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Table of Contents
VIDEO COMMENTARY  
Year : 2016  |  Volume : 19  |  Issue : 4  |  Page : 587-588
Transesophageal echocardiography in an atrioventricular septal defect


Department of Cardiac Anaesthesia, CTC, AIIMS, New Delhi, India

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Date of Web Publication7-Oct-2016
 

How to cite this article:
Magoon R, Choudhury A, Sharma A, Kapoor PM. Transesophageal echocardiography in an atrioventricular septal defect. Ann Card Anaesth 2016;19:587-8

How to cite this URL:
Magoon R, Choudhury A, Sharma A, Kapoor PM. Transesophageal echocardiography in an atrioventricular septal defect. Ann Card Anaesth [serial online] 2016 [cited 2019 Jul 16];19:587-8. Available from: http://www.annals.in/text.asp?2016/19/4/587/191558





   Introduction Top


Atrioventricular septal defects (AVSDs) characterized by deficient atrioventricular (AV) septation and AV valve anomalies as the endocardial cushions fail to fuse embryonically.


   Terminology Top


Complete atrioventricular septal defect

Complete AVSD is a primum atrial septal defect (ASD) contiguous with inlet ventricular septal defect (VSD) and common AV valve [Figure 1].
Figure 1: A primum atrial septal defect contiguous with inlet ventricular septal defect and common atrioventricular valve

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Partial atrioventricular septal defect

Partial AVSD is the absence of an inlet VSD with distinct mitral and tricuspid valves and separate annuli [Figure 2]. The hallmarks are primum ASD and a cleft in the anterior mitral leaflet [Figure 3].
Figure 2: Absence of an inlet ventricular septal defect with distinct mitral and tricuspid valves and separate annuli

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Figure 3: The hallmarks are primum atrial septal defect and a cleft in the anterior mitral leaflet

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   Typical Echocardiographic Characteristics Common to an Atrioventricular Septal Defect Top


  • AV valves inserting at the same level at the cardiac crux due to lack of a normal offset [Video 1]
  • Absence of the AV septum [Video 2]
  • Unwedging and anterior displacement of the aortic valve [Video 3]
  • A scooped-out appearance of the septum resulting in a shorter inlet
  • [INLINE:1]










  • Counterclockwise rotation of papillary muscles [Video 4]
  • Cleft of left AV valve component directed toward the septum resulting in AV valve regurgitation (AVVR) [Video 5].
Figure 4: An elongated and narrowed left ventricular outflow tract, a “goose neck” appearance

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   Transesophageal Echocardiography Views Useful for an Atrioventricular Septal Defect: Mid-Esophageal 4c, Transgastric Basal View, Three-Dimensional Atrioventricular Valve Views Top


Yielding important information on

  • Atrial and ventricular septum
  • AV valve structure and degree of AVVR
  • Chordal insertions of valves
  • Classification (Rastelli Type A/B/C based on anterosuperior bridging leaflet morphology)
  • Patency of the outflow tracts
  • Categorizing as “balanced” or “unbalanced” based on sharing of AV inlet by the ventricles. In an unbalanced AVSD, one ventricle is hypoplastic; transesophageal echocardiography helps predict feasibility of biventricular repair in such cases
  • Associated lesions: Left superior vena cava, right ventricular outflow tract obstruction, subaortic stenosis, coarctation, inferior alveolar artery, or posterior descending artery.
  • Estimation of pulmonary artery pressures
  • AVSD: Readily identified with fetal echocardiography.


Top
Correspondence Address:
Rohan Magoon
Department of Cardiac Anaesthesia, CTC, AIIMS, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9784.191558

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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