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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2 Comments
Dear Dr Said,
thank you for the wonderful video: excellent surgical skills, excellent teaching, excellent video technique,.
Thank you also for showing imperfection: reclamp and annuloplasty, even if it is routine, showing that is very educative for beginners!
the examination and preparation is gold for education!
the resection of all these chordae is also very brave: interesting technique!
My question is a bit simple (I apologize for that) but why bilateral PA vessel loop and not central PA.
mathieu vergnat
Dear Mathieu
Thank you for your kind comments and glad you liked the video.
I really not afraid of showing imperfections: this is where I and many others learn. I like to show the whole case experience and show what exactly happens and we as cardiac surgeons face these situations more often than what we publish or read so it is good to show these tips and pitfalls
Yes, i have never seen this in my training and never dared to change the techniques that I have learned but now i think differently and looking back, i think dividing these chords make actually most sense. They do not contribute to the valve function by any means or to the valve competence. In fact i think they limit the leaflet freedom and mobility. So i started to divide them completely and it makes the VSD closure very straightforward and secured. I also mentioned other advantages in the video.
In terms of snaring the PA branches, i guess it is something i got use to it to control back flow however it is possible to just clamp both aorta and PA together as you indicated.
Thank you again and hope these answers your questions