Long-term follow-up after surgical correction of the partial form of common atrioventricular canal (ostium primum)

Abstract

The operative results in our first 100 consecutive patients treated for a partial form of atrioventricular canal have been reviewed. There were sixteen hospital deaths. Seventy-eight of the remaining 84 have been followed for an average of 55.6 months. An attempt was made to compare surgical results with the natural history as assessed from the literature in order to define criteria for surgery. The degree of mitral incompetence influenced the operative mortality rate: The operative risk was 53.8 per cent in 13 patients with severe mitral incompetence as compared to 10.34 per cent in 87 with moderate or no mitral incompetence. Operative heart block occurred in 19 patients. In 7 cases the heart block persisted and was followed by two deaths. In view of the poor prognosis for patients with partial persistent atrioventricular canal treated medically, the reduction of the operative mortality rate (5.4 per cent during the last 4 years), and of the incidence of operative heart block, surgical management of the condition is warranted. The degree of mitral incompetence is a critical determinant in the selection of surgical candidates, since those with little or no incompetence do extremely well whereas those with a severe degree of incompetence still bear a high operative risk.