Elizabeth H. Stephens, M.D., Ph.D., a pediatric and congenital cardiac surgeon at Mayo Clinic in Rochester, Minnesota, discusses the anatomy, physiology and surgical management of atrioventricular septal defects, also called canal defects.
Each of the various canal defects — including complete, intermediate, transitional and partial — is characterized by different degrees of mitral and tricuspid valve involvement and holes in the atrial and ventricular septum of the heart.
My name is Elizabeth Stephens. I'm a pediatric and congenital cardiac surgeon. Mayo Clinic. Today I'll be talking about atrial ventricular septal defects, also called canal defects. Today I'll be showing a repair of complete atrial ventricular septal defect. In this animation, you can see the right atrium, right ventricle, left atrium and left ventricle. Shown is the large ventricular septal defect and large atrial septal defect. The arrows show the direction of blood flow from the left side of the heart to the right side. This causes increased volume and work for the right heart. The surgical repair of atrial ventricular septal defect involves closing the ventricular septal defect and the atrial septal defect and then reconstructing the two valves. There are two main methods for repairing complete atrial ventricular septal defect. One is the double patch repair, and the second is the modified single patch, which will be shown in the upcoming video in the modified single patch. There is one patch that closes both the atrial septal defect and the ventricular septal defect, and the edges of the valve are brought down to the top part of the ventricular septum. This is a four month old with down syndrome and complete atrial ventricular septal defect. We are already on the heart lung machine and the heart is stopped. We're examining the common valve first, the inferior part and now the superior. What's called the bridging Leaflet? Here we are testing the valve and floating the leaflets you can appreciate. Right now there is one big valve. Instead of separate Mitchell and truck husband valves, the first step will be figuring out where the middle will be, where the new septum that we will create will go. Now we're putting in stitches for where the middle will be. This shows placing each of the stitches, taking bites in the ventricular septum, going through where the midpoint of the common valve is, where it will be partitioned and then going through the patch again. This partitions the common valve into two valves and at the same time will close the ventricular septal defect. The patch now has been pushed down in place, and we will tie all the suitors. The patch is made of the baby's own pericardium, which is the lining around the heart. Now we're examining the mitral valve and will close the gap that you can see near the patch. This is also called the Mitchell Cleft. This gap is closed with fines. Future. We're testing the valve again to make sure that it doesn't leak. And here you can see the row of suitors closing the cleft. Now we are repairing the trick custom A valve in a similar manner. The last step of the operation is to close the atrial septal defect utilizing the same patch here. The operation is finished and the heart is beating.