RIGHT DOMINANT ATRIOVENTRICULAR SEPTAL DEFECT:

Stratified echocardiographic assessment for surgical decision-making.

Lugones I, Biancolini MF, Biancolini J, de Dios AMS, Lugones G.

Unbalanced forms of atrioventricular septal defect (uAVSD) continue to be challenging and present poor surgical outcomes, especially in those patients with mild or moderate hypoplasia of the left ventricle (LV), also known as borderline cases.

Among other important variables, three indexes impact on the ability of the LV to maintain systemic cardiac output after surgical repair. The first one is the “modified atrioventricular valve index” (mAVVI), described long ago by Jegatheeswaran and collaborators. It is defined as the ratio between the area of the left component of the atrioventricular valve (AVV) and total AAV area. The other two were recently described by Lugones and colleagues: the “indexed ventricular septal defect” (inVSD) and the “indexed secondary annulus” (inSA). The inVSD reflects the size of the VSD relative to the total AVV diameter (Lugones et al. World J Pediatr Congenit Heart Surg. 2017;8(4):460-467).

The inSA evaluates the “true” entrance into the LV, i.e. the presence or absence of obstruction at the level of the mitral subvalvar apparatus. It is defined as the ratio between the size of the secondary annulus (measured by color Doppler at the LV “true” inflow) and total AVV diameter. Patient´s inSA must be compared to its critical value to assess the severity of the obstruction.

These variables interplay in a geometric model at the crux of the heart with the potential ability to predict the most appropriate surgical strategy for each patient. All indexes are referred to the AVV, allowing a simple, fast and even intuitive assessment of the relationship between the different anatomic structures at the crux of the heart.

The aim of this study is to validate a proposed surgical decision-making algorithm based on the geometric interaction of the aforementioned echocardiographic indexes.

Submit New Patient

Here you can download the pdf file with the form you will fill in. Please print the file, complete it during hospital stay of the patient and submit the data at discharge clicking on the link below. In case you need help, please contact Dr. Lugones (+54 9 221 525 6264) or Dr. Biancolini (+54 9 11 4023 1202) anytime via Whatsapp or email (ignaciolugones@cardiocongenital.com, mfbiancolini@gmail.com).

Update Patient

Here you can download the pdf file with the form you will fill in. Please print the file, complete it and then submit the data on the link below. In case you need help, please contact Dr. Lugones (+54 9 221 525 6264) or Dr. Biancolini (+54 9 11 4023 1202) anytime via Whatsapp or email (ignaciolugones@cardiocongenital.com, mfbiancolini@gmail.com).