Surgical Treatment of Systemic Atrioventricular Valve Insufficiency in Corrected Transposition

Three cases are presented of surgical treatment of systemic atrioventricular valve insufficiency in patients with corrected transposition of the great vessels. The severity of the symptoms of mitral regurgitation indicated surgical correction. In the first case, an adult male, a fairly normal but widened tricuspid valve in combination with an atrial septa1 defect was found. A locally successful annuloplastic procedure was performed, but the patient died two weeks after operation from a surgical lesion to the left circumflex branch of the left coronary artery, which caused a myocardial infarction. In the other two patients, both children, the valve was grossly deformed, necessitating valve replacement, which was performed, using a Björk-Shiley mitral valve prosthesis.Both patients are doing well 2 1/2 and 1/2 years, respectively, after operation. Due to the difficulty in obtaining a perfect result with an annuloplasty in a three-leaflet systemic atrioventricular valve, a valve replacement is the procedure of choice in most patients. It is necessary to place all sutures superficially in the annulus in the region that corresponds to the mural leaflet, as the left circumflex coronary artery may be as close as 1 or 2 mm from the annulus.