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Updated: Jun 25, 2025
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Predictors of post-operative left atrioventricular valve regurgitation in pediatric patients with complete
Kaitlyn Freeman1, Elizabeth Caris2, Amy H Schultz3
1Department of Pediatrics, Division of Cardiology, Massachusetts General Hospital for Children, Harvard Medical School, Boston, Massachusetts, USA.
Insights
Pre-operative left atrioventricular valve regurgitation (LAVVR) predicts severity one year after complete atrioventricular canal (CAVC) repair. Many patients with moderate or greater LAVVR improve, and routine post-operative day 1 echocardiograms do not predict outcomes.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Surgery
- Echocardiography
Background:
- Post-operative left atrioventricular valve regurgitation (LAVVR) is a significant cause of morbidity and mortality in infants with complete atrioventricular canal (CAVC) defects.
- Identifying risk factors for poor outcomes after CAVC repair is crucial for improving patient management.
- Echocardiographic characteristics are key to predicting post-operative LAVVR and long-term outcomes.
Purpose of the Study:
- To identify echocardiographic predictors of post-operative LAVVR at discharge and 1-year follow-up in infants undergoing CAVC repair.
- To evaluate the association between pre-operative LAVVR and long-term LAVVR severity.
- To determine the predictive value of early post-operative echocardiograms for LAVVR outcomes.
Main Methods:
- Retrospective cohort study of 52 infants with CAVC repair between 2013 and 2022.
- Analysis of serial echocardiograms (pre-operative, post-operative transesophageal, post-operative day 1, discharge, and 1-year).
- Statistical analysis including paired t-tests, chi-square, and linear regression to identify predictors of LAVVR severity.
Main Results:
- Pre-operative LAVVR was the sole significant predictor of LAVVR severity at 1-year follow-up.
- Of patients with moderate or greater LAVVR post-operatively, 40% improved to less than moderate by 1 year.
- Routine post-operative day 1 echocardiograms showed no association with altered outcomes.
Conclusions:
- Pre-operative LAVVR is a critical factor in determining long-term LAVVR severity after CAVC repair.
- A substantial proportion of patients with initial moderate or greater LAVVR experience improvement by one year.
- Routine post-operative day 1 echocardiography is not a reliable predictor of long-term LAVVR outcomes.
Background:
In infants with complete atrioventricular canal (CAVC) defects, post-operative left atrioventricular valve regurgitation (LAVVR) is a known major cause of morbidity and mortality and a common indication for re-operation. However, there is scarce data to identify risk factors for poor outcomes. Our study aims to find echocardiographic characteristics that predict post-operative LAVVR at discharge and 1-year follow-up.
Methods:
Retrospective cohort study of patients with initial CAVC repair at our hospital who were followed for 1 year between 2013 and 2022. Patients with major co-morbid conditions were excluded. Serial echocardiograms were reviewed. Anatomic details, quantitative and qualitative measure of LAVVR including the number of regurgitant jets, regurgitant jet length and vena contracta width, and ventricular function were collected. The time points measured include pre-operative transthoracic echocardiogram (TTE), post-operative transesophageal echocardiogram (PO-TEE), routine protocol based post-operative day 1 (POD1) TTE, discharge TTE and 1-year post-operative (1yPO) TTE. Paired t-tests, chi-square analysis, and linear regression analysis were performed comparing measured variables to LAVVR outcomes.
Results:
Fifty-two patients were included; 92% had Trisomy 21. The majority were classified as Rastelli A (71%), others Rastelli C (29%). Only two patients had moderate or greater LAVVR pre-operatively. The mean age at repair was 125 ± 44 days. Pre-operative LAVVR was the only significant predictor of LAVVR severity at 1 year after backward stepwise regression. Of those with < moderate LAVVR on PO-TEE, 20% had worsening to ≥ moderate at discharge, but only 9% remained that way at 1 year. Of those with ≥ moderate LAVVR on PO-TEE, 40% improved to < moderate by 1 year. Two patients who worsened at 1 year, both secondary to likely cleft suture dehiscence. Only one patient required reoperation in the immediate post-operative period secondary to severe LAVVR due to suture dehiscence. Routine protocol-based POD1 echo did not have any association with altered outcomes.
Conclusion:
Pre-operative LAVVR was the only significant predictor of LAVVR severity at 1 year. A significant percentage (40%) of patient with ≥ moderate LAVVR on PO-TEE improved to < moderate by 1 year. Furthermore, routine protocol-based POD1 echo did not have any association with altered outcomes.
