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Common Atrioventricular Canal. CONGENIT HEART DIS 2022. [DOI: 10.1016/b978-1-56053-368-9.00011-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Schusterova I, Jakubova M, Vachalcova M, Sieradzka K, Gibarty C, Poruban T, Gasparovic I, Artemiou P. Three-dimensional transesophageal echocardiography in diagnosis of intermediate atrioventricular septal defect in the adult: case report and literature review. J Cardiothorac Surg 2021; 16:209. [PMID: 34330308 PMCID: PMC8325229 DOI: 10.1186/s13019-021-01596-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 07/26/2021] [Indexed: 12/02/2022] Open
Abstract
Background Intermediate type atrioventricular septal defect is less frequent than complete or partial atrioventricular septal defect, and is rarely encountered in the elderly and the utility of three dimensional transesophageal echocardiography in the diagnosis has not been reported to date. Case presentation In this case report, we described a rare case of an intermediate atrioventricular septal defect in an adult patient and we showed the valuable utility of real time 3D transesophageal echocardiography in the diagnosis and future surgical planning. The patient was referred to a tertiary center for an elective surgical repair. Finally, we provided a detailed review of the literature concerning the intermediate type of atrioventricular septal defect. Conclusion Although 2D transthoracic and transesophageal echocardiography enables diagnosis of the intermediate type atrioventricular septal defect, precise assessment of anatomy of atrioventricular septal defects and common atrioventricular valve was enabled only by real time 3D echocardiography.
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Affiliation(s)
- Ingrid Schusterova
- Medical Faculty of University Pavel Jozef Safarik, First Cardiology Clinic, Eastern Slovakian Institute of Cardiovascular Diseases, Kosice, Slovakia
| | - Marta Jakubova
- Medical Faculty of University Pavel Jozef Safarik, First Cardiology Clinic, Eastern Slovakian Institute of Cardiovascular Diseases, Kosice, Slovakia
| | - Marianna Vachalcova
- Medical Faculty of University Pavel Jozef Safarik, First Cardiology Clinic, Eastern Slovakian Institute of Cardiovascular Diseases, Kosice, Slovakia
| | - Karolinska Sieradzka
- Medical Faculty of University Pavel Jozef Safarik, First Cardiology Clinic, Eastern Slovakian Institute of Cardiovascular Diseases, Kosice, Slovakia
| | - Claudia Gibarty
- Medical Faculty of University Pavel Jozef Safarik, First Cardiology Clinic, Eastern Slovakian Institute of Cardiovascular Diseases, Kosice, Slovakia
| | - Tibor Poruban
- Medical Faculty of University Pavel Jozef Safarik, First Cardiology Clinic, Eastern Slovakian Institute of Cardiovascular Diseases, Kosice, Slovakia
| | - Ivo Gasparovic
- Medical Faculty of the Comenious University, Clinic of Cardiac Surgery, National Institute of Cardiovascular Diseases, Pod Krasnou horkou 1, 83101, Bratislava, Slovakia
| | - Panagiotis Artemiou
- Medical Faculty of the Comenious University, Clinic of Cardiac Surgery, National Institute of Cardiovascular Diseases, Pod Krasnou horkou 1, 83101, Bratislava, Slovakia.
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Commentary: To see with eyes unclouded. J Thorac Cardiovasc Surg 2019; 157:e297-e298. [PMID: 30661809 DOI: 10.1016/j.jtcvs.2018.11.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 11/30/2018] [Indexed: 11/21/2022]
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Rice K, Simpson J. Three-dimensional echocardiography of congenital abnormalities of the left atrioventricular valve. Echo Res Pract 2015; 2:R13-24. [PMID: 26693328 PMCID: PMC4676473 DOI: 10.1530/erp-15-0003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 01/16/2015] [Indexed: 01/01/2023] Open
Abstract
Congenital abnormalities of the left atrioventricular (AV) valve are a significant diagnostic challenge. Traditionally, reliance has been placed on two-dimensional echocardiographic (2DE) imaging to guide recognition of the specific morphological features. Real-time 3DE can provide unique views of the left AV valve with the potential to improve understanding of valve morphology and function to facilitate surgical planning. This review illustrates the features of congenital abnormalities of the left AV valve assessed by 3DE. The similarities and differences in morphology between different lesions are described, both with respect to the valve itself and supporting chordal apparatus. The potential advantages as well as limitations of this technique in clinical practice are outlined.
