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Cross-sectional echocardiography in the diagnosis of atrioventricular septal defect
A Cabrera1, E Pastor, J M Galdeano
1Department of Paediatric Cardiology, Children's Hospital Cruces, Vizcaya, Spain.
Insights
Cross-sectional echocardiography effectively analyzes atrioventricular septal defects with a common atrioventricular orifice. This imaging technique provides excellent visualization of complex cardiac anatomy in affected patients.
Area of Science:
- Cardiology
- Medical Imaging
- Pediatric Cardiology
Background:
- Atrioventricular septal defects (ASDs) with a common atrioventricular orifice are complex congenital heart anomalies.
- Accurate diagnosis and anatomical characterization are crucial for patient management.
Purpose of the Study:
- To evaluate the utility of cross-sectional echocardiography in assessing atrioventricular septal defects with a common atrioventricular orifice.
- To describe the spectrum of anatomical variations observed using this imaging modality.
Main Methods:
- Cross-sectional echocardiography was performed in 63 patients with atrioventricular septal defects and a common atrioventricular orifice.
- Standard echocardiographic views (parasternal, apical, subcostal) were utilized.
- Specific attention was paid to ventricular dominance, associated defects, and valve morphology.
Main Results:
- Echocardiography revealed various anatomical features including ventricular dominance (19 patients), atrial septal defects (53 patients), ventricular septal defects (all patients), and abnormal leaflet attachments (32 patients).
- Hypoplasia of the inferior leaflet (19 patients) and outflow tract obstructions (11 patients) were also noted.
- A unique parachute-like arrangement was observed in 6 cases due to a solitary papillary muscle.
Conclusions:
- Cross-sectional echocardiography is an excellent and highly informative technique for the detailed analysis of atrioventricular septal defects with a common atrioventricular orifice.
- The study highlights the diverse anatomical spectrum of this condition and the capability of echocardiography to delineate these variations.
Abstract:
Between 1983-1988 cross-sectional echocardiography was performed in 63 patients having an atrioventricular septal defect with common atrioventricular orifice. We excluded from this study all those patients with separate right and left orifices ("ostium primum" defects), those with isomerism of the right and left atrial appendages, those with univentricular atrioventricular connexions and those with discordant atrioventricular and ventriculo-arterial connexions. Parasternal long- and short-axis views, apical 4-chamber views and subcostal long-axis views were employed in all patients. In the last 26 cases, we also obtained the subcostal short-axis view. Nineteen patients showed ventricular dominance, with the right ventricle being dominant in 15. Ten patients had an associated defect in the oval fossa, while the atrial septum was partially or completely absent in the other 53. A ventricular septal defect was observed in all, but it was small in 10 and multiple in 2. Attachments of the superior and inferior bridging leaflets to the crest or the right side of the ventricular septum were seen in 32 cases. The inferior leaflet was hypoplastic in 19 patients. There was narrowing of the left ventricular outflow tract in 8 patients, and obstruction of the right ventricular outflow tract in 3. Abnormal attachment of the right portion of the common valvar orifice was present in 2 cases. A solitary papillary muscle supporting the left ventricular component of the common valve was seen in 6 cases producing a parachute-like arrangement. Our study shows that cross-sectional echocardiography is an excellent technique for the analysis of this anomaly.