Department of Pediatrics The Heart Institute Cincinnati Children's Hospital Medical Center University of Cincinnati College of Medicine Cincinnati OH.
Department of Pediatrics Heart Institute Children's Hospital Colorado University of Colorado School of Medicine Aurora CO.
J Am Heart Assoc. 2020 Jun 2;9(11):e015737. doi: 10.1161/JAHA.119.015737. Epub 2020 May 16.
The Fontan procedure has provided patients with single ventricle physiology extended survival into adulthood and in many cases has improved their quality of life. Atrioventricular valve regurgitation (AVVR) is common in single ventricle patients and is associated with increased risk of mortality. AVVR is more common in patients with a systemic tricuspid or common atrioventricular valve but is generally progressive irrespective of underlying valve morphology. AVVR can be attributable to diverse structural and functional abnormalities at multiple levels of the valvar apparatus, as well as ventricular dysfunction and dilation. Multiple imaging modalities including recent advances in 3-dimensional echocardiography and cross-sectional imaging have been used to further understand AVVR. Surgery to address AVVR must be tailored to the underlying mechanism and the timing of surgical repair should be chosen carefully. In this review, we discuss the etiologies, treatment options, surgical timing, and outcomes of valve repair or replacement for AVVR in patients with single ventricle congenital heart disease, with a focus on those with a Fontan circulation as AVVR is associated with increased risk for Fontan failure and mortality. In-depth understanding of the current literature will help guide clinicians in their approach and management of AVVR in this population.
法洛四联症手术为单心室生理患者提供了延长至成年期的生存机会，并在许多情况下提高了他们的生活质量。房室瓣反流（AVVR）在单心室患者中很常见，并且与死亡率增加相关。AVVR 在具有系统性三尖瓣或共同房室瓣的患者中更为常见，但无论基础瓣膜形态如何，通常都是进行性的。AVVR 可归因于瓣膜装置多个水平的多种结构和功能异常，以及心室功能障碍和扩张。多种成像方式，包括最近在三维超声心动图和横截面成像方面的进展，已被用于进一步了解 AVVR。解决 AVVR 的手术必须针对潜在的机制，并且应仔细选择手术修复的时机。在这篇综述中，我们讨论了单心室先天性心脏病患者 AVVR 的病因、治疗选择、手术时机和瓣膜修复或置换的结果，重点是那些具有法洛四联症循环的患者，因为 AVVR 与法洛四联症失败和死亡率增加相关。深入了解当前的文献将有助于指导临床医生在该人群中处理和管理 AVVR。
