scholarly journals Unbalanced atrioventricular septal defect with dominant right ventricle: diagnostic criteria, indications for biventricular correction, and results. A clinical observation series

2021 ◽  
Vol 49 (5) ◽  
pp. 347-354
Author(s):  
V. P. Didyk ◽  
V. A. Belov ◽  
O. N. Bukhareva ◽  
O. A. Laryutina ◽  
T. L.  Akobyan ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Right Ventricle ◽  
Diagnostic Criteria ◽  
Septal Defect ◽  
Atrioventricular Septal Defect ◽  
Z Score ◽  
Biventricular Repair ◽  
Cavopulmonary Anastomosis ◽  
Left And Right ◽  
The Mean

Relevance: Surgical treatment for congenital heart disease (CHD) with borderline left ventricle (LV) dimensions is one of the most challenging issues in current pediatric cardiac surgery. Despite the prevailing general trend to the expansion of indications for biventricular repair of an unbalanced atrioventricular septal defect (AVSD) with a dominant right ventricle (RV), the diagnostic criteria for imbalance, feasibility of radical repair and its functional results are intensively discussed in the literature.Aim: To present quantitative criteria for the assessment of the LV size which could serve as an indication for biventricular repair of the right dominant unbalanced AVSD.Materials and methods: We present a  series of 4  patients with AVSD and dominant RV, who underwent radical repair of the defect. The mean age of the patients was 2.4 years, and 3 of 4 had concomitant CHD: tetralogy of Fallot, double outlet right ventricle with pulmonary artery stenosis, and moderate hypoplasia of the aortic arch with subaortic stenosis. Three of 4 patients had previously undergone palliative interventions: two of them – pulmonary bending, one, the first stage of univentricular repair (atrioseptostomy, cavopulmonary anastomosis). Two children had been diagnosed with Down syndrome. The mean left ventricular end diastolic diameter (LVEDD) at baseline was 17.9 mm, corresponding to Z score of -5.4.Results: All four patients underwent biventricular repair of the defect with a  two-patch technique. In one case, it was supplemented with placement of the pulmonary trunk homograft prosthesis, in the other with pulmonary valve commissurotomy and cavopulmonary anastomosis due to moderate tricuspid valve stenosis and in the third case the mitral valve was replaced. In 3 patients pacemaker implantation was performed. The criterion for feasibility of complete septation was the ratio of the longitudinal dimensions of the left and right ventricles (LAR > 0.7), confirmed by computed tomography performed before the surgery. The mean LVEDD after surgery was 28.3 mm, corresponding to Z score of -0.8. At the time of the hospital discharge, the left and right atrioventricular valves insufficiency did not exceed 2 and 1 degrees, respectively.Conclusion: Computed tomography allows for accurate measurement and comparison of the longitudinal dimensions of the heart ventricles with LAR index as a tool for assessment of the LV size before the biventricular repair. An additional prospective study is required to objectify the data obtained and identify predictors of an unfavorable outcome of radical repair in patients with right dominant unbalanced AVSD.

Borderline left ventricles in prenatally diagnosed atrioventricular septal defect or double outlet right ventricle: Echocardiographic predictors of biventricular repair

2006 ◽  
Vol 152 (1) ◽  
pp. 163.e1-163.e7 ◽  
Author(s):  
Olli M. Pitkänen ◽  
Lisa K. Hornberger ◽  
Steven E.S. Miner ◽  
Tapas Mondal ◽  
Jeffrey F. Smallhorn ◽  
...  
Keyword(s):  
Right Ventricle ◽  
Septal Defect ◽  
Atrioventricular Septal Defect ◽  
Double Outlet Right Ventricle ◽  
Biventricular Repair

Surgical repair of atrioventricular septal defect with common atrioventricular junction when associated with tetralogy of Fallot or double outlet right ventricle

2006 ◽  
Vol 16 (S3) ◽  
pp. 59-64 ◽  
Author(s):  
Christo I. Tchervenkov ◽  
Samantha Hill ◽  
Danny Del Duca ◽  
Stephen Korkola
Keyword(s):  
Right Ventricle ◽  
Tetralogy Of Fallot ◽  
Septal Defect ◽  
Surgical Techniques ◽  
Atrioventricular Septal Defect ◽  
Double Outlet Right Ventricle ◽  
Biventricular Repair ◽  
Atrioventricular Junction ◽  
Common Arterial Trunk ◽  
Arterial Trunk

The association of atrioventricular septal defect with common atrioventricular junction and malformations of the ventricular outflow tracts presents a significant challenge for the surgeon. In the most common of these, the association with tetralogy of Fallot, several surgical techniques have been described, and shown to deliver excellent results.1–10On the other hand, in the setting of more extreme malformations, such as double-outlet right ventricle, discordant ventriculo-arterial connections, or common arterial trunk, albeit rare lesions, the combination presents a more formidable surgical challenge, as evidenced by the few reports of successful repair of these lesions. This challenge is both physiological, when dealing with a very sick neonate or infant, as well as anatomical in terms of the complexity of the malformation and the ability to achieve a successful biventricular repair. Our goal in this review is to discuss the surgical treatment in the setting of tetralogy of Fallot and double outlet right ventricle, with emphasis on biventricular repair.