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Affiliation(s)
- Kathryn Rice
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas NHS Foundation Trust , Westminster Bridge Road, London, SE1 7EH , UK
| | - John Simpson
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas NHS Foundation Trust , Westminster Bridge Road, London, SE1 7EH , UK
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Jang WS, Kim WH, Choi K, Lee JR, Kim YJ, Kwon BS, Kim GB. What factors predict long-term survival and valve durability in patients with atrioventricular valve regurgitation in single-ventricle physiology? Pediatr Cardiol 2013; 34:1366-73. [PMID: 23397336 DOI: 10.1007/s00246-013-0650-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 01/24/2013] [Indexed: 10/27/2022]
Abstract
Although significant atrioventricular valve regurgitation (AVVR) is well known for its association with increased morbidity and mortality in patients with single-ventricle physiology, there is a lack of consensus in management of AVVR. The purpose of this study was to analyze the clinical outcomes in patients receiving AVV repair or replacement. From 2001 to 2010, a total of 33 patients (25 male and 8 female) with more than moderate-degree AVVR among 160 patients who underwent staged single-ventricle palliation were included. The median follow-up duration was 6.0 years (range 0.1-14.1). Valve repair (n = 27) or valve replacement (n = 6) was performed at the initial surgery. There were six late mortalities (18.18 %): five in the repair group and one in the replacement group and seven morbidities. Among patients with valve repair, 11 were required to undergo redo-valve operations (valve repair n = 6, valve replacement n = 5) due to deteriorated valve function. Initial shunt procedure (p = 0.04) and arrhythmia (p = 0.01) were risk factors for survival. Freedom from reoperation in the valve replacement group was higher than that in the valve repair group (67.0 ± 9.7 and 44.6 ± 11.2 % at 5 and 6 years, respectively, p = 0.03). Need for early repair (p = 0.02), presence of mitral- or tricuspid-dominant AVV (p = 0.005), and male sex (p = 0.04) were risk factors for valve durability. Early valve regurgitation affects valve durability. Thus, successful repair in the early stage may improve later outcomes. Therefore, aggressive valve surgery was required and AVV replacement might be one of the options for selected patients.
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Affiliation(s)
- Woo Sung Jang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, South Korea
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Aeba R, Kudo M, Okamoto K, Yozu R. Bridging Annuloplasty for Left Atrioventricular Valve of Partial Atrioventricular Septal Defect. Ann Thorac Surg 2012; 93:e137-9. [DOI: 10.1016/j.athoracsur.2011.12.071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Revised: 12/09/2011] [Accepted: 12/14/2011] [Indexed: 10/28/2022]
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Abstract
Complete atrioventricular septal defects have been repaired at the Medical University of South Carolina for the past 25 years using the "single-patch technique" as first described by the Mayo Clinic group in 1968. In this technique, the single atrioventricular valve is separated into left (mitral) and right (tricuspid) components by dividing the superior and inferior bridging leaflets back to the annulus. A single patch of bovine pericardium is sutured to the right ventricular aspect of the ventricular septum, the previously divided valve leaflets are resuspended to the patch, the "cleft" in the left-sided valve is closed with interrupted sutures, and the atrial component of the defect closed by suturing the patch to the atrial septum with a continuous suture. Since 1995, there have been no operative deaths in the 88 consecutive infants undergoing this repair in our institution. Nine patients (10.2%) have required reoperation for severe mitral regurgitation. While the issue of operative mortality in patients undergoing single-patch repair of complete atrioventricular septal defect has largely been eliminated, residual or recurrent mitral regurgitation continues to be a problem.
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Affiliation(s)
- Fred A Crawford
- Department of Surgery, Medical University of South Carolina, Charleston, SC 29425, USA.
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Mitchell ME, Litwin SB, Tweddell JS. Complex atrioventricular canal. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2007:32-41. [PMID: 17433989 DOI: 10.1053/j.pcsu.2007.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Complex forms of atrioventricular (AV) canal (C) such as; AVC with left ventricular outflow tract obstruction, tetralogy of Fallot with complete AVC, double orifice left AV valve, unbalanced complete AVC, and single ventricle patients with common AVC valve require careful preoperative planning and special techniques. This review will explore these technical modifications and outcomes for repair of complex variants of AVC. Optimal results will be achieved using an individually tailored approach that is guided by careful evaluation of the preoperative studies, precise operative technique, and intraoperative assessment of the reconstructed AV valve, as well as a willingness to re-intervene should the postoperative course not proceed as anticipated.
