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[Echocardiographic evaluation of a single atrioventricular valve: problem of differential diagnosis]
Insights
Echocardiography of the crux-cordis accurately differentiates common atrioventricular valves from atresia in univentricular hearts. This 2-D imaging technique aids in diagnosing complex congenital heart disease in pediatric patients.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Medical Imaging
Context:
- Univentricular hearts (UH) present complex congenital anomalies.
- Accurate diagnosis of atrioventricular valve status is crucial for managing UH.
- Echocardiography is a primary imaging modality in pediatric cardiology.
Purpose:
- To evaluate the utility of 2-D echocardiographic analysis of the crux-cordis.
- To differentiate between common atrioventricular valves and atresia of an atrioventricular valve in patients with UH.
- To assess the diagnostic accuracy of echocardiography in identifying specific valve abnormalities in UH.
Summary:
- This study analyzed 55 patients with univentricular hearts (UH).
- Echocardiographic assessment of the crux-cordis correctly identified common atrioventricular valves or atresia in 53 out of 55 patients.
- Diagnosis was based on visualizing the atretic atrial floor and the origin of the patent valve leaflets.
Impact:
- The findings demonstrate the effectiveness of 2-D echocardiography of the crux-cordis for diagnosing atrioventricular valve anomalies in UH.
- This imaging approach can improve diagnostic accuracy and guide treatment strategies for complex congenital heart disease.
- Accurate echocardiographic assessment aids in better patient stratification and management of univentricular hearts.
Abstract:
In the normal subject, the echocardiographic crux-cordis is defined by the spatial relationship between the plane of the interatrial and interventricular septa and the plane of the A-V valves. The bidimensional echocardiographic image of the crux-cordis may be obtained from various approaches: apical, subcostal, or precordial. In the present study we have assessed the usefulness of 2-D echocardiographic analysis of the crux-cordis in identifying the presence of a common A-V valve vs a single A-V valve (i.e. with atresia of the contralateral valve) in univentricular hearts (UH). We have studied 55 patients. Eight patients had a UH with a common A-V valve (6 with a rudimentary chamber, and 2 without a rudimentary chamber). Thirty-three patients were found to have atresia of the right A-V valve (29 with absent connection, and 4 with an imperforated valve), and 14 with atresia of the left A-V valve (9 with absent connection, and 5 with an imperforate valve). A correct differential diagnosis between common A-V valve and atresia of an A-V valve was achieved in 53 out of 55 patients through the direct visualization of the atretic atrial floor and by recognizing the origin of the leaflets of the one patent valve present. Of the patients with UH and common A-V valve, 5 presented a low interatrial septal defect, 3 a single atrium, 3 an interventricular septum which was clearly misaligned with the echocardiographic crux-cordis, in 5 an analysis of the crux-cordis did not permit visualization of a ventricular septal structure of which 3 resulted as false negatives.(ABSTRACT TRUNCATED AT 250 WORDS)