scholarly journals 555 Echocardiographic follow-up of patients after surgical correction of atrioventricular septal defect

2003 ◽  
Vol 4 ◽  
pp. S68
Author(s):  
A TENHARKEL ◽  
B HEINERMAN ◽  
A BOGERS ◽  
W HOP ◽  
A CROMMEDIJKHUIS
Keyword(s):  
Septal Defect ◽  
Atrioventricular Septal Defect ◽  
Surgical Correction

Surgical management of complete atrioventricular septal defect with tetralogy of Fallot: results from a national audit database

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
D Dorobantu ◽  
R Tulloh ◽  
S Stoica
Keyword(s):  
Tetralogy Of Fallot ◽  
Surgical Management ◽  
Septal Defect ◽  
Atrioventricular Septal Defect ◽  
National Audit ◽  
Treatment Pathways ◽  
Complete Atrioventricular Septal Defect ◽  
Complete Repair ◽  
Complete Atrioventricular

Abstract Background Complete atrioventricular septal defect (CAVSD) with tetralogy of Fallot (CAVSD-ToF) is an uncommon association, and the management is more difficult than for each lesion in isolation. Depending on the anatomy, clinical status and ventricular morphology, definitive repair is offered either as staged or single operation with few undergoing single or one and a half ventricle procedures. Currently available data are limited to single centre studies. Purpose We aim to use data from a national audit dataset to describe outcomes in the surgical management of CAVSD-ToF with data from the national audit. Methods All children with CAVSD and tetralogy of Fallot (including double outlet right ventricle and pulmonary atresia variants) undergoing the first cardiac procedure between 2000–2013 were included and all subsequent procedures extracted. Three treatment pathways were defined: definitive primary procedure (“primary complete repair”), staged repair or “unbalanced ventricles repair” (Glenn shunt or modified Fontan). Continuous data is expressed as median (range). Survival data obtained using the Kaplan Meier method and subgroup comparisons done using the log-rank test. Results A total of 125 patients were included, 50.4% male, first procedure at 150 (1–2770) days. Down syndrome was present in 79.4% (63/79 of those with reported non-cardiac comorbidities), while 8% (10/125) had heterotaxy syndrome. “Primary complete repair” was performed in 40% (n=50), at 319 (33–2770) days. Staged repair was undertaken in 28% (n=35), first palliation at 80 (1–733) days. An “unbalanced ventricles” approach was used in 16.8% (n=21), first procedure at 135 (1–1742) days). The other 15.2% (n=19), first procedure at 53 (range 1–436) days, had at least one palliation procedure, but no identifiable committed pathway. Survival at 5 years from the first procedure in “primary complete repair” compared to the remainder of the group is shown in the Figure. No significant differences in survival were found. Specifically in the “unbalanced ventricle repair” group, just 1 patient died during follow-up. A total of 85 patients (68%) achieved either primary or staged “complete repair”. Early mortality (30 day) after the “complete repair” was 6.6% (similar for both approaches, p=0.9). Survival at 5 years after “complete repair” was 82.7% (similar for both approaches, p=0.8). Freedom from any cardiac re-intervention at 5 years was 69.5% (77.6% after primary, 58.1% after staged repair, p=0.03). Conclusion Early-life mortality in this heterogeneous group of CAVSD-ToF remains high, even in patients receiving definitive “complete repair”. We found no survival differences in the medium term between primary repair and a palliation approach, but more cardiac re-interventions were undertaken after staged complete repair. Surprisingly good results were seen in the unbalanced ventricles group, but longer follow up is needed to examine their attrition and longer term outcome. Survival at 5 years by treatment option Funding Acknowledgement Type of funding source: None

Repair of tetralogy of Fallot associated with atrioventricular septal defect

1998 ◽  
Vol 8 (1) ◽  
pp. 105-112 ◽  
Author(s):  
Tomás̆ Tláskal ◽  
Bohumil Huc̆ín ◽  
Martin Kostelka ◽  
Václav Chaloupecký ◽  
Jan Marek ◽  
...  
Keyword(s):  
Tetralogy Of Fallot ◽  
Septal Defect ◽  
Pulmonary Stenosis ◽  
Pulmonary Arteries ◽  
Pulmonary Regurgitation ◽  
Atrioventricular Septal Defect ◽  
Arterial Stenosis ◽  
Long Term Results

