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The Congenital Heart Surgeon's Society Complete Atrioventricular Septal Defect Cohort: Baseline, Preintervention
James M Meza1, Paul J Devlin1, David M Overman2
1Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Canada.
Insights
Quantifying unbalance in complete atrioventricular septal defect (AVSD) is difficult. Common echocardiographic measures of unbalance show weak correlations with each other and with valve/ventricular sizes, complicating surgical decisions.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Echocardiography
Background:
- Complete atrioventricular septal defect (AVSD) presents challenges in surgical decision-making.
- Determining the threshold for single ventricle palliation versus biventricular repair in unbalanced AVSD is complex.
- Echocardiographic indices are commonly used to assess ventricular and atrioventricular valve (AVV) unbalance.
Purpose of the Study:
- To evaluate the correlation between commonly used echocardiographic measures of unbalance.
- To assess the relationship between unbalance indices and atrioventricular valve (AVV) and ventricular dimensions in infants with complete AVSD.
- To determine the reliability of baseline echocardiographic indices in defining "unbalance".
Main Methods:
- Core laboratory review of baseline echocardiograms from infants (<1 year) with complete AVSD.
- Standardized protocol assessing 111 quantitative and qualitative measures.
- Calculation of Pearson correlation coefficients to analyze relationships between unbalance indices and anatomical measurements.
Main Results:
- Two hundred fifty-seven echocardiograms from infants with complete AVSD were analyzed.
- Weak to moderate correlations were observed among different measures of unbalance.
- Statistically significant correlations between unbalance indices and AVV/ventricular sizes were generally weak to moderate.
Conclusions:
- Commonly used echocardiographic measures of unbalance show poor or no correlation with each other and with AVV/ventricular dimensions.
- The concept of "unbalance" in complete AVSD is difficult to precisely define using baseline echocardiographic indices.
- These findings suggest that current indices may represent distinct morphologic and functional aspects, necessitating further research into their predictive value for patient outcomes.
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 11 days (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.