Echocardiographic assessment of obstructive lesions in atrioventricular septal defects
Rekwan Sittiwangkul, MDa,
R. Y. Ma, MDa,
Brian W. McCrindle, MD, MPH, FACCa,
John G. Coles, MDa and
Jeffrey F. Smallhorn, MBBSa
a Division of Cardiology, Department of Pediatrics and Department of Cardiovascular Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Figure 1 (A) Parasternal long axis in a patient with tunnel narrowing of the LVOT, indicating the sites of measurement. (B) Parasternal long-axis view of AVSD and fibromuscular subaortic stenosis. (C) Parasternal long-axis view of AVSD and subaortic obstruction due to fixed chordae that are attached to the LVOT. AO = aorta; LA = left atrium; LV = left ventricle; RCC = right coronary cusp; RV = right ventricle; SM = subaortic membrane.
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Figure 2 (A) Parasternal long-axis view, in systole, in a patient with thin, mobile unattached chordae in the LVOT (solid arrow). (B) Subcostal long-axis view in a patient with high insertion of the anterolateral papillary muscle. Note that the papillary muscle sits high on the shoulder of the left ventricle. (C) Parasternal long-axis view in a patient with combined obstruction. Note the tunnel narrowing, the fixed chordae in the LVOT and the increased angle between the aorta and the interventricular septum. ANT LAT PAP MUS = anterolateral papillary muscle; AO = aorta; LA = left atrium; LV = left ventricle; RV = right ventricle.
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Figure 3 (A) Diagram outlining the papillary muscle measurements in the study. A = angle of the anterolateral papillary muscle (ALPM); B = angle of the posteromedial papillary muscle (PMPM); C = interpapillary muscle angle. (B) Diagram outlining the measurements of the LVOT. A = subaortic measurement; B = aortic annulus measurement; C = aortoseptal angle. LA = left atrium; LV = left ventricle; RV = right ventricle.
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Figure 4 (A) Short-axis view in a patient with DOLAVV and two papillary muscles. Note the second orifice is situated in the vicinity of the posteromedial papillary muscle. (B) Similar specimen after repair, with the second orifice situated close to the posteromedial papillary muscle. LA = left atrium; OR1 = orifice 1; OR2 = orifice 2; RV = right ventricle.
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