AbstractTetralogy of Fallot, when associated with atrioventricular septal defect permitting shunting at ventricular level, represents a complex cyanotic congenital malformation. Experience with surgical repair is limited, and results vary considerably. Between 1984 and 1996, we repaired 14 consecutive patients with this combination seen in our center. Their ages ranged from 8 months to 21 years (median 7.4 years). Six (42.9%) had Down's syndrome. In eight patients the correct diagnosis was made using echocardiogra phy alone. In the remaining six patients, who had previously-constructed arterial shunts and/or suspected pulmonary arterial stenosis, catheterization and angiocardiography were also performed. The repair consisted of double patch closure of the septal defect, reconstruction of two atrioventricular orifices, and relief of pulmonary stenosis at all levels. In five patients with a hypoplastic pulmonary trunk, a monocusp transannular patch (four patients) or an allograft (one patient) was used for restroration of continuity from the right ventricle to the pulmonary arteries. Patch enlargement of one or both pulmonary arteries was necessary in five patients. One patient (7.1%) died early, and another late. The twelve surviving (85.8%) patients have been followed for 1.2–12.5 years after surgery (median 4.9 years, mean 5.9 ± 3.9 years). During the follow-up, reoperation was necessary for repair of residual ventricular septal defect and pulmonary regurgitation in two patients, and closure of an atrial septal defect and alteration to left atrioventricular valvar regurgitation in one patient. Seven patients are in class I of the New York Heart Association, four in class II, and one in class III. Tetralogy of Fallot associated with atrioventricular septal defect can be corrected with low mortality and good long-term results. Residual lesions, however, have a tendency to progress, especially when seen in combination. After surgery, all patients need long-term close follow-up.

scholarly journals 870 Surgical Outcomes of Primary and Two-Stage Atrioventricular Septal Defect (AVSD) Repair: A Single Institution Experience

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
J J Kwong ◽  
C C Hew ◽  
M Haranal
Keyword(s):  
Surgical Outcomes ◽  
Septal Defect ◽  
Atrioventricular Septal Defect ◽  
Two Stage ◽  
Palliative Procedure ◽  
Complete Repair ◽  
Significant Difference ◽  
Valve Insufficiency ◽  
Valve Function

Abstract Objective To examine the surgical outcomes of primary and two-stage repair of complete atrioventricular septal defect(AVSD). Method This retrospective study included 74 patients who underwent operation for balanced complete AVSD between January 2015 and December 2018 in National Heart Centre Kuala Lumpur. Patient demographics, types of procedure, post-op complications and follow-up atrioventricular (AV) valve function were analysed. Results Twenty-one patients (median age: 3 months(2.28-4.32months)), weight: 3.10kg( 2.7-3.82kg)) had Pulmonary Artery Banding (PAB) prior to complete AVSD repair. The post-banding weight of patients rose from 3.1kg to 6.4kg prior to complete repair. The rate of ventilator dependence decreased from 19.8 to 4.8%. There was no worsening of post-banding left AV valve insufficiency (5%) before the complete repair. There was no statistically significant difference in the outcomes after complete AVSD repair in both groups (mortality p = 0.133, morbidities p = 0.471). There was a trend towards higher left AV valve insufficiency in the PAB group over time (at discharge, 10 vs 12%; at 3-months, 12 vs 6%; at 1-year, 14 vs 11%). Similarly, the PAB group also demonstrated a trend towards higher rates of major post- operative complications (33 vs 21%) and in-hospital mortality (9.5 vs 1.9%). Conclusions PAB remained as an effective palliative procedure for patients who are not suitable for primary AVSD repair at the time of presentation. However, it is associated with a higher incidence of left AV valve insufficiency at follow up.

