Original Articles
Surgery for partial atrioventricular septal defect in the adult

https://doi.org/10.1016/S0003-4975(98)01137-0Get rights and content

Abstract

Background. We sought to determine the clinical profile, operative results, and long-term outcome for adult patients undergoing operations for partial atrioventricular septal defects.

Methods. Between 1976 and 1996, 50 adults (mean age, 36.6 ± 13.2 years) underwent surgery for partial atrioventricular septal defects. Thirty-nine of them underwent primary repair for a substantial left-to-right shunt (≥1.8), associated with symptoms in 29. The remaining 11 patients had previous atrioventricular septal defect repair in childhood, but required reoperation as adults for severe left atrioventricular valve regurgitation (6), subaortic (3) or mitral (1) stenosis, and a residual atrial shunt (1).

Results. No patients died in hospital. Of the 39 patients first repaired in adulthood, left atrioventricular valve repair was performed in 37, valve replacement in 1, and no repair in 1. In contrast, left atrioventricular valve replacement was necessary in 2 of the 6 adults undergoing reoperation for left atrioventricular valve regurgitation. At 7 years median follow-up, 8 patients have died (2 from noncardiac causes). Of 42 patients alive in 1997, 39 are New York Heart Association class I or II, and 3 were class III (class improved in 81%). Two patients required left atrioventricular valve replacement (1 week and 5 years after repair, respectively) for valvar failure.

Conclusions. Low operative risk and excellent long-term results support repair of partial atrioventricular septal defect in adults.

Section snippets

Patients and methods

The study group comprised all 50 adult patients (18 years and older) who underwent surgery for partial AVSD at the TCCCA between 1976 and 1996. This 20-year period was selected both to reflect a reasonably contemporary surgical approach and to allow a minimum follow-up time of 6 months. Thirty-nine of these patients underwent primary repair for symptoms or a substantial left-to-right shunt. The remaining 11 patients had previous AVSD repair in childhood, and required reoperation as adults for

Results

The overall profile of the 50 patients enrolled in the study is shown in Table 1. Diagnoses additional to partial AVSD are listed in Table 2.

Comment

In agreement with recent reports by Bergin and associates [10] and Burke and colleagues [11], perioperative mortality and morbidity in our series of 50 adults undergoing operation for partial AVSD is low. Although the feasibility and safety of surgical repair are now well established, controversy continues to exist as to the optimal management of the adult with an ASD. Partial AVSDs share the same hemodynamic burden of chronic right heart volume overload with secundum ASDs, allowing for certain

Acknowledgements

We acknowledge Drs Rebeyka and Van Arsdell, who performed AVSD repair in some of the patients from this series. We also thank our colleagues from The Hospital for Sick Children, Toronto, for their continuing support of the TCCCA program. This paper was prepared with the assistance of Editorial Services, The Hospital for Sick Children.

Doctor Gatzoulis was supported in part by a 1997 University of Toronto, Department of Medicine, Postgraduate Fellowship Award.

References (25)

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