Bivalvation Valvuloplasty for Common Atrioventricular Valve Regurgitation in Functional Single Ventricle; Early and Mid-term Results

Chang, Yun Hee; Sung, Si Chan; Kim, Seon Hee; Lee, Hyoung Doo; Ban, Ji Eun

Abstract

BACKGROUND: Atrioventricular valve regurgitation in pediatric patients with a functional single ventricles (FSV) - has been known as one of the important risk factors for death and unfavorable long-term results after a Fontan operation. We evaluated early and mid-term results of bivalvation valvuloplasty in FSV patients. MATERIAL AND METHOD: We retrospectively evaluated 11 patients with a functional single ventricle who underwent bivalvation valvuloplasty between 1999 and 2007. The degree of common atrioventricular valve regurgitation (CAVVR) was determined by color Doppler echocardiography (regurgitation grade scoring, trivial; 1, mild; 2, moderate; 3, severe; 4). Mean age at valve surgery was 6.9+/-7.0 months (median 4 months, 24 days~21 months) and mean body weight was 6.2+/-2.8 kg (3.1~11.3 kg). Nine patients had isomerism heart and two of them had TAPVC. The concomitant procedures were performed in all but one patient. Additional commissural closure was performed in 3 patients and commissural annuloplasty in another 3 patients. RESULT: There was one hospital death after surgery. A 32-day old patient who had been preoperatively dependent on a ventilator died of air way and lung problems 4.3 months after pulmonary artery banding and bivalvation valvuloplasty. Mean follow-up duration was 40 months (4.3~114 months). Mean preoperative CAVVR score was 3.3+/-0.6, which decreased to 1.9+/-0.7 postoperatively (p<0.0001). This residual regurgitation slightly increased to 2.2+/-0.4 (no statistical significance) after a mean follow-up of 14.3 months. Six patients (60%) required re-operations for residual regurgitation at a subsequent bidirectional cavopulmonary shunt or Fontan operation. One patient with Ebsteinoid malformation of the right sided atrioventricular valve required valve replacement due to stenoinsufficiency. Another patient required edge-to-edge repair at the right sided AV valve (between the right mural leaflet and the bridging leaflets). The remaining 4 patients required additional suture placements between bridging leaflets with or without commissural annuloplasty. All survivor had trivial or mild CAVVR at the latest follow-up.
CONCLUSION
Bivalvation valvuloplasty for CAVVR in FSV patients is an effective and safe procedure. However, significant numbers of the patients have small residual regurgitation and require additional valve procedures at subsequent operations. Long-term observations to monitor progression of the CAVVR is mandatory.