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Surgically created double-orifice left atrioventricular valve: A valve-sparing repair in selected atrioventricular septal defects  Loïc Macé, MDa, Patrice.

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Presentation on theme: "Surgically created double-orifice left atrioventricular valve: A valve-sparing repair in selected atrioventricular septal defects  Loïc Macé, MDa, Patrice."— Presentation transcript:

1 Surgically created double-orifice left atrioventricular valve: A valve-sparing repair in selected atrioventricular septal defects  Loïc Macé, MDa, Patrice Dervanian, MDa, Lucile Houyel, MDb, Evelyne Chaillon-Fracchia, MDb, Dominique Piot, MDa, Virginie Lambert, MDa, Jean Losay, MDa, Jean-Yves Neveux, MDa  The Journal of Thoracic and Cardiovascular Surgery  Volume 121, Issue 2, Pages (February 2001) DOI: /mtc Copyright © 2001 American Association for Thoracic Surgery Terms and Conditions

2 Fig. 1 Operative procedure in complete AVSDs. Note that the base of the VSD patch is tailored in a concave shape (arrow) so as to fit exactly with valvular tissue, which is sandwiched between the VSD and ostium primum patches. Inset: Sandwiched patch technique. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /mtc ) Copyright © 2001 American Association for Thoracic Surgery Terms and Conditions

3 Fig. 2 Intraoperative classification of the aspect of valvular tissue and position of the papillary muscles (dotted circle) according to Uemura and associates24 (surgical view). A, Parallel arrangement. B, Anterior displacement. C, Posterior displacement. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /mtc ) Copyright © 2001 American Association for Thoracic Surgery Terms and Conditions

4 Fig. 3 Surgically created double-orifice LAVV. A, Mechanism of the residual regurgitation: defect in apposition to the top edge of the mural leaflet either by a lateral displacement/central malalignment (*) or an anteroposterior (**) defect of coaptation. B, Surgical creation of the double orifice by interrupted (n = 8) or interrupted and mattress sutures (n = 2) with commissural annuloplasties. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /mtc ) Copyright © 2001 American Association for Thoracic Surgery Terms and Conditions

5 Fig. 4 Measurements of pathologic specimens. A, Shape of the mural leaflet. Interpapillary muscle distance (IPPM) and mural leaflet height. B, Subvalvular apparatus. Length of each chorda (C) and papillary muscle (PM) of anterolateral and posteromedial subvalvular apparatus. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /mtc ) Copyright © 2001 American Association for Thoracic Surgery Terms and Conditions

6 Fig. 5 Representative postoperative bidimensional echocardiographic aspect in parasternal short-axis view (patient 5). The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /mtc ) Copyright © 2001 American Association for Thoracic Surgery Terms and Conditions

7 Fig. 6 Representative postoperative echocardiographic aspect in apical two-cavity long-axis views (patient 2). A, Bidimensional view. B, Diastolic color-coded flow showing an unrestricted flow through the inferior orifice and a restricted flow through the superior orifice, divided in two parts by the presence of the head of the anterolateral papillary muscle. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /mtc ) Copyright © 2001 American Association for Thoracic Surgery Terms and Conditions

8 Fig. 7 Anatomic study on pathologic specimens. A, Scatterplot showing a direct significant correlation between the width (estimated by the interpapillary muscles distance) and height of the mural leaflet. B, Bivariate plots showing relationships between the width or height of the mural leaflet and the total length of the subvalvular apparatus (papillary muscle plus chordae). C, Bivariate plots showing no correlation between the width or height of the mural leaflet and the length of chordae. (See text for statistical significance.) The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /mtc ) Copyright © 2001 American Association for Thoracic Surgery Terms and Conditions

9 Fig. 8 Pathologic specimens with similar interpapillary muscle distance and mural leaflet height/inlet ratio (ie, mural leaflet shapes) but with two different aspects of the subvalvular apparatus and chordal lengths. A, Long chordae, in which double-orifice repair seems feasible, if necessary. B, Short chordae, with the risk of creation of a double parachute mitral valve in the event a double-orifice repair being used. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /mtc ) Copyright © 2001 American Association for Thoracic Surgery Terms and Conditions

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