Symptomatic infants with atrioventricular septal defects may improve with medicine, but in all cases corrective heart surgery will be necessary.
Medicines commonly used to treat congestive heart failure from left-to-right shunts in infants include diuretics such as Lasix (furosemide) and angiotensin converting enzyme (ACE) inhibitors such as enalapril.
These type of defects will never close on their own and will always require corrective surgery for treatment.
Medical treatment of infants with atrioventricular septal defects is usually used to relieve symptoms and allow the baby to get big enough to undergo surgical repair with lower risks.
This usually occurs at 3-6 months for infants with a complete atrioventricular septal defect and 6-18 months for infants with a partial atrioventricular septal defect.
Surgical repair of either type of defect involves closure of the holes in the atrial and / or ventricular septa with a patch or patches, and reconstruction of the common atrioventricular valve.
A particularly challenging aspect of the repair of a complete atrioventricular septal defect is dividing the common AV valve found in this condition.
Complications following surgery can arise if the opening in the mitral valve is now too narrow or it is still very leaky. Other problems to be avoided include narrowing the path for blood to pass from the left ventricle to the aorta, or disturbances of the electrical system of the heart.
The specialized tissue that conducts the impulse for the heart to beat runs very near the area where the stitches for the ventricular patch need to be placed. If this is disrupted, placement of a pacemaker may be necessary.
Atrioventricular Septal Defects Treatment Outcomes
The usual recovery period following repair of a partial atrioventricular septal defect is relatively brief. Most patients are out of the intensive care unit (ICU) in one to two days and home in four to five days following surgery.
Reported surgical survival is greater than 97 percent but is probably close to 100 percent in the current era.
Repair of a complete atrioventricular septal defect is often more complex and may be associated with other factors that can prolong the postoperative course.
In particular, the presence of elevated PVR preoperatively can necessitate a prolonged time on a mechanical ventilator and the need for higher amounts of medication to help the heart work well after surgery.
Additionally, problems with the mitral valve being too leaky, the path out of the left ventricle being too narrow or with the electrical system of the heart are more common after this type of surgery.
Most patients require two to four days in the intensive care unit after repair of a complete atrioventricular septal defect, and a five- to seven-day hospital stay. Recent results indicated that operative survival is around 97 percent for this type of operation.
The most common later problem that is seen following surgery is a leaky mitral valve which may require reoperation in up to 10 percent of patients, but most become medication-free and are free of cardiac symptoms.
Follow-up visits with the cardiologist are important to assess valve and heart muscle function and continued antibiotic prophylaxis for endocarditis is recommended.