Article

lock Open Access lock Peer-Reviewed

413

Views

ARTIGO ORIGINAL

Análise dos fatores de risco na correção cirúrgica do defeito septal atrioventricular de forma total

Eduardo Keller SaadiI; Darryl ShoreII; Christopher LincolnII

DOI: 10.1590/S0102-76381993000200009

RESUMO

Pacientes com defeito septal atrioventricular de forma total (DSAVT) freqüentemente apresentam insuficiência cardíaca intratável e hipertensão arterial pulmonar nos primeiros meses de vida, e apenas uma minoria sobrevive sem tratamento cirúrgico precoce. Por essa razão, indica-se a correção definitiva para alterar favoravelmente a história natural da doença. Entretanto, vários fatores são responsáveis pela alta mortalidade cirúrgica. O presente trabalho estuda a experiência na correção cirúrgica do DSAVT com o objetivo de identificar alguns fatores de risco estatisticamente significativos para a ocorrência de morte operatória. Analisaram-se, retrospectivamente, 52 pacientes submetidos, entre janeiro de 1974 e dezembro de 1990, a cirurgia definitiva para correção de DSAVT no Royal Brompton and National Heart and Lung Institute, sendo estudadas as seguintes variáveis: idade, peso, sexo, ano da operação, presença de síndrome de Down, grau de regurgitação da valva AV, bandagem prévia do tronco pulmonar, presença de anomalias associadas, pressão sistólica pulmonar, duplo orifício mitral, classificação do defeito segundo Rastelli, emprego de parada circulatória e técnica de correção (1 x 2 retalhos). Todos os fatores foram avaliados isoladamente, mediante a análise univariada. Para determinar quais os fatores que, independentemente da ação de outros, contribuíram significativamente para maior mortalidade cirúrgica, foi utilizada a análise multivariada com regressão logística. A análise multivariada demonstrou que o baixo peso na época da operação e a técnica de correção com um retalho aumentam significativamente a mortalidade cirúrgica.

ABSTRACT

Patients with complete atrioventricular septal defects (CAVSD) frequently present with severe heart failure which cannot be controllable medically and pulmonary hypertension in infancy. Just a small number survives without early surgical treatment. For this reason the definitive repair is indicated to improve the disease's natural history. However many factors are responsible for a still high surgical mortality in this condition. In the present study the surgical experience in the correction of CAVSD is reviewed in order to identify potential statistically important risk factors for operative death. Between January 1974 and December 1990,52 patients with complete atrioventricular septal defects underwent definitive surgical repair at The Royal Brompton and National Heart and Lung Institute. They were retrospectively studied and the following variables analysed: age, weight, sex, year of the operation, Down's syndrome, atrioventricular valve regurgitation, previous pulmonary artery banding, associated anomalies, systolic pulmonary artery pressure, double "mitral" valve orifice, Rastelli's classification, circulatory arrest, and the surgical technique (1 x 2 patches). All this variables were studied by the univariate analysis and, to determine which factors were independently responsible for the operative risk, multivariate analysis with logistic regression was applied. Multivariate analysis showed that the low weight at operation an 1 patch technique significantly increased surgical mortality.
Texto completo disponível apenas em PDF.

REFERÊNCIAS

1. ABBRUZZESE, P. A.; LIVERMORE, J.; SUNDERLAND, C. O.; NUNLEY, D. L.; ISSEMBERG, H.; KHONSARI, S.; GARCIA, C. E.; STARR, A. - Mitral repair in complete atrioventricular canal: case of correction in early infancy. J. Thorac. Cardiovasc. Surg., 85: 388-395, 1983. [MedLine]

2. ALFIERI, O. & PLOKKER, M. - Repair of common atrioventricular canal associated with transposition of the great arteries and left ventricular outflow obstruction. J. Thorac. Cardiovasc. Surg., 84: 872-875, 1982. [MedLine]

3. ALFIERI, O. & SUBRAMANIAN, S. - Successful repair of complete atrioventricular canal with undivided anterior common leaflet in a 6 month old infant. Ann. Thorac. Surg., 19: 92-96, 1975.

4. ALVIZATOS, P.; ANDERSON, R. H.; MACARTNEY, F. J.; ZUBERBUHLER, J. R.; STARK, J. - Atrioventricular septal defect with balanced ventricles and malaligned atrial septum: double outlet right atrium: report of two cases. J. Thorac. Cardiovasc. Surg., 89: 295-297, 1985. [MedLine]

5. ALLWORK, S. P. - Anatomical-embryological correlates in atrioventricular septal defect. Br. Heart. J., 47: 419-429, 1982. [MedLine]

6. ANDERSON, R. H.; ZUBERBUHLER, J. R.; PENKOSKE, P. A.; NECHES, W. H. - Of clefts, comissures and things. J. Thorac. Cardiovasc. Surg., 90: 605-610, 1985. [MedLine]

