A Case of Intermediate Type Atrioventricular Septal Defect Associated with a Membranous Ventricular Septal Aneurysm in a 70-Year-Old Female Patient / 日本心臓血管外科学会雑誌

The case was a 70-year-old female. Atrioventricular septal defect was diagnosed in her childhood, however, surgical treatment had not been performed. The patient had suffered from heart failure at the age of 69, and she was referred to our hospital for treatment. Her diagnosis was intermediate type atrioventricular septal defect, moderate left atrioventricular valve regurgitation, membranous ventricular septal aneurysm and atrial flutter. An autologous pericardial patch was used to close the ostium primum type atrial septal defect associated with simultaneous covering of membranous ventricular septal aneurysmal wall. Concomitant left and right atrioventricular valvuloplasty and arrhythmia surgery were performed. Her postoperative course was uneventful and the patient was discharged from our department on the 16th postoperative day. To our knowledge, there are few reports of surgery for incomplete type atrioventricular septal defect in the elderly and no report for intermediate type atrioventricular septal defect in Japan. In incomplete type atrioventricular septal defect, symptoms such as supraventricular arrhythmia and heart failure develop according to aging. Reported surgical results in the elderly are quite good, and improvement of excise tolerance is expected. Precise evaluation and proper indication of surgical treatment is mandatory even in older patients.

Value of atrioventricular valve regurgitation in screening for atrioventricular septal defect in the first trimester / 中华超声影像学杂志

Objective:To investigate the value of atrioventricular valve regurgitation in predicting atrioventricular septal defect (AVSD) in the first trimester.Methods:Fetuses were examined prospectively by ultrasound at 11-13 + 6 weeks in Maternity & Child Healthcare Hospital of Guangxi Zhuang Autonomous Region between February 2016 and February 2021. Congenital heart disease was screened and atrioventricular valve regurgitation was observed in fetuses of gestational age 11 to 13 + 6 weeks using color Doppler in four-chamber view and three vessels and trachea view. Results:Totally 43 549 fetuses of gestational age 11 to 13 + 6 weeks were screened by echocardiography, of whom 37 cases were screened out with AVSD, including complete atrioventricular septal defect (31 cases), partial atrioventricular septal defect(3 cases) and intermediate atrioventricular septal defect(1 cases), 2 cases were misdiagnosed, and ultrasonic scanning in the second trimester found 2 missed cases of intermediate atrioventricular septal defect. Atrioventricular valve regurgitation was observed in 91.89% of atrioventricular septal defects (34/37) in the first trimester, 59.46% (22/37) nuchal translucency greater than 95th percentile, 29.73% (11/37) absence of nasal bone, 32.43% (12/37) ductus venosus A wave inversion, and 40.54% (15/37) had tricuspid regurgitation. The sensitivity of common atrioventricular valve regurgitation in predicting atrioventricular septal defect is better than other ultrasonic indexes. Conclusions:Atrioventricular regurgitation can be used as a clue to predict atrioventricular septal defect in the first trimester, which is beneficial to detect atrioventricular septal defect in the first trimester.

Reoperation for severe left atrioventricular regurgitation by standardized mitral repair-oriented strategy in complete atrioventricular septal defect patients / 中国胸心血管外科临床杂志

@#Objective    To summarize the reoperation experience for complete atrioventricular septal defect (CAVSD) with severe left atrioventricular valve regurgitation (LAVVR) by standardized mitral repair-oriented strategy. Methods    From 2016 to 2019, 11 CAVSD patients underwent reoperation for severe LAVVR by standardized mitral repair-oriented strategy at Fuwai Hospital, including 5 males and 6 females with a median age of 56 (22-152) months. The pathological characteristics of severe LAVVR, key points of repair technique and mid-term follow-up results were analyzed. Results    The interval time between the initial surgery and this surgery was 48 (8-149) months. The aortic cross-clamp time was 54.6±21.5 min and the cardiopulmonary bypass time was 107.4±38.1 min, ventilator assistance time was 16.4±16.3 h. All patients recovered smoothly with no early or late death. The patients were followed up for 29.0±12.8 months, and the echocardiograph showed trivial to little mitral regurgitation in 5 patients, little regurgitation in 5 patients and moderate regurgitation in 1 patient. The classification (NYHA) of cardiac function was class Ⅰ in all patients. Conclusion    Standardized mitral repair-oriented strategy is safe and effective in the treatment of severe LAVVR after CAVSD surgery, and the mid-term results are satisfied.

