{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T15:07:19Z","timestamp":1787238439587,"version":"build-2736575974"},"reference-count":24,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2019,3,21]],"date-time":"2019-03-21T00:00:00Z","timestamp":1553126400000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p\/>\n                  <jats:sec>\n                    <jats:title>OBJECTIVES<\/jats:title>\n                    <jats:p>A double orifice of the left atrioventricular valve (LAVV) associated with atrioventricular septal defects (AVSD) can significantly complicate surgical repair. This study reports our experience of AVSD repair over 3 decades, with special attention to the zone of apposition (ZoA) of the main orifice, and presents a technique of hemivalve pericardial extension in specific situations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>We performed a retrospective study from 1987 to 2016 on 1067 patients with AVSD of whom 43 (4%) had a double orifice, plus 2 additional patients who required LAVV pericardial enlargement. Median age at repair was 1.3\u2009years. Mean follow-up was 8.2\u2009years (1\u2009month\u201332\u2009years).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Associated abnormalities of the LAVV subvalvular apparatus were found in 7 patients (5 parachute LAVV and 2 absence of LAVV subvalvular apparatus). ZoA was noted in 4 patients (9%): partially closed in 15 (35%) and completely closed in 24 (56%). Four patients required, either at first repair or secondarily, a hemivalve enlargement using a pericardial patch without closure of the ZoA. The early mortality rate was 7% (n\u2009=\u20093), all before 2000. Two patients had unbalanced ventricles and the third had a single papillary muscle. There were no late deaths. Six patients (14%) required 7 reoperations (3 early and 4 late reoperations) for LAVV regurgitation and\/or dysfunction, of whom 4 (9%) required mechanical LAVV replacement (all before 2000). Freedom from late LAVV reoperation was 97% at 1\u2009year, 94% at 5\u2009years and 87% at 10, 20 and 30\u2009years. Unbalanced ventricles (P\u2009=\u20090.045), subvalvular abnormalities (P\u2009=\u20090.0037) and grade &gt;2 LAVV postoperative regurgitation (P\u2009=\u20090.017) were identified as risk factors for LAVV reoperations. Freedom from LAVV mechanical valve replacement was 95% at 1\u2009year, 90% at 5\u2009years and 85% at 10, 20 and 30\u2009years. An anomalous LAVV subvalvular apparatus was identified as a risk factor for mechanical valve replacement (P\u2009=\u20090.010). None of the patients who underwent LAVV pericardial extension had significant LAVV regurgitation at the last follow-up examination.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Repair of AVSD and double orifice can be tricky. Preoperative LAVV regurgitation was not identified as an independent predictor of surgical outcome. LAVV hemivalve extension appears to be a useful and effective alternate surgical strategy when the ZoA cannot be closed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ejcts\/ezz085","type":"journal-article","created":{"date-parts":[[2019,2,23]],"date-time":"2019-02-23T15:12:06Z","timestamp":1550934726000},"page":"541-548","source":"Crossref","is-referenced-by-count":7,"title":["Double orifice and atrioventricular septal defect: dealing with the zone of apposition\u2020"],"prefix":"10.1093","volume":"56","author":[{"given":"Margaux","family":"Pontailler","sequence":"first","affiliation":[{"name":"Department of Pediatric Cardiac Surgery, Necker Sick Children Hospital-M3C, University Paris Descartes, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moussa","family":"Haidar","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiac Surgery, Necker Sick Children Hospital-M3C, University Paris Descartes, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathilde","family":"M\u00e9ot","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, Necker Sick Children Hospital-M3C, University Paris Descartes, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Moreau de Bellaing","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, Necker Sick Children Hospital-M3C, University Paris Descartes, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R\u00e9gis","family":"Gaudin","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiac Surgery, Necker Sick Children Hospital-M3C, University Paris Descartes, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucile","family":"Houyel","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, Necker Sick Children Hospital-M3C, University Paris Descartes, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivier","family":"Metton","sequence":"additional","affiliation":[{"name":"Cardio-Pediatric and Congenital Medico-Surgical Department C, Cardiologic Hospital Louis Pradel, Lyon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pamela","family":"Moceri","sequence":"additional","affiliation":[{"name":"Department of Cardiology, H\u00f4pital Pasteur, CHU de Nice, Nice, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Damien","family":"Bonnet","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, Necker Sick Children Hospital-M3C, University Paris Descartes, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pascal","family":"Vouh\u00e9","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiac Surgery, Necker Sick Children Hospital-M3C, University Paris Descartes, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivier","family":"Raisky","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiac Surgery, Necker Sick Children Hospital-M3C, University Paris Descartes, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,3,20]]},"reference":[{"key":"2019091011525657800_ezz085-B1","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1016\/j.acvd.2011.06.004","article-title":"Congenital malformations of the mitral valve","volume":"104","author":"S\u00e9gu\u00e9la","year":"2011","journal-title":"Arch Cardiovasc Dis"},{"key":"2019091011525657800_ezz085-B2","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1016\/S0022-5223(19)38537-X","article-title":"Surgical treatment of double-orifice mitral valve in atrioventricular canal defects. 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