ATRIOVENTRICULAR SEPTAL-DEFECT REPAIR IN INFANTS

From September 1984 through August 1989, 33 consecutive infants (mean age, 9 months; 13 male) received a single-stage intracardiac repair of complete atrioventricular septal defect. Preoperative evaluation of valvar morphology and function involved echocardiograms in 21% (7/33) and echocardiograms with cineangiograms in 79% (26/33). All infants operated on were included in the analysis. Patients with other complicating abnormalities were not excluded. All operations used a two-patch technique for closure of the atrioventricular septal defect in association with mitral valve repair. The newly formed septal leaflet of the mitral valve was repaired using unpledgeted interrupted sutures. Preoperative and postoperative echocardiograms were used to evaluate mitral valve regurgitation and left ventricular dysfunction as mild, moderate, or severe. The 30-day mortality was 6% (2/33). Follow-up ranged from 1 month to 60 months. Postoperative mitral valve insufficiency was mild in 84% versus 6% preoperatively, moderate in 3% versus 52% preoperatively, and severe in 13% versus 42% preoperatively. Mitral valve dysfunction necessitating reoperation occurred in 6% (2/31). Mitral valve function postoperatively was improved compared with preoperatively (p < 0.001). The low 30-day operative mortality and the excellent late postoperative valvar function demonstrate the value of single-stage two-patch repair of atrioventricular septal defect early in life.