Surgical treatment for complete atrioventricular septal defect in patients above the optimal age / 中国胸心血管外科临床杂志

@#Objective    To summarize the clinical outcomes and experience of surgical treatment for patients with complete atrioventricular septal defect (CAVSD) above the optimal age for surgery. Methods    We retrospectively reviewed clinical data of 163 simple type CAVSD patients less than 7 years who underwent operations in Fuwai Hospital from 2002 to 2013. The patients were divided into a normal group (n=84, including 37 males and 16 females with an average age of 7.6±2.7 months) and an over-age group (n=79, including 30 males and 49 females with an average age of 34.6±19.6 months) according to whether the age was more than 1 year. Results    The average aortic cross clamp time (88.3±24.4 min vs. 106.1±35.4 min, P<0.001) and cardiopulmonary bypass time (123.6±31.1 min vs. 142.6±47.1 min, P=0.003) were statistically different between the two groups. During the follow-up period (the normal group 53.3±43.9 months, the over-age group 57.2±48.2 months), there was no statistical difference in all-cause mortality (10.7% vs. 8.9%, P=0.691), the incidence of moderate or severe left atrioventricular valve regurgitation (16.7% vs. 21.5%, P=0.430) and reintervention rate (3.6% vs. 0.0%, P=0.266) between the two groups. No left ventricular outflow tract obstruction and complete atrioventricular block occurred in both groups. Conclusion    For CAVSD children above the optimal age, rational surgical treatments can also achieve satisfying results.

Modified single-patch technique for children with complete atrioventricular septal defect in a single center / 中国胸心血管外科临床杂志

@#Objective    To sum up the experience of the primary modified single-patch (MSP) technique applied in our hospital for children with complete atrioventricular septal defect (CAVSD). Methods    The clinical data of 141 children who underwent primary MSP technique for CAVSD between June 2009 and December 2017 were retrospectively analyzed, including 62 males and 79 females with a median age of 6 (3, 11) months and a median weight of 5.8 (4.5, 7.0) kg. According to Rastelli classification, there were 116 patients in type A, 14 in type B and 11 in type C. Among them, 15 patients were diagnosed with Down’s syndrome. Cardiopulmonary bypass time, aortic cross clamp time, atrioventricular valve regurgitation and other clinical data were recorded during and after operation. Results    Postoperatively, 17 patients suffered from severe left atrioventricular valve regurgitation (LAVVR) and 6 patients severe right atrioventricular valve regurgitation (RAVVR). In the follow-up period, 5 patients suffered from severe LAVVR and 1 patient severe RAVVR. Left ventricular outflow tract obstruction (LVOTO) appeared in 1 patient during follow-up period and none at the end of follow-up. There were 5 early deaths and 2 late deaths. Twelve patients underwent reoperation with a median interval time of 268 (8, 1 270) days. Conclusion    MSP technique is a wise surgical strategy for CAVSD children with good outcomes, improved postoperative mortality and decreased atrioventricular valve regurgitation.

Surgical management of atrioventricular valve regurgitation in functional single ventricle / 中华外科杂志

