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CLINICAL STUDY

Echocardiographic assessment of obstructive lesions in atrioventricular septal defects

^a Division of Cardiology, Department of Pediatrics and Department of Cardiovascular Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada

Manuscript received November 10, 2000; revised manuscript received March 8, 2001, accepted March 26, 2001.

Reprint requests and correspondence: Dr. Jeffrey F. Smallhorn, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8

OBJECTIVES

We sought to determine the accuracy of transthoracic echocardiography (TTE) in identifying risk factors in patients with an atrioventricular septal defect (AVSD).

BACKGROUND

Atrioventricular septal defect is a common lesion, and many decisions about it are based on echocardiography alone. The identification of associated left-sided inflow and outflow obstructive lesions is important, as they are responsible for mortality and morbidity.

METHODS

Between 1983 to 1998, 549 patients with AVSD underwent repair. The TTE findings were correlated with surgery, angiocardiography, autopsy or postoperative TTE. Papillary muscle measurements were made in those with either a left ventricular outflow tract (LVOT) or left ventricular inflow abnormality and compared with those measurements from control subjects. Measurements of the LVOT were made in patients with an identified LVOT abnormality.

RESULTS

There were 63 missed lesions, decreasing over time. Double-orifice left atrioventricular valve (DOLAVV) and nonobstructive chordae in the LVOT were more often missed. Re-operation was performed to address a missed lesion in 2 of 68 patients. Two of 55 patients died of reasons related to a missed lesion. In 67% of patients, DOLAVV was missed. Abnormal papillary muscle angles were seen with either a LVOT abnormality or DOLAVV. High insertion of the anterolateral papillary muscle was a risk factor for death or residual LVOT obstruction. Abnormal LVOT measurements were found in patients with tunnel obstruction and those with an acquired subaortic ridge.

CONCLUSIONS

Transthoracic echocardiography provides accurate preoperative information on AVSD.

Abbreviations and Acronyms   AV = atrioventricular   AVSD = atrioventricular septal defect   DOLAVV = double orifice left atrioventricular valve   LV = left ventricle   LVOT = left ventricular outflow tract   TTE = transthoracic echocardiogram   RVOT = right ventricular outflow tract   VSD = ventricular septal defect

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