Tláskal T, Hucín B, Marek J, Chaloupecky V, Kostelka M, Janousek J, Skovránek J, Hruda J
Kardiocentrum, University Hospital Motol, Prague, Czech Republic.
J Cardiovasc Surg (Torino). 1997 Jun;38(3):233-9.
From September 1977 to October 1995, 287 patients with atrioventricular septal defect (AVSD) aged from 2 months of 21 years underwent total repair in Kardiocentrum in prague. In 97 patients complete, in 20 transitional and in 170 patients partial form of AVSD was present. The repair consisted of closure of the defect and individually modified reconstruction of two atrioventricular (AV) orifices. In cases with a common orifice a two-patch technique was used. Fixation of undivided anterior and posterior common leaflets to patches in an appropriate level was essential in combination with complete closure of the cleft. Incomplete closure of the cleft was performed if potentially stenotic morphology was present. Commissuroplasty with pladgeted mattress stitches was done in patients with dilated annulus and commissuroplasty with a single stitch was performed if the annulus was not dilated. The methods were similar in cases with two AV orifices. The AV valve repair was difficult in the presence of severe regurgitation in valves with potentially stenotic morphology. Of the 287 operated patients 26 (9.1%) died during the early postoperative period. Mortality was 19.6% in the complete form and 3.7% in the partial and transitional forms. The mortality depended on morphology of the left atrioventricular valve. Potentially stenotic valvar morphology represented an important risk factor for death and reoperation. It was necessary to reoperate on 18 (6.3%) patients for significant "mitral" valve regurgitation. Reconstruction of a competent left AV valve is the most important step of AVSD repair which must always be modified according to individual morphological and functional abnormalities.
1977年9月至1995年10月，287例年龄在2个月至21岁之间的房室间隔缺损（AVSD）患者在布拉格的心脏中心接受了完全修复手术。其中97例为完全型，20例为过渡型，170例为部分型AVSD。修复手术包括关闭缺损以及对两个房室（AV）口进行个体化的改良重建。对于共同口的病例，采用双补片技术。将未分开的前后共同瓣叶固定在适当水平的补片上，并结合完全关闭瓣裂至关重要。如果存在潜在狭窄形态，则进行瓣裂的不完全关闭。对于瓣环扩张的患者，采用带垫片褥式缝合进行瓣叶成形术；如果瓣环未扩张，则采用单针进行瓣叶成形术。对于两个AV口的病例，方法类似。在具有潜在狭窄形态的瓣膜存在严重反流的情况下，AV瓣修复困难。在287例接受手术的患者中，26例（9.1%）在术后早期死亡。完全型的死亡率为19.6%，部分型和过渡型的死亡率为3.7%。死亡率取决于左房室瓣的形态。潜在狭窄的瓣膜形态是死亡和再次手术的重要危险因素。有18例（6.3%）患者因严重的“二尖瓣”反流需要再次手术。重建一个功能良好的左AV瓣是AVSD修复最重要的步骤，必须始终根据个体的形态和功能异常进行改良。
