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J Thorac Cardiovasc Surg 1997;113:262-269
© 1997 Mosby, Inc.

SURGERY FOR CONGENITAL HEART DISEASE

MODIFIED FONTAN PROCEDURE IN NINETY-NINE CASES OF ATRIOVENTRICULAR VALVE REGURGITATION

Received for publication May 6, 1996 revisions requested June 25, 1996; revisions received Sept. 25, 1996 accepted for publication Sept. 25, 1996. Address for reprints: Yasuharu Imai, MD, Department of Pediatric Cardiovascular Surgery, The Heart Institute of Japan, Tokyo, Women's Medical College, 8-1 Kawadacho, Shinjuku-ku, Tokyo 162, Japan.

Abstract

Between January 1985 and August 1995, among 242 patients who underwent a modified Fontan procedure, 99 had atrioventricular valve regurgitation ranging in degree from 1 to 4, for which concomitant repair of the atrioventricular valve regurgitation was done in the majority of cases. In all but 4 cases the atrioventricular valve was repaired mainly by circular annuloplasty and valve replacement was not done in any case. Although the hospital mortality rate was significantly higher in cases with atrioventricular valve regurgitation (12/99, 12%) than in cases without (4/143, 3%; p < 0.0037, ² test), actuarial survival in atrioventricular valve regurgitation was 84% for years 5 through 10. The degree of atrioventricular valve regurgitation before operation was 1.6 ± 0.7 on average: in 49 cases with higher than grade 2 regurgitation before operation there was a significant decrease to 0.4 ± 0.49 (p < 0.0001) after operation in short-term survivors. Patients with atrioventricular valve regurgitation can be treated with reasonable risk, provided proper repair of the valve is done. Circular annuloplasty is a simple and uniformly effective method to control regurgitation even in cases of common atrioventricular valve.

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