Medication Summary

Medical treatment of complete atrioventricular septal defect (AVSD) is similar to treatment of any cardiac defect with volume overload. Digoxin is frequently used to decrease the heart rate and to increase inotropy, although little evidence (if any) suggests that it is effective in patients with congestive heart failure (CHF) due to left-to-right shunt lesions. At the present time, it is not the first line of therapy. Diuretics may decrease preload and ACE inhibitors decrease afterload. Care must be taken when administering ACE inhibitors to reproductive-age females, given their teratogenic effects. More recent, but limited, data suggest that the use of beta blockers in patients with left-to-right shunts who have CHF improves symptoms.^[41]

The daily dosage of digoxin is approximately 5-10 mcg/kg/d. The diuretic used most frequently in the author's institution is furosemide 1-2 mg/kg/d. In children with clinical signs of CHF, 58% improved with enalapril. The mean maximal dose was 0.3 mg/kg/d. The most significant adverse effect observed was renal failure, particularly in young infants with large left-to-right shunts. Most of the older patients in the author's institution who need ACE inhibitors are treated with lisinopril because of its lower cost and long half-life. The dose generally is 0.5 mg/kg/d, but is individualized for each patient. Data about the efficacy of beta-blockers in patients with large left-to-right shunts is sparse. In small studies, beta-blockers appear to decrease renin levels and heart rates in infants with CHF due to left-to-right shunts.

Antibiotics for endocarditis prophylaxis are no longer recommended for most patients with congenital heart disease. Some significant exceptions are noted, including patients who have previously had endocarditis or patients within 6 months of their surgical repair. Current American Heart Association guidelines also recommend subacute bacterial endocarditis (SBE) prophylaxis for patients who have a complete repair and those who have a jet lesion aimed at a patch to impair the growth of endothelial cells on the patch.^[42]This situation may occur in patients with atrioventricular septal defects and can only be discovered by the use of imaging modalities such as echocardiography.

Class Summary

The agents provide symptomatic improvement for CHF. Positive inotropic agents increase the force of contraction of the myocardium and are used to treat acute and chronic CHF. Positive or negative chronotropic agents may also increase or decrease the heart rate, provide vasodilatation, or improve myocardial relaxation. These additional properties influence the choice of drug for specific circumstances.

Digoxin (Lanoxicaps, Lanoxin)

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Acts directly on cardiac muscle, increasing myocardial systolic contractions. Indirect actions increase carotid sinus nerve activity and enhance sympathetic withdrawal for any given increase in mean arterial pressure.

Class Summary

These agents provide symptomatic improvement for CHF and promote the excretion of water and electrolytes by the kidneys. They are indicated to treat heart failure or hepatic, renal, or pulmonary disease when sodium and water retention has resulted in edema or ascites.

Furosemide (Lasix)

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Increases excretion of water by interfering with chloride-binding cotransport system, which inhibits sodium and chloride reabsorption in ascending loop of Henle and distal renal tubule.

Class Summary

These drugs are indicated for treatment of symptomatic CHF. ACE inhibitors are beneficial in all stages of chronic heart failure. Pharmacologic effects result in a decrease in systemic vascular resistance, reducing blood pressure, preload, and afterload.

Captopril (Capoten)

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Short-acting ACE inhibitor. Predominant action is suppressing the renin-angiotensin aldosterone system. Prevents conversion of angiotensin I to angiotensin II (potent vasoconstrictor), increasing levels of plasma renin and reducing aldosterone secretion.

Enalapril (Vasotec)

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Competitive ACE inhibitor. Reduces angiotensin II levels, decreasing aldosterone secretion.

Lisinopril (Prinivil, Zestril)

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Prevents conversion of angiotensin I to angiotensin II (potent vasoconstrictor), reducing aldosterone secretion.

