Surgical management of common atrioventricular canal

Abstract

Surgical management of common atrioventricular (AV) canal has evolved significantly since original descriptions of repairs in 1955. Currently, complete repair is performed in infancy in most forms of complete AV canal with low mortality and morbidity. Various modifications to the original surgical techniques have been proposed and are utilized to close the inter-atrial and inter-ventricular communications, and achieve a competent AV valve. The two most commonly used techniques (single and double patch) are described in detail along with our approach to the management of the AV valves. Associated defects such as coarctation of the aorta, tetralogy of Fallot, transposition of the great arteries, and unusual left AV valve anatomy are discussed. Management of unbalanced forms of AV canal and criteria for deciding adequacy of cavity size for two-ventricle repair remains an area of some controversy and is still evolving. Our experience with common AV canal from 1990 to the end of 1998 covers 365 patients who underwent two-ventricle repair at a median age of 4.6 months. Early mortality for complete AV canal patients was 1.5%, and 10% of these had at least moderate left AV valve regurgitation post-operatively. Eighteen patients have required re-operation for severe mitral valve regurgitation at a mean of 20 months after the original repair and three others for sub-aortic obstruction. Our current management of children with complete common AV canal is to perform corrective surgery electively early in infancy, within the first 4–6 months of life. Symptomatic infants with signs of congestive heart failure should undergo repair as soon as symptoms are apparent.