SYMPOSIUM: CARDIAC VALVE SURGERY IN PEDIATRICS
Valvular Repair for Atrioventricular Regurgitation in Complex Anomalies in Modified Fontan Procedure With Reference to a Single Ventricle Associated With a Common Atrioventricular Valve
Yasuharu Imai, Kazuhiro Seo, Masatsugu Terada, Mitsuru Aoki, Toshiharu Shin'oka, Jun Ohta, and Yuhsuke Iwata
Between January 1985 and October 1998, 169 of 372 patients who underwent a modified Fontan procedure had atrioventricular valve regurgitation (AVVR) that ranged in degrees from 1 to 4. Concomitant repair for AVVR was performed in the majority of cases. All but 12 patients had the AV valve repaired, mainly by circular annuloplasty; none had valve replacement. Although mortality was significantly higher in the AVVR cases (21 of 169 [12%]) than in the cases without AVVR (eight of 203 [3.9%]; P < .007, chi-square), actuarial survival in the AVVR cases was 83% at 5 years, 81% at 10 years, and 73% at 12 years. The degree of AVVR before surgery was 1.62 ± 0.73 on average; 82 cases had more than grade 2 regurgitation. There was a significant decrease to 0.54 ± 0.61 (P < .0001) after surgery in long-term survivors. Cases with AVVR can be treated with reasonable risk provided proper repair of the valve is performed. Circular annuloplasty is a simple and uniformly effective method with which to control regurgitation, even for the common AV valve.
Key words: Modified Fontan operation, single ventricle, common atrioventricular valve, atrioventricular valve requrgitation, circular annuloplasty.
From the Department of Pediatric Cardiovascular Surgery, The Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan.
Address reprint requests to Yasuharu Imai, MD, Department of Pediatric Cardiovascular Surgery, The Heart Institute of Japan, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo 162, Japan.
© 1999 by W.B. Saunders Company
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