Complete Atrioventricular Canal: Comparison of Modified Single-Patch Technique With Two-Patch Technique Carl L. Backer, MD, Robert D. Stewart, MD, Frédérique.

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Complete Atrioventricular Canal: Comparison of Modified Single-Patch Technique With Two-Patch Technique Carl L. Backer, MD, Robert D. Stewart, MD, Frédérique Bailliard, MD, Angela M. Kelle, BS, Catherine L. Webb, MD, Constantine Mavroudis, MD The Annals of Thoracic Surgery Volume 84, Issue 6, Pages 2038-2046 (December 2007) DOI: 10.1016/j.athoracsur.2007.04.129 Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Transesophageal apical four-chamber view during end diastole. The arrow indicates the size of the ventricular septal defect as measured from the top of the ventricular septum to the level of the common atrioventricular valve. The Annals of Thoracic Surgery 2007 84, 2038-2046DOI: (10.1016/j.athoracsur.2007.04.129) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Evolution of the modified single-patch technique at Children’s Memorial Hospital during the study period (single-patch [] and two-patch []). (CAVC = complete atrioventricular canal.) The Annals of Thoracic Surgery 2007 84, 2038-2046DOI: (10.1016/j.athoracsur.2007.04.129) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Pledgeted sutures (5-0 Tycron) are placed on the right ventricular side of the crest of the ventricular septal component of the atrioventricular (AV) canal. They are then sequentially passed through first the midportion of the common AV valve and then through an autologous pericardial patch. The location of the AV node is indicated by the green oval. The Annals of Thoracic Surgery 2007 84, 2038-2046DOI: (10.1016/j.athoracsur.2007.04.129) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 The pledgeted sutures have now sandwiched the atrioventricular (AV) valve tissue between the ventricular endocardium and the harvested pericardial patch. This effectively septates the common AV valve into a right-sided AV valve and a left-sided AV valve. The left-sided AV valve is shown in the dotted lines under the pericardial patch. The right AV valve is anterior. Small inset shows how the pledget and suture sandwich the ventricular endocardium, AV valve, and pericardium. (LA = left atrium; LV = left ventricle; RA = right atrium; RV = right ventricle.) The Annals of Thoracic Surgery 2007 84, 2038-2046DOI: (10.1016/j.athoracsur.2007.04.129) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Interrupted Prolene sutures are used to approximate the zone of apposition and ensure that the left-sided atrioventricular valve is competent and does not develop late insufficiency. The Annals of Thoracic Surgery 2007 84, 2038-2046DOI: (10.1016/j.athoracsur.2007.04.129) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 Running Prolene suture is used to approximate the pericardium to the edges of the atrial septal defect effectively closing the atrial component of the atrioventricular (AV) canal defect. The zone of apposition of the right-sided AV valve is usually approximated with only two or three interrupted prolene sutures. The coronary sinus is kept draining to the right atrium. The Annals of Thoracic Surgery 2007 84, 2038-2046DOI: (10.1016/j.athoracsur.2007.04.129) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 7 Mean age at the time of complete atrioventricular canal repair. The mean age dropped from six months in 2000 to four months in 2006. The mean age in the modified single-patch group was less than in the “classic” two-patch group (p = 0.03). (○ = mean age all repairs; ■ = mean age 1-patch; ▲ = mean age 2-patch.) The Annals of Thoracic Surgery 2007 84, 2038-2046DOI: (10.1016/j.athoracsur.2007.04.129) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 8 Degree of left (A) and right (B) atrioventricular (AV) valve insufficiency as assessed by postoperative transthoracic echocardiography. The AV valve insufficiency was graded as trivial, mild, mild to moderate, moderate, moderate to severe, and severe along the x axis. The y axis indicates the number of patients in the two different groups (single-patch [] and two-patch []). The Annals of Thoracic Surgery 2007 84, 2038-2046DOI: (10.1016/j.athoracsur.2007.04.129) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions