Surgical results of double-orifice left atrioventricular valve associated with atrioventricular septal defects

Background. Double-orifice left atrioventricular valve (LAVV) is a rare but surgically important anomaly, which is regarded as a risk factor for surgical correction of atrioventricular septal defects (AVSDs). Methods. Of 209 consecutive patients with AVSDs, double-orifice LAW was identified in 19 patients (9.1%, including 7 infants). Preoperative LAW function, surgical procedures and results, incidence of postoperative LAW dysfunction and reoperations were reviewed and compared between patients with this valve malformation (group I, n = 19) and those without it (group II, n = 190). Results. There were no operative or late deaths in group I. Preoperative LAW function was similar in both groups. The cleft was totally closed in 77.2% of group II and 47.1% of group I (p < 0.01). In partial AVSDs, freedom from postoperative LAW insufficiency was 77.0% in group II versus 30.5% in group I at 5 years (p = 0.009) and freedom from reoperation was 89.9% in group II versus 58.3% in group I at 5 years (p = 0.012); however, there was no difference in complete AVSDs. None of the infants in group I under-went total cleft closure and 4 of them showed more than moderate LAW insufficiency postoperatively. Conclusions. Double-orifice LAW is a significant predictor for postoperative LAW incompetence and reoperation in partial AVSDs, but not in complete AVSDs. Surgical procedures for the cleft should be individualized with careful intraoperative evaluation of the structure and function of this abnormal valve, especially in partial AVSDs and infants. (C) 2002 by The Society of Thoracic Surgeons.