7. ARCINIEGAS, E. - Pediatric cardial surgery. Chicago, Year Book Medical Publishers, 1985. 466 p.

8. ARCINIEGAS, E.; HAKIMI, M.; FAROOKI, Z. Q.; GREEN, E. W. - Results of total correction of Fallot with complete atrioventricular canal. J. Thorac. Cardiovasc. Surg., 81: 768-773, 1981. [MedLine]

9. ARTMAN, M.; PARRISH, M. D.; BOERTH, R. C.; BOUCEK, R. J.; GRAHAM, T. P. - Short-term hemodynamic effects of hydralazine in infants with complete atrioventricular canal defects. Circulation, 69: 949-954, 1984. [MedLine]

10. BAILEY, L. L.; TAKEUCHI, Y.; WILLIAMS, W. G.; TRUSLER, G. A.; MUSTARD, W. T. - Surgical management of congenital cardiovascular anomalies with the use of profound hypothermia and circulatory arrest: analysis of 180 consecutive cases. J. Thorac. Cardiovasc. Surg., 71: 485-492, 1976. [MedLine]

11. BARGERON, L. M.; ELLIOT, L. P.; SOTO, B.; BREAM, P. R.; CURRY, G. C. - Axial cineangiography in congenital heart disease. Section I: Concept, technical and anatomic considerations. Circulation, 56: 1075-1083, 1977. [MedLine]

12. BECKER, A. E. & ANDERSON, R. H. - Atrioventricular septal defect: what is in a name? J. Thorac. Cardiovasc. Surg., 83: 461-469, 1982. [MedLine]

13. BENDER, H. W.; HAMMON, J. W.; HUBBARD, S. G.; MUIRHEAD, J.; GRAHAN, T. P. - Repair of atrio ventricular malformation in the first year of life. J. Thorac. Cardiovasc. Surg., 84: 515-522, 1982. [MedLine]

14. BERGER, T. J.; BLACKSTONE, E. H.; KIRKLIN, J. W.; BARGERON, L. M.; HAZELRIG, J. B.; TURNER, M. E. - Survival and probability of cure without and with operation in complete atrioventricular canal. Ann. Thorac. Surg., 27: 104-111, 1979. [MedLine]

15. BERGER, T. J.; KIRKLIN, J. W.; BLACKSTONE, E. H.; PACIFICO, A. D.; KOUCHOUKOS, N. T. - Primary repair of complete atrioventricular canal in patients less than 2 years old. Am. J. Cardiol., 41: 906-913, 1978. [MedLine]

16. BHARATI, S. & LEV, M. - The spectrum of common atrioventricular oriffice (canal). Am. Heart J., 86: 553-561, 1973. [MedLine]

17. BLOOM, K. R.; FREEDOM, R. M.; WILLIAMS, C. M.; TRUSLER, G. A.; ROWE, R. D. - Echocardiographic recognition of atrioventricular valve stenosis associated with endocardial cushion defect: pathologic and surgical correlates. Am. J. Cardiol., 44: 1326-1331, 1979. [MedLine]

18. BOVE, E. L.; SONDHEIMER, H. M.; KAVEY, R. E. W.; BYRUM, C. J.; BLACKMAN, M. S. - Results with two-patch technique for repair of complete atrioventricular septal defect. Ann. Thorac. Surg., 38: 157-161, 1984. [MedLine]

19. BULL, C.; COOPER, J.; STARK, J. - Cardioplegic protection of the child's heart. J. Thorac. Cardiovasc. Surg., 88: 287-293, 1984. [MedLine]

20. BULL, C.; RIGBY, M. L.; SHINEBOURNE, E. A. - Should management of complete atrioventricular canal defect be influenced by coexistent Down syndrome? Lancet, 1: 1147-1149, 1985. [MedLine]

21. CAPOUYA, E. R.; LACKS, H.; DRINKWATER, D. C.; PEARL, J. M.; MILGALTER, E. - Management of the left atrioventricular valve in the repair of complete atrioventricular septal defects. J. Thorac. Cardiovasc. Surg., 104: 196-203, 1992.

22. CARPENTIER, A. - Surgical anatomy and management of the mitral component of atrioventricular canal defects. In: ANDERSON, R. H.; SHINEBOURNE, E. A. Paediatric cardiology. London, Churchill Livingstone, 1978. p. 477-490.

