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Congenital Heart Surgeon Society Atrioventricular Septal Defect
prospective inception cohort
Webinar Series
uAVSD Echo Core Lab Members
• Michael Quartermain [email protected]
• Luc Mertens [email protected]
• Meryl Cohen [email protected]
• David Gremmels [email protected]
• Gina Baffa [email protected]
CHSS Data Center Staff
• Bill Williams [email protected]
• Bill DeCampli [email protected]
• Veena Sivarajan [email protected]
Principal Investigator:
David Overman [email protected]
Study protocol
• Acquire images on enrolled subjects
at set time intervals
• Submit to virtual core lab
• Measurements will be performed by
core lab
Timing of Echo Studies
• 3 Echocardiograms per patient
1. Pre-operative study (most complete
diagnostic study, discretion of site)
2. Pre-discharge post-op study (or 30 days
post-op, whichever first)
3. 1 year post-operative study
Inclusion Criteria
• Diagnosis of complete AVSD
• Admitted to a CHSS institution for surgery
after January 1, 2012
• Age < 365 days at admission for surgery
• Atrioventricular and Ventriculoarterial
concordance (includes TOF and DORV).
• Informed written consent.
Exclusion Criteria• Partial or Transitional AVSD.
– Separate AV valve orifices
– Non-existent ventricular septal defect
• Aortic Atresia
• Total or Partial Anomalous Pulmonary Venous
Drainage (TAPVC or PAPVC)
• Heterotaxy
• First Intervention at a non-CHSS institution
ASD views
ASD subcostal
ASD views
VSD
Image additional VSDs
AVVI: SC en face view of AVV
AVVI
• Atrioventricular Valve Index (AVVI)– Subcostal LAO view
– Measure area of common AV valve apportioned
over each ventricle
– LAVV:RAVV or RAVV:LAVV
Morphometric Analysis of Unbalanced Common Atrioventricular Canal Using Two-Dimensional Echocardiography
MERYL S. COHEN, MD, MARSHALL L. JACOBS, MD, PAUL M. WEINBURG, MD, FACC, JACK RYCHIK, MD, FACC
Philadelphia, Pennsylvania (J Am Coll Cardiol 1996;28: 1017-23)
AVVI UAVSD
AVVI
CHSS Lookback
• Modified AVVI
– LAVV:Total AVV
0.5Right dominant Left Dominant
Overman DM, et al. WJSPCHS
1(1), Sept 2008
Apica 4 Ch view
APICAL 4-Chamber
LV 2-chamber
LV 3-Chamber
Sweep through LAVV +RAVV
LAVVR + RAVVR
RAVVR
RV inflow
LV inflow
Left AV Valve Index (LVII)
Szwast AL, et al. Am J Cardiol 2011;107:103–109
RV/LV Inflow Angle - Balanced
154°
RV/LV Inflow - Unbalanced
154°82°
Other measurements
Papillary muscles
Parachute-like with one dominant papillary muscle group
LVOT views
LVOT
LVOT measurements
LVOTO- describe mechanism
Doppler gradient
RVOT
PA branches
Ductal cut
Aortic arch
Pulmonary veins
Systemic Venous anomalies
3-D if available (subcostal)
3-D if available (apical 4)
Further information
• Two additional webinars in March
• Online information via the CHSS
website:
– http://www.chssdc.org/studies
• Ongoing open forum with Echo core
and Data Center
Summary
• There are no unique or novels views
• Focus on high quality, complete sweeps with
particular attention to:
– Subcostal (Left anterior oblique)
– Apical 4 chamber on inlet region and secondary
inflow
– LV outflow tracts from multiple views
• 3D when available
Questions ?
• Thank you for your participation