Atrioventricular Septal Defect Surgery Workup

Updated: Apr 12, 2017
  • Author: Richard G Ohye, MD; Chief Editor: Suvro S Sett, MD, FRCSC, FACS  more...
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Workup

Laboratory Studies

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

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

Doppler echocardiography

In incomplete AVSDs, Doppler echocardiography findings are diagnostic of the atrial defect, the absence of ventricular level shunting, and the presence of any AV valve abnormalities. In complete AVSDs, 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 (AV) septal defects (AVSDs), electrocardiography (ECG) reveals left axis deviation, prominent P waves associated with atrial enlargement, and a prolonged PR interval. In complete AVSDs, ECG 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 (AV) septal defects (AVSDs), cardiac catheterization is indicated only in adults with a diagnosis of incomplete AVSDs 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 AVSD, 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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