• Journal of Chest Surgery
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• v.17 no.2
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• pp.171-176
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• 1984

Successful correction of the partial form of atrioventricular[AV] canal is now readily achievable. The most challenging technical features of this anomaly are the associated mitral valvular deformity and the frequent inability to obtain mitral competence. Residual mitral incompetence after repair of mitral cleft figures importantly in the causes of early and late failure. So, accurate and complete repair of the mitral valve cleft might be important. Determination of residual severe mitral regurgitation after repair is desirable to permit mitral valve replacement at the time. We have experienced one case of severe mitral regurgitation which was occurred 6 months after repair of partial form of A-V canal [ASD primum] in 22 years old virgin. Pre-op. left ventriculogram revealed severe mitral regurgitation in this patient. We preferred to perform mitral valve replacement with St. Jude valve in this patient at March 1984. Post-op. course was uneventful to now for 5 months and we report this case, review and discuss the literatures.

• Journal of Chest Surgery
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• v.20 no.4
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• pp.760-764
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• 1987

Fifty seven patients underwent repair of a partial atrioventricular septal defect from January 1980 to December 1986. The ostium primum atrial septal defect was closed with autologous or bovine pericardium. The cleft in the anterior mitral leaflet was present in 53 cases, absent in 4 cases. Of the 53 cases with a cleft in the anterior mitral leaflet, 48 received suture repair of the cleft, 3 received mitral valve replacement. There was no hospital death and all the patients were followed-up for a mean period of 26.4 months. Four required permanent pacemaker implantation due to complete heart block, and one of them died of sudden malfunction of pacemaker. Two received reoperation due to significant residual mitral insufficiency. Suture repair of the cleft in the anterior mitral leaflet resulted in significant decrease in degree of mitral regurgitation. During follow-up period 49 patients were in NYHA class I, 7 patients were in NYHA class II. This report suggests that excellent result can be achieved from repair of the partial atrioventricular septal defect by managing the left A-V valve as a bileaflet structure.

• Journal of Chest Surgery
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• v.27 no.11
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• pp.902-906
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• 1994

Between May 1991 and August 1993, 16 patients underwent repair of complete atrioventricular septal defect without another major anomaly at Cardiovascular Center,Yonsei University College of Medicine. Ages of the patients ranged from 3 months to 38 years with a mean of 42 months. Among 16, 10 patients[63%] are associated with Down`s syndrome. All patients underwent primary repair except and one who received had been repaire of coactation of aorta and patent ductus arteriosus 2 month before. Preoperative mitral valve regurgitation [MR] was evaluated with Doppler echocardiography and angiography which revealed absent or grade I in 1, grade II in 8, grade III in 4, and grade IV in 3. Operative technique was performed under the moderate hypothermic cardiopulmonary bypass with crystalloid cardioplegia. Intraoperative echocardiography was performed epicardial approach [n=7] in the operative table or transthoracic approach [n=9] at intensive care unit. In all patients except 3, MR were improved. But in 3 patients, was not improved or exagerated comparing preoperative one. All of them were died.One patient was showed MR grade IV in intraoperative echocardiography, we re-repaired atriventricular valve with cardiopulmonary bypass. During follow-up period [at a mean of 11 months after repair], doppler echocardiography was performed in all patients. The follow up echocardiography revealed that the degree of MR in immediate postoperative period was not changed except in two patients in whom it was aggravated. Thus it seems that intraoperative and early postoperative echocardiography was employed important role of survival and can be predictable for long term results.

• Journal of Chest Surgery
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• v.32 no.7
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• pp.628-636
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• 1999

