[III-JCKAP6-2-2] Complete atrioventricular septal defect repair by one-patch technique in the patient with large ventricular septal defect.
キーワード：atrioventricular septal defect, biventricular repair, ventricular septal defect
A 17 month-old female patient, diagnosed as Down syndrome with complete atrioventricular septal defect (AVSD) during fetal development, visited outpatient clinic for staged operation. With multiple ventricular septal defects (VSD) including 21mm-sized perimembraneous (PM) VSD with nearly single ventricle and 3mm-sized apical muscular VSD, she underwent palliatve pulmonary artery (PA) banding 14 day after birth at outside hospital. We decided staged biventricular repair due to balanced Rastelli type A AVSD without left ventricular outflow track obstruction.We performed one-patch technique. After we identified and marked both coaptation zones, the apical muscular VSD was closed using sandwich patch technique consisting of autopericardial and synthetic patch pledgets at both sides. The PM VSD was closed with autopercardial patch after resecting accessory endocardial cushion tissue. Left cleft was primarily repaired by coaptation sutures followed by suturing bridging leaflets to both sides of patch, and right cleft was also closed. Given stenosis in the distal main PA and proximal branch PAs due to external banding, we performed RPA os cut-back angioplasty and LPA & MPA & 2 sinuses inverted Y-patch angioplasty.The patient was weaned from cardiopulmonary bypass smoothly and echocardiography revealed no significant valve lesion and good biventricular function. After routine postoperative management, she was discharged 9 days after the operation without any complication.Even large complete AVSD with muscular VSD can be indicated for biventricular repair using one-patch technique.