23. CASTANEDA, A. R.; NICOLOFF, D. M.; MOLLER, J. H.; LUCAS, R. V. - Surgical correction of complete atrioventricular canal utilizing ball-valve replacement of the mitral valve: technical considerations and results. J. Thorac. Cardiovasc. Surg., 62: 926-931, 1971. [MedLine]

24. CHIH, P. & CHUN, C. - Surgical treatment of atrioventricular canal malformations. Ann. Thorac. Surg., 43: 150-154, 1987. [MedLine]

25. CHIN, A. J.; KEANE, J. F.; NORWOOD, W. I.; CASTANEDA, A. R. - Repair of complete common atrioventricular canal in infancy. J. Thorac. Cardiovasc. Surg., 84: 437-445, 1982. [MedLine]

26. CLAPP, S. K.; PERRY, B. L.; FARROOKI, Z. O.; JACKSON, W. L.; KARPAWICH, P. P.; HAKIMI, M.; ARCINIEGAS, E.; GREEN, E. W.; PINSKY, W. W. - Down's syndrome, complete atrioventricular canal, and pulmonary vascular obstructive disease. J. Thorac. Cardiovasc. Surg., 100: 115-121, 1990. [MedLine]

27. CLAPP, S. K.; PERRY, B. L.; FAROOKI, Z. Q.; JACKSON, W. L.; KARPAWICH, P. P.; HAKIMI, M.; ARCINIEGAS, E.; GREEN, E. W. - Surgical and medical results of complete atrioventricular canal: a ten year review. Am. J. Cardiol., 59: 454-454, 1987.

28. CULPEPPER, W.; KOLFF, J.; LIN, C. Y.; VITULLO, D.; LAMBERTI, J.; ARCILLA, R. A.; REPLOGLE, R. - Complete common atrioventricular canal in infancy: surgical repair and postoperative hemodynamics. Circulation, 58: 550-558, 1978. [MedLine]

29. DANIELSON, G. K.; McMULLAN, M. H.; KINSLEY, R. H.; DUSHANE, J. W. - Successful repair of complete atrioventricular canal associated with dextroversion, common atrium, and total anomalous systemic venous return. J. Thorac. Cardiovasc. Surg., 66: 817-822, 1973. [MedLine]

30. DAVID, I.; CASTANEDA, A. R.; VAN PRAAGH, R. - Potentially parachute mitral valve in common atrioventricular canal: pathological anatomy and surgical importance. J. Thorac. Cardiovasc. Surg., 84: 178-186, 1982. [MedLine]

31. DEANFIELD, J. E.; LEANAGE, R.; STROOBANT, J.; CHISPIN, A. R.; TAYLOR, J. F. N.; MACARTNEY, F. J. - Use of high kilovoltage filtered beam radiographs for detection of bronchial situs in infants and young children. Br. Heart J., 44: 577-583, 1980. [MedLine]

32. DISKINSON, D. F.; ARNOLD, R.; WILKINSON, J. L. - Congenital heart disease among 160 480 liveborn children in Liverpool 1960 to 1969: implications for surgical treatment. Br. Heart J., 46: 55-62, 1981. [MedLine]

33. DRAPER, N. R. & SMITH, H. - Applied regression analysis. 2. ed. New York, John Wiley and Sons, 1981.

34. EBELS, T.; HO, S. Y.; ANDERSON, R. H.; MEIJBOOM, E. J.; EIJGELAAR, A. - The surgical anatomy of the left ventricular outflow tract in atrioventricular septal defect. Ann. Thorac. Surg., 41: 483-488, 1986. [MedLine]

35. EBELS, T.; MEIJBOOM, E. J.; ANDERSON, R. H.; LEEUWEN, J. M. S.; LENSTRA, D.; EIJGELAR, A.; BOSSINA K. K.; HOMAN, J. N.; HEIDE, H. - Anatomic and functional obstruction of the outflow tract in atrioventricular septal defects with separate valve orifices (ostium primum septal defects): an echocardiographic study. Am. J. Cardiol., 54: 843-847, 1984. [MedLine]

36. EMANUEL, R.; SOMERVILLE, J.; INNS, A.; WITHERS, R. - Evidence of congenital heart disease in offsprings of parents with atrioventricular defects. Br. Heart J., 30: 645-651, 1983.

37. EPSTEIN, M. L.; MOLLER, J. H.; AMPLATZ, K.; NICOLOFF, D. M. - Pulmonary artery banding in infants with complete atrioventricular canal. J. Thorac. Cardiovasc. Surg., 78: 28-31, 1979. [MedLine]

38. FELDT, R. H.; DUSHANE, J. W.; TITUS, J. L. - The atrioventricular conduction system in persistent common atrioventricular canal defect: correlations with electrocardiogram. Circulation, 42: 437-444, 1970. [MedLine]

39. FRATER, R. W. M. - Persistent common atrioventricular cannal: anatomy and function in relation to surgical repair. Circulation, 32: 120-129, 1965. [MedLine]

40. GERBODE, F.; SANCHEZ, P. A.; ARGUERO, R.; KERTH, W. J.; HILL, J. D.; DEVRIES, P. A.; SELZER, A.; ROBINSON, S. J. - Endocardial cushion deffects. Ann. Surg., 166: 486-492, 1967.

