pediatrics
Atrioventricular Septal Defect
Treatment of Atrioventricular Septal Defect
Surgical repair For heart failure, medical therapy (eg, diuretics,digoxin, angiotensin-converting enzyme inhibitors) before surgery Complete atrioventricular septal defect should be repaired by age 2 to 4 months because most infants have heart failure and failure to thrive. Even if infants are growing well without significant symptoms, repair should be done before 6 months to prevent development of pulmonary vascular disease, especially in infants with Down syndrome. In patients with 2 adequately sized ventricles and no additional defects, the large central defect (combination of the primum ASD and inlet VSD) is closed and the common AV valve is reconstructed into 2 separate valves. Surgical mortality rate is 3 to 4% ( Treatment reference ). Surgical complications include complete heart block (3%), residual ventricular septal defect, and/or left AV valve regurgitation. Less common residual abnormalities include right AV valve regurgitation, left or right AV valve stenosis, or subaortic stenosis. Pulmonary artery banding may be used as a palliative procedure to delay the timing of open heart repair, particularly in preterm infants or those with associated abnormalities that make complete repair at an early age or low body weight higher risk. For asymptomatic patients with a partial defect, elective surgery is done at age 1 to 3 years. Surgical mortality rate is very low. The subset of patients with unbalanced AV septal defect, associated with either a hypoplastic right ventricle or hypoplastic left ventricle, generally are not amenable to a 2-ventricle repair and require operative staging toward a single ventricle circulation, ultimately with a Treatment . For patients with large shunts and Heart failure in neonates , diuretics, Prevention is not needed preoperatively and is required only for the first 6 months after repair or if there is a residual defect adjacent to a surgical patch. 1.Spector LG, Menk JS, Knight JH, et al: Trends in Long-Term Mortality After Congenital Heart Surgery.J Am Coll Cardiol71(21):2434-2446, 2018. doi:10.1016/j.jacc.2018.03.491 