Complete endocardial cushion defect: Operative technique and results

Abstract

Thirteen patients have undergone repair of a complete endocardial cushion defect since 1975. Three patients had associated intracardiac anomalies, including tetralogy of Fallot, cor triatriatum, and parachute mitral valve, and none survived operation. Ten patients had no associated anomalies and nine survived operation (90%). Four of the five patients less than 2 years of age survived (80%). The mean age at the time of operation was 15 months and the mean weight was 7.8 kg. All patients except those with tetralogy of Fallot had systemic pressure in the pulmonary artery. The Qp/Qs ranged from 1.0 to 3.0 and the pulmonary vascular resistance from 2.0 to 9.3 m 2 . All except those with tetralogy of Fallot had cardiomegaly. Ten patients were predominantly of type A anatomy while three were of type C. A previously described standard repair was performed. Cold cardioplegia has been used recently for myocardial preservation. The right ventricular-left ventricular pressure ratio was approximately 0.5 immediately after operation in most patients. All patients remained in normal sinus rhythm and all surviving patients had an excellent cardiac index early after operation. On discharge most patients were prescribed a combination of digoxin and a diuretic. These medications were usually discontinued within 6 months. One patient required reoperation for dehiscence of the mitral valve repair. She survived with a good result. Seven patients have no mitral valve incompetence and the remainder have minimal incompetence. Most infants had acceleration of their growth curve after operation. Six have had an excellent clinical result, and one, with residual neurologic sequelae, had a satisfactory result although her hemodynamic status is excellent.