Atrioventricular Septal Defect Surgery Workup
- Author: Richard G Ohye, MD; Chief Editor: John Kupferschmid, MD more...
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.
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.
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.
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.
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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