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Atrioventricular Septal Defect Surgery Workup

  • Author: Richard G Ohye, MD; Chief Editor: John Kupferschmid, MD  more...
 
Updated: Jan 05, 2016
 

Laboratory Studies

Routine preoperative studies (eg, CBC count, platelet counts, electrolyte levels, BUN levels, creatinine levels) are indicated. Typing and crossmatching blood are necessary for cardiopulmonary bypass preparation.

ABG determinations are not routinely warranted; however, cyanosis alerts the physician to the possibility of pulmonary vascular obstructive disease in older patients or concurrent right-sided obstructive lesions.

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Imaging Studies

Chest radiography

In incomplete atrioventricular septal defects (AVSDs), chest radiographs usually reveal mild cardiomegaly and increased pulmonary vascular markings. In complete atrioventricular septal defects, Significant cardiomegaly and pulmonary overcirculation are depicted on chest radiographs.

Doppler echocardiography

In incomplete atrioventricular septal defects, Doppler echocardiography findings are diagnostic of the atrial defect, the absence of ventricular level shunting, and the presence of any atrioventricular (AV) valve abnormalities. In complete atrioventricular septal defects, Doppler echocardiography findings are diagnostic, defining the atrial and ventricular level shunting, valvular anatomy, and any associated anomalies.

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Other Tests

Electrocardiography

In incomplete atrioventricular septal defects, electrocardiography reveals left axis deviation, prominent P waves associated with atrial enlargement, and a prolonged PR interval. In complete atrioventricular septal defects, electrocardiography reveals biventricular hypertrophy, atrial enlargement, prolonged PR interval, leftward axis, and counterclockwise frontal plane loop.

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Diagnostic Procedures

Cardiac catheterization

In incomplete atrioventricular septal defects, cardiac catheterization is indicated only in adults with a diagnosis of incomplete atrioventricular septal defects or in patients manifesting physical or radiologic signs of decreased pulmonary blood flow. Decreased pulmonary artery blood flow may be a result of pulmonary vascular disease or concurrent right-sided obstructive lesions. High fraction of inspired oxygen (FiO2) and nitric oxide may be needed to assess the reversibility of increased pulmonary vascular resistance.

In complete atrioventricular septal defect, perform cardiac catheterization for patients older than 1 year, patients with signs or symptoms of increased pulmonary vascular resistance, or in some individuals to further evaluate other associated major cardiac anomalies. High FiO2 and nitric oxide may be needed to assess the reversibility of increased pulmonary vascular resistance.

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Contributor Information and Disclosures
Author

Richard G Ohye, MD Head, Section of Pediatric Cardiovascular Surgery, Associate Professor of Cardiac Surgery, Program Director, Pediatric Cardiac Surgery Fellowship, University of Michigan Medical Center

Richard G Ohye, MD is a member of the following medical societies: Alpha Omega Alpha, American Association for Thoracic Surgery, Congenital Heart Surgeons Society, Society of University Surgeons, American College of Cardiology, American College of Chest Physicians, American College of Surgeons, Association for Academic Surgery, International Society for Heart and Lung Transplantation, Society of Thoracic Surgeons

Disclosure: Nothing to disclose.

Coauthor(s)

Edward L Bove, MD Associate Director, PICU, CS Mott Children's Hospital; Director, Division of Pediatric Cardiovascular Surgery, Professor, Department of Surgery, Section of Thoracic Surgery, University of Michigan Medical Center

Edward L Bove, MD is a member of the following medical societies: American Association for Thoracic Surgery, American College of Cardiology, American College of Chest Physicians, American College of Surgeons, American Heart Association, American Medical Association, American Surgical Association, Central Surgical Association, Congenital Heart Surgeons Society, Medical Society of the State of New York, Society of Thoracic Surgeons, Society of University Surgeons

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Mary C Mancini, MD, PhD, MMM Professor and Chief of Cardiothoracic Surgery, Department of Surgery, Louisiana State University School of Medicine in Shreveport

Mary C Mancini, MD, PhD, MMM is a member of the following medical societies: American Association for Thoracic Surgery, American College of Surgeons, American Surgical Association, Society of Thoracic Surgeons, Phi Beta Kappa

Disclosure: Nothing to disclose.

Chief Editor

John Kupferschmid, MD Director of Congenital Heart Surgery, Department of Surgery, Methodist Children's Hospital at San Antonio

John Kupferschmid, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, Society of Thoracic Surgeons, Society of Thoracic Surgeons

Disclosure: Nothing to disclose.

Additional Contributors

Daniel S Schwartz, MD, FACS Medical Director of Thoracic Oncology, St Catherine of Siena Medical Center, Catholic Health Services

Daniel S Schwartz, MD, FACS is a member of the following medical societies: Society of Thoracic Surgeons, Western Thoracic Surgical Association, American College of Chest Physicians, American College of Surgeons

Disclosure: Nothing to disclose.

References
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(a) An incomplete atrioventricular septal defect (AVSD) with right superior leaflet (RSL), right lateral leaflet (RLL), right inferior leaflet (RIL), left superior leaflet (LSL), left lateral leaflet (LLL), and left inferior leaflet (LIL). (b) A complete AVSD with superior bridging leaflet (SBL), inferior bridging leaflet (IBL), LLL, RSL, and RIL. The locations of the atrioventricular (AV) node and bundle of His are indicated. All images are surgeon's-eye views with cranial leftward, caudad rightward, superior upward, and posterior downward.
Rastelli classification. (a) Rastelli type A. (b) Rastelli type B. (c) Rastelli type C.
The common atrioventricular (AV) valve is floated to a closed position using isotonic sodium chloride solution. The central apposition points of the superior and inferior bridging leaflets are identified and marked with fine polypropylene sutures.
Two-patch technique. A patch of polytetrafluoroethylene (Gore-Tex) is fashioned and secured along the crest of the ventricular septal defect.
Two-patch technique. Interrupted horizontal mattress sutures are placed through the crest of the ventricular septal defect (VSD) patch and the inferior and superior bridging leaflets, dividing the common atrioventricular (AV) valve into right and left components.
Two-patch technique. The pericardial patch is secured to the crest of the prosthetic ventricular septum with the superior and inferior bridging leaflet sandwiched between the 2 patches.
One-patch technique. The superior and inferior bridging leaflets are divided into right and left components.
One-patch technique. The leaflets are resuspended to the patch by passing sutures through the cut edge of the left atrioventricular (AV) valve leaflet, the patch, and the cut edge of the right AV valve and tying the sutures.
The cleft of the mitral valve between the superior and inferior bridging leaflets is closed
The atrial septal defect (ASD) is closed with an autologous pericardial patch. The coronary sinus is placed in the left atrium to avoid injury to the conduction system. The rim of the ASD, the atrioventricular (AV) node, and the bundle of His are indicated. The dashes represent the proposed suture line.
 
 
 
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