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

Lugones, Ignacio; Biancolini, María Fernanda; Biancolini, Julio Cesar; Dios, Ana M S de; Lugones, G.

doi:10.1177/2150135117716420

Cited by 15 publications

(15 citation statements)

References 6 publications

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“…As a part of these efforts, the LV flow index, RV/LV inflow angle ( 3 ), and, more recently, the ventricular septal defect index ( 16 ) have been developed to help surgical decision making for a modified AVV index between 0.2 and 0.39, but they are disease specific (e.g., unbalanced atrioventricular septal defect). Notably, the echocardiography-based AVV index and the CT-based AVV area ratio differ in their formulas: the former is defined as the left AVV area divided by the total AVV area, whereas the latter is defined as the left AVV area divided by the right AVV area.…”

Section: Discussionmentioning

confidence: 99%

“…Other variables, such as a complex mix of anatomic substrates, cardiac and non-cardiac comorbidities, institutional factors, and a broad array of surgical techniques, should be comprehensively considered in determining the feasibility of BVR ( 3 16 ). Therefore, various scoring systems, including multiple variables such as endocardial fibroelastosis and tricuspid regurgitation, have been developed to improve the predictability of successful BVR exclusively for patients with critical aortic stenosis ( 4 22 23 24 ).…”

Section: Discussionmentioning

confidence: 99%

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Computed Tomography-Based Ventricular Volumes and Morphometric Parameters for Deciding the Treatment Strategy in Children with a Hypoplastic Left Ventricle: Preliminary Results

Goo

Park

2018

Korean J Radiol

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ObjectiveTo determine the utility of computed tomography (CT) ventricular volumes and morphometric parameters for deciding the treatment strategy in children with a hypoplastic left ventricle (LV).Materials and MethodsNinety-four consecutive children were included in this study and divided into small LV single ventricle repair (SVR) (n = 28), small LV biventricular repair (BVR) (n = 6), disease-matched control (n = 19), and control (n = 41) groups. The CT-based indexed LV volumes, LV-to-right-ventricular (LV/RV) volume ratio, left-to-right atrioventricular valve (AVV) area ratio, left-to-right AVV diameter ratio, and LV/RV long dimension ratio were compared between groups. Proportions of preferred SVR in the small LV SVR group suggested by the parameters were evaluated.ResultsIndexed LV end-systolic (ES) and end-diastolic (ED) volumes in the small LV SVR group (6.3 ± 4.0 mL/m2 and 14.4 ± 10.2 mL/m2, respectively) were significantly smaller than those in the disease-matched control group (16.0 ± 4.7 mL/m2 and 37.7 ± 12.0 mL/m2, respectively; p < 0.001) and the control group (16.0 ± 5.5 mL/m2 and 46.3 ± 10.8 mL/m2, respectively; p < 0.001). These volumes were 8.3 ± 2.4 mL/m2 and 21.4 ± 5.3 mL/m2, respectively, in the small LV BVR group. ES and ED indexed LV volumes of < 7 mL/m2 and < 17 mL/m2, LV/RV volume ratios of < 0.22 and < 0.25, AVV area ratios of < 0.33 and < 0.24, and AVV diameter ratios of < 0.52 and < 0.46, respectively, enabled the differentiation of a subset of patients in the small LV SVR group from those in the two control groups. One patient in the small LV biventricular group died after BVR, indicating that this patient might not have been a good candidate based on the suggested cut-off values.ConclusionCT-based ventricular volumes and morphometric parameters can suggest cut-off values for SVR in children with a hypoplastic LV.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Computed Tomography-Based Ventricular Volumes and Morphometric Parameters for Deciding the Treatment Strategy in Children with a Hypoplastic Left Ventricle: Preliminary Results