Background: Recent advances in understanding the anatomy of the complete atrioventricular septal defect(including right-dominant unbalanced atrioventricular septal defect) have led to alternative methods of repairing these defects. Material and Method: From May 1997 to July 1998, 8 consecutive infants(age range, 2 to 28 months, mean body weight 6.0$\pm$2.2 kg) received a single-stage intracardiac repair of the complete atrioventricular septal defect with modified surgical methods. Depending on the specific anatomic structure, the procedure was simplified in 3 patients by a direct closure of the ventricular element of the defect(Group I). Two patients judged unsuitable for direct closure due to a potential left ventricular outflow tract obstruction had received a standard two-patch repair(Group II). The remaining 3 patients with right-dominant unbalanced complete atrioventricular septal defect underwent biventricular repair; to enlarge the orifice of the left atrioventricular valve, the ventricular septal patch was placed slightly more to the right of the ventricular crest, a left sided bridging leaflet was augmented with an autologous pericardial patch, and the leaflet was repaired with a double- orifice(Group III . Result: In all 8 patients, the postoperative echocardiography demonstrated good hemodynamics. Seven patients were weaned from the ventilators after a mean 3$\pm$1 days, and 1 patient was weaned after 24 days due to a reoperation and emphysematous lung problem. A reoperation was performed in 1 patient for progressive left atrioventricular valve regurgitation due to leaflet tearing. There were no early and late mortalities. At the time of the latest review, judging from the echocardiographic criteria, left atrioventricular valve stenosis was mild in 1 patient(mean pressure gradient 6.5 mmHg, 13.5%), left atrioventricular valve regurgitation was absent or grade I in 7 patients(87.5%). The right atrioventricular valve regurgitation was absent or grade I in all 8 patients(100%). Conclusion: Infants with complete atrioventricular septal defect were treated with either a simplified approach with direct closure of the ventricular element of the defect or a modified surgical technique for a right-dominant unbalanced atrioventricular septal defect, depending on the anatomic structure. The results were no operative mortalities and low morbidity.

• Journal of Chest Surgery
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• v.48 no.6
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• pp.404-406
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• 2015

Gebode defect, that can accurately be treated surgical repair, is defined as a true communication between left ventricle and right atrium. A 74-year-old woman with a worsening history of ortophnea and peripheral edema was hospitalised. A communication between right atrium and left ventricle was diagnosed using transeusophageal echocardiography. The defect was repaired and mitral valve was replaced with a biologic valve. It would be beter to tailor surgical strategy for each case with atrioventricular canal defect after preoperative transeusophageal echocardiography and peroperative direct sight.

• Journal of Chest Surgery
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• v.26 no.12
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• pp.904-908
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• 1993

Twelve patients had undergone repair of atrioventricular septal defects. Age at operation ranged from 2.4 years to 17 years[mean, 8.25 years]. Five patients were male and seven were female. Three patients had complete atrioventricular septal defect[Rastelli type A] associated with Down`s syndrome. One of the three patient with complete atrioventricular septal defect had tetralogy of Fallot. Three patients had the intermediate form and seven patients had the partial form. The primum atrial septal defect was closed with pericardial patch. The atrioventricular valve septal commissure[mitral cleft] was closed with pledgeted sutures. Three complete atrioventricular septal defect were undergone by two-patch technique. A crescent-shaped Dacron patch was used to occlude the ventricular septal defect. One patient of partial form was sudden death 5 days postoperatively. There were no another complications after surgery. One patient underwent reoperation for opened mitral cleft 2.5 years postoperatively. New York Heart Association functional class of patients was improved postoperatively.

• Journal of Chest Surgery
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• v.16 no.4
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• pp.476-484
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• 1983

Ventricular septal defect[VSD] associated with aortic regurgitation[AR] represents 2 to 7.5% of all VSD which is most common congenital heart disease. The aortic valve may by normal in infants with VSD, but the aortic regurgitation may be developed in these patients later. The aortic valve became fibrotic, thickened, deformed and prolapsed, so these late deformities require to be corrected with plication, valvuloplasty or aortic valve replacement [AVR]. There are some controversy between the early repair of VSD alone and the late repair of VSD and aortic valve till now. From December 1971 to August 1983, we had experienced 24 patients of VSD associated with AR which constitute 6.5% of our total patients with VSD. The VSD was subpulmoary [type I] in 14[58.3%], subcristal [type II] in 8[33.3%], atrioventricular canal type[type III] in 1, and combine of type I and II in 1. Patch repair of VSD was made in 15 patients and direct suture of small VSD in 9.14 patients had aortic plication of valvuloplasty and 9 had AVR accompanying VSD repair, and 1 patient had VSD closure alone. The postoperative courses of these patients were uneventful except in some cases. A patient who was undertaken AVR with Starr-Edwards ball valve and VSD closure, died due to left ventricular failure and low cardiac output syndrome. Follow up shows, in 14 patients with aortic plication or valvuloplasty, AR was developed in 9. In 9 AVR, there were two later complications which were paravalvular leakage in one and re-AVR due to subacute bacterial endocarditis in another.