Van Praagh S, Vangi V, Sul JH, et al. Tricuspid atresia or severe stenosis with partial common atrioventricular canal: anatomic data, clinical profile and surgical considerations. J Am Coll Cardiol. 1991 Mar 15. 17(4):932-43. [QxMD MEDLINE Link].
Wenink AC, Zevallos JC. Developmental aspects of atrioventricular septal defects. Int J Cardiol. 1988 Jan. 18(1):65-78. [QxMD MEDLINE Link].
Moore KL, Persaud TVN. Before We are Born. 5th ed. Philidelphia, PA: WB Saunders; 1998.
Wenink AC, Zevallos JC. Developmental aspects of atrioventricular septal defects. Int J Cardiol. 1988 Jan. 18(1):65-78. [QxMD MEDLINE Link].
Rastelli GC, Kirklin JW, Titus JL. Anatomic observations on complete form of persistent common atrioventricular canal with special reference to atrioventricular valves. Mayo Clin Proc. 1966. 41:296-308.
Bharati S, Lev M. Common atrioventricular orifice - complete type. The Pathology of Congenital Heart Disease: A Personal Experience with More Than 6,300 Congenitally Malformed Hearts. Armonk, NY: Futura Publinshing Company, Inc; 1996. 553-86.
Karl TR. Atrioventricular septal defect with tetralogy of Fallot or double-outlet right ventricle: surgical considerations. Semin Thorac Cardiovasc Surg. 1997 Jan. 9(1):26-34. [QxMD MEDLINE Link].
Hoffman JI. Incidence of congenital heart disease: I. Postnatal incidence. Pediatr Cardiol. 1995 May-Jun. 16(3):103-13. [QxMD MEDLINE Link].
Rosenthal GL, Wilson PD, Permutt T, Boughman JA, Ferencz C. Birth weight and cardiovascular malformations: a population-based study. The Baltimore-Washington Infant Study. Am J Epidemiol. 1991 Jun 15. 133(12):1273-81. [QxMD MEDLINE Link].
Hoffman JI. Incidence of congenital heart disease: II. Prenatal incidence. Pediatr Cardiol. 1995 Jul-Aug. 16(4):155-65. [QxMD MEDLINE Link].
Freeman SB, Taft LF, Dooley KJ, et al. Population-based study of congenital heart defects in Down syndrome. Am J Med Genet. 1998 Nov 16. 80(3):213-7. [QxMD MEDLINE Link].
Digilio MC, Marino B, Cicini MP, et al. Risk of congenital heart defects in relatives of patients with atrioventricular canal. Am J Dis Child. 1993 Dec. 147(12):1295-7. [QxMD MEDLINE Link].
Newfeld EA, Sher M, Paul MH, Nikaidoh H. Pulmonary vascular disease in complete atrioventricular canal defect. Am J Cardiol. 1977 May 4. 39(5):721-6. [QxMD MEDLINE Link].
Kozak MF, Kozak AC, Marchi CH, et al. Factors associated with moderate or severe left atrioventricular valve regurgitation within 30 days of repair of complete atrioventricular septal defect. Rev Bras Cir Cardiovasc. 2015 Jul-Sep. 30 (3):304-10. [QxMD MEDLINE Link].
Ginde S, Lam J, Hill GD, et al. Long-term outcomes after surgical repair of complete atrioventricular septal defect. J Thorac Cardiovasc Surg. 2015 Aug. 150(2):369-74. [QxMD MEDLINE Link]. [Full Text].
Harmandar B, Aydemir NA, Karaci AR, et al. Results for surgical correction of complete atrioventricular septal defect: associations with age, surgical era, and technique. J Card Surg. 2012 Nov. 27(6):745-53. [QxMD MEDLINE Link].
Chauhan S. Atrioventricular septal defects. Ann Card Anaesth. 2018 Jan-Mar. 21(1):1-3. [QxMD MEDLINE Link]. [Full Text].
Atz AM, Hawkins JA, Lu M, et al. Surgical management of complete atrioventricular septal defect: Associations with surgical technique, age, and trisomy 21. J Thorac Cardiovasc Surg. 2011 Jun. 141(6):1371-9. [QxMD MEDLINE Link]. [Full Text].
Tweddell JS, Litwin SB, Berger S, et al. Twenty-year experience with repair of complete atrioventricular septal defects. Ann Thorac Surg. 1996 Aug. 62(2):419-24. [QxMD MEDLINE Link].
Miller A, Siffel C, Lu C, Riehle-Colarusso T, Frias JL, Correa A. Long-term survival of infants with atrioventricular septal defects. J Pediatr. 2010 Jun. 156(6):994-1000. [QxMD MEDLINE Link].
Bando K, Turrentine MW, Sun K, et al. Surgical management of complete atrioventricular septal defects. A twenty-year experience. J Thorac Cardiovasc Surg. 1995 Nov. 110(5):1543-52; discussion 1552-4. [QxMD MEDLINE Link].