Objective@#To evaluate the early- and mid-term outcomes of surgical atrioventricular valve (AVV) intervention in patients with functional single ventricle (FSV).@*Methods@#The clinical data of 40 consecutive FSV patients who underwent surgical AVV intervention between January 2008 and December 2017 at Department of Cardiac Surgery, Guangzhou Women and Children′s Medical Center, Guangzhou Medical University were reviewed retrospectively. There were 25 male and 15 female patients. The median age at AVV intervention was 4.5 to 204.0 months (M(QR): 42.5 (59.7) months), and the median body weight was 6.0 to 55.4 kg (M(QR): 13.8 (8.1) kg). The systemic AVV morphology included common AVV in 21 patients, mitral valve in 7 patients, tricuspid valve in 3 patients, and both mitral and tricuspid valve in 9 patients. At first surgical intervention, 15 patients had severe, 25 patients had moderate AVV regurgitation. The timings of the initial surgical intervention were at the first palliative, Glenn, between Glenn and Fontan, and Fontan stage in 5, 23, 4, and 8 patients, respectively. The methods of the initial surgical intervention were AVV repair in 31 patients, AVV replacement in 9 patients. Actuarial survivals were estimated by the Kaplan-Meier method. Prognosis factors for atrioventricular valve reoperation were analyzed using the Cox regression hazard model.@*Results@#There were 6 early deaths, with a mortality of 15.0%. Thirty-four survival patients received a follow-up of 1 to 117 months (M(QR): 44 (34) months). Survival of patients after the initial surgical intervention were 85.0% (95% CI: 74.0% to 95.9%), 79.3% (95% CI: 66.6% to 92.0%), and 79.3% (95% CI: 66.6% to 92.0%) at 1 year, 5 years and 10 years, respectively. In all, only 13 patients completed the Fontan procedure. Six patients underwent 8 reoperations, including AVV replacement in 5 patients, redo AVV repair in 3 patients. Freedom from AVV reoperation at 1 and 5 years was 89.8% (95% CI: 78.8% to 100%) and 79.4% (95% CI: 64.7% to 94.1%), respectively. Multivariate Cox regression analysis revealed that common AVV (HR=3.53, 95% CI: 1.63-7.67, P=0.020) was the prognosis factors for AVV reoperation.@*Conclusions@#The early- and mid-term outcomes of surgical AVV intervention in FSV patients are not satisfactory. The mortality and reoperation rate are still high, and common AVV predicts the AVV reoperation after the initial surgical intervention.

Application of bidirectional Glenn procedure in adult congenital heart disease / 中国胸心血管外科临床杂志

@#Objective    To analyze the feasibility of bidirectional Glenn procedure (BDG) in treatment of adult congenital heart disease (ACHD). Methods    From December 2004 to December 2015, 42 ACHD patients received BDG in our hospital. There were 23 males and 19 females with a mean age of 24.6±8.5 years (range: 18 to 49 years). There were functional single ventricle (FSV) in 14 patients, Ebstein’s anomaly in 11, corrected transposition of great arteries in 7, transposition of great arteries in 5, double outlet of right ventricle in 3 and tricuspid atresia in 2. Twenty patients suffered moderate or severe atrioventricular valve regurgitation (AVVR). Half of the patients were operated upon with cardiopulmonary bypass (CPB) and the others with off-pump coronary artery bypass grafting (OPCABG). Thirty-four patients underwent unilateral BDG shunt and eight bilateral BDG shunts. Concomitant procedures included correction of Ebstein’s anomaly (7 patients), atrioventricular valve replacement (7), atrial septostomy (3), ligation of patent ductus arteriosus (3), ligation of major aortopulmonary collateral arteries (2), correction of total anomalous pulmonary venous connection (1) and mitral valve repair (1). Results    The early operative mortality was 9.5% (4/42). FSV and moderate or severe AVVR were risk factors for BDG in ACHD. Early postoperative oxygen saturation increased from 78.8%±11.2% to 89.3%±6.6% (P<0.05). The follow-up time was 6-132 (41.4±33.1) months. There was no death. The heart function improved (2.7±0.5 vs. 1.9±0.4, P<0.05). Conclusion    The BDG shunt can be applied to ACHD. Although the early mortality is relatively high, the middle- and long-term results are satisfactory. The oxygen saturation increases and  the heart function improves. The life quality of patients will also improve. FSV and moderate or severe AVVR are risk factors for BDG in ACHD.

