Douglas William I, Doshi Unnati
Division of Pediatric Cardiovascular Surgery, The University of Texas Medical School at Houston, Houston, TX, USA
Division of Pediatric Cardiology, The University of Texas Medical School at Houston, Houston, TX, USA.
World J Pediatr Congenit Heart Surg. 2014 Jul;5(3):434-9. doi: 10.1177/2150135114531297.
Two-patch, single-patch, and modified single-patch repairs are accepted techniques for repair of complete atrioventricular (AV) canal defects. We propose a novel, alternative technique: the central patch technique.
For the central patch technique, the superior and inferior bridging leaflets are attached with simple sutures to the right and left of their coaptation point. Both bridging leaflets are incised along a line above the ventricular crest, similar to a traditional single-patch technique. An oval pericardial patch is sewn to the central defect created in the AV valve tissue. Interrupted, horizontal mattress sutures are placed along the ventricular crest, through the midline of the central patch and through the edge of the atrial septal defect (ASD) patch. Tying the sutures simultaneously closes the ventricular septal defect (VSD) and secures the ASD patch to the ventricular crest. Repair of the left AV valve and ASD closure are performed in the routine fashion.
Five patients underwent the central patch technique repair of complete AV canal defect. Weight was 4.8 to 6.3 kg; age was four to eight months. Cardiopulmonary bypass and myocardial times averaged 137 minutes and 109 minutes, respectively. No patient had more than mild left AV valve regurgitation or trivial residual VSD at completion of repair. No patient developed left ventricular outflow tract obstruction.
The central patch technique is applicable to all forms of complete AV canal defect. Subjectively, it offers technical advantages compared to standard techniques and may result in a shorter learning curve for junior congenital heart surgeons. Results are preliminary but are consistent with standard techniques.
双补片、单补片及改良单补片修补术是治疗完全性房室通道缺损公认的技术。我们提出一种新颖的替代技术：中央补片技术。
对于中央补片技术，将上、下桥瓣叶用简单缝线分别缝合于其对合点的右侧和左侧。沿室嵴上方的一条线切开两个桥瓣叶，类似于传统单补片技术。将椭圆形心包补片缝至房室瓣组织形成的中央缺损处。间断水平褥式缝线沿室嵴放置，穿过中央补片的中线及房间隔缺损（ASD）补片的边缘。结扎缝线可同时关闭室间隔缺损（VSD）并将ASD补片固定于室嵴。左房室瓣修复及ASD闭合按常规方式进行。
5例患者接受了中央补片技术修复完全性房室通道缺损。体重4.8至6.3千克；年龄4至8个月。体外循环和心肌阻断时间平均分别为137分钟和109分钟。术后无患者出现超过轻度的左房室瓣反流或微小的残余VSD。无患者发生左心室流出道梗阻。
中央补片技术适用于所有形式的完全性房室通道缺损。主观上，与标准技术相比它具有技术优势，可能会使初级先天性心脏病外科医生的学习曲线更短。结果是初步的，但与标准技术一致。
