الفهرس 
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Abstract
S
UMMARY
he spectrum of atrioventricular septal defects account for about 7–17% of congenital heart disease (1), and 25% of them are partial atrioventricular canal defects (2). The repair of partial atrioventricular canal are preferred to be performed when diagnosed and before an operation might interfere with school.
According to the long-term follow-up results of other centers, surgical outcomes were excellent. There were many reports about the surgery outcomes of patients in young age. The aim of this retrospective study is to review the results of treating infants with partial atrioventricular canal patients in our centers. The mortality rate, surgery procedures and valve regurgitation associated data were described. (3,6)
Our study aimed to evaluate the outcomes of patients undergoing surgical repair of partial atrioventricular septal defect (AVSD) and analyzed the effect of age on outcome. Objective is to assess the best time of repair in this congenital cardiac anomaly and to study different postoperative clinical pathways.
This study is a Retrospective cohort study. This retrospective cohort study was carried out on 75 patients with successfully surgical PAVC repair patients were recruited from cardiothoracic department, Ain Shams University and affiliated Hospitals.
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Were given informed consent. The study protocol was approved by the ethical committee, Faculty of Medicine, Ain Shams University hospitals, cardiothoracic department.
Inclusion criteria:
Any Patient need partial atrioventricular canal repair.
Exclusion criteria:
Any patient with syndrome.
Any associated congenital heart anomaly.
Redo patients.
Sampling Method: Retrospective, cohort, non- randomized sample.
Sample Size: Using PASS11 program for sample size calculation setting confidence level at 95% and margin of error at 5% it is estimated that sample size of 75 patients
Study Procedures:
Date has been collected from medical reports.
Records included:
Preoperative preparations:
History taking: Detailed history has been taken, as regards the age, sex, body weight, race, mothers’ related pregnancy disorders, any NICU.
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Clinical examination: A complete clinical general and local cardiological examination has been performed
Pre-Operative Measurements:
Laboratory: Complete blood count (CBC), liver function tests, prothrombin time and concentration, INR, kidney function tests, fasting blood sugar, serum electrolytes, electrocardiogram (ECG).
Radiological: Plain chest x-ray P-A view in the erect position, echocardiography.
Surgical technique:
After median sternotomy, Standard cardiopulmonary bypass was established after cannulating ascending aorta and venae cavae, Antegrade cold blood cardioplegia was used for cardiac arrest. Moderate hypothermia was achieved for myocardial protection. After right atriotomy, We used interrupted mattress prolene 5/0 sutures to sew the pericardial patch to close inter atrial defect and to repair of left A-V val regurge with interrupted suture then close the tissues in layers.
Post-operative measurements:
Electrocardiogram after surgery to detect any electrocardiographic Changes manly heart block.
ICU stay (in days) and hospital stay.
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Laboratory: Cardiac enzymes, complete blood count (CBC), liver function tests, prothrombin time and concentration, INR, kidney function test, serum electrolytes.
Radiological: Plain chest x-ray,ECHO one weak and 6 moths post operative.
The main results of this study were as follows:
The study included 75 patients, 32 (42.7%) females and 43 (57.3%) females, with a median (IQR) age of 23 (15 to 48) months (range, 4 to 190 months). Forty-six (61.3%) patients were ≤ 24 months and 29 (38.7%) patients were > 24 months of age.
Pre operative data results was as following.
A single (1.3%) patient had thrombocytopenia prior to surgery. All other biochemical and hematological tests were normal in all patients. Preoperative ECG and CXR were normal in all patients.
The size of ASD ranged from 4.0 to 26.0 mm (median, 12.0 mm; IQR, 10.0 to 15 mm).
Eleven (14.7%) patients had mild mitral regurgitation, 25 (33.3%) had moderate mitral regurgitation and 39 (52.0%) had severe mitral regurgitation. The prevalence of mild, moderate or severe tricuspid regurgitation was 24.0% (18 patients), 42.7% (32 patients) and 33.3% (25 patients), respectively.
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Thirty-one patients (41.3%) had RA dilatation and 42 (56.0%) patients had pulmonary hypertension. A single patient (1.3%) had LV dilatation but none had LVOT obstruction. Median (IQR) EF was 72% (68% to 75%), range, 55% to 82%.
There was no statistically significant difference between both groups regarding the male/female proportion (P = 0.106), history of NICU admission (P > 0.999) or history of other congenital anomalies (P = 0.555).
Preoperative echocardiographic findings in either group. Both groups were comparable as regards the size of ASD (P = 0.311), severity of mitral or tricuspid regurgitation (P = 0.513 and 0.685, respectively), prevalence of RA dilatation (P = 0.635).
The proportion of patients with pulmonary hypertension was significantly higher in the younger age group (65.2% versus 41.4%, respectively, P = 0.043) this is may be related to repeted chest infection. and so the EF was significantly higher in this younger age group (median (IQR = 75% (70% - 75%) versus 70 (65 – 73), respectively, P = 0.003).
But both still in the normal range of EF.
Post operative results from data collected was as the following.
There was no statistically significant difference between both groups as regards ICU or in-patient stay after surgery (P = 0.500 and 0.949, respectively). The median (IQR) total
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postoperative hospital stay was 8 (5- 8) days versus 7 (6 - 8) days in patients aged ≤ 24 months or 24months, respectively (P = 0.641) postoperative outcomes in either age group at 1 week after surgery. A single (2.4%) patient in the younger age group had residual ASD versus 3 (11.1%) patients in the older group. This difference was not statistically significant (P = 0.292).There was no statistically significant difference between both group as regards the size of residual ASD (0.129) and the EF (P = 0.124).
The incidence of heart block (P = 0.391), RA dilatation (P= 0.702), RV dilatation (P = 0.508) and pulmonary hypertension improvement (P = 0.342) both groups. Similarly, the severity of mitral regurgitation (P = 0.454) and tricuspid regurgitation (P = 0.801) was not significantly different.
Postoperative outcomes in either age group at 6 months after surgery. A single (3.7%) patient in the older age group had residual ASD versus none in the younger group. This difference was not statistically significant (P = 0.391).
There was no statistically significant difference between both group as regards the size of residual ASD (0.212) and the EF (P = 0.105).
The improvement of RA dilatation (P > 0.999), RV dilatation (P = 0.729) and pulmonary hypertension (P = 0.729) was comparable in both groups. Similarly, the severity of mitral
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regurgitation (P = 0.207) and tricuspid regurgitation (P = 0.840) was not significantly different.
Our study conclusion is that Age of repair of PAVC of both included age groups with a median age 23 month is not related to post operative outcome as regarding post operative mortality, severity of MR,TR ,post operative EF, improvement of PH,RV dilatation, RAdilitation, LVOT obstruction and incidence of heart block nor residual ASD.