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Affiliation(s)
- Michael E Mitchell
- Herma Heart Center, Children's Hospital of Wisconsin, Division of Cardiothoracic Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
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Lamberti JJ, Kriett JM. Mitral/systemic atrioventricular valve repair in congenital heart disease. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2007:94-100. [PMID: 17433999 DOI: 10.1053/j.pcsu.2007.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Because there is no ideal substitute for the mitral or the systemic atrioventricular valve (SAVV) in a patient of any age, repair is the optimal treatment for important congenital or acquired mitral/SAVV disease. Valve repair techniques have evolved to the point where early repair may be offered to asymptomatic patients with favorable anatomy. The indications for operation depend on the presence or absence of symptoms and the physiologic consequences of mitral/SAVV pathology. Concomitant arrhythmia surgery may be appropriate in selected cases. Surgical outcomes are good to excellent when appropriate techniques are used. Repair of congenital SAVV abnormalities is safe and durable in many patients.
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Affiliation(s)
- John J Lamberti
- Children's Heart Institute, Rady Children's Hospital-San Diego, University of California, San Diego, CA, USA.
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Hori H, Yoshikawa K, Tayama E, Aoyagi S. Double-orifice repair for left atrioventricular valve regurgitation in atrioventricular septal defect: report of two cases. J Card Surg 2006; 21:500-2. [PMID: 16948771 DOI: 10.1111/j.1540-8191.2006.00284.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We describe two patients who successfully underwent a surgically created double-orifice repair using the edge-to-edge repair for residual left atrioventricular valve (LAVV) regurgitation in an atrioventricular septal defects (AVSD). Both patients had previously received patch closure of the AVSD and partial closure of a cleft of the LAVV. Preoperatively, echocardiography showed a wide open cleft and remarkable dilatation of the LAVV annulus. Doppler study revealed severe regurgitation through the cleft and the central portion of the LAVV orifice and no intracardiac shunt. Postoperative echocardiography showed a remarkable decrease of the AV valve regurgitation to none or trivial levels without stenosis of the LAVV in both patients. Among several valve-sparing techniques, our experience suggests that the surgically created double-orifice repair is one of the most effective reparative procedures for LAVV regurgitation in AVSD.
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Affiliation(s)
- Hidetsugu Hori
- Department of Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan.
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Lai YQ, Luo Y, Zhang C, Zhang ZG. Utilization of double-orifice valve plasty in correction of atrioventricular septal defect. Ann Thorac Surg 2006; 81:1450-4. [PMID: 16564291 DOI: 10.1016/j.athoracsur.2005.10.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2005] [Revised: 10/20/2005] [Accepted: 10/31/2005] [Indexed: 11/30/2022]
Abstract
BACKGROUND Atrioventricular valve regurgitation represents the principal indication for reoperation after repair of atrioventricular septal defect. Deciding how to correct atrioventricular valve regurgitation is challenging in some cases because of the complexity of the anatomic features. This report deals with our surgical experience in using a double-orifice valve plasty technique in cases with atrioventricular septal defect. METHODS From August 2002 to August 2004, 8 patients underwent double-orifice valve plasty in surgical correction of atrioventricular septal defect. Anatomic types were partial (6 patients), intermediate (1 patient), and complete (1 patient). After the mitral cleft was closed, moderate to severe atrioventricular valve regurgitation was still present in these patients. Double-orifice valve plasty was used in the mitral valve in 7 patients and in the tricuspid valve in 1. RESULTS No hospital deaths or postoperative morbidity occurred. The follow-up ranged from 6 months to 30 months (median, 14.4 months). No or trivial atrioventricular valve regurgitation was found in 6 patients and mild atrioventricular valve regurgitation was present in 2. CONCLUSIONS Double-orifice valve plasty is an easy and effective additional procedure for children and for adult patients who have moderate or severe atrioventricular valve regurgitation after repair of atrioventricular septal defect.
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Affiliation(s)
- Yong-Qiang Lai
- Division of Cardiac Surgery, Beijing Anzhen Hospital, Capital University of Medical Sciences, Beijing, China.
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Fukuda T, Kashima I, Yoshiba S. Surgically created double orifice repair of tricuspid regurgitation in infants with congenital heart disease. J Thorac Cardiovasc Surg 2003; 126:1220-1. [PMID: 14566284 DOI: 10.1016/s0022-5223(03)00786-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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