Changes in left atrioventricular valve geometry after surgical repair of complete atrioventricular canal

Objective: The most common reason for late surgical reintervention after repair of complete atrioventricular canal defects is the development of left atrioventricular valve regurgitation. We sought to determine the changes in left atrioventricular valve geometry after surgical repair that may predispose to regurgitation. Methods: Atrioventricular valve measurements were obtained by 2-dimensional echocardiography at 3 different time points (preoperative, early postoperative, and midterm postoperative [6-12 months]). Left atrioventricular valve annulus area and left ventricular volume were calculated; vena contracta of the regurgitant jet orifice was measured. All measurements were normalized relative to an appropriate power of body surface area. Results: From January 2000 to January 2008, 101 patients with complete atrioventricular canal repair were included. Left atrioventricular valve annulus was noted to remodel from an elliptical shape to a circular shape after surgery. Left atrioventricular valve annulus area increased early postoperatively (systole: 4.1 +/- 0.2 cm(2)/m(2) vs 6.1 +/- 0.3 cm(2)/m(2), P < .001; diastole: 7.2 +/- 0.4 cm(2)/m(2) vs 10.0 +/- 0.5 cm(2)/m(2), P < .001, pre- vs postoperative, respectively). This increase was sustained in the midterm postoperative period (systole: 6.1 +/- 0.3 cm(2)/m(2), P = .85, vs diastole: 10.0 +/- 0.4 cm(2)/m(2), P = .78, early vs midterm postoperative). Left ventricular volume increased in the early and midterm postoperative periods compared with preoperative (systole: 16.9 +/- 1.2 mL/m(2) vs 26.2 +/- 1.7 mL/m(2), P < .001; diastole: 35.0 +/- 2.4 mL/m(2) vs 52.5 +/- 3.2 mL/m(2), P < .001). Conclusions: Complete atrioventricular canal repair leads to left atrioventricular valve annular shape change with increased area and circular shape. The change in left atrioventricular valve annulus shape appeared to be mainly due to increased circumference in the posterior free wall of the annulus. These findings may provide a mechanism for the progression of central regurgitation seen after complete atrioventricular canal repair and a potential solution. (J Thorac Cardiovasc Surg 2012; 143: 1117-24)