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Intraoperative evaluation of atrioventricular septal defect repair by color flow mapping echocardiography
C E Canter1, D C Sekarski, T C Martin
1Edward Mallinckrodt Department of Pediatrics, St. Louis Children's Hospital, Washington University School of Medicine, Missouri.
Insights
Intraoperative echocardiography accurately predicts heart failure after atrioventricular septal defect repair. Severe left atrioventricular valve regurgitation identified during surgery correlates with reoperation need.
Area of Science:
- Cardiology
- Pediatric Surgery
- Echocardiography
Background:
- Atrioventricular septal defect (AVSD) repair survival is improving.
- Postoperative heart failure and reoperation remain significant concerns following AVSD repair.
Purpose of the Study:
- To evaluate the utility of intraoperative color flow mapping echocardiography in predicting outcomes after AVSD repair.
- To correlate intraoperative echocardiographic findings with postoperative heart failure and need for reoperation.
Main Methods:
- Prospective study of 19 consecutive patients undergoing AVSD repair.
- Intraoperative color flow mapping echocardiography was performed and compared with postoperative assessments at 3-5 days and 3-11 months.
- Correlation analysis was used to assess relationships between echocardiographic findings and clinical outcomes.
Main Results:
- Close correlation observed between intraoperative and postoperative echocardiography for assessing left atrioventricular valve regurgitation.
- 4 out of 19 patients (21%) developed postoperative congestive heart failure due to left atrioventricular valve regurgitation.
- Severity of left atrioventricular valve regurgitation (intraoperative) and preoperative valve abnormalities significantly correlated with reoperation (r=0.68).
Conclusions:
- Intraoperative color flow mapping echocardiography is a reliable tool for predicting early postoperative heart failure after AVSD repair.
- Early identification of severe left atrioventricular valve regurgitation intraoperatively can guide management and potentially prevent reoperation.
Abstract:
Despite improving survival rates after repair of atrioventricular septal defect, many patients require reoperation because of postoperative heart failure. We used intraoperative color flow mapping echocardiography to assess the results of surgical repair of atrioventricular septal defect in 19 consecutive patients and compared those findings with results three to five days and 3 to 11 months after repair. There was close correlation between intraoperative and postoperative color flow mapping echocardiography in estimating the presence and severity of left atrioventricular valve regurgitation. All patients survived surgical repair, but in 4 (21%), postoperative congestive heart failure due to left atrioventricular valve regurgitation developed. The need for reoperation was significantly correlated with the severity of left atrioventricular valve regurgitation (r = 0.68) as estimated by intraoperative echocardiography and preoperative aberrancies in the atrioventricular valve (r = 0.68). Age, weight, additional congenital heart disease, preoperative pulmonary vascular resistance, preoperative atrioventricular valve regurgitation, and postoperative mean pulmonary arterial or left atrial pressure were not significantly correlated with the need for reoperation. Intraoperative color flow mapping echocardiography can accurately predict the development of early postoperative heart failure and subsequent reoperation after surgical repair of atrioventricular septal defect.