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


CONCLUSIONS
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.
Roman
Kevin S
KS
Division of Cardiology, The Hospital for Sick Children, The University of Toronto, Faculty of Medicine, Toronto, Ontario, Canada.
Nii
Masaki
M
Macgowan
Christopher K
CK
Barrea
Catherine
C
Coles
John
J
Smallhorn
Jeffrey F
JF
D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery*; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D005500:Follow-Up Studies; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging* / Q000601:surgery*; D006345:Heart Septal Defects, Ventricular / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D007223:Infant; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013997:Time Factors; D016896:Treatment Outcome