[Medium-remote Term Results of the Atrioventricular Valve Replacement with Mechanical Valve for Functional Single Ventricles].

We prospectively investigated the relation of adaptation, timing of atrioventricular valve replacement (AVVR), valve type, size, durability of replacement valve, and preoperative cardiac function with prognosis of AVVR. The subjects included 26 patients[ 15.5 years old( day 2-43 years)] with functional single ventricle who underwent AVVR at our institution between August 1996 and January 2014. Of these patients, 24 had regurgitation, whereas 2 had stenosis. Of 7 patients who died, 3 were infants who died in the postoperative acute phase, and all of them had severe heart failure at the preoperative stage. The 5-year survival rate was 67% as assessed by Kaplan-Meier curve. On univariate analysis of the preoperative data, pulmonary artery pressure (PAP), pulmonary capillary wedge pressure, age at operation, body height, and body weight were significant risk factors for death;of these, only PAP remained in the last model for multiple regression analysis. AVVR for regurgitation is supposed to reduce cardiac volume load and help improve prognosis. Atrioventricular valve plasty or replacement should be performed prior to the development of severe heart failure.

Quantitative real-time three-dimensional echocardiography provides new insight into the mechanisms of mitral valve regurgitation post-repair of atrioventricular septal defect.

BACKGROUND: Mechanisms of mitral valve regurgitation after atrioventricular septal defect repair are unclear. METHODS: To gain further insight into mitral valve regurgitation, real-time three-dimensional echocardiography was performed in 53 patients after atrioventricular septal defect repair (30 partial and 23 complete) and 40 controls. Mitral valve {x, y, z} coordinates from the annulus, leaflet surface, papillary muscle, and chordal attachments were recorded. Vena contracta area of the regurgitant jet(s) and volume of leaflet prolapse and tethering were measured. RESULTS: Twenty-three patients had mild (group 1) and 30 moderate (group 2) mitral valve regurgitation. Patients in both groups 1 and 2 had more circular annuli than controls. Annular area was greater in group 2 than in group 1 and controls (P < .01). Group 2 had more frequent segmental prolapse in the superior-mural leaflet segment. The anterolateral papillary muscle was more laterally displaced in group 2 than in controls and group 1 at end-diastole (P = .01 and P = .05) and formed a more acute angle with the mitral valve annulus than in controls or group 1 (P = .01). CONCLUSIONS: In patients with atrioventricular septal defects, significant mitral valve regurgitation is associated with leaflet prolapse, larger annular area, and lateral papillary muscle displacement.

Bronchial migration of a systemic-pulmonary shunt conduit.

Using an expanded polytetrafluoroethylene conduit, a subclavian artery-to-pulmonary artery shunt was created in an infant with tetralogy of Fallot. The postoperative course was complicated by sepsis, shunt occlusion, and pneumonia. Four years later, an obstructive mass was found in the right main bronchus on fluoroscopy and was retrieved on rigid endoscopy, which turned out to be the migrated conduit. This case implies that a vascular conduit anastomosed to a systemic artery can migrate into the airway without bleeding, pseudoaneurysm formation, or host artery occlusion.