41. GOMES, A. S.; NATH, P. H.; SINGH, A.; LUCAS, R. V.; AMPLATZ, K.; NICOLOFF, D. M.; EDWARDS, J. E. - Accessory flaplike tissue causing ventricular outflow obstruction. J. Thorac. Cardiovasc. Surg., 80: 211-216, 1980. [MedLine]

42. GOW, R. M.; FREEDOM, R. M.; WILLIAMS, W. G.; TRUSLER, G. A.; ROWE, R. D. - Coarctation of the aorta or subaortic stenosis with atrioventricular septal defect. Am. J. Cardiol., 53: 1421-1428, 1984. [MedLine]

43. GRIFFITHS, S. P.; ELLIS, K.; BURRIS, J. O.; BUMENTHAL, S.; BOWMAN F. O.; MALM, J. R. - Postoperative evaluation of mitral valve function in ostium primum defect with cleft mitral valve (partial form of atrioventricular canal). Circulation, 40: 21-29, 1969. [MedLine]

44. HAWORTH, S. G. - Pulmonary vascular bed in children with atrioventricular septal defect: relation between structural and hemodynamic abnormalities. Am. J. Cardiol., 57: 833-839, 1986. [MedLine]

45. HEATH, D. & EDWARDS, J. E. - The pathology of hypertensive pulmonary vascular disease: a description of six grades of structural changes in the pulmonary arteries with special reference to congenital cardiac septal defects. Circulation, 18: 533-547, 1958. [MedLine]

46. HO, S. Y.; MILO, S.; ANDERSON, R. H.; MACARTNEY, F. J.; GOODWIN, A.; BECKER, A. E.; WENINK, A. C. G.; GERLIS, L. M.; WILKINSON, J. I. - Straddling atrioventricular valve with absent atrioventricular connection: report of ten cases. Br. Heart J., 47: 344-352, 1982. [MedLine]

47. HO, S. Y.; ROSSI, M. B.; METHA, A. V.; HEGERTY, A.; LENNOS, S.; ANDERSON, R. H. - Heart block and atrioventricular septal defect. Thorac. Cardiovasc. Surg., 33: 362-365, 1985. [MedLine]

48. ILBAWI, M. N.; IDRISS, F. S.; DeLEON, S. Y.; RIGGS, T. W.; MUSTER, A. J.; BERRY, T. E.; PAUL, M. H. - Unusual mitral valve abnormalities complicating surgical repair of endocardial cushion defects. J. Thorac. Cardiovasc. Surg., 85: 697-704, 1983. [MedLine]

49. JACOBSTEIN, M. D.; FLETCHER, B, D.; GOLDSTEIN, S.; RIEMENSCHNEIDER, T. A. - Evaluation of atrioventricular septal defects by Magnetic Resonance Imaging. Am. J. Cardiol., 55: 1158-1161, 1985. [MedLine]

50. JARMAKANI, J. M.; GEORGE, B.; WHELLER, J. - Ventricular volume characteritics in infants and children with endocardial cushing defects. Circulation, 58: 153-157, 1978. [MedLine]

51. KAHN, D. R.; LEVY, J.; FRANCE, N. E.; CHUNG, K. J.; DACUNHOS, G. C. - Recent results after repair of atrioventricular canal. Thorac. cardiovasc. Surg., 73: 413-415, 1977.

52. KATZ, N. M.; BLACKSTONE, E. H.; KIRKLIN, J. W.; BRADLEY, E. L.; LEMMONS, J. E. - Suture techniques for atrioventricular valves: experimental study. J. Thorac. Cardiovasc. Surg., 81: 528-536, 1981. [MedLine]

53. KAWASHIMA, Y.; MATSURA, H.; HIROSE, H.; NAKAMO, S.; SHIMAZAKI, Y.; MIYAMOTO, K. - Surgical treatment of atrioventricular canal defect with an endocardial cushion prosthesis. Circulation, 68: 139-143, 1983.

54. KAWASHIMA, Y.; NAKANO, S.; KATO, M.; DANNO, M.; SATO, K.; MANABE, H. - Fate of pericardium utilized for the closure of ventricular septal defect: post-operative ventricular septal aneurysm. J. Thorac. Cardiovasc. Surg., 68: 209-218, 1974. [MedLine]

55. KIRKLIN, J. K.; BLACKSTONE, E. H.; KIRKLIN, J. W.; McKAY, R.; PACIFICO, A. D.; BARGERON, L. M. - Intracardiac surgery in infants under age 3 months: incremental risk factors for hospital mortality. Am. J. Cardiol., 48: 500-506, 1981. [MedLine]

56. KIRKLIN, J. W.; BARRAT-BOYES, B. G. - Cardiac surgery. New York, John Wiley and Sons, 1986. 1550 p.

57. KIRKLIN, J. W. & BLACKSTONE, E. H. - Management of the infant with complete atrioventricular canal. J. Thorac. Cardiovasc. Surg., 78: 32-34, 1979. [MedLine]

58. KIRKLIN, J. W.; BLACKSTONE, E. H.; BARGERON, L. M.; PACIFICO, A. D.; KIRKLIN, J. K. - The repair of atrioventricular septal defects in infancy. Int. J. Cardiol., 13: 333-360, 1986. [MedLine]

59. KIRKLIN, J. W.; BLACKSTONE, E. H.; PACIFICO, A. D.; BROWN, R. N.; BARGERON, L. M. - Routine primary repair vs two-stage repair of tetralogy of Fallot. Circulation, 60: 373-385, 1979.

