Repair of Complete Atrioventricular Septal Defects: Results with Maintenance of the Coronary Sinus on the Right Atrial Side

Baslaim, Ghassan; Basioni, Alaa

doi:10.1111/j.1540-8191.2006.00293.x

Cited by 6 publications

(5 citation statements)

References 10 publications

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“…This option permits the surgeon to place the line of suturing so as to leave a wide margin around the site of the atrioventricular node. 6,7 Although it has been suggested that suturing so as to leave the sinus draining to the right atrium can safely be accomplished as long as careful attention is paid to the anatomy of the conduction system, 8 our measurements show that, in the small hearts found in neonates and young infants, there is little margin for error. The node can be positioned within 1À2 mm from the mouth of the sinus, and is usually no more than 1 mm below the right atrial surface.…”

Section: Discussionmentioning

confidence: 69%

“…The system used, and its processing values, have been described in detail elsewhere. 8,9 Briefly, the system was located 200 m from the synchrotron X-ray source. The X-ray energy was tuned to 25 keV by passing through a Si (111) double-crystal monochromator.…”

Section: Methodsmentioning

confidence: 99%

“…6,7 As yet, however, at least to the best of our knowledge, no measurements have been provided to guide the placement of sutures on the right or left sides of the septal structures during surgical closure of the interatrial component of the septal defect so as to avoid iatrogenic heart block. 8,9 The precise dimensions of the ventricular components of the conduction axis are similarly as yet unknown. We have now shown that, when using phase-contrast computed tomography, it is possible to demonstrate the precise location of the conduction axis relative to its surroundings without destroying or altering the properties of autopsied human heart specimens.…”

Section: Introductionmentioning

confidence: 99%

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Reassessment of the Location of the Conduction System in Atrioventricular Septal Defect Using Phase-Contrast Computed Tomography

Yoshitake

Kaneko

Morita

et al. 2020

Seminars in Thoracic and Cardiovascular Surgery

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on behalf of the SPring 8 Cardiovascular Structure Analyzing Research Group 2 The location of the atrioventricular conduction axis in the setting of atrioventricular septal defect has previously been shown by histology and intraoperative recordings. We have now reassessed the arrangement using phasecontrast computed tomography, aiming to provide precise measurements so as to optimize future surgical repairs. We used the system based on an X-ray Talbot grating interferometer using the beamline BL20B2 in a SPring-8 synchrotron radiation facility available in Japan. We analyzed 18 specimens. The atrioventricular node was found within a nodal triangle 1.7 mm from the coronary sinus, with 95% confidence intervals from 1.45 to 2.0 millimeters. The depth of the node from the right atrial endocardium was 1.0 mm, with 95% confidence intervals from 0.73 to 1.34 mm. The overall length of the scooped-out ventricular septum was 30.8 mm, with 95% confidence intervals from 27.5 to 34.1 millimeters. The length from the inferior atrioventricular junction to the takeoff of the right bundle branch was 12.8 mm, with 95% confidence intervals from 11.12 to 14.38 mm, giving a ratio of 0.43 for the extent of the axis along the inferior septum, with 95% confidence intervals of 0.38À0.48. The length of the non-branching bundle was 6.6 mm, with 95% confidence intervals from 5.57 to 7.7 mm. The proportion of septum occupied by the non-branching bundle was 0.22, with 95% confidence intervals from 0.18 to 0.26. Our findings confirm previous histological studies, The reconstructed block showing the precise location of the conductionaxis. Central Message Use of phase contrast computed tomography revealed the precise location of the atrioventricular conduction axis in hearts with atrioventricular septal defect. Perspective Statement No precise measurements have been provided to guide the placement of sutures during

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Section: Discussionmentioning

confidence: 69%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Reassessment of the Location of the Conduction System in Atrioventricular Septal Defect Using Phase-Contrast Computed Tomography

Yoshitake

Kaneko

Morita

et al. 2020

Seminars in Thoracic and Cardiovascular Surgery

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“…It is important to know that, during surgical repair, the patch used to close the ostium primum atrial septal defect is sometimes sewn with the coronary ostium kept on the left atrial side to limit the risk of AV node injury. 32 In those patients, His potential recording and successful slow pathway catheter ablation have been described in the left atrium after transseptal access. 33,34 Single Ventricle Physiology…”

