Timing of aortic valve intervention in pediatric chronic aortic insufficiency
The timing of aortic valve intervention (AVI) in pediatric patients with chronic aortic insufficiency (AI) is largely based on adult experience, which is fraught with uncertainty and controversy. Current adult guidelines in the absence of symptoms use left ventricular (LV) systolic function and LV dimensions to guide AVI timing, with few studies translating these recommendations to pediatric patients. This article reviews the current guidelines for AVI timing in chronic AI along with the emerging data for pediatric patients.
EARLY CORRECTION OF COMPLETE ENDOCARDIAL CUSHION DEFECTS UTILIZING THE 2-PATCH TECHNIQUE - A 10-YEAR RETROSPECTIVE EXPERIENCE
The goal of this study was to review the short-term and long- term results of aggressive corrective intervention in a consecutive series of patients with atrioventricular canal defects, especially with respect to minimizing progressive valvular insufficiency or pulmonary hypertension. A total of 46 consecutive patients with atrioventricular canal defects had operative repair between 1981 and 1991, using a two-patch technique in all but 4 patients. The median age was 8.5 months, with 29 patients (63%) < 1 year old. Left-to-right shunting was severe in all cases (mean Qp/Qs = 2.9:1), with a mean systolic pulmonary artery pressure of 63.6 mm Hg and a mean pulmonary vascular resistance of 4.03 Wood units. Preoperatively, 35 patients (76.1%) had moderate to severe congestive heart failure. Hospital mortality was 6.5% (3 patients), and the systolic pulmonary artery pressure dropped significantly in all cases, with a postrepair mean of 25.7 mm Hg. The 5 year actuarial survival rate was 70.3%. Late echocardiographic studies graded mitral insufficiency as 0-2+ in 41 patients (95.2%) and 3-4+ in 2 patients (4.6%); 2 patients required reoperation, and 41 (95.2%) were New York heart Association functional class I at follow-up. These data demonstrate excellent lat survival and functional results when complete atrioventricular canal correction is performed in infancy, despite significant preoperative pulmonary hypertension, valvular insufficiency, or symptoms. Prompt operative repair should be done for symptomatic patients and those with valvular incompetence; electrive repair is recommended before 1 year of age for most others