60. KRONGRAD, E.; MALM, J. R.; BOWMAN, F. O.; HOFFMAN, B. F.; KAISER, G. A.; WALDO, A. L. - Electrophysiological delineation of the specialized atrioventricular conduction system in patients with congenital heart disease. 1: Delineation of His bundle proximal to the membranous septum. J. Thorac. Cardiovasc. Surg., 67: 875-882, 1974. [MedLine]

61. KRONGRAD, E.; MALM, J. R.; BOWMAN, F. O.; HOFFMAN, B. F.; WALDO, B. A. - Electrophysiological delineation of the specialized A-V conduction system in patients with congenital heart disease. II: Delineation of the distal His bundle and the right bundle branch. Circulation, 49: 1232-1238, 1974. [MedLine]

62. LACORTE, M. A.; FELLOWS, K. E.; WILLIAMS, R. G. - Overiding tricuspid valve: echocardiography and angiocardiographic features. Am. J. Cardiol., 37: 911-919, 1976. [MedLine]

63. LAURSEN, H. B. - Congenital heart disease in Down's syndrome. Br. Heart J., 38: 32-35, 1976.

64. LEE, C. N.; DANIELSON, G. K.; SCHAFF, H. V.; PUGA, F. J.; MAIR, D. D. - Surgical treatment of double orifice mitral valve in atrioventricular canal defects: experience in 25 patients. J. Thorac. Cardiovasc. Surg., 90: 700-705, 1985. [MedLine]

65. LEV, M. - The architecture of the conduction system in congenital heart disease. I: Common atrioventricular orifice. AMA Arch. Patol., 65: 174-181, 1958.

66. LILLEHAY, C. W.; COHEN, M.; WARDEN, H. E.; VARCO, R. L. - The direct-vision intracardiac correction of congenital anomalies by controlled cross circulation: results in thirty-two patients with ventricular septal defects, tetralogy of Fallot, and atrioventricularis communis defects. Surgery, 38: 11-19, 1955.

67. MACARTNEY, F. J.; REES, P. G.; DALY, K.; PICCOLI, G. P.; TAYLOR, J. F. N.; DE LEVAL, M. R.; STARK, J.; ANDERSON, R. H. - Angiocardiographic appearances of atrioventricular defects with particular reference to distinction of ostium primum atrial septal defect from common atrioventricular orifice. Br. Heart J., 42: 640-656, 1979. [MedLine]

68. MACARTNEY, F. J.; TAYLOR, J. F. N.; GRAHAM, G. R.; DE LEVAL, M. R.; STARK, J. - The fate of survivors of cardiac surgery in infancy. Circulation, 62: 80-91, 1980. [MedLine]

69. MACHADO, M. V. L; CRAWFORD, D. C.; ANDERSON, R. H.; ALLAN, L. D. - Atrioventricular septal defect in prenatal life. Br. Heart J., 59: 352-355, 1988. [MedLine]

70. MAIR, D. D. & McGOON, D. C. - Surgical correction of atrioventricular canal during the first year of life. Am. J. Cardiol., 40: 66-69, 1977. [MedLine]

71. MALONEY Jr., J. V.; MARABLE, S. A.; MULDER, D. G. - The surgical treatment of common atrioventricular canal. J. Thorac. Cardiovasc. Surg., 43: 84-90, 1962.

72. MAVROUDIS, C.; WEINSTEIN, G.; TURLEY, K.; EBERT, P. A. - Surgical management of complete atrioventricular canal. J. Thorac. Cardiovasc. Surg., 83: 670-679, 1982. [MedLine]

73. McGOON, D. C.; DUSHANE, J. W.; KIRKLIN, J. W. - Surgical treatment of endocardial cushion defects. Surgery, 46: 185-190, 1956.

74. McGOON, D. C.; McMULLAN, M. H.; MAIR, D. D.; DANIELSON, G. K. - Correction of complete atrioventricular canal in infants. Mayo Clin. Proc, 48: 769-772, 1973. [MedLine]

75. McGRATH, L. B. & GONZALEZ-LAVIN, L. - Actuarial survival, freedom from reoperation and other events after repair of atrioventricular septal defects. J. Thorac. Cardiovasc. Surg., 94: 582-590, 1987. [MedLine]

76. MIDGLEY, F. M.; GALIOTO, F. M.; SHAPIRO, S. R.; PERRY, L. W.; SCOTT, L. P. - Experience with repair of complete atrioventricular canal. Ann. Thorac. Surg., 30: 151-159, 1980. [MedLine]

77. MILLIS, N. L.; OSHNER, J. L.; KING, T. D. - Correction of type C complete atrioventricular canal: surgical considerations. J. Thorac. cardiovasc. Surg., 71: 20-28, 1976. [MedLine]

