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| Depth of Ventricular Septal Defect and Impact on Reoperation for Left Ventricular Outflow Obstruction after Repair of Complete Atrioventricular Septal Defect: Does Double Patch Technique Decrease the Incidence of Left Ventricular Outflow Obstruction? Anatomical and Clinical Correlation | |
Anastasios C. Polimenakos1, Shyam K. Sathanandam2, Soraia Bharati2, Vivian Cui2, David Roberson2, Mary jane Barth2, Chawki ElZein2, Robert S.D. S. Higgins1, Michel Ilbawi2; 1Center for Congenital and Structural Heart Disease / Rush University Medical Center, Chicago, IL; 2The Heart Institute for Children at Hope Christ Hospital, Oak Lawn, IL
Methods: From September 2002 to August 2008, 77 infants underwent CAVSD repair. Thirteen had MSP and 64 DP. Seven of 13 had trisomy 21 vs 46 of 64 (p ns). Mean age was 4.6+/-1.1 months (MSP) vs 4.9+/-1.3 months (DP) (p ns). LVOT peak gradient (PG) and depth of the ventricular component of the AVSD (dVSD) from AV valve annulus were measured by echocardiogram and dVSD expressed as a ratio to the length of ventricular septum from the apex (D). Sixteen anatomy specimens were examined. Each had MSP. The repair was, then, taken down followed by DP. Each specimen served as its own control. Measurements of LVOT were taken: 1 at the level of the free edge of AV valve anterior leaflet, 3 immediately in the subaortic valve area, 2 at the mid-distance. A and B indicate DP and MSP respectively. Finally, dVSD and D ratio were measured Results: Rastelli type A were 47 (10 MSP vs 37 DP), 3 type B (1 MSP vs 2 DP) and 27 type C (2 MSP vs 25 DP). Patients with smaller dVSD (D ratio) preferentially had MSP (0.21 +/-0.07 in MSP vs 0.32 +/-0.07 in DP, p<0.001). Mean follow-up was 36.4 +/-2.3 months. Fifteen patients developed LVOT PG greater than 20 mmHg (4 of 13 had MSP, 30.8% vs 11 of 64 had DP, 20.7% - p<0.05 ). When freedom from reoperation for LVOT obstruction (LVOT PG greater than 50 mmHG) was analyzed 3 of 13 (23%) with MSP and 6 of 64 (9.4%) with DP (p <0.05) required surgical intervention. Seven had modified Konno and 2 subaortic resection. In anatomical comparison, 1A was 20.67 +/-7.05 mm vs 1B 12.33 +/-4.96 mm (p< 0.001). 2A was 12.55 +/-3.36 mm vs 2B 8.72 +/-1.71 mm (p<0.001). 3A was 8.99 +/-2.29 mm vs 3B 7.65 +/-1.81 mm (p<0.001). There was direct correlation between reduction of LVOT at level 1 and dVSD (D ratio) when the MSPT was used (p 0.025, Pearson’s r 0.557). Conclusion: MSP is associated with higher incidence of LVOT gradient and lower freedom from reoperation for LVOT obstruction. The impact of dVSD ( D ratio) on LVOT, especially at level 1 (as shown in anatomical comparison), can be essential in selecting surgical strategy. Preoperative assessment, as described here, is warranted. Back to 2009 Annual Meeting Back to Program Outline Back to Main Program |
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