Section: Specific Features Of Main Chds D-transposition Of the Great ...mentioning

confidence: 99%

Catheter Ablation of Atrioventricular Nodal Reentrant Tachycardia in Patients With Congenital Heart Disease

Waldmann

Hebe²,

Walsh

et al. 2022

Circ: Arrhythmia and Electrophysiology

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Atrioventricular nodal reentrant tachycardia represents the most common regular supraventricular arrhythmia in humans, and catheter ablation of the so called slow atrioventricular nodal pathway has been effectively performed for decades. In patients with congenital heart disease, a combination of different factors makes catheter ablation of atrioventricular nodal reentrant tachycardia substrate particularly challenging, including abnormal venous access to intracardiac structures, abnormal intracardiac anatomy, potentially deviant and often unpredictable sites of the specific conduction system, loss of traditional anatomic landmarks, and congenital cardiac surgery that may complicate the access to the atrioventricular nodal area. Published experiences have confirmed the efficacy and the relative safety of such procedures when performed by experts, but the risk of complications, in particular atrioventricular block, remains non-negligible. A thorough knowledge and understanding of anatomic and electrical specificities according to underlying phenotype are essential in addressing these complex cases. Considering the major consequences associated with atrioventricular block in patients with complex congenital heart disease, particularly those without low risk access for transvenous ventricular pacing (eg, single ventricle physiology or Eisenmenger syndrome), the individual risk-benefit ratio should be carefully evaluated. The decision to defer ablation may be the wisest approach in selected patients with either infrequent or hemodynamically tolerated arrhythmias, or when the location of the atrioventricular conduction pathways remains uncertain. This narrative review aims to synthetize existing literature on catheter ablation of atrioventricular nodal reentrant tachycardia in congenital heart disease, to present main features of common associated pathologies, and to discuss approaches to mapping and safely ablating the slow atrioventricular nodal pathway in challenging cases.

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“…As in all patients with CHD, pre-procedural planning should include a comprehensive assessment of cardiac anatomy and a thorough review of prior surgical interventions. For example, in some cases, the patch used to close the ostium primum ASD is sewn with the coronary ostium retained on the left atrial side to limit the risk of AV node injury [ 19 ]. This information is important to note and could prevent frustrating attempts to cannulate a coronary sinus ostium that is not accessible from the right atrium.…”

Section: Atrioventricular Septal Defectmentioning

confidence: 99%

Atrial flutter catheter ablation in adult congenital heart diseases

Waldmann

Bessière

Rabascio

et al. 2021

Indian Pacing and Electrophysiology Journal

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The important increase in life expectancy of adult patients with congenital heart disease (ACHD) has generated new challenges, including arrhythmias that represent one of the main late complications. Reentrant atrial arrhythmias are by far the main mechanism encountered, and catheter ablation has been now presented as a first-line therapy in this patient population. The number of procedures is expected to continuously increase year after year. The heterogeneity and complexity of phenotypes encountered require these cases to be performed by highly experienced operators, in specialized centers with multidisciplinary competencies. A thorough knowledge and understanding of anatomic specificities, vascular access issues, and main circuits encountered according to underlying phenotype is essential. Acute success rates have significantly improved and are now excellent, but recurrences remain a common issue, with different mechanisms or circuits frequently encountered. Observational data have suggested the interest of systematically targeting all inducible atrial arrhythmias, whether previously documented or not, and a lot of hope and research is based on the prediction of arrhythmia substrate before arrhythmia development by imaging or electroanatomic mapping to deliver a prophylactic patient tailored ablation approach. In this review, we summarize those different points in the most common or distinctive defects to offer a didactic overview of atrial flutter catheter ablation in ACHD patients.

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Repair of Complete Atrioventricular Septal Defects: Results with Maintenance of the Coronary Sinus on the Right Atrial Side

Cited by 6 publications

References 10 publications

Reassessment of the Location of the Conduction System in Atrioventricular Septal Defect Using Phase-Contrast Computed Tomography

Reassessment of the Location of the Conduction System in Atrioventricular Septal Defect Using Phase-Contrast Computed Tomography

Catheter Ablation of Atrioventricular Nodal Reentrant Tachycardia in Patients With Congenital Heart Disease

Atrial flutter catheter ablation in adult congenital heart diseases

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