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A four-month-old girl weighing 4.9 kg with trisomy 21 syndrome was referred for the repair of a complete atrioventricular septal defect (AVSD). The technique shown in this video is based on new perspectives from the senior author, in which two different patches were used to close the inlet ventricular septal defect (VSD) and the ostium primum atrial septal defect (ASD), respectively. However, the technique is based on combining principles from the single-patch and two-patch techniques for AVSD repair. It is also combined with augmentation of the left atrioventricular valve (LAVV) leaflet.
The superior and inferior bridging leaflets were completely divided up to the annulus of the common atrioventricular valve, followed by the complete clearance of the crest of the septum from any chordal or leaflet attachments. These two maneuvers allowed for the closure of the VSD with minimal to no risk of a residual defect and cleared the left ventricular outflow tract (LVOT) from any potential of future obstruction caused by accessory tissues. The routine augmentation of the LAVV leaflet increases the leaflet height and allows for better coaptation with the mural (posterior) leaflet, which should improve valve competence and may decrease future regurgitation.
The postoperative course was uneventful, and the patient continued to do well during follow-up with no significant shunts, no right or left atrioventricular valve regurgitation, and a widely patent LVOT.
References
- Said SM, Mashadi A. Modified two-patch repair with left atrioventricular valve augmentation for complete atrioventricular septal defect: a novel modification to an older concept. Multimed Man Cardiothorac Surg. 2025 Oct 20;2025. doi: 10.1510/mmcts.2025.111
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