Atrioventricular canal: single-patch technique.

Complete atrioventricular septal defects have been repaired at the Medical University of South Carolina for the past 25 years using the "single-patch technique" as first described by the Mayo Clinic group in 1968. In this technique, the single atrioventricular valve is separated into left (mitral) and right (tricuspid) components by dividing the superior and inferior bridging leaflets back to the annulus. A single patch of bovine pericardium is sutured to the right ventricular aspect of the ventricular septum, the previously divided valve leaflets are resuspended to the patch, the "cleft" in the left-sided valve is closed with interrupted sutures, and the atrial component of the defect closed by suturing the patch to the atrial septum with a continuous suture. Since 1995, there have been no operative deaths in the 88 consecutive infants undergoing this repair in our institution. Nine patients (10.2%) have required reoperation for severe mitral regurgitation. While the issue of operative mortality in patients undergoing single-patch repair of complete atrioventricular septal defect has largely been eliminated, residual or recurrent mitral regurgitation continues to be a problem.