty (n = 9). Six had LAVV replacement. There were 61 deaths over a median follow-up of 21 years (IQR 10, 38), with only 4 early deaths. In a limited subset of patients with 80 paired measurements (n = 40), median right ventricular systolic pressure declined from 43 mm Hg (IQR 35–51) to 33 mm Hg (IQR 30–44) postoperatively (P
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#2Justin T. TretterH-Index: 12
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3 Citations
#1Paul J. Devlin (Children's Memorial Hospital)H-Index: 6
#2Carl L. Backer (NU: Northwestern University)H-Index: 76
Last. John M. Costello (NU: Northwestern University)H-Index: 18
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Background We evaluated the outcomes of patients undergoing surgical repair of partial atrioventricular septal defect (AVSD) and analyzed the effect of age on outcome. Methods In this single-center retrospective study, we included all children who underwent repair of partial AVSD between 1990 and 2014. We divided the patients into 4 age quartiles (first quartile: 0–0.75 years, n = 22; second quartile: 0.75–1.5 years, n = 21; third quartile: 1.5–3.75 years, n = 22; and fourth quartile: >3.75 year...
14 CitationsSource
#1Nazzareno GalièH-Index: 98
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ALAT : alanine aminotransferase ASAT : aspartate aminotransferase APAH : associated pulmonary arterial hypertension BAS : balloon atrial septostomy BMPR2 : bone morphogenetic protein receptor 2 BNP : brain natriuretic peptide BPA : balloon pulmonary angioplasty BREATHE : Bosentan
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#1Alexander R. Opotowsky (Boston Children's Hospital)H-Index: 43
Pulmonary hypertension (PH) refers to elevated pulmonary artery (PA) pressure (PAP), defined as mean PAP≥25 mm Hg. PH is not synonymous with pulmonary arterial hypertension (PAH), which specifies resistive PH characterized by elevated pulmonary vascular resistance (PVR) and normal pulmonary venous pressure. Approximately 5% to 10% of adults with congenital heart disease (CHD) have PH, and this subset of CHD patients is at higher risk of hospitalization and death.1–3 Understanding the epidemiolog...
29 CitationsSource
#1Jessica L. Bowman (Nationwide Children's Hospital)H-Index: 3
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Surgical repair of partial atrioventricular septal defects (AVSD) has been successful for more than 60 years. However, recent data from the Pediatric Heart Network show that 31% of patients have moderate or severe left atrioventricular valve regurgitation (LAVVR) at follow-up. Previously, our institution found that only 9% of patients had more than moderate LAVVR at the last follow-up. Our objective was to determine the long-term outcomes after repair of partial AVSD in the current era. We revie...
16 CitationsSource
Left ventricular outflow tract obstruction (LVOTO) is an important source of morbidity and mortality after repair of atrioventricular septal defect (AVSD). The intrinsic anatomy of the left ventricular outflow tract in AVSD is complex and predisposes to the development of LVOTO. LVOTO after repair of AVSD usually involves multiple levels and sources of obstruction, and surgical intervention must address each component of the obstruction. This includes fibromuscular obstruction, septal hypertroph...
11 CitationsSource
#1Camilla Nyboe (Aarhus University Hospital)H-Index: 2
#2Morten Fenger-Grøn (AU: Aarhus University)H-Index: 20
Last. Vibeke E. Hjortdal (Aarhus University Hospital)H-Index: 41
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OBJECTIVES: Treatment of atrial septal defect (ASD) in adults is still controversial, and with older age the likelihood of treatment is decreased. The aim of this study was to investigate the effect of ASD closure in adults and especially in the elderly in our institution in a retrospective review. METHODS: Adult patients (n= 220) underwent surgical or catheter closure for an isolated ASD at Aarhus University Hospital from 1990 to 2008. Eleven were lost to follow-up and 13 had cardiac comorbidit...
21 CitationsSource
#1Sameh M. Said (Mayo Clinic)H-Index: 24
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Last. Joseph A. Dearani (Mayo Clinic)H-Index: 95
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Congenital tricuspid valve regurgitation (TR) is a relatively uncommon condition that includes a heterogeneous group of lesions with a unique management strategy. There are wide anatomic variations that lead to congenital TR in patients without Ebstein malformation. Possible etiologies may include primary valve abnormalities (eg, congenital absence of chordae) or other forms of tricuspid valve dysplasia as in congenitally unguarded tricuspid valve, and patients with pulmonary atresia and intact ...
24 CitationsSource
#1Aditya K. Kaza (UofU: University of Utah)H-Index: 30
#2Steven D. Colan (Boston Children's Hospital)H-Index: 116
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Background The influence of atrioventricular septal defect (AVSD) subtype on outcomes after repair is poorly understood. Methods Demographic, procedural, and outcome data were obtained 1 and 6 months after AVSD repair in an observational study conducted at 7 North American centers. Results The 215 AVSD patients were subtyped as 60 partial, 27 transitional, 120 complete, and 8 with canal-type VSD. Preoperatively, transitional patients had the highest prevalence of moderate or severe left atrioven...
28 CitationsSource
#1Daniel J. Penny (Royal Children's Hospital)H-Index: 16
#2G. Wesley Vick (BCM: Baylor College of Medicine)H-Index: 24
Summary Ventricular septal defects account for up to 40% of all congenital cardiac malformations. The diagnosis encompasses a broad range of anomalies, including isolated defects and those associated with other congenital cardiac malformations. Presentation, symptoms, natural history, and management of ventricular septal defects depend on size and anatomical associations of the anomaly, patient's age, and local diagnostic and interventional expertise. In this Seminar, we describe the anatomical ...
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