scholarly journals Can Left Atrioventricular Valve Reduction Index (LAVRI) Predict the Surgical Strategy for Repair of Atrioventricular Septal Defect?

2021 ◽  
Author(s):  
Anastasia Schleiger ◽  
Peter Kramer ◽  
Marie Schafstedde ◽  
Mustafa Yigitbasi ◽  
Friederike Danne ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Septal Defect ◽  
Reoperation Rate ◽  
Atrioventricular Septal Defect ◽  
Surgical Strategy ◽  
Atrioventricular Valve ◽  
Biventricular Repair ◽  
Entire Cohort ◽  
Cleft Closure ◽  
Reduction Index

AbstractDespite improved survival, surgical treatment of atrioventricular septal defect (AVSD) remains challenging. The optimal technique for primary left atrioventricular valve (LAVV) repair and prediction of suitability for biventricular approach in unbalanced AVSD are still controversial. We evaluated the ability of our recently developed echocardiographic left atrioventricular valve reduction index (LAVRI) in predicting LAVV reoperation rate and surgical strategy for unbalanced AVSD. Retrospective echocardiographic analysis was available in 352 of 790 patients with AVSD treated in our institution and included modified atrioventricular valve index (mAVVI), ventricular cavity ratio (VCR), and right ventricle/left ventricle (RV/LV) inflow angle. LAVRI estimates LAVV area after complete cleft closure and was analyzed with regard to surgical strategy in primary LAVV repair and unbalanced AVSD. Of the entire cohort, 284/352 (80.68%) patients underwent biventricular repair and 68/352 (19.31%) patients underwent univentricular palliation. LAVV reoperation was performed in 25/284 (8.80%) patients after surgical correction of AVSD. LAVRI was significantly lower in patients requiring LAVV reoperation (1.92 cm2/m2 [IQR 1.31] vs. 2.89 cm2/m2 [IQR 1.37], p = 0.002) and significantly differed between patients receiving complete and no/partial cleft closure (2.89 cm2/m2 [IQR 1.35] vs. 2.07 cm2/m2 [IQR 1.69]; p = 0.002). Of 82 patients diagnosed with unbalanced AVSD, 14 were suitable for biventricular repair (17.07%). mAVVI, LAVRI, VCR, and RV/LV inflow angle accurately distinguished between balanced and unbalanced AVSD and predicted surgical strategy (all p < 0.001). LAVRI may predict surgical strategy in primary LAVV repair, LAVV reoperation risk, and suitability for biventricular approach in unbalanced AVSD anatomy.

Feasibility of Biventricular Repair in Right Dominant Unbalanced Atrioventricular Septal Defect: A New Echocardiographic Metric to Refine Surgical Decision-Making

2017 ◽  
Vol 8 (4) ◽  
pp. 460-467 ◽  
Author(s):  
Ignacio Lugones ◽  
María Fernanda Biancolini ◽  
Julio César Biancolini ◽  
Ana M. S. de Dios ◽  
Germán Lugones
Keyword(s):  
Decision Making ◽  
Left Ventricle ◽  
Ventricular Septal Defect ◽  
Right Ventricle ◽  
Septal Defect ◽  
Atrioventricular Septal Defect ◽  
Atrioventricular Valve ◽  
Biventricular Repair ◽  
Surgical Decision ◽  
Surgical Decision Making

Background: Unbalanced forms of atrioventricular septal defect continue to be challenging and present poor surgical outcomes. Echocardiographic indicators such as atrioventricular valve index, right ventricle/left ventricle inflow angle, and size of the ventricular septal defect have been identified as relevant discriminators that may guide surgical strategy. Our purpose is to describe another metric to refine surgical decision-making. Methods: We outline a geometrical description of the anatomic features of atrioventricular septal defect and describe equations that help explain the interplay between the main echocardiographic variables. Results: A new metric called “indexed ventricular septal defect” is defined as the size of the defect in relation to the valve diameter. We derive a final equation relating this index with the atrioventricular valve index and the right ventricle/left ventricle inflow angle. In the light of that equation, we discuss the interdependence of variables and employ data from a Congenital Heart Surgeons’ Society study to set the limits of the new index. Conclusion: Combined use of indexed ventricular septal defect and atrioventricular valve index might help clarify surgical decision-making in patients with mild and moderate unbalance (modified atrioventricular valve index between 0.2 and 0.39). For indexed ventricular septal defect smaller than 0.2, biventricular repair may be recommended. Between 0.2 and 0.35, this strategy could probably be achieved depending on other factors. However, other strategies should be considered for those patients showing an indexed ventricular septal defect between 0.35 and 0.5. For values above 0.5 to 0.55, univentricular palliation might be a reasonable strategy.

