Surgical strategies of atrioventricular septal defect with left ventricular outflow tract stenosis: Clinical outcome of single center_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CAO Yuefeng , LI Lei , SU Junwu , CHENG Pei ,  FAN Xiangming

Center of Pediatric Heart, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, P.R.China;

Corresponding author：

FAN Xiangming, Email: fanxiangming@126.com

Keywords：

Atrioventricular septal defect; left ventricular outflow tract stenosis; surgical treatment

DOI：

10.7507/1007-4848.202005073

Video：

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Objective To explore the anatomical characteristics and surgical strategies of atrioventricular septal defect (AVSD) with left ventricular outflow tract (LVOT) stenosis.Methods The clinical data of 11 AVSD patients with LVOT stenosis who underwent surgeries in our hospital from 2008 to 2019 were retrospectively analyzed, including 6 males and 5 females with a median age of 15.0 (7.6-22.0) years.Results There were 3 patients of complete AVSD and 8 patients of partial AVSD. Subaortic stenosis resulted from discrete subaortic membrane in 3 patients, diffused subaortic membrane in 4 patients, hypertrophied muscle bundles in 3 patients and distorted valve frame in 1 patient. Among these patients, 5 patients underwent LVOT stenosis and AVSD repairs simultaneously for the first time, 5 patients underwent LVOT stenosis repair for the second time and 1 patient for the third time. No postoperative death occurred. The postoperative LVOT flow velocity decreased dramatically after LVOT stenosis repair compared with preoperative one [449.0 (393.0, 507.5) cm/s vs. 212.0 (183.0, 253.5) cm/s, P<0.05].Conclusion Surgical results of AVSD combined with LVOT stenosis are satisfactory, but the restenosis should be paid attention to via long-term follow-up.

Citation： CAO Yuefeng, LI Lei, SU Junwu, CHENG Pei, FAN Xiangming. Surgical strategies of atrioventricular septal defect with left ventricular outflow tract stenosis: Clinical outcome of single center. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(9): 1072-1075. doi: 10.7507/1007-4848.202005073 Copy

1.	Najm HK, Coles JG, Endo M, et al. Complete atrioventricular septal defects: Results of repair, risk factors, and freedom from reoperation. Circulation, 1997, 96(9 Suppl): Ⅱ-311-5.
2.	Vohra HA, Chia AX, Yuen HM, et al. Primary biventricular repair of atrioventricular septal defects: An analysis of reoperations. Ann Thorac Surg, 2010, 90(3): 830-837.
3.	Birim O, van Gameren M, de Jong PL, et al. Outcome after reoperation for atrioventricular septal defect repair. Interact Cardiovasc Thorac Surg, 2009, 9(1): 83-87.
4.	Bakhtiary F, Takacs J, Cho MY, et al. Long-term results after repair of complete atrioventricular septal defect with two-patch technique. Ann Thorac Surg, 2010, 89(4): 1239-1243.
5.	Tlaskal T, Gebauer R, Gilik J, et al. Experience with the surgical treatment of atrioventricular septal defect with left ventricular outflow tract obstruction. Interact Cardiovasc Thorac Surg, 2014, 18(6): 789-796.
6.	Draulans-Noë HA, Wenink AC. Anterolateral muscle bundle of the left ventricle in atrioventricular septal defect: Left ventricular outflow tract and subaortic stenosis. Pediatr Cardiol, 1991, 12(2): 83-88.
7.	Overman DM. Reoperation for left ventricular outflow tract obstruction after repair of atrioventricular septal. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2014, 17(1): 43-47.
8.	Buratto E, Ye XT, Bullock A, et al. Long-term outcomes of reoperations following repair of partial atrioventricular septal defect. Eur J Cardiothorac Surg, 2016, 50(2): 293-297.
9.	Abarbanell GL, Morrow G, Kelleman MS, et al. Echocardiographic predictors of left ventricular outflow tract obstruction following repair of atrioventricular septal defect. Congenit Heart Dis, 2016, 11(6): 554-561.
10.	Myers PO, del Nido PJ, Marx GR, et al. Improving left ventricular outflow tract obstruction repair in common atrioventricular canal defects. Ann Thorac Surg, 2012, 94(2): 599-605.
11.	Wang G, Ma K, Pang K, et al. Modified single repair technique for complete atrioventricular septal defect: A propensity score matching analysis. Pediatr Cardiol, 2020, 41(3): 615-623.
12.	Backer CL, Eltayeb O, Mongé MC, et al. Modified single patch: Are we still worried about subaortic stenosis? Ann Thorac Surg, 2015, 99(5): 1671-1675.

1. Najm HK, Coles JG, Endo M, et al. Complete atrioventricular septal defects: Results of repair, risk factors, and freedom from reoperation. Circulation, 1997, 96(9 Suppl): Ⅱ-311-5.
2. Vohra HA, Chia AX, Yuen HM, et al. Primary biventricular repair of atrioventricular septal defects: An analysis of reoperations. Ann Thorac Surg, 2010, 90(3): 830-837.
3. Birim O, van Gameren M, de Jong PL, et al. Outcome after reoperation for atrioventricular septal defect repair. Interact Cardiovasc Thorac Surg, 2009, 9(1): 83-87.
4. Bakhtiary F, Takacs J, Cho MY, et al. Long-term results after repair of complete atrioventricular septal defect with two-patch technique. Ann Thorac Surg, 2010, 89(4): 1239-1243.
5. Tlaskal T, Gebauer R, Gilik J, et al. Experience with the surgical treatment of atrioventricular septal defect with left ventricular outflow tract obstruction. Interact Cardiovasc Thorac Surg, 2014, 18(6): 789-796.
6. Draulans-Noë HA, Wenink AC. Anterolateral muscle bundle of the left ventricle in atrioventricular septal defect: Left ventricular outflow tract and subaortic stenosis. Pediatr Cardiol, 1991, 12(2): 83-88.
7. Overman DM. Reoperation for left ventricular outflow tract obstruction after repair of atrioventricular septal. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2014, 17(1): 43-47.
8. Buratto E, Ye XT, Bullock A, et al. Long-term outcomes of reoperations following repair of partial atrioventricular septal defect. Eur J Cardiothorac Surg, 2016, 50(2): 293-297.
9. Abarbanell GL, Morrow G, Kelleman MS, et al. Echocardiographic predictors of left ventricular outflow tract obstruction following repair of atrioventricular septal defect. Congenit Heart Dis, 2016, 11(6): 554-561.
10. Myers PO, del Nido PJ, Marx GR, et al. Improving left ventricular outflow tract obstruction repair in common atrioventricular canal defects. Ann Thorac Surg, 2012, 94(2): 599-605.
11. Wang G, Ma K, Pang K, et al. Modified single repair technique for complete atrioventricular septal defect: A propensity score matching analysis. Pediatr Cardiol, 2020, 41(3): 615-623.
12. Backer CL, Eltayeb O, Mongé MC, et al. Modified single patch: Are we still worried about subaortic stenosis? Ann Thorac Surg, 2015, 99(5): 1671-1675.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Surgical strategies of atrioventricular septal defect with left ventricular outflow tract stenosis: Clinical outcome of single center

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