Anatomic and functional “obstruction” of the outflow tract in atrioventricular septal defects with separate valve orifices (“ostium primum atrial septal defect”): An echocardiographic study

Ebels, Tjark; Meijboom, Erik J.; Anderson, Robert H.; Leeuwen, M. J. M. Schasfoort-van; Lenstra, D; Eijgelaar, A; Bossina, K. K.; Heide, J. N. Homan van der

doi:10.1016/s0002-9149(84)80218-0

Cited by 41 publications

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“…This increases the length of the left ventricular outflow tract. In radiology, this appears as the “goose‐neck deformation.” Although the left ventricular outflow tract extension alone does not lead to stenosis of the left ventricular outflow tract, accessory left atrioventricular valve tissue and chordae, abnormal papillary muscles, and aneurysm of the left‐sided atrioventricular valves can all contribute to subaortic stenosis in patients with AVSD . The chordae on the ventricular septum causes the anterior mitral valve to have a forward movement in the systolic period, as well as causes an increase in blood flow and the formation of fibers, eventually leading to stenosis of the left ventricular outflow tract …”

Section: Resultsmentioning

confidence: 99%

Surgical treatment results of secondary tunnel‐like subaortic stenosis after congenital heart disease operations: A 7‐year, single‐center experience in 25 patients

et al. 2019

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Objective: To summarize the surgical results of secondary tunnel-like subaortic stenosis (STSS) after congenital heart disease (CHD) operations, the pathogenesis of STSS is analyzed and its operative effect and prognosis are evaluated. Methods: We analyzed clinical data from 25 patients who underwent surgical repair for STSS in Fuwai Hospital from 1 January 2009 to 31 December 2015. There were 17 males and 8 females. The types of CHD included a double outlet right ventricle (DORV), a ventricular septal defect (VSD), and partial atrioventricular septal defects (PAVSDs). The median age of the patients at the time of their first CHD operation was 1 year (1 month to 42 years). The median age of the patients at the time of STSS repair was 5 years and 8 months (2 years and 10 months to 48 years). The surgical types included the modified Konno procedure, Konno procedure, fibromuscular resection (FMR), and removal and reconstruction of the intraventricular baffle (RRIB).Results: All patients successfully received STSS repair. There were no surgical deaths in this study. The preoperative gradient across the left ventricular outflow tract was 81 (43-159) mm Hg, and the postoperative gradient was 8.2 (4-46.2) mm Hg. On the basis of the surgical techniques used for subaortic stenosis repair, we divided the patients into three subgroups: the Konno group (n = 11), the FMR group (n = 11), and the RRIB group (n = 3). Preoperatively, there was no significant difference in the gradient between the Konno group and the FMR group (ΔP, P = .287), but the Konno group was significantly better than the FMR group postoperatively (ΔP, P = .022). There were no significant statistical differences between the RRIB group and the other two groups in all these data. A third-degree atrioventricular block occurred in two patients after the operation, and both patients required a permanent pacemaker. All patients were followed up after discharge for a median duration of 5 years (3-9 years). During the follow-up period, none of the patients had any clinical symptoms or subaortic restenosis, and there was no late death.Abbreviations: ASO, arterial switch operation; AV, aortic valve; CHD, congenital heart disease; COA, coarctation of the aorta; DORV, double outlet right ventricle; FMR, fibromuscular resection; PAVSD, partial atrioventricular septal defect; PDA, patent ductus arteriosus; SSS, secondary subaortic stenosis; STSS, secondary tunnel-like subaortic stenosis; TOF, Tetralogy of Fallot; VSD, ventricular septal defect; ΔP, left ventricle-to-aorta peak pressure gradient.

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Section: Resultsmentioning

confidence: 99%

Surgical treatment results of secondary tunnel‐like subaortic stenosis after congenital heart disease operations: A 7‐year, single‐center experience in 25 patients

et al. 2019

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“…-The causes of left ventricular outflow tract obstruction are many and have been detailed by Ben-Shachar et al 4 The subaortic lesion is not usually symptomatic. In some instances the subaortic lesion has become apparent only after repair of the atrioventricular canal defects.4 7 How operation leads to the unmasking or development of a subaortic abnormality that was not present before intervention is a matter of conjecture. Several explanations have been suggested.…”

Section: Discussionmentioning

confidence: 99%

Development of subaortic stenosis and regurgitation several years after