Goo

Park

2018

Korean J Radiol

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“…However, some investigators advocate TV repair if AV valve index (left/right valve area) is more than 0.5 149 , more than 0.65 150 , or more than 0.67 152 for right dominant unbalanced AVSDs. Other suggestions for selecting TV repair are indexed potential LV volume of more than 15 mL/m 2 151 , left ventricular inflow index greater than 0.5 154 , and indexed ventricular septal defect smaller than 0.2 158 . The last group of investigators 158 also recommended that patients with indexed VSD values between 0.2 and 0.35 may be considered for TV repair on the basis of other factors.…”

Section: Atrioventricular Septal Defectsmentioning

confidence: 99%

“…Other suggestions for selecting TV repair are indexed potential LV volume of more than 15 mL/m 2 151 , left ventricular inflow index greater than 0.5 154 , and indexed ventricular septal defect smaller than 0.2 158 . The last group of investigators 158 also recommended that patients with indexed VSD values between 0.2 and 0.35 may be considered for TV repair on the basis of other factors. If the indexed VSD value is between 0.35 and 0.5, SV palliation may be required.…”

Section: Atrioventricular Septal Defectsmentioning

confidence: 99%

“…Another group of investigators used angiographic measures and suggested that patients with LV-to-RV long axis ratio of more than 0.65 on cine-angiograms may be suitable for TV repair 150 . Perhaps a combination of indexed VSD, AV valve index, and RV/LV inflow angle in systole may guide the selection of patients for TV repair 158 , 160 .…”

Section: Atrioventricular Septal Defectsmentioning

confidence: 99%

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Recent advances in managing septal defects: ventricular septal defects and atrioventricular septal defects

Rao

Harris

2018

F1000Res

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This review discusses the management of ventricular septal defects (VSDs) and atrioventricular septal defects (AVSDs). There are several types of VSDs: perimembranous, supracristal, atrioventricular septal, and muscular. The indications for closure are moderate to large VSDs with enlarged left atrium and left ventricle or elevated pulmonary artery pressure (or both) and a pulmonary-to-systemic flow ratio greater than 2:1. Surgical closure is recommended for large perimembranous VSDs, supracristal VSDs, and VSDs with aortic valve prolapse. Large muscular VSDs may be closed by percutaneous techniques. A large number of devices have been used in the past for VSD occlusion, but currently Amplatzer Muscular VSD Occluder is the only device approved by the US Food and Drug Administration for clinical use. A hybrid approach may be used for large muscular VSDs in small babies. Timely intervention to prevent pulmonary vascular obstructive disease (PVOD) is germane in the management of these babies. There are several types of AVSDs: partial, transitional, intermediate, and complete. Complete AVSDs are also classified as balanced and unbalanced. All intermediate and complete balanced AVSDs require surgical correction, and early repair is needed to prevent the onset of PVOD. Surgical correction with closure of atrial septal defect and VSD, along with repair and reconstruction of atrioventricular valves, is recommended. Palliative pulmonary artery banding may be considered in babies weighing less than 5 kg and those with significant co-morbidities. The management of unbalanced AVSDs is more complex, and staged single-ventricle palliation is the common management strategy. However, recent data suggest that achieving two-ventricle repair may be a better option in patients with suitable anatomy, particularly in patients in whom outcomes of single-ventricle palliation are less than optimal. The majority of treatment modes in the management of VSDs and AVSDs are safe and effective and prevent the development of PVOD and cardiac dysfunction.

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Echocardiographic scores for biventricular repair risk prediction of congenital heart disease with borderline left ventricle: a review

et al. 2022

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

Cited by 15 publications

References 6 publications

Computed Tomography-Based Ventricular Volumes and Morphometric Parameters for Deciding the Treatment Strategy in Children with a Hypoplastic Left Ventricle: Preliminary Results

Computed Tomography-Based Ventricular Volumes and Morphometric Parameters for Deciding the Treatment Strategy in Children with a Hypoplastic Left Ventricle: Preliminary Results

Recent advances in managing septal defects: ventricular septal defects and atrioventricular septal defects

Echocardiographic scores for biventricular repair risk prediction of congenital heart disease with borderline left ventricle: a review

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