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Purpose : Progressive regurgitation of the left atrioventricular valve (AV) remains a major postoperative problem in the repair of atrioventricular septal defect (AVSD). The aim of this study was to r...eview a case series of AVSD repair and reoperation for significant left AV valve regurgitation from this institution. Methods : Forty-nine patients underwent initial repair of AVSD between February 1990 and March 2011, and 4 of them underwent reoperation for left AV valve regurgitation. Another 5 patients, who had received initial repair of AVSD before 1990, underwent reoperation of the left AV valve during the same period. This study retrospectively reviewed all cases of AVSD operation, and considered the causes of the left AV valve incompetence, and furthermore addressed how to manage most effectively this problem. Results : There were 4 early deaths (8.6%) and no late deaths after initial repair of AVSD. No death was observed after reoperation of the left AV valve. Six patients underwent re-repair of left AV valve, but three patients needed prosthetic valve replacement. An additional cleft closure and commissuroplasty were performed on the 6 re-repaired cases. No significant AV valve regurgitation was observed among the 6 re-repaired cases. The actuarial survival was 92% at 10 and 15 years after AVSD repair. Freedom from reoperation of the left AV valve was 81% at 10 and 15 years for the patients who survived the initial repair during the study period. Freedom from significant left AV valve regurgitation was 46% at 10 years for all patients who survived the initial repair during the study period. A partial ring annuloplasty using Gore-Tex graft was applied to the last 2 cases, and this employment yielded encouraging results. Conclusion : The results were acceptable in terms of the mortality and reoperation free ratio, but the freedom from significant left AV valve regurgitation was disappointing. The outcome of reoperation for significant left AV valve regurgitation was also satisfactory. The application of Gore-Tex graft partial annuloplasty of the left AV valve appears to be a potentially useful and effective treatment modality.
目的：房室中隔欠損症（AVSD）根治術後の進行性の左側房室弁逆流は，本疾患に対する外科治療 における最も重要な問題点である．本研究において，当施設におけるAVSD 根治術症例術後の左 側房室弁逆流，および左側房室弁に対する再手術に検討を加える．方法：1990 年１月から2011 年５月までに49 例に対しAVSD の根治手術を行い，うち４例に左側房室弁に対する再手術を行った．同時期に1990 年より以前に根治術を受けた５例に対し，左側房室弁に対する再手術を行った．本研究では，これらすべての症例に検討を加え，左側房室弁逆流発生の原因を考察し，この問題に対しいかに対処すべきかに言及する．結果：初回根治術後早期死亡を４例（8.6％）に認めたが，遠隔死亡はなかった．再手術後は早期死亡，遠隔死亡とも認めなかった．再手術では，６例に左側房室弁の再形成を行い，３例に人工弁置換術を行った．再形成の６例において，裂隙の再閉鎖と，交連部における弁輪縫縮術を行った．再形成の６例において，有意な左側房室弁逆流の再発を認めていない．AVSD 初回根治術後の累積生存率は10 年，15 年で92％であった．初回根治手術生存例における，左側房室弁に対する再手術からの回避率は，10 年，15 年で81％であった．初回根治術後の有意な左側房室弁逆流からの回避率は10 年で46％であった．Gore-Texグラフトを用いた部分弁輪縫縮術は有用であった．結語：AVSD に対する初回根治術の成績は，死亡率，再手術回避率の点で満足すべき結果であったが，術後の有意な左側房室弁逆流からの回避率は不満足な結果であった．左側房室弁に対する再手術の成績は満足すべきものであった．Gore-Tex グラフトを用いた部分弁輪縫縮術は，術後左側房室弁逆流発生を減少させる可能性を有する有用な方法であると考えられた．show more
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