Abstract 17938: Sub-valve and Valvar Pathology Predict Post-operative Valve Failure After Primum Repair
Background Atrioventricular valve regurgitation (AVVR) is the most common reason for reoperation after primum defect repair. Descriptions of pre-operative (pre-op) anatomical risk factors predicting significant post-operative (post-op) AVVR are limited. We utilized three-dimensional echocardiography (3DE) to examine pre-op anatomical and functional characteristics of left AVV in primum defects for insights into post-op valve failure.
Methods We reviewed 33 selected children (median age 6 years, range 2 months to 19 years) presenting for primum defect repair. Pre-op two-dimensional echocardiography (2DE) was analyzed for LAVVR (pre-op and at follow-up). We assessed for specific pre-op valvar or sub-valve risk factors, such as abnormally short chordae, commissural deformities and an eccentric cleft, using 3DE and surgical reports. 3DE was analyzed to quantify papillary muscle (PM) and cleft position, chordae length and annular size.
Results Thirty six percent had moderate pre-op LAVVR. The mean post-op follow-up was 23±16 months with 45% of patients having moderate LAVVR (group A) and 55% having mild or less LAVVR (group B). We identified pre-op valve or subvalve risk factors in 74% by RT-3DE and in 56% by surgical findings. Quantitative 3DE analysis demonstrated shortened chordae to the anterior PM in group A (P<0.01) but no difference in cleft or PM position or annular dimesion. Patients with moderate post-op LAVVR were more likely to have significant pre-op LAVVR and abnormal 3DE findings than patients with mild post-op LAVVR. There was no difference in the rate of abnormal surgical findings between these two groups. Moderate pre-op LAVVR had a positive predictive value (PPV) for post-op regurgitation of 77% whilst a normal 3DE had a 100% negative predictive value. Combined pre-op LAVVR and 3DE findings improved PPV to 83%.
Conclusion In addition to moderate pre-op LAVVR, 3DE findings of valve and sub-valve abnormalities improve prediction of significant LAVVR after primum repair. Early identification of these under recognized valve and sub-valve complicating factors for surgical repair, may facilitate surgical planning, procedure modification and improve outcome.
- © 2012 by American Heart Association, Inc.