78. MILO, S.; HO, S. Y.; WILKINSON, J. I.; ANDERSON, R. H. - Surgical anatomy and atrioventricular conduction tissues of hearts with isolated ventricular septal defects. J. Thorac. Cardiovasc. Surg., 79: 244-255, 1980. [MedLine]

79. MITCHELL, S. C.; KORONES, S. B.; BERENDES, H. W. - Congenital heart disease in 56.109 births: incidence and natural history. Circulation, 43: 323-332, 1971. [MedLine]

80. MORENO-CABRAL, R. & SHUMWAY, N. E. - Double-patch technique for correcting of complete atrioventricular canal. Ann. Thorac. Surg., 33: 88-91, 1982. [MedLine]

81. NATH, P. H.; SOTO, B.; BINI, R. M.; BARGERON, L. M.; PACIFICO, A. D. - Tetralogy of Fallot with atrioventricular canal: an angiographic study. J. Thorac. Cardiovasc. Surg., 87: 421-430, 1984. [MedLine]

82. NEUFELD, H. N.; TITUS, J. L.; DUSHANE, J. W.; BURCHELL, H. B.; EDWARDS, J. E. - Isolated ventricular septal defect of the persistent common atrioventricular canal type. Circulation, 23: 685-696, 1961. [MedLine]

83. NEWFELD, E. A.; SHER, M.; PAUL, M. H.; NIKAIDON, H. - Pulmonary vascular disease in complete atrioventricular canal defect. Am. J. Cardiol., 39: 721-726, 1977. [MedLine]

84. NORA, J. J. & NORA, A. H. - The evolution of specific genetic and environmental counseling in congenital heart disease. Circulation, 57: 205-213, 1978. [MedLine]

85. PACIFICO, A. D. - Surgical treatment of complex atrioventricular septal defects. Cardiol. Clin., 7: 399-410, 1989. [MedLine]

86. PACIFICO, A. D. & KIRKLIN, J. W. - Surgical repair of complete atrioventricular canal with anterior common leaflet attached to an anomalous right ventricular papillary muscle. J. Thorac. Cardiovasc. Surg., 65: 727-730, 1973. [MedLine]

87. PACIFICO, A. D.; KIRKLIN, J. W.; BARGERON, L. M. - Repair of complete atrioventricular canal associated with terralogy of Fallot or double outlet right ventricle: report of 10 patients. Ann. Thorac. Surg., 29: 351-351, 1980.

88. PACIFICO, A. D.; RICCHI, A.; BARGERON, L. M.; COLVIN, E. C.; KIRKLIN, J. W.; KIRKLIN, J. K. - Corrective repair of complete atrioventricular canal defects and major associated cardiac anomalies. Ann. Thorac. Surg., 46: 645-651, 1988. [MedLine]

89. PENKOSKE, P. A.; NECHES, W. H.; ANDERSON, R. H.; ZUBERBUHLER, J. R. - Further observations on the morphology of atrioventricular septal defects. J. Thorac. Cardiovasc. Surg., 90: 611-622, 1985. [MedLine]

90. PICOLLI, G. P.; HO, S. Y.; WILKINSON, J. L.; MACARTNEY, F. J.; GERLIS, L. M.; ANDERSON, R. H. - Left-sided obstructive lesions in atrioventricular septal defects: an anatomic study. J. Thorac. Cardiovasc. Surg., 83: 453-460, 1982. [MedLine]

91. PICCOLLI, G. P.; MACARTNEY, F. J.; WILKINSON, J. L.; GERLIS, L. M.; ANDERSON, R. H. - Morphology and classification of complete atrioventricular defects. Br. Heart. J., 42: 633-633, 1978.

92. PIERONI, D. R.; HOMCY, E.; FREEDOM, R. M. - Echocardiography in atrioventricular canal defect: a clinical spectrum. Am. J. Cardiol., 35: 54-58,1975. [MedLine]

93. PILLAI, R.; HO, S. Y.; ANDERSON, R. H.; LINCOLN, C. - Ostium primum atrioventricular septal defect: an anatomical and surgical review. Ann. Thorac. Surg., 41: 458-461, 1986. [MedLine]

94. POZZI, M.; M.; REMIG, J.; FIMMERS, R.; URBAN, A. E. - Atrioventricular septal defects: analysis of short and medium term results. J. Thorac. Cardiovasc. Surg., 101: 138-142, 1991. [MedLine]

95. QUAEGEBEUR, J.; KIRKLIN, J. W.; PACIFICO, A. D.; BARGERON, L. M. - Surgical experience with unroofed coronary sinus. Ann. Thorac. Surg., 27: 418-425, 1979. [MedLine]

96. RASTELLI, G. C.; KIRKLIN, J. W.; TITUS, J L. - Anatomic observations on complete form of persistent common atrioventricular canal with special reference to atrioventricular valves. Mayo Clin. Proc., 41: 296-301, 1966.

