Application Of 3d Echocardiography And Atrioventricular Valve Repair Using Artificial Chordae In Unbalanced Atrioventricular Defect And Single-ventricle Palliation
Juan Contreras Reyes, Alvise Guariento, Mimi Xiaoming Deng, Mark Friedberg, Andrea Dragulescu, Osami Honjo.
Sick Kids Hospital, Toronto, ON, Canada.
Introduction Adequate competence of systemic atrioventricular valve(AVV) in patients with single-ventricle physiology is crucial to achieve optimal long-term outcomes. 3D echocardiography is an excellent method to assess anatomy and potential repair. Case Video Here we present the case of a two-year-old girl with a left dominant unbalanced atrioventricular defect, initially palliated with main pulmonary artery banding. Subsequently, she underwent bidirectional cavopulmonary shunt, atrial septectomy, and AVV repair, the latter consisting of cleft closure and annuloplasty of the inferior bridging leaflet due to moderate AVV regurgitation. She developed recurrent severe AVV regurgitation that required re-repair. 3D echocardiography demonstrated prolapse of the superior bridging leaflet and restriction and attenuation of the inferior bridging leaflet. Based on the 3D echocardiographic findings, AV valve repair was performed by means of artificial chord placement to the superior bridging leaflet, resection of secondary chords on the inferior bridging leaflet, and posterior annuloplasty. The intraoperative echo showed trivial AVV regurgitation, a mean inflow gradient of 5 mmHg, and good ventricular function. The patient was extubated in the operative room. Her postoperative course was unremarkable and she was discharged home on postoperative day 4. One year later, her single-ventricle pathway was completed with an uneventful Fontan procedure. At the time of surgery, the AVV continued to demonstrate trivial regurgitation and mild inflow gradient. Conclusion 3D echocardiography is useful to delineate the complexity of AVV pathology, which helps to design the valve repair. Artificial chordae are effective and durable means to repair complex valve disease in a single-ventricle population.
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