Symptomatic partial and transitional atrioventricular septal defect repaired in infancy

Heart ◽  
2017 ◽  
Vol 104 (17) ◽  
pp. 1411-1416 ◽  
Author(s):  
Sylvia Krupickova ◽  
Gareth J Morgan ◽  
Mun Hong Cheang ◽  
Michael L Rigby ◽  
Rodney C Franklin ◽  
...  
Keyword(s):  
Septal Defect ◽  
Surgical Repair ◽  
Primary Repair ◽  
Nyha Class ◽  
Multivariable Analysis ◽  
Heart Association ◽  
Reoperation Rate ◽  
Atrioventricular Septal Defect ◽  
Atrioventricular Valve ◽  
Atrioventricular Valve Regurgitation

ObjectivesInfants with symptomatic partial and transitional atrioventricular septal defect undergoing early surgical repair are thought to be at greater risk. However, the outcome and risk profile of this cohort of patients are poorly defined. The aim of this study was to investigate the outcome of symptomatic infants undergoing early repair and to identify risk factors which may predict mortality and reoperation.MethodsThis multicentre study recruited 51 patients (24 female) in three tertiary centres between 2000 and 2015. The inclusion criteria were as follows: (1) partial and transitional atrioventricular septal defect, (2) heart failure unresponsive to treatment, (3) biventricular repair during the first year of life.ResultsMedian age at definitive surgery was 179 (range 0–357) days. Sixteen patients (31%) had unfavourable anatomy of the left atrioventricular valve: dysplastic (n=7), double orifice (n=3), severely deficient valve leaflets (n=1), hypoplastic left atrioventricular orifice and/or mural leaflet (n=3), short/poorly defined chords (n=2). There were three inhospital deaths (5.9%) after primary repair. Eleven patients (22%) were reoperated at a median interval of 40 days (4 days to 5.1 years) for severe left atrioventricular valve regurgitation and/or stenosis. One patient required mechanical replacement of the left atrioventricular valve. After median follow-up of 3.8 years (0.1–11.4 years), all patients were in New York Heart Association (NYHA) class I. In multivariable analysis, unfavourable anatomy of the left atrioventricular valve was the only risk factor associated with left atrioventricular valve reoperation.ConclusionsAlthough surgical repair is successful in the majority of the cases, patients with partial and transitional atrioventricular septal defect undergoing surgical repair during infancy experience significant morbidity and mortality. The reoperation rate is high with unfavourable left atrioventricular valve anatomy.

Starnes procedure for severe left atrioventricular valve regurgitation

2016 ◽  
Vol 25 (2) ◽  
pp. 140-142 ◽  
Author(s):  
Tomohiro Nakata ◽  
Tadashi Ikeda ◽  
Hiraku Doi ◽  
Shiro Baba ◽  
Shuma Taguchi ◽  
...  
Keyword(s):  
Prosthetic Valve ◽  
Septal Defect ◽  
Atrioventricular Septal Defect ◽  
Atrioventricular Valve ◽  
Valve Regurgitation ◽  
Valve Repair ◽  
Biventricular Repair ◽  
Muscular Ventricular Septal Defect ◽  
Atrioventricular Valve Regurgitation ◽  
Patch Closure

We present the case of a 19-day-old girl with incomplete atrioventricular septal defect, muscular ventricular septal defect, and severe left atrioventricular valve regurgitation. We attempted biventricular repair with left atrioventricular valve repair; however, we could not control the regurgitation. Moreover, the commercially available prosthetic valve was too large to implant. Thus we switched intraoperatively to a univentricular repair. We successfully performed patch closure of the left atrioventricular valve (Starnes procedure), Damus-Kaye-Stansel anastomosis, and a systemic-to-pulmonary artery shunt.