Surgical management of atrioventricular valve regurgitation in single-ventricle / 中华胸心血管外科杂志

Objective The aim of this article is to review and analyze the timing and surgical management of mediate and severe atrioventricular valve regurgitation(AVVR) in single-ventricle patients.Methods Between June 2006 and October 2011,twenty-three cases of single-ventricle patients accompanied with AVVR underwent atrioventricular valve plasty or replacement.There were 17 males and 6 females.Their ages ranged from 2.1 to 22.0 years,and their weight from 12.5 to 59.0 kg.There were 3 cases of A type of single ventricle,17 of B type,2 of C type,and 1 of D type.All cases had one atrioventricular valve except one of D type with 2 groups of atrioventricular valves.There were 18 patients with sever AVVR and 5 with the moderate.Before the management of AVVR,12 patients had undergone the first stage palliation,including B-D Glenn procedure 11 cases and A-P shunt 1 case.The periods between the two stages operations were 7-96 months.Among the all,there were 7 cases of atrioventricular valve replacement ; 3 cases of atrioventricular valve replacement and TCPC ; 5 cases of atrioventricular valve replacement and B-D Glenn procedure ; 2 cases of atrioventricular valve repair and TCPC ; 4 cases of atrioventricula repair and B-D Glenn procedure; 1 case of atrioventricular valve repair,B-D Glenn procedure and TAPVC repair; 1 case of atrioventricular valve repair,B-D Glenn procedure,PA Banding and TAPVC repair.Results In this group,there were 65.2％ patients who underwent atrioventricular valve replacement.The ones with moderate regurgitation underwent atrioventricular valve repair.Only 3 of the 18 cases with severe regurgitation could underwent atrioventricular valve repair(P =0.002).Three cases died.The mortality was 13％.All cases undergone atrioventricular valve repair were alive.The mortality of atrioventricular valve replacement was 20％.All the post-operative alive were followed up.Their follow-up period were between 0.8-6.3 years,withoud a dead case.Conclusion The regurgitation with single ventricle should be managed before the image of myocardium occurred.It is the best time to manage the atrioventricular valve when the regurgitation was moderate.The atrioventricular valve replacement is effective to the cases of single ventricle with severe AVVR.

Diastolic Regurgitation of Atrioventricular Valves in Patients with Complete Atrioventricular Block

BACKGROUND: The presence of diastolic mitral regurgitation has been described in patients with complete atrioventricular(AV) block, aortic valve regurgitation, hypertrophic and restrictive cardiomyopathy, and in patients with long diastolic filling period in atrial fibrillation. However, because of rare incidence and difficulty in making diagnosis of this phenomenon, the frequency and hemodynamic effects of diastolic AV valve regurgitation(DAVVR) and relationship of electrocardiographic(ECG) parameters with DAVVR in patients with complete heart block have not been reported in Korea. METHODS: To evaluate the frequency, hemodynamic effects of DAVVR and relation of ECG parameters with DAVVR in patients with complete AV block, we studied 14 consecutive patients with complete AV block by means of two dimensional and Doppper echocardiography. RESULTS: The DAVVR was observed in all cases of complete AV block except 3 cases on temporary pacemaker. The peak velocy of diastolic mitral and tricuspid valve regurgitaton were 105+/-23cm/sec and 98+/-30cm/sec, respectively. The peak and mean pressure gradient of diastolic mitral regurgitation were 4.7+/-1.7mmHg and 3.1+/-1.5mmHg respectively, and the peak and mean pressure gradient of diastolic tricuspid regurgitation were 4.1+/-2.6mmHg and 2.7+/-2.1mmHg, respectively. There was regular interval between p-wave of ECG and onset of diastolic AV valve regurgitation, which was 215+/-12msec, Diastolic AV valve regurgitation disappeared immediately after recovery of complete AV block to sinus rhythm or insertion of DDD-type permanent pacemaker in all cases. CONCLUSION: In Conclusion, the DAVVR was observed in all cases of complete AV block except cases on temporary pacemaker insertion and its hemodynamic effect was mild. There was regular interval between p-wave of ECG and the onset of diastolic AV valve regurgitation.