Video Commentary
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
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]. 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]. TYPICAL ECHOCARDIOGRAPHIC CHARACTERISTICS COMMON TO AN ATRIOVENTRICULAR SEPTAL DEFECT Videos Available on: www.annals.in Access this article online
Website: www.annals.in PMID: *** DOI: 10.4103/0971-9784.191558 Quick Response Code:
• 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 • An elongated and Substrate narrowed left for left ventricular ventricular outflow tract, a outflow tract “goose neck” obstruction appearance [Figure 4]
© 2016 Annals of Cardiac Anaesthesia | Published by Wolters Kluwer - Medknow
Figure 1: A primum atrial septal defect contiguous with inlet ventricular septal defect and common atrioventricular valve
Figure 2: Absence of an inlet ventricular septal defect with distinct mitral and tricuspid valves and separate annuli
Figure 3: The hallmarks are primum atrial septal defect and a cleft in the anterior mitral leaflet
Address for correspondence: Dr. Rohan Magoon, Department of Cardiac Anaesthesia, CTC, AIIMS, New Delhi, India. E‑mail: [email protected]
587
Video Commentary
Figure 4: An elongated and narrowed left ventricular outflow tract, a “goose neck” appearance
• 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]. 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
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• 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 • AV S D : R e a d i l y i d e n t i f i e d w i t h f e t a l echocardiography.
This is an open access article distributed under the terms of the Creative Commons Attribution‑NonCommercial‑ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non‑commercially, as long as the author is credited and the new creations are licensed under the identical terms.
Cite this article as: Magoon R, Choudhury A, Sharma A, Kapoor PM. Transesophageal echocardiography in an atrioventricular septal defect. Ann Card Anaesth 2016;19:587-8.
Annals of Cardiac Anaesthesia | Oct-Dec-2016 | Vol 19 | Issue 4
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
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]. 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]. TYPICAL ECHOCARDIOGRAPHIC CHARACTERISTICS COMMON TO AN ATRIOVENTRICULAR SEPTAL DEFECT Videos Available on: www.annals.in Access this article online
Website: www.annals.in PMID: *** DOI: 10.4103/0971-9784.191558 Quick Response Code:
• 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 • An elongated and Substrate narrowed left for left ventricular ventricular outflow tract, a outflow tract “goose neck” obstruction appearance [Figure 4]
© 2016 Annals of Cardiac Anaesthesia | Published by Wolters Kluwer - Medknow
Figure 1: A primum atrial septal defect contiguous with inlet ventricular septal defect and common atrioventricular valve
Figure 2: Absence of an inlet ventricular septal defect with distinct mitral and tricuspid valves and separate annuli
Figure 3: The hallmarks are primum atrial septal defect and a cleft in the anterior mitral leaflet
Address for correspondence: Dr. Rohan Magoon, Department of Cardiac Anaesthesia, CTC, AIIMS, New Delhi, India. E‑mail: [email protected]
587
Video Commentary
Figure 4: An elongated and narrowed left ventricular outflow tract, a “goose neck” appearance
• 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]. 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
588
• 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 • AV S D : R e a d i l y i d e n t i f i e d w i t h f e t a l echocardiography.
This is an open access article distributed under the terms of the Creative Commons Attribution‑NonCommercial‑ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non‑commercially, as long as the author is credited and the new creations are licensed under the identical terms.
Cite this article as: Magoon R, Choudhury A, Sharma A, Kapoor PM. Transesophageal echocardiography in an atrioventricular septal defect. Ann Card Anaesth 2016;19:587-8.
Annals of Cardiac Anaesthesia | Oct-Dec-2016 | Vol 19 | Issue 4
