Left atrioventricular valve regurgitation after correction of atrioventricular septal defects.

PURPOSE Progressive regurgitation of the left atrioventricular valve (AV) remains a major postoperative problem in the repair of atrioventricular septal defect (AVSD). The aim of this study was to review a case series of AVSD repair and reoperation for significant left AV valve regurgitation from this institution. METHODS Forty-nine patients underwent initial repair of AVSD between February 1990 and March 2011, and 4 of them underwent reoperation for left AV valve regurgitation. Another 5 patients, who had received initial repair of AVSD before 1990, underwent reoperation of the left AV valve during the same period. This study retrospectively reviewed all cases of AVSD operation, and considered the causes of the left AV valve incompetence, and furthermore addressed how to manage most effectively this problem. RESULTS There were 4 early deaths (8.6%) and no late deaths after initial repair of AVSD. No death was observed after reoperation of the left AV valve. Six patients underwent re-repair of left AV valve, but three patients needed prosthetic valve replacement. An additional cleft closure and commissuroplasty were performed on the 6 re-repaired cases. No significant AV valve regurgitation was observed among the 6 re-repaired cases. The actuarial survival was 92% at 10 and 15 years after AVSD repair. Freedom from reoperation of the left AV valve was 81% at 10 and 15 years for the patients who survived the initial repair during the study period. Freedom from significant left AV valve regurgitation was 46% at 10 years for all patients who survived the initial repair during the study period. A partial ring annuloplasty using Gore-Tex graft was applied to the last 2 cases, and this employment yielded encouraging results. CONCLUSION The results were acceptable in terms of the mortality and reoperation free ratio, but the freedom from significant left AV valve regurgitation was disappointing. The outcome of reoperation for significant left AV valve regurgitation was also satisfactory. The application of Gore-Tex graft partial annuloplasty of the left AV valve appears to be a potentially useful and effective treatment modality.