EARLY OUTCOME AFTER AORTIC VALVE REPLACEMENT ON PATIENTS WITH REDUCED LEFT VENTRICULAR EJECTION FRACTION

2014 ◽  
pp. 31-36
Author(s):  
Quang Thuu Le
Keyword(s):  
Septal Defect ◽  
Intraoperative Complications ◽  
Systolic Pressure ◽  
Atrioventricular Septal Defect ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Mitral Insufficiency ◽  
Atrioventricular Valve ◽  
Ventricular Ejection Fraction ◽  
Mitral Incompetence

Background: To evaluate the early results of operation for partial atrioventricular septal defect. Methods: Twenty-sevent patients underwent surgical correction of partial atrioventricular septal defect from 1/2011 to 12/2013 at Cardiovascular Centre of Hue Central Hospital. There were 7 (25.9%) female patients and 20 (74.1%) male patients, 18.5% of patients aged < 1 age, 55.6% of patients aged ≥ 1 to 15 years, and 25.9% of patients aged ≥ 16 to 60 years. Sevent (25.9%) had congestive heart failure. There was a primum atrial septal defect in 100% of patients. A cleft of the anterior mitral leaflet was diagnosed in 100% of patients. 92.6% of patients had either moderate or severe mitral incompetence prior to operation. The pulmonary artery systolic pressure exceeded 40 mmHg in 85,.2% of patients. Results: Atrial septal defects were closed with a pericardial patch in 100% of patients. The cleft in its anterior leaflet was closed in 100% of patients. Postoperatively, moderate mitral insufficiency developed in 14.8% of patients. 85.2% of patients have mild mitral incompetence. One patients (3.7%) needed a permanent pacemaker. There was no intraoperative mortality. At 6-9 months postoperatively, left atrioventricular valve insufficiency was moderate in 2 (7.4%) patients and mild in 25 (92.6%) patients who had had cleft closure alone. Conclusions: Repair of partial atrioventricular septal defect is safe and good. It is important to close the cleft in the left atrioventricular valve. The mitral valve should be repaired in a conservative manner. Intraoperative complications occur but are uncommon, suggesting that short-term follow is excellent.

Significance of left ventricular wall stress in infants with atrioventricular septal defect, common atrioventricular orifice and regurgitation across the left atrioventricular valve

1991 ◽  
Vol 1 (4) ◽  
pp. 390-395
Author(s):  
Masahi Seguchi ◽  
Makoto Nakazawa ◽  
Kataro Oyama ◽  
Masa-aki Kawada ◽  
Hiromi Kurosawa ◽  
...  
Keyword(s):  
Septal Defect ◽  
Primary Repair ◽  
Wall Stress ◽  
Ventricular Volume ◽  
Atrioventricular Septal Defect ◽  
Left Ventricular ◽  
Ventricular Wall ◽  
Atrioventricular Valve ◽  
Left Heart Failure ◽  
Young Infants

SummaryThe outcome of primary repair in young infants having atrioventricular septal defect with a common atrioventricular orifice and regurgitation across the left atrioventricular valve is not yet satisfactory. We studied the significance of the characteristics of left ventricular volume and mass and the predicted wall stress for the outcome of repair in 13 infants with this lesion. Three patients died of left heart failure after operation, although neither residual shunting at ventricular level nor regurgitation across the left atrioventricular valve was present. End-diastolic volume and ejection fraction of the left ventricle were 228 ±66% and 0.65 ±0.06 of normal, respectively, with no difference between the survivors and non-survivors. End-diastolic thickness of the posterior ventricular wall, determined by echocardiogram, was within normal range for body size in all patients.

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