• Journal of Chest Surgery
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• v.40 no.12
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• pp.855-858
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• 2007

A left ventricular rupture might be one of the most disastrous complications after a mitral valve replacement. An acute atrioventricular groove rupture (type I) was detected in a 54-year-old female diagnosed with a mitral stenosis combined with severe tricuspid regurgitation. She had a prior medical history of an open mitral commissurotomy in Japan at 30 years ago. The surgical findings suggested that the previous procedure was not a simple commissurotomy but a commissurotomy combined with a posteromedial annuloplasty procedure. After a successful mitral valve replacement and a measured (De Vega type) tricuspid annuloplasty, the weaning from a cardiopulmonary bypass was uneventful. However, copious intraoperative bleeding from the posterior wall was detected and the cardiopulmonary bypass was restarted. Exposure of the posterior wall of the left ventricle showed bleeding from the atrioventricular groove 3 cm lateral to the left atrial auricle. Under the impression of a Type I left ventricular rupture, epicardial repair (primary repair of the Teflon felt pledgetted suture, continuous sealing suture using auto-pericardial patch and application of fibrin-sealant) was attempted. Successful local control was made and the patient recovered uneventfully. The patient was discharged at 14 postoperative days without complications. We report this successful epicardial repair of an acute type I left ventricular rupture after mitral valve replacement.

• Journal of Chest Surgery
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• v.22 no.6
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• pp.990-995
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• 1989

Since 1984, 24 patients underwent repair of atrioventricular septal defect. Nineteen had a partial defect and 5 had a complete atrioventricular septal defect. There were 9 men and 15 women, ranging in age from 1 to 50 years [mean age, 13.3 years]. Four patients had a Downs syndrome. Additional congenital heart defects were present in 11 patients. One patient had palliative operation prior to total correction. In partial defects, the primum atrial septal defect was closed with Xenomedica patch and the mitral valve was repaired with simple closure of the septal commissure. Central incompetence from annular dilatation was repaired by a local annuloplasty. In complete defect, the septal defects were closed with two patches except one. Operative mortality was 5% in partial defects and 60% in complete defects and low cardiac output was the commonest etiology. In a mean follow-up period of 27.9 months [range, 4 to 63 months] there were no late death and no instances of late-onset complete heart block. One patient required reoperation [MVR] for residual mitral regurgitation. The majority of patients were asymptomatic and mean postop. NYHA functional class was 1.2.

• Journal of Yeungnam Medical Science
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• v.40 no.2
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• pp.187-192
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• 2023

Background: This study aimed to present the short- and midterm outcomes after complete atrioventricular canal defect (CAVC) repair using a single-patch technique. Methods: This study included 30 children who underwent surgical correction of the CAVC using a single-patch technique. Results: The median age of the patients was 5.7 months (interquartile range [IQR], 5.0-7.5 months), and 23 patients (76.7%) had type A CAVC. Fourteen patients (46.7%) were female and 17 (56.7%) had been diagnosed with Down syndrome. The in-hospital mortality rate was 0%. No deaths were observed during a median follow-up of 4 years (IQR, 3.5-5.0 years). Patients without Down syndrome were associated with late moderate mitral regurgitation (MR) (p=0.02). Late MR less than moderate degree was observed in 96.6%, 78.5%, and 50% of patients after 2, 4, and 5 years of follow-up, respectively, while late tricuspid valve regurgitation less than moderate degree was observed in 96.7%, 85.9%, and 59.0% of patients after 2, 4, and 6 years of follow-up, respectively. After a median follow-up of 4 years, only one patient had required surgical repair of a left ventricular outflow tract obstruction, which occurred 26 months after the first operation. Multivariable logistic regression analysis adjusted for the type of CAVC, sex, Down syndrome, age, and weight revealed that the absence of Down syndrome was a risk factor for late moderate MR (MR-2) (odds ratio, 0.05; 95% confidence interval, 0.006-0.50; p=0.01). Conclusion: A single-patch technique for CAVC surgical repair is a safe method with acceptable short- and midterm results.