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The impact of patch augmentation on left atrioventricular valve dynamics in patients with atrioventricular septal defects: early and midterm follow-up.

Roman KS, Nii M, Macgowan CK, Barrea C, Coles J, Smallhorn JF

Division of Cardiology, The Hospital for Sick Children, The University of Toronto, Faculty of Medicine, Toronto, Ontario, Canada.

OBJECTIVE: Left atrioventricular valve pericardial patch may prevent valve replacement. We assessed patch annular dynamics compared with conventional repair and normal annuli. METHODS: Transesophageal 3-dimensional echocardiography was acquired preoperatively and postoperatively in atrioventricular septal defects (n = 10, 5 patch, 5 conventional repair). Real-time 3-dimensional annular motion at midterm was compared with that of healthy children (n = 10). Parameters were: annular area, perimeter, segmental diameter, bending angle, stenosis, and regurgitation. RESULTS: Regurgitant jet area ratio decreased in both patient groups. Conventional repair reduced annular area (P = .02). Patch repair showed an annular area larger than normal (P = .01). Control subjects had increased systolic area whereas operative groups showed a reduction. Patch repair had segmental diameters similar to normal whereas conventional repair was inhomogeneous. Annular bending angle was maintained after operation. CONCLUSION: Patch repair in pediatrics shows durability without shrinkage or expansion. Improved stenosis and regurgitation does not change by midterm. Operation causes increased annular stiffness and diminished compliance. Neither technique establishes normal annular eccentricity.

Published 13 November 2006 in J Am Soc Echocardiogr, 19(11): 1382-92.
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