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Semin Thorac Cardiovasc Surg. 2018 Feb 8. pii: S1043-0679(18)30011-X. doi: 10.1053/j.semtcvs.2018.02.004. [Epub ahead of print]

The Congenital Heart Surgeon's Society Complete Atrioventricular Septal Defect Cohort: Baseline, Preintervention Echocardiographic Characteristics.

Author information

1
Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Canada.
2
Division of Cardiovascular Surgery, The Children's Heart Clinic, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota.
3
Division of Pediatric Cardiology, The Children's Heart Clinic, Children's Hospital and Clinics of Minnesota, Minneapolis, Minnesota.
4
Division of Pediatric Cardiology, Nemours Cardiac Center, Wilmington, Delaware.
5
Division of Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
6
Division of Pediatric Cardiac Surgery, Arnold Palmer Hospital for Children, Orlando, Florida.
7
Division of Pediatric Cardiology, The Hospital for Sick Children, Toronto, Canada.
8
Division of Pediatric Cardiology, The Hospital for Sick Children, Toronto, Canada. Electronic address: luc.mertens@sickkids.ca.

Abstract

Quantifying unbalance, the threshold for single ventricle palliation vs biventricular repair in patients with unbalanced complete atrioventricular septal defect (AVSD), is challenging. Using a core laboratory review of baseline echocardiograms, we sought to assess the correlations among commonly used measures of unbalance and common atrioventricular valve (AVV) and ventricular sizes. A single reviewer evaluated baseline echocardiograms from an inception cohort of babies < age 1 year with complete AVSD admitted to 1 of 25 Congenital Heart Surgeon's Society institutions. A standardized echo review protocol of 111 quantitative and qualitative measures was used. Descriptive statistics were computed and Pearson correlation coefficients were calculated to assess correlation among unbalance indices with valvar and ventricular dimensions. Two-hundred fifty-seven baseline echocardiograms of infants with complete AVSD were included. Median age at baseline echocardiogram was 11days (interquartile range 1-79) and mean atrioventricular valve index was 0.45 ± 0.1. Mean right ventricle/left ventricle inflow angle was 90.2 ± 15.6° and median left ventricular inflow index was 0.46 (interquartile range 0.4-0.5). There are weak or moderate correlations between the measures of unbalance. Correlations between the measures of unbalance with common AVV leaflet or ventricular sizes are also weak to moderate, when statistically significant. Measures of unbalance in common clinical use correlate poorly, or not at all, with one another, common AVV, and ventricular dimensions. The concept of "unbalance" is difficult to define using baseline echocardiographic indices. These findings suggest that the indices may describe different morphologic and functional characteristics. Further analysis is necessary to quantify the contributions of unbalance indices to patient outcome.

KEYWORDS:

atrioventricular septal defect; echocardiography; surgical decision making

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