97. RASTELLI, G. C.; ONGLEY, P. A.; KIRKLIN, J. W.; McGOON, D. C. - Surgical repair of complete form of persistent common atrioventricular canal. J. Thorac. Cardiovasc. Surg., 55: 299-304, 1968.

98. RASTELLI, G. C.; ONGLEY, P. A.; McGOON, D. C. - Surgical repair of complete atrioventricular canal with anterior common leaflet undivided and unattached to ventricular septum. Mayo din. Proc., 44: 335-341, 1969.

99. RASTELLI, G. C.; ONGLEY, P. A.; TITUS, J. L. - Ventricular septal detect of atrioventricular canal type with straddling right atrioventricular valve and mitral valve deformity. Circulation, 37: 816-825, 1968. [MedLine]

100. RASTELLI, G. C; WEIDMAN, W. H.; KIRKLIN, J. W. - Surgical repair of the partial form of persistent common atrioventricular canal, with special reference to the problem of mitral valve incompetence. Circulation, 31: 31-35, 1965. [MedLine]

101. RIZZOLI, G.; MAZZUCCO, A.; BRUMANA, T.; VALFRE, C.; RUBINO, M.; ROCCO, F.; DALIENTO, L.; FRESCURA, C.; GALLUCCI, V. - Operative risk of correction of atrioventricular septal detects. Br. Heart J., 52: 258-265, 1984. [MedLine]

102. SANTOS, A.; BOUCEK, M.; RUTTENBERG, H.; VEASY, G.; ORSMOND, G.; McGOUGH, E. - Repair of atrioventricular septal defects in infancy. J. Thorac. cardiovasc. Surg., 91: 505-510, 1986. [MedLine]

103. SILVERMAN, N.; LEVITSKY, S.; FISCHER, E.; DUBROW, I.; HASTREITER, A.; SCAGLIOTTI, D. - Efficacy of pulmonary artery banding in infants with complete atrioventricular canal. Circulation, 68: 148-153, 1983.

104. SMALLHORN, J. F.; SUTHERLAND, G. R.; ANDERSON, R. H.; MACARTNEY, F. J. - Cross-sectional echocardiography assessment of conditions with atrioventricular valve leaflets attached to the atrial septum at the same level. Br. Heart J., 48: 331-41, 1982. [MedLine]

105. SMALLHORN, J. F.; TOMMASINI, G.; ANDERSON, R. H.; MACARTNEY, F. J. - Assessment of atrioventricular septal defects by two dimensional echocardiography. Br. Heart J., 47: 109-121, 1982. [MedLine]

106. SMALLHORN, J. F.; TOMMASINI, G.; MACARTNEY, F. J. - Two-dimensional echocardiographic assessment of common atrioventricular valves in univentricular hearts. Br. Heart. J., 46: 30-34, 1981. [MedLine]

107. SMALLHORN, J. F.; DE LEVAL, M. R.; STARK, J.; SOMERVILLE, J.; TAYLOR, J. F. N.; ANDERSON, R. H.; MACARTNEY, F. J. - Isolated anterior mitral cleft: two dimensional echocardiographic assessment and differentiation from clefts associated with atrioventricular septal defect. Br. Heart. J., 48: 109-116, 1982. [MedLine]

108. SOMERVILLE, J.; AGNEW, T.; STARK, J.; WATERSTON, D. J.; ABERDEEN, E.; CARTER, B.; WAICH, S. - Banding of the pulmonary artery for common atrioventricular canal. Br. Heart J., 29: 816-828, 1967. [MedLine]

109. SOTO, B.; BARGERON, L. M.; PACIFICO, A. D.; VANINI, V.; KIRKLIN, J. W. - Angiography of atrioventricular canal defects. Am. J. Cardio., 48: 492-499, 1981.

110. SOTO, B.; BECKER, A.; MOULAERT, A. J.; LIE, T. J.; ANDERSON, R. H. - Classification of ventricular septal defects. Br. Heart. J., 43: 332-343, 1980. [MedLine]

111. SRIDAROMONT, S.; FELDT, R.; RITTER, D. G.; DAVIS, G. D.; McGOON, D. C.; EDWARDS, J. E. - Double-outlet right ventricle associated with persistent common atrioventricular canal. Circulation, 52: 933-942, 1975. [MedLine]

112. STARK, J. - Do we really correct congenital heart defects? J. Thorac. Cardiovasc. Surg., 97: 1-9, 1989. [MedLine]

113. STEWART, S.; HARRIS, P.; MANNING, J. - Complete endocardial cushion defect: operation technique and results. J. Thorac. Cardiovasc. Surg., 78: 914-919, 1979. [MedLine]

114. STUDER, M.; BLACKSTONE, E. H.; KIRKLIN, J. W.; PACIFICO, A. D.; SOTO, B.; CHUNG, G. K. T.; KIRKLIN, J. K.; BARGERON, L. M. - Determinants of early and late results of repair of atrioventricular septal (canal) defects. J. Thorac. Cardiovasc. Surg., 84: 523-542, 1982. [MedLine]

