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Albert Starr, MD, Hagop Hovaguimian, MD 

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1 Surgical repair of subaortic stenosis in atrioventricular canal defects 
Albert Starr, MD, Hagop Hovaguimian, MD  The Journal of Thoracic and Cardiovascular Surgery  Volume 108, Issue 2, Pages (August 1994) DOI: /uri:pii:S Copyright © 1994 Mosby, Inc. Terms and Conditions

2 Fig. 1 a, Right atrial approach to the tricuspid and mitral valves. b, Anterior leaflet is detached from the septal crest to interpose a small patch that will allow reattachment of the leaflet at a higher level. c, The patch partially fills the scooped-out defect in the septum. After resuspension of the leaflet, the mitral cleft was sutured and the primum defect was closed in the usual fashion. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /uri:pii:S ) Copyright © 1994 Mosby, Inc. Terms and Conditions

3 Fig. 2 a, Long-axis section through the normal left ventricle. Note that inflow and outflow lengths are approximately equal. b, The underlying morphologic anomaly that results in the "goose-neck" appearance of the left ventricle. Note that the left ventricular inflow/outflow ratio is significantly reduced. The asymmetric contour of the scooped-out area of the interventricular septum is characteristic, and the anterior mitral leaflet's close attachment to this deficient septum contributes to the narrowing, which results in subaortic stenosis. c, After repair, the same abnormal geometry persists, but the outflow tract has been restored to normal dimensions by lifting the mitral leaflet to the natural level. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /uri:pii:S ) Copyright © 1994 Mosby, Inc. Terms and Conditions

4 Fig. 3 A stylized view of the relationship of the AV valves to the interventricular septum. a, Complete AV canal defect. b, Partial AV canal defect. Note the concavity created in the anterior leaflet of the valve. The valve releasing procedure described in this paper would convert b to a and close the created defect with a patch. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /uri:pii:S ) Copyright © 1994 Mosby, Inc. Terms and Conditions

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