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.

The degree of scooping of the interventricular septum influences electrocardiographic findings in atrioventricular septal defect

1995 ◽  
Vol 5 (3) ◽  
pp. 262-266 ◽  
Author(s):  
Kiyoshi Suzuki ◽  
Shigekazu Mimori ◽  
Yasuo Murakami ◽  
Katsuhiko Mori ◽  
Katsuhiko Tatsuno ◽  
...  
Keyword(s):  
Septal Defect ◽  
Pressure Ratio ◽  
Interventricular Septum ◽  
Atrioventricular Septal Defect ◽  
Left Ventricular ◽  
Stress Factors ◽  
Ventricular Pressure ◽  
Electrocardiographic Findings ◽  
The Mean ◽  
Significant Factors

AbstractThe aim of this study was to clarify those morphological features and hemodynamic stress factors which influence the electrocardiographic findings in atrioventricular septal defect. In 64 patients with the incomplete form of atrioventricular septal defect (separate valvar orifices) with usual atrial arrangement, the length from the left ventricular apex to the aortic valve (outlet dimension), to the so-called cleft (scoop dimension), and to the lowest point of the left atrioventricular valve (inlet dimension) were measured by biplanar cineangiography. The size of the ostium primum defect, the ventricular pressure ratio, and the pulmonary/systemic flow ratio were also evaluated. The results showed that the lower the scoop/outlet ratio (r=0.60, p<0.001), or the higher the ventricular pressure ratio (r= −0.55, p<0.001), the more deviated to the left and superior was the mean frontal QRS axis. These factors also had significant correlation with the QRS patterns in the Frank vectorcardiogram. We conclude that the scoop/outlet ratio, supposedly reflecting the degree of scooping of the interventricular septum, is one of the most significant factors which influence the electrocardiographic findings in atrioventricular septal defect.

Biventricular repair of lesions with straddling tricuspid valves using techniques of cordal translocation and realignment

1997 ◽  
Vol 7 (2) ◽  
pp. 147-152 ◽  
Author(s):  
V. Mohan Reddy ◽  
John R. Liddicoat ◽  
Doff B. McElhinney ◽  
Michael M. Brook ◽  
Jacques A.M. van Son ◽  
...  
Keyword(s):  
Ventricular Septal Defect ◽  
Right Ventricle ◽  
Tetralogy Of Fallot ◽  
Tricuspid Valve ◽  
Septal Defect ◽  
Fontan Procedure ◽  
Biventricular Repair ◽  
The Right ◽  
Cardiac Medication ◽  
Cavopulmonary Shunt

AbstractSurgical Management of straddling tricuspid valve and associated defects is a complex problem. Between August 1992 and August 1995, 5 patients with major straddling of the tricuspid valve underwent a complete or partial biventricular repair. All patients had either an inlet ventricular septal defect (n=4) or a ventricular septal defect with an inlet component (n=1), Co-existing cardiac lesions included hypoplasia of the right ventricle (n=3), discordant ventriculoarterial connections (n=1), tetralogy of Fallot (n=1), and multiple muscular vetricular septal defects (n=2). At the time of presentation to our institution, two of these patients had previously been palliated in preparation for a Fontan procedure, having undergone construction of a bidirectional superior cavopulmonary shunt. One patient was referred specifically for a Fontan procedure. The tricuspid valve was repaired by transecting all of the straddling cords and reattaching them in the right ventricle or onto the right side of the patch used to close the ventricular septal defect. Associated procedures included closure of the septum in all patients, an arterial switch procedure in one, repair of tetralogy of Fallot in one, and construction of a bidirectional superior cavopulmonary shunt in one. There has been no early or late mortality. Complete heart block requiring insertion of a pacemaker occurred after surgery in three patients. At a median follow-up of 32 months, functional integrity of the tricuspid valve is well maintained, with only one patient having moderate tricuspid regurgitation. None of the patients are receiving any cardiac medication.

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