115. SUTHERLAND, G. R.; GODMAN, M. J.; SMALLHORN, J. F.; GUITERRAS, P.; ANDERSON, R. H.; HUNTER, S. - Ventricular septal defects: two dimensional echocardiographic and morphological correlations. Br. Heart J., 47: 316-328, 1982. [MedLine]

116. TENKHOFF, L. & STAMM, S. J. - An analysis of 35 cases of the complete form persistent common atrioventricular canal. Circulation, 48: 416-427, 1973. [MedLine]

117. THANOPOULOS, B. D.; FISCHER, E. A.; DUBROW, I. W.; HASTREITER, A. R. - Right and left ventricular volumes characteristics in common atrioventricular canal. Circulation, 57: 991-995, 1978. [MedLine]

118. THIENE, G.; WENINK, A. C. C.; FRESCURA, C.; WILKINSON, J. L.; GALLUCI, V.; HO, S. Y.; MAZZUCCO, A.; ANDERSON, R. H. - Surgical anatomy and pathology of the conduction tissues in atrioventricular defects. J. Thorac. Cardiovasc. Surg., 82: 928-937, 1981. [MedLine]

119. UGARTE, M.; SLAMANCA, F. E.; QUERO, M. - Endocardial cushion defects: an anatomical study of 54 specimens. Br. Heart J., 38: 674-682, 1976. [MedLine]

120. URBAN, A. E. - Total correction of complete atrioventricular canal: surgical technique and analysis of long-term results. Prog. Pediatr. Surg., 25: 118-122, 1990. [MedLine]

121. URETZKY, G.; PUGA, F. J.; DANIELSON, G. K.; FELDT, R. H.; JULSRUD, P. R.; SEWARD, J. B.; EDWARDS, W. D.; McGOON, D. C. - Complete atrioventricular canal associated with tetralogy of Fallot: morphologic surgical considerations. J. Thorac. Cardiovasc. Surg., 87: 756-766, 1984. [MedLine]

122. VARGAS, F. J.; COTO, E. O.; MAYER, J. E.; JONAS, R. A.; CASTANEDA, A. R. - Complete atrioventricular canal and tetralogy of Fallot: surgical considerations. Ann. Thorac. Surg., 42: 258-265, 1986.

123. VOUHE, P. R. & NEVEUX, J. Y. - Surgical repair of tetralogy of Fallot with complete atrioventricular canal. Ann. Thorac. Surg., 41: 342-344, 1986. [MedLine]

124. WAKAI, C. S. & EDWARDS, J. E. - Development and pathologic considerations in persistent common atrioventricular canal. Proc. Mayo Clin., 31: 487-492, 1956.

125. WALKER, S. H. & DUNCAN, D. B. - Estimation of the probability of an event as a function of several independent variables. Biometrica, 54: 167-179, 1967.

126. WARNES, C. & SOMERVILLE, J. - Double mitral valve orifice in atrioventricular defects. Br. Heart J., 49: 59-64, 1983. [MedLine]

127. WEINTRAUB, R. G.; BRAWN, W. J.; VENABLES, A. W.; MEE, R. B. B. - Two-patch repair of complete atrioventricular septal defect in the first year of life. J. Thorac. Cardiovasc. Surg., 99: 302-326, 1990.

128. WILLIAMS, R.& RUDD, M. - Echocardiographic features of endocardial cushing defects. Circulation, 49: 418-422, 1974. [MedLine]

129. WILLIAMS, W. H.; GUYTON, R. A.; MICHALIK, R. E.; PLAUTH, W. H.; ZORN-CHELTON, S.; JONES, E. L.; RHEE, K. H.; HATCHER, C. R. - Individualized surgical management of complete atrioventricular canal. J. Thorac. Cardiovasc. Surg., 86: 838-844, 1983. [MedLine]

130. YOKOYAMA, M.; ANDO, M.; TAKAO, A.; SAKAKIBARA, S. - The location of the coronary sinus in endocardial cushion defects. Am. Heart J., 85: 302-307, 1973.

131. YOSHIDA, H.; FUNABASHI, T.; NAKAYA, S.; MAEDA, T.; TANIGUCHI, N. - Subxiphoid cross-sectional echocardiographic imaging of the goose neck deformity in endocardial cushion defect. Circulation, 62: 1319-1323, 1980. [MedLine]

132. ZAVANELLA, C.; MATSUDA, H.; SUBRAMANIAN, S. - Successful correction of a complete form of atrioventricular canal associated with tetralogy of Fallot: case report. J. Thorac. cardiovasc. Surg., 74: 195-198, 1977. [MedLine]

CCBY All scientific articles published at www.bjcvs.org are licensed under a Creative Commons license

Indexes

All rights reserved 2017 / © 2024 Brazilian Society of Cardiovascular Surgery DEVELOPMENT BY