Short and long term outcomes of repaired complete atrioventricular septal defects: risk factor analysis

To study rates of survival and incidence of reoperation of complete atrioventricular septal defects [CAVSD] repair in Kuwait and to determine the risk factors affecting surgical outcome. Retrospective study. Chest Diseases Hospital, Kuwait. One hundred and forty consecutive patients during the 16-year period between January 1992 and December 2007. Surgical correction for CAVSD. Short and long-term surgical outcomes of repaired CAVSD; demographic, cardiac and surgical risk factors that influence the postoperative mortality and morbidity. Median age and weight at primary repair were 4.4 months and 5 kg respectively. Down syndrome was diagnosed in 78.6% of the patients. The operative mortality was 12.9% [95% CI 7.5, 18.3]. Significant postoperative complications, relative hypoplasia of left atrioventricular valve [LAVV] and / or left ventricle were shown to be independent risk factors of operative mortality in multivariate Cox's model [p < 0.01]. Actuarial estimate of survival at six months and 15.5 years following definitive repair after discharge was 99.1% and 98%, respectively. Freedom from reoperation at 16.5 years after definitive operation was 93.5% [95% CI 89.4,97.6]; most reoperations were related to LAVV regurgitation. In the multivariate model with LAVV dysplasia [2/8 = 25%] and hypoplasia [2/7 = 28.6%], patients with such valve abnormalities had less freedom from reoperation [p < 0.001]. Left heart obstructive lesion was shown to be an independent risk factor for CAVSD surgical outcomes. Detailed evaluation for such lesions should be performed peri-operatively to reduce the impact on operative mortality and LAVV reoperation

complex atheromatous plaque of the thoracic aorta: the role of transesophageal echocardiography

Large mobile protruding aortic arch atheromas are strongly associated with strokes and other vascular events. Transesophageal echocardiography is the imaging modality of choice for diagnosis and risk stratification. The optimal therapy is unclear. A case of a large mobile aortic atheromatous plaque with recurrent systemic embolization in a 47-year-old female is reported. This finding led to a surgical resection of the diseased part of the aorta and graft replacement without complications. The case illustrates the utility of transesophageal echocardiography in defining the complexity of the atheromas. Surgery in selected patients is a reasonable option