Year : 2016  |  Volume : 19  |  Issue : 4  |  Page : 587--588

Transesophageal echocardiography in an atrioventricular septal defect


Rohan Magoon, Arindam Choudhury, Amita Sharma, Poonam Malhotra Kapoor 
 Department of Cardiac Anaesthesia, CTC, AIIMS, New Delhi, India

Correspondence Address:
Rohan Magoon
Department of Cardiac Anaesthesia, CTC, AIIMS, New Delhi
India




How to cite this article:
Magoon R, Choudhury A, Sharma A, Kapoor PM. Transesophageal echocardiography in an atrioventricular septal defect.Ann Card Anaesth 2016;19:587-588


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 2021 Jan 16 ];19:587-588
Available from: https://www.annals.in/text.asp?2016/19/4/587/191558


Full Text



 Introduction



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

 Terminology



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}

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}{Figure 3}

 Typical Echocardiographic Characteristics Common to an Atrioventricular Septal Defect



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]

[MULTIMEDIA:1]

[MULTIMEDIA:2]

[MULTIMEDIA:3]

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}

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



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.