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Predisposing factors of valve regurgitation in complete atrioventricular septal defect

Kiyoshi Suzuki, MD, PhD^a, Katsuhiko Tatsuno, MD, PhD, Toshio Kikuchi, MD^* and Shigekazu Mimori, MD, PhD^a

^a Department of Pediatrics, The Sakakibar Heart Institute, Tokyo, Japan
^* Department of Cardiac Surgery, The Sakakibara Heart Institute, Tokyo, Japan
Department of Cardiovascular Surgery, Chiba Cardiovascular Center, Chiba, Japan

View larger version (15K): [in a new window]   Figure 1 Actuarial freedom from preoperative valve regurgitation by the Kaplan–Meier method was almost the same among the groups, except for those with Rastelli type C and an undivided morphology of the inferior bridging leaflet (IBL).

View larger version (15K): [in a new window]   Figure 2 Those with Rastelli type C and an undivided inferior bridging leaflet (IBL) had better competence of the atrioventricular valve remaining than did those with the other valve morphologies (p < 0.01 by the generalized Wilcoxon test). Solid lines = actuarial freedom from preoperative regurgitation by the Kaplan–Meier method; dotted lines = 95% confidence intervals.

View larger version (38K): [in a new window]   Figure 3 Echocardiographic evaluation of atrioventricular valve regurgitation before and after surgical repair. Six of the 64 patients (9%) without preoperative regurgitation and 3 of 26 patients (12%) with marked regurgitation died after the operation. Of the remaining 58 patients without preoperative regurgitation, 42 (72%) showed no regurgitation after surgery, but regurgitation developed postoperatively in 16 (28%). On the other hand, of the 23 patients with preoperative regurgitation, regurgitation improved in 11 (48%), but remained in 12 (52%) (p < 0.001 by the McNemar test).

View larger version (21K): [in a new window]   Figure 4 In those with Rastelli type A and/or a divided inferior leaflet, the coaptation zone between both bridging leaflets is triangular or diamond shaped (painted in black). On the other hand, those with Rastelli type C and an undivided inferior leaflet, showing a lesser degree of progression of preoperative regurgitation, do not have such a structure.