OBJECTIVE: Reoperation rates to correct left atrioventricular valve regurgitation after primary repair of atrioventricular canal defects remain relatively high. The causes of valvular regurgitation are likely multifactorial, and simple cleft closure is often insufficient to prevent recurrence. METHODS: To elucidate the mechanisms leading to regurgitation, we conducted hemodynamic studies using isolated native mitral valves. Anatomy of these valves was altered to mimic atrioventricular canal type valves and studied under pediatric hemodynamic conditions. The impact of subvalvular geometry, cleft closure, annular dilatation, and annular undersizing on regurgitation were investigated. RESULTS: Papillary muscle position did not have a significant effect on regurgitation. Cleft closure had a significant impact on valvular competence, with reduction in regurgitation volume with increased cleft closure. Regurgitation volume decreased from 12.5 +/- 2.4 mL/beat for an open cleft to 4.9 +/- 1.9 mL/beat for a partially closed cleft and to 1.4 +/- 1.6 mL/beat when the cleft was completely closed. Annular dilatation had a significant impact on regurgitation even after cleft closure. A 40% increase in annular size increased regurgitation by 59% for a partially closed cleft and by 84% for a fully closed cleft. Reducing the annular size by 20% from the physiologic level decreased the regurgitation volume by 12% for a fully open cleft and by 58% for the partially closed cleft case. CONCLUSIONS: Annular dilatation after primary repair has a potentially significant role in the recurrence of atrioventricular valve regurgitation. Reducing the annular size and restricting dilatation as an adjunct to cleft closure is a promising surgical approach in such valve anatomies.
OBJECTIVE: Reoperation rates to correct left atrioventricular valve regurgitation after primary repair of atrioventricular canal defects remain relatively high. The causes of valvular regurgitation are likely multifactorial, and simple cleft closure is often insufficient to prevent recurrence. METHODS: To elucidate the mechanisms leading to regurgitation, we conducted hemodynamic studies using isolated native mitral valves. Anatomy of these valves was altered to mimic atrioventricular canal type valves and studied under pediatric hemodynamic conditions. The impact of subvalvular geometry, cleft closure, annular dilatation, and annular undersizing on regurgitation were investigated. RESULTS: Papillary muscle position did not have a significant effect on regurgitation. Cleft closure had a significant impact on valvular competence, with reduction in regurgitation volume with increased cleft closure. Regurgitation volume decreased from 12.5 +/- 2.4 mL/beat for an open cleft to 4.9 +/- 1.9 mL/beat for a partially closed cleft and to 1.4 +/- 1.6 mL/beat when the cleft was completely closed. Annular dilatation had a significant impact on regurgitation even after cleft closure. A 40% increase in annular size increased regurgitation by 59% for a partially closed cleft and by 84% for a fully closed cleft. Reducing the annular size by 20% from the physiologic level decreased the regurgitation volume by 12% for a fully open cleft and by 58% for the partially closed cleft case. CONCLUSIONS: Annular dilatation after primary repair has a potentially significant role in the recurrence of atrioventricular valve regurgitation. Reducing the annular size and restricting dilatation as an adjunct to cleft closure is a promising surgical approach in such valve anatomies.
Authors: J Wetter; N Sinzobahamvya; C Blaschczok; A M Brecher; L M Grävinghoff; A A Schmaltz; A E Urban Journal: Eur J Cardiothorac Surg Date: 2000-02 Impact factor: 4.191
Authors: K Bando; M W Turrentine; K Sun; T G Sharp; G J Ensing; A P Miller; K A Kesler; R S Binford; G N Carlos; R A Hurwitz Journal: J Thorac Cardiovasc Surg Date: 1995-11 Impact factor: 5.209
Authors: H Miyamura; S Eguchi; H Watanabe; H Kanazawa; M Sugawara; S Tatebe; M Shinonaga; J Hayashi Journal: J Thorac Cardiovasc Surg Date: 1994-06 Impact factor: 5.209
Authors: Andrew M Atz; John A Hawkins; Minmin Lu; Meryl S Cohen; Steven D Colan; James Jaggers; Ronald V Lacro; Brian W McCrindle; Renee Margossian; Ralph S Mosca; Lynn A Sleeper; L LuAnn Minich Journal: J Thorac Cardiovasc Surg Date: 2010-12-15 Impact factor: 5.209
Authors: Aditya K Kaza; Steven D Colan; James Jaggers; Minmin Lu; Andrew M Atz; Lynn A Sleeper; Brian W McCrindle; Linda M Lambert; Renee Margossian; Ronald V Lacro; Marc E Richmond; Shobha Natarajan; L Luann Minich Journal: Ann Thorac Surg Date: 2011-08-26 Impact factor: 4.330
Authors: L LuAnn Minich; Andrew M Atz; Steven D Colan; Lynn A Sleeper; Seema Mital; James Jaggers; Renee Margossian; Ashwin Prakash; Jennifer S Li; Meryl S Cohen; Ronald V Lacro; Gloria L Klein; John A Hawkins Journal: Ann Thorac Surg Date: 2010-02 Impact factor: 4.330