Direct closure was the first described surgical treatment for complete atrioventricular canal (CAVC) (1). At the expense of increasing complexity, double-patch repair was introduced to minimize the risk of left ventricular outflow tract (LVOT) obstruction and heart block due to a repair under tension. Modified single-patch repair, which forgoes the VSD patch, has been shown to be a simplified repair with excellent outcomes in selected patients (2). Using an inverted single-patch technique, direct ASD closure has been reported to be safe and minimizes the risk of heart block (3). The authors have been using a modification of these techniques in the hope of combining the advantages of each one and have previously reported the results using this technique (4). This video illustrates the technical aspects of this repair.
The simplicity of the defect closure and preservation of AV conduction and the LVOT make it attractive in CAVC defects, while avoiding the use of a patch and reducing the duration of ischemia and CPB. This technique represents an additional tool in the surgical armamentarium for CAVC repair.
References
- Lillehei C, Cohen M, Warden H, Varco R. The direct-vision intracardiac correction of congenital anomalies by controlled cross circulation; results in thirty-two patients with ventricular septal defects, tetralogy of Fallot, and atrioventricularis communis defects. Surgery 1955;38(1):11-29.
- Backer C, Stewart R, Bailliard F, Kelle A, Webb C, Mavroudis C. Complete Atrioventricular Canal: Comparison of Modified Single-Patch Technique With Two-Patch Technique. Ann Thorac Surg 2007;84(6):2038-46.
- Prêtre R, Dave H, Kadner A, Bettex D, Turina MI. Direct closure of the septum primum in atrioventricular canal defects. J Thorac Cardiovasc Surg 2004 Jun 1;127(6):1678-81.
- Myers PO, Cikirikcioglu M, Aggoun Y, Murith N, Kalangos A. No-patch technique for complete atrioventricular canal repair. Ann Thorac Surg. 2010 Jul;90(1):317-9.
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1 Comment
i congratulate Dr Patrick for excellent video. i just want to highlight 2 points here is if VSD component is shallow then this technique works well but in large vsd using this technique change the plane of mitral valve , it become more oblique as mitral tissue has been used for vsd component.
and i have noticed more arrythmias in this technique then double patch technique, pull on conduction tissue may be responsible . can you tell us your experience.