Hoohenkerk Gerard J F, Wenink Arnold C G, Schoof Paul H, Koolbergen Dave R, Bruggemans Eline F, Rijlaarsdam Mary, Hazekamp Mark G
Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.
J Thorac Cardiovasc Surg. 2009 Nov;138(5):1167-71. doi: 10.1016/j.jtcvs.2009.05.012. Epub 2009 Jun 26.
The outcome of surgical correction of atrioventricular septal defect with double-orifice left atrioventricular valve has improved in recent years but is still reported to be associated with high mortality and reoperation rates. Controversy exists about the management of the accessory orifice. We evaluated our results with correction of atrioventricular septal defect with double-orifice left atrioventricular valve.
Between 1975 and 2006, 21 patients underwent correction of atrioventricular septal defect with double-orifice left atrioventricular valve. Clinical data were obtained by means of retrospectively reviewing inpatient and outpatient medical records. To evaluate the influence of double-orifice left atrioventricular valve on mortality and the need for reoperation, a comparison was made with 291 consecutive patients who, during the same period, underwent correction of atrioventricular septal defect without double-orifice left atrioventricular valve.
None of the 21 patients with double-orifice left atrioventricular valve had undergone a previous operation. The accessory orifice was managed with different techniques depending on the severity of the regurgitation. There was no in-hospital mortality, and there were 3 late deaths. Seven patients required 12 reoperations, 7 for left atrioventricular valve insufficiency. Double-orifice left atrioventricular valve had no influence on mortality but was a significant predictor for reoperation compared with repair of atrioventricular septal defect without double-orifice left atrioventricular valve. At the latest follow-up, all 18 survivors were in New York Heart Association functional class capital I, Ukrainian without medication. Only 1 patient showed residual mild left atrioventricular valve insufficiency.
Atrioventricular septal defect with double-orifice left atrioventricular valve can be repaired with low mortality. However, double-orifice left atrioventricular valve is a predictor for reoperation. The accessory orifice is often competent and should then be left untouched. If regurgitation of the accessory orifice is present, this is best managed with suture or patch closure.
近年来，采用双孔型左房室瓣矫治房室间隔缺损的手术效果有所改善，但仍有报道称其与高死亡率和再次手术率相关。关于副孔的处理存在争议。我们评估了采用双孔型左房室瓣矫治房室间隔缺损的结果。
1975年至2006年间，21例患者接受了采用双孔型左房室瓣矫治房室间隔缺损的手术。通过回顾性查阅住院和门诊病历获取临床资料。为评估双孔型左房室瓣对死亡率和再次手术需求的影响，将其与同期连续291例未采用双孔型左房室瓣矫治房室间隔缺损的患者进行了比较。
21例双孔型左房室瓣患者均未接受过先前手术。根据反流的严重程度，采用不同技术处理副孔。无院内死亡病例，有3例晚期死亡。7例患者需要进行12次再次手术，其中7次是因为左房室瓣关闭不全。双孔型左房室瓣对死亡率无影响，但与未采用双孔型左房室瓣修复房室间隔缺损相比，是再次手术的重要预测因素。在最近一次随访时，所有18名存活患者的心功能均为纽约心脏协会I级，无需药物治疗。仅1例患者存在轻度左房室瓣关闭不全残余。
采用双孔型左房室瓣矫治房室间隔缺损可实现低死亡率。然而，双孔型左房室瓣是再次手术的预测因素。副孔通常功能良好，应不予处理。如果存在副孔反流，最好采用缝合或补片闭合进行处理。
