Complete endocardial cushion defect: operative technique and results
Stewart, S.; Harris, P.; Manning, J.
Journal of Thoracic and Cardiovascular Surgery 78(6): 914-919
1979
ISSN/ISBN: 0022-5223 PMID: 388086 Document Number: 150424
Children [13] underwent repair of a complete endocardial cushion defect. Three patients had associated intracardiac anomalies including tetralogy of Fallot, cor triatriatum and parachute mitral valve, and none survived operation. Ten patients had no associated anomalies and 9 survived operation (90%). Of the 5 patients less than 2 yr of age 4 survived (80%). The mean age at the time of operation was 15 mo. and the mean weight was 7.8 kg. All patients except those with tetralogy of Fallot had systemic pressure in the pulmonary artery. The Qp/Qs [pulmonary-systemic flow ratio] ranged from 1.0-3.0 and the pulmonary vascular resistance from 2.0-9.3 m2. All except those with tetralogy of Fallot had cardiomegaly. Ten patients were predominantly type A anatomy; 3 were type C. A previously described standard repair was performed. Cold cardioplegia is used recently for myocardial preservation. The right ventricular-left ventricular pressure ratio was approximately 0.5 immediately after operation in most patients. All patients remained in normal sinus rhythm and all surviving patients had an excellent cardiac index early after operation. On discharge most pateints were prescribed a combination of digoxin and a diuretic. These medications were usually discontinued within 6 mo. One patient required reoperation for dehiscence of the mitral valve repair. She survived with a good result. Seven patients have no mitral valve incompetence and the remainder have minimal incompetence. Most infants had acceleration of their growth curve after operation. Six had an excellent clinical result, and 1 with residual neurologic sequelae, had a satisfactory results although her hemodynamic status is excellent.