Key result
CAVC repair before age 2 linked to ~3-fold higher postoperative Rp/Rs versus later repair.
Why the study?
The postoperative changes of pulmonary vascular resistance in children with complete atrioventricular canal defect and their relation to age at primary repair were unclear.
Does primary repair of complete atrioventricular canal defect before 2 years of age improve postoperative pulmonary vascular resistance compared to repair after 2 years of age?
Cohort (n=9)
Does primary repair of complete atrioventricular canal defect before 2 years of age improve postoperative pulmonary vascular resistance compared to repair after 2 years of age?
Early progression of pulmonary vascular obstructive disease in complete atrioventricular canal defect may result in poor postoperative improvement even when primary repair is performed before 2 years of age.
Small series leaves open whether earlier CAVC repair alters postoperative PVR trajectory; larger prospective studies needed.
The postoperative changes of pulmonary vascular resistance (PVR) of two age groups of children with complete atrioventricular canal (CAVC) were compared. Patients were divided by age at the time of primary repair; Group-1 (G-1, n = 4) with age below 2 years (average 13.8 mo.) and Group-2 (G-2, n = 5) with age over 2 years (average 44.0 mo.). All except one were Down's syndrome. Preoperatively, pulmonary to systemic resistance ratio (Rp/Rs) were 0.87 +/- 0.50 in G-1 and 0.41 +/- 0.13 in G-2 (n.s.), and postoperative study (average 6.5 mo.) showed no significant falls in Rp/Rs in both groups. However, G-2 showed significantly lower Rp/Rs postoperatively (0.79 +/- 0.19 in G-1 vs 0.27 +/- 0.12 in G-2, p less than 0.05). Mean pulmonary artery pressure (mPA) showed significant fall after surgery in only G-2 (66.8 +/- 6.6 to 31.8 +/- 11.6 mmHg, p less than 0.005). Anatomically, type-A showed better postoperative change in mPA compared to type-C. This study summarized the early progression of pulmonary vascular obstructive disease with poor postoperative improvement even the primary repair was done before 2 years of age. The less advanced pulmonary vascular disease in G-2 might have some relations to the natural selection of the disease.
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Matsuda et al. (1984) conducted a cohort in Complete atrioventricular canal defect (n=9). Age at primary repair < 2 years vs. Age at primary repair > 2 years was evaluated on Postoperative pulmonary to systemic resistance ratio (Rp/Rs) (p=<0.05). Primary repair of complete atrioventricular canal defect at age <2 years resulted in significantly higher postoperative pulmonary to systemic resistance ratios compared to repair at >2 years (p<0.05).
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