It is increasingly apparent that atrioventricular valve (AVV) failure is a major cause of mortality in patients with a Fontan circulation.Furthermore, patients with a common AVV are at the highest risk of AVV failure among those with a Fontan circulation. Atrioventricular valve repair is notoriously difficult in the setting of a common AVV, and failed repair is associated with very high mortality. 3One of the major contributing factors to AVV failure in these patients is the attenuated fibrous skeleton of the heart, which increases the risk of annular dilatation. Several techniques of bridging annulo-plasty have been described which aim to recreate the fibrous skeleton of the heart, and thereby reduce the risk of dilatation of the atrioventricular junction and recurrent AVV fail-ure.In this issue of the Journal an important article by Kasahara and Kotani describes a novel technique to address AVV failure in the setting of AVSD and single ventricle physiology. They have employed an adjustable bridging technique using a heavy expanded polytetrafluorethylene (ePTFE) suture, which allows guided reduction of the antero-posterior diameter of the common atrioventricular junction. They adjust the degree of annular reduction until the dominant orifice is equal to the predicted tricuspid valve diameter. Furthermore, they aim to minimize intervention on the leaflets themselves in order to preserve long term valve function and repairability.
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