Surgical setup · Cardiac

Atrioventricular Septal Defect (AVSD) Repair

The holes between the upper chambers and between the lower chambers are closed with one or two patches, and the single shared valve in the middle of the heart is divided and rebuilt into separate left and right valves that close properly.

Official 57 instruments

The case

An atrioventricular septal defect (AVSD), also called an atrioventricular canal defect, is a gap in the center of the heart where the walls between the chambers and the two inflow valves should meet. In the complete form there is a low hole between the atria, a hole between the ventricles, and one common valve shared by both sides instead of separate mitral and tricuspid valves. In the partial form there is only the low atrial hole with a split (cleft) left valve. Large amounts of blood flood the lungs, and babies develop heart failure early. AVSD is strongly linked with Down syndrome (trisomy 21). Most centers now repair the complete form in early infancy rather than first placing a band on the pulmonary artery. The operation is done through a median sternotomy on cardiopulmonary bypass with the heart stopped, usually with moderate cooling. Three repair methods are common. The single-patch method uses one patch for both holes and cuts the common valve into two parts. The two-patch method closes the ventricular hole with a PTFE or Dacron patch and the atrial hole with pericardium. The modified single-patch method closes the ventricular hole by stitching the valve tissue straight down to the septum. In every method the left valve's cleft is closed and the valves are tested with saline. The main risks are heart block from stitches near the conduction node, a leaky or narrowed left valve, a leftover hole, and narrowing under the aortic valve. TEE is used before and after the repair, and the surgeon may go back on bypass to fix a problem it shows. For the scrub, this is a pediatric open-heart setup with several patch materials, many pledgeted sutures and a bulb syringe for valve testing.

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