Congenital Heart Surgeon Society Atrioventricular Septal Defect

prospective inception cohort

Webinar Series

uAVSD Echo Core Lab Members

• Michael Quartermain mquarter@wakehealth.edu

• Luc Mertens luc.mertens@sickkids.ca

• Meryl Cohen cohenm@email.chop.edu

• David Gremmels DGremmels@chc-pa.org

• Gina Baffa gbaffa@NEMOURS.ORG

CHSS Data Center Staff

• Bill Williams bill.williams@sickkids.ca

• Bill DeCampli William.Decampli@orlandohealth.com

• Veena Sivarajan veena.sivarajan@sickkids.ca

Principal Investigator:

David Overman DOverman@chc-pa.org

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