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. 1992;19(4):265–269.

Late Results after Repair of Partial Atrioventricular Septal Defect in Adolescents and Adults

László Lukács 1, György Szántó 1, Imre Kassai 1, Mária Lengyel 1
PMCID: PMC325030  PMID: 15227452

Abstract

From January 1966 through December 1985, 29 adolescents and adults underwent surgical repair of a partial atrioventricular septal defect at our institution. The patients included 20 females and 9 males, whose ages ranged from 16 to 47 years (mean, 27.6 ± 10.1 years). Preoperatively, 24 patients were in New York Heart Association functional class I or II, and 5 were in class III. The pulmonary artery systolic pressure ranged from 22 to 62 mmHg (mean, 38.3 ± 12.7 mmHg). The pulmonary-to-systemic flow ratio ranged from 1.4 to 2.9 (mean, 2.3 ± 0.5). Upon left ventriculography, regurgitation through the left atrioventricular valve was trivial or nonexistent in 4 patients (13.8%), mild in 14 (48.3%), moderate in 10 (34.5%), and severe in 1 patient (3.4%).

All patients underwent patch closure of the ostium primum defect, and all but 2 underwent partial or complete suturing of the septal commissure. One patient died within 30 days, for a hospital mortality of 3.4%. The follow-up period ranged from 7 to 25 years (mean, 15.2 ± 5.3 years). Postoperatively, all patients were evaluated with 2-dimensional and Doppler echocardiography. One patient underwent early implantation of a permanent pacemaker for persistent complete heart block.

Three patients succumbed to late death 10, 15, and 21 years after operation. Among the 25 long-term survivors, 1 patient required late valve replacement because of severe left atrioventricular valve regurgitation. Nine (37.5%) of the other 24 long-term survivors had little or no regurgitation. Of the 11 patients with moderate-to-severe preoperative left atrioventricular valve regurgitation, 4 had moderate postoperative regurgitation. Seventeen patients had a moderate or severe persistent apical systolic murmur. At the latest follow-up in 1991, 5 (20%) of the 25 long-term survivors had significant arrhythmias.

At 25 years, the actuarial survival rate was 78.9% ± 25.6%. All 25 surviving patients were in New York Heart Association class I or II. The rate of freedom from reoperation was 77.7% ± 25.9%. We conclude that, in adolescents and adults, correction of a partial atrioventricular septal defect entails little risk and is likely to improve the patient's functional status. Repair of the left atrioventricular valve yields good results, even at long-term follow-up. (Texas Heart Institute Journal 1992;19:265-9)

Keywords: Atrioventricular septal defect, partial

Keywords: endocardial cushion defects

Keywords: heart defects, congenital

Keywords: heart septal defects, atrial

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Selected References

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