The two-patch technique for complete atrioventricular canal.

Abstract

The goals for repairing complete atrioventricular canal (atrioventricular septal defect) are ventricular septation, atrial septation, mitral valve reconstruction, and tricuspid valve reconstruction. Complications to avoid are heart block, residual septal defects, and dysfunctional atrioventricular valves. The surgical repair of atrioventricular canal has undergone major advances over the past 40 years. Excellent short- and long-term results have been achieved with both the single-patch technique and the two-patch technique. The single-patch technique is accomplished by dividing the common valve leaflets into their respective tricuspid and mitral components, suspending them from a single patch used to close the atrial and ventricular septal defects. The two-patch technique uses a prosthetic patch for the ventricular septal defect, a pericardial patch for the atrial septal defect, and suture closure of the anterior mitral cleft. Other variables include the use of deep hypothermia and circulatory arrest, mitral cleft closure, interrupted versus continuous suturing technique, and age at operation. Perhaps more important than the applied method is that the operation be properly executed to ensure defect closure and competent valves. We review our experience in 120 patients using the two-patch technique with special reference to the technical aspects of the operation. The two-patch technique of repair with routine cleft closure as evaluated by intraoperative transesophageal echocardiography results in a low surgical mortality, a low incidence of permanent heart block, and competent atrioventricular valves.