Utility of expert focused cardiac ultrasound in paediatric cardiology outreach clinics

2019 ◽  
Vol 29 (12) ◽  
pp. 1468-1473
Author(s):  
Kristina K. Rauser-Foltz ◽  
David A. Danford ◽  
Jennifer K. Strawn ◽  
Shelby Kutty
Keyword(s):  
Patient Experience ◽  
Septal Defect ◽  
Assessment Tool ◽  
Ductus Arteriosus ◽  
Atrioventricular Septal Defect ◽  
Cardiac Ultrasound ◽  
Paediatric Cardiology ◽  
Focused Cardiac Ultrasound ◽  
Spectral Doppler

AbstractObjective:This prospective observational study evaluates the utility of expert focused cardiac ultrasound (eFCU) with spectral Doppler to inform decision making in established patients with specific, selected congenital cardiac defects in outreach clinics. Secondary objectives include determining if the addition of eFCU expands capacity in paediatric cardiology outreach clinics and if it improves the patient experience.Methods:Patients aged 2 months to 19 years old with a diagnosis of ventricular septal defect, atrial septal defect, atrioventricular septal defect, patent ductus arteriosus, aortic valve stenosis, or pulmonary valve stenosis with the need for follow-up echocardiography in an outreach clinic from August 2017 to June 2018 were studied. A novel assessment tool was used to determine the success of eFCU.Results:Forty-two patients from 11 clinics underwent eFCU with one unsuccessful exam making the failure rate 2.3% (95% CI 0.0006–0.1256). Addition of eFCU led to a significant increase in volume of patients able to be seen 19 versus 15.5 (p < 0.01). A majority of parents/patients reported a positive experience with eFCU.Conclusion:Expert focused cardiac ultrasound with spectral Doppler can be used successfully for follow-up in patients with select CHD and the addition of eFCU permits increased patient capacity in outreach clinics and has the potential to improve the patient experience.

Outcomes of Partial Atrioventricular Septal Defect Repair in Children

2021 ◽  
Author(s):  
Görkem Çitoğlu ◽  
Serhat Bahadır Genç ◽  
Hacer Kamalı ◽  
Fatma Sevinç Şengül ◽  
İsmihan Selen Onan
Keyword(s):  
Down Syndrome ◽  
Risk Factor ◽  
Septal Defect ◽  
Pacemaker Implantation ◽  
Reoperation Rate ◽  
Atrioventricular Septal Defect ◽  
Defect Repair ◽  
Reoperation Rates ◽  
Mean Time

Objectives: Repair of the partial atrioventricular septal defect (pAVSD) has an excellent survival but reoperation is still an issue. Left atrioventricular (AV) valve regurgitation (LAVVR) is the most common reason for reoperation. This study aimed to retrospectively analyze the results of patients undergoing pAVSD repair to determine the morbidity and mortality rates. Patients and Methods: Follow-up data of a total of 25 patients younger than 18 years of age, who underwent pAVSD at our centre within the period from 2011 to 2019, were obtained from hospital records. The incidence of Down syndrome, death, complications and reoperation rates were analyzed. Results: Mean age at operation was 4.64 years. Preoperative LAVVR grade was found to be relatively high in patients who underwent surgery at an older age (p<0.05). Two patients (8%) had Down syndrome. Follow-up ranged from two months to 96 months (mean: 33.48 months). There was no perioperative mortality. Arrhythmia were observed in four patients (16%) after the operation. One patient (4%) had complete AV block requiring permanent pacemaker implantation. The rate of postoperative LAVVR was observed to increase as the time elapsed after the operation increased. The presence of Down syndrome was observed to be protective against postoperative LAVVR (p<0.05). Two patients (8%) had reoperation for LAVVR. The mean time from the initial operation to reoperation was six years. The absence of Down syndrome was found to be a risk factor for reoperation (p<0.05) Conclusion: Repair of pAVSD is performed with low mortality and favourable outcomes. Major indication for reoperation following the initial repair of pAVSD is LAVVR and regurgitation rate increases as the time elapsed following the operation increases. Furthermore, preoperative LAVVR rate becomes higher as the operation age of the patient increases. Down syndrome is protective in terms of postoperative LAVVR whereas it is a risk factor for reoperation. High reoperation rate suggest the requirement of close follow-up.

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