McElhinney DB, Reddy VM, Silverman NH, Hanley FL. Accessory and anomalous atrioventricular valvar tissue causing outflow tract obstruction: surgical implications of a heterogeneous and complex problem. J Am Coll Cardiol. 1998 Nov 15. 32(6):1741-8. [QxMD MEDLINE Link].
Alsoufi B, Al-Halees Z, Khouqeer F, et al. Results of left atrioventricular valve reoperations following previous repair of atrioventricular septal defects. J Card Surg. 2010 Jan-Feb. 25(1):74-8. [QxMD MEDLINE Link].
Stulak JM, Burkhart HM, Dearani JA, et al. Reoperations after initial repair of complete atrioventricular septal defect. Ann Thorac Surg. 2009 Jun. 87(6):1872-7; discussion 1877-8. [QxMD MEDLINE Link].
Reeder GS, Danielson GK, Seward JB, et al. Fixed subaortic stenosis in atrioventricular canal defect: a Doppler echocardiographic study. J Am Coll Cardiol. 1992 Aug. 20(2):386-94. [QxMD MEDLINE Link].
Perloff JK. The Clinical Recognition of Congenital Heart Disease. Philadelphia, PA: WB Saunders; 1987. 322-38.
Nora JJ. Multifactorial inheritance hypothesis for the etiology of congenital heart diseases. The genetic-environmental interaction. Circulation. 1968 Sep. 38(3):604-17. [QxMD MEDLINE Link]. [Full Text].
Sheffield VC, Pierpont ME, Nishimura D, et al. Identification of a complex congenital heart defect susceptibility locus by using DNA pooling and shared segment analysis. Hum Mol Genet. 1997 Jan. 6(1):117-21. [QxMD MEDLINE Link].
Vannay A, Vasarhelyi B, Kornyei M, et al. Single-nucleotide polymorphisms of VEGF gene are associated with risk of congenital valvuloseptal heart defects. Am Heart J. 2006 Apr. 151(4):878-81. [QxMD MEDLINE Link]. [Full Text].
Cabrera A, Pastor E, Galdeano JM, et al. Cross-sectional echocardiography in the diagnosis of atrioventricular septal defect. Int J Cardiol. 1990 Jul. 28(1):19-23. [QxMD MEDLINE Link].
Chin AJ, Bierman FZ, Sanders SP, et al. Subxyphoid 2-dimensional echocardiographic identification of left ventricular papillary muscle anomalies in complete common atrioventricular canal. Am J Cardiol. 1983 Jun. 51(10):1695-9. [QxMD MEDLINE Link].
Silverman NH, Zuberbuhler JR, Anderson RH. Atrioventricular septal defects: cross-sectional echocardiographic and morphologic comparisons. Int J Cardiol. 1986 Dec. 13(3):309-31. [QxMD MEDLINE Link].
Del Pasqua A, Sanders SP, de Zorzi A, et al. Impact of three-dimensional echocardiography in complex congenital heart defect cases: the surgical view. Pediatr Cardiol. 2009 Apr. 30(3):293-300. [QxMD MEDLINE Link].
Takahashi K, Guerra V, Roman KS, Nii M, Redington A, Smallhorn JF. Three-dimensional echocardiography improves the understanding of the mechanisms and site of left atrioventricular valve regurgitation in atrioventricular septal defect. J Am Soc Echocardiogr. 2006 Dec. 19(12):1502-10. [QxMD MEDLINE Link].
Takahashi K, Mackie AS, Thompson R, et al. Quantitative real-time three-dimensional echocardiography provides new insight into the mechanisms of mitral valve regurgitation post-repair of atrioventricular septal defect. J Am Soc Echocardiogr. 2012 Nov. 25(11):1231-44. [QxMD MEDLINE Link].
Najm HK, Coles JG, Endo M, et al. Complete atrioventricular septal defects: results of repair, risk factors, and freedom from reoperation. Circulation. 1997 Nov 4. 96(9 Suppl):II-311-5. [QxMD MEDLINE Link].
Kaza AK, Colan SD, Jaggers J, et al. Surgical interventions for atrioventricular septal defect subtypes: the pediatric heart network experience. Ann Thorac Surg. 2011 Oct. 92(4):1468-75. [QxMD MEDLINE Link].
Ten Harkel AD, Cromme-Dijkhuis AH, Heinerman BC, et al. Development of left atrioventricular valve regurgitation after correction of atrioventricular septal defect. Ann Thorac Surg. 2005 Feb. 79(2):607-12. [QxMD MEDLINE Link].
Suzuki T, Bove EL, Devaney EJ, et al. Results of definitive repair of complete atrioventricular septal defect in neonates and infants. Ann Thorac Surg. 2008 Aug. 86(2):596-602. [QxMD MEDLINE Link].
Myers PO, del Nido PJ, Marx GR, et al. Improving left ventricular outflow tract obstruction repair in common atrioventricular canal defects. Ann Thorac Surg. 2012 Aug. 94(2):599-605; discussion 605. [QxMD MEDLINE Link].
Buchhorn R, Hulpke-Wette M, Ruschewski W, et al. Effects of therapeutic beta blockade on myocardial function and cardiac remodelling in congenital cardiac disease. Cardiol Young. 2003 Feb. 13(1):36-43. [QxMD MEDLINE Link].
[Guideline] Wilson W, Taubert KA, Gewitz M, et al. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation. 2007 Oct 9. 116(15):1736-54. [QxMD MEDLINE Link]. [Full Text].
Alexi-Meskishvili V, Ishino K, Dahnert I, et al. Correction of complete atrioventricular septal defects with the double-patch technique and cleft closure. Ann Thorac Surg. 1996 Aug. 62(2):519-24; discussion 524-5. [QxMD MEDLINE Link].
Atz AM, Hawkins JA, Lu M, Cohen MS, Colan SD, Jaggers J. Surgical management of complete atrioventricular septal defect: associations with surgical technique, age, and trisomy 21. J Thorac Cardiovasc Surg. 2011 Jun. 141(6):1371-9. [QxMD MEDLINE Link].
Backer CL, Mavroudis C, Alboliras ET, Zales VR. Repair of complete atrioventricular canal defects: results with the two- patch technique. Ann Thorac Surg. 1995 Sep. 60(3):530-7. [QxMD MEDLINE Link].
Capouya ER, Laks H, Drinkwater DC Jr, et al. Management of the left atrioventricular valve in the repair of complete atrioventricular septal defects. J Thorac Cardiovasc Surg. 1992 Jul. 104(1):196-201; discussion 201-3. [QxMD MEDLINE Link].
Cousineua AJ, Lauer RM, Pierpont ME, et al. Linkage analysis of autosomal dominant atrioventricular canal defects: exclusion of chromosome 21. Human Genetics. 1994. 93(2):103-8. [QxMD MEDLINE Link].
DeLeon SY, Ilbawi MN, Wilson WR Jr, et al. Surgical options in subaortic stenosis associated with endocardial cushion defects. Ann Thorac Surg. 1991 Nov. 52(5):1076-82; discussion 1082-3. [QxMD MEDLINE Link].
Eisenberg LM, Markwald RR. Molecular regulation of atrioventricular valvuloseptal morphogenesis. Circ Res. 1995 Jul. 77(1):1-6. [QxMD MEDLINE Link].
Formigari R, Di Donato RM, Gargiulo G, et al. Better surgical prognosis for patients with complete atrioventricular septal defect and Down's syndrome. Ann Thorac Surg. 2004 Aug. 78(2):666-72; discussion 672. [QxMD MEDLINE Link].
Gembruch U, Knopfle G, Chatterjee et al. Prenatal diagnosis of atrioventricular canal malformations with up-to-date echocardiographic technology: report of 14 cases. Am Heart J. 1991 May. 121(5):1489-97. [QxMD MEDLINE Link].
Hanley FL, Fenton KN, Jonas RA, et al. Surgical repair of complete atrioventricular canal defects in infancy. Twenty-year trends. J Thorac Cardiovasc Surg. 1993 Sep. 106(3):387-94; discussion 394-7. [QxMD MEDLINE Link].
Jacobstein MD, Fletcher BD, Goldstein S, Riemenschneider TA. Evaluation of atrioventricular septal defect by magnetic resonance imaging. Am J Cardiol. 1985 Apr 15. 55(9):1158-61. [QxMD MEDLINE Link].
Kosaki K, Curry CJ, Roeder E, Jones KL. Ritscher-Schinzel (3C) syndrome: documentation of the phenotype. Am J Med Genet. 1997 Feb 11. 68(4):421-7. [QxMD MEDLINE Link].
Kurnit DM, Aldridge JF, Matsuoka R, Matthysse S. Increased adhesiveness of trisomy 21 cells and atrioventricular canal malformations in Down syndrome: a stochastic model. Am J Med Genet. 1985 Feb. 20(2):385-99. [QxMD MEDLINE Link].
Lange A, Mankad P, Walayat M, et al. Transthoracic three-dimensional echocardiography in the preoperative assessment of atrioventricular septal defect morphology. Am J Cardiol. 2000 Mar 1. 85(5):630-5. [QxMD MEDLINE Link].
LeBlanc JG, Williams WG, Freedom RM, Trusler GA. Results of total correction in complete atrioventricular septal defects with congenital or surgically induced right ventricular outflow tract obstruction. Ann Thorac Surg. 1986 Apr. 41(4):387-91. [QxMD MEDLINE Link].
Leversha AM, Wilson NJ, Clarkson PM, et al. Efficacy and dosage of enalapril in congenital and acquired heart disease. Arch Dis Child. 1994 Jan. 70(1):35-9. [QxMD MEDLINE Link].
Maslen CL. Molecular genetics of atrioventricular septal defects. Curr Opin Cardiol. 2004 May. 19(3):205-10. [QxMD MEDLINE Link].
Miyamura H, Eguchi S, Watanabe H, et al. Total circular annuloplasty with absorbable suture for the repair of left atrioventricular valve regurgitation in atrioventricular septal defect. J Thorac Cardiovasc Surg. 1994 Jun. 107(6):1428-31. [QxMD MEDLINE Link].
Rizzoli G, Mazzucco A, Maizza F, et al. Does Down syndrome affect prognosis of surgically managed atrioventricular canal defects?. J Thorac Cardiovasc Surg. 1992 Oct. 104(4):945-53. [QxMD MEDLINE Link].
Roach RM, Tandon R, Moller JH, Edwards JE. Ebstein's anomaly of the tricuspid valve in persistent common atrioventricular canal. Am J Cardiol. 1984 Feb 1. 53(4):640-2. [QxMD MEDLINE Link].
Rosenthal GL, Wilson PD, Permutt T, et al. Birth weight and cardiovascular malformations: a population-based study. The Baltimore-Washington Infant Study. Am J Epidemiol. 1991 Jun 15. 133(12):1273-81. [QxMD MEDLINE Link].
Ross DA, Nanton M, Gillis DA, Murphy DA. Atrioventricular canal defects: results of repair in the current era. J Card Surg. 1991 Sep. 6(3):367-72. [QxMD MEDLINE Link].
Sakamoto K, Galletti L, Touchot A, et al. Two-stage correction of transposition of great arteries with complete atrioventricular canal. Ann Thorac Surg. 1998 Jan. 65(1):250-2. [QxMD MEDLINE Link].
Sigfusson G, Ettedgui JA, Silverman NH, Anderson RH. Is a cleft in the anterior leaflet of an otherwise normal mitral valve an atrioventricular canal malformation?. J Am Coll Cardiol. 1995 Aug. 26(2):508-15. [QxMD MEDLINE Link].
Sim EK, Black MD, Smallhorn J, et al. Surgical repair of complete atrioventricular septal canal defects with absent posterior leaflet. Ann Thorac Surg. 1995 Nov. 60(5):1399-400. [QxMD MEDLINE Link].
Tedziagolska M. Two-patch repair of atrioventricular canal. Ann Thorac Surg. 1996 May. 61(5):1589-90. [QxMD MEDLINE Link].
Tennant SN, Hammon JW Jr, Bender HW Jr, et al. Familial clustering of atrioventricular canal defects. Am Heart J. 1984 Jul. 108(1):175-7. [QxMD MEDLINE Link].
Torfs CP, Christianson RE. Anomalies in Down syndrome individuals in a large population-based registry. Am J Med Genet. 1998 Jun 5. 77(5):431-8. [QxMD MEDLINE Link].
van Son JA, Kinzel P, Mohr FW. Repair of Ebstein's anomaly associated with partial atrioventricular canal. J Card Surg. 1997 Nov-Dec. 12(6):434-6. [QxMD MEDLINE Link].
van Son JA, Van Praagh R, Falk V, Mohr FW. Pericardial patch augmentation of the tissue-deficient mitral valve in common atrioventricular canal. J Thorac Cardiovasc Surg. 1996 Oct. 112(4):1117-9. [QxMD MEDLINE Link].
Yamaki S, Yasui H, Kado H, et al. Pulmonary vascular disease and operative indications in complete atrioventricular canal defect in early infancy. J Thorac Cardiovasc Surg. 1993 Sep. 106(3):398-405. [QxMD MEDLINE Link].
Zellers TM, Zehr R, Weinstein E, et al. Two-dimensional and Doppler echocardiography alone can adequately define preoperative anatomy and hemodynamic status before repair of complete atrioventricular septal defect in infants J Am Coll Cardiol</i>. 1994 Nov 15. 24(6):1565-70. [QxMD MEDLINE Link].
St Louis JD, Jodhka U, Jacobs JP, et al. Contemporary outcomes of complete atrioventricular septal defect repair: analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database. J Thorac Cardiovasc Surg. 2014 Dec. 148(6):2526-31. [QxMD MEDLINE Link].
Zhong PP, Gu YQ, Wang AC, et al. [Complete atrioventricular septal defect: a clinicopathologic study of 35 cases] [Chinese]. Zhonghua Bing Li Xue Za Zhi. 2016 Feb 8. 45(2):107-10. [QxMD MEDLINE Link].
Muresan D, Marginean C, Zaharie G, Stamatian F, Rotar IC. Complete atrioventricular septal defect in the era of prenatal diagnosis. Med Ultrason. 2016 Dec 5. 18(4):500-7. [QxMD MEDLINE Link]. [Full Text].
Fong LS, Betts K, Kannekanti R, Ayer J, Winlaw DS, Orr Y. Modified-single patch vs double patch repair of complete atrioventricular septal defects. Semin Thorac Cardiovasc Surg. 2019 Jul 12. [QxMD MEDLINE Link].

Media Gallery

Atrioventricular (A-V) valve leaflets viewed from the cardiac apex in normal valves (A) and in the Rastelli type A complete form of common A-V canal (B). In A, the normal tricuspid valve (TV) has anterior (AL), septal (SL), and posterior (PL) leaflets. A normal mitral valve (MV) has ALs and PLs.In B, the superior cushion–derived leaflet bridges the ventricular septum and attaches to the papillary muscle of the conus at its rightmost extent. A right superior leaflet (RSL) typically attaches to the papillary muscle of the conus and to the anterior papillary muscle of the right ventricle (RV), and a right lateral leaflet (RLL) attaches to the anterior papillary muscle of the RV and to the posterior papillary muscle of the RV. The inferior cushion–derived bridging leaflet is usually cleft, giving the appearance of a right inferior leaflet (RIL) and a left inferior leaflet (LIL).
Apical 4-chamber echocardiographic image demonstrating a complete atrioventricular septal defect. A large primum atrial septal defect, a large inlet ventricular septal defect, and a single common orifice atrioventricular valve are noted.
Apical 4-chamber echocardiographic image with color Doppler demonstrating moderately-severe insufficiency of the common atrioventricular valve.
Parasternal long axis echocardiographic image of a complete atrioventricular septal defect. A large inlet ventricular septal defect is seen. Accessory atrioventricular valve tissue is visualized within the left ventricular outflow tract.
Subcostal sagittal echocardiographic image demonstrating the common atrioventricular valve. The anterior bridging leaflet inserts onto the interventricular septum consistent with a Rastelli type A valve.

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Sections Pediatric Complete Atrioventricular Septal Defects
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Pediatric Complete Atrioventricular Septal Defects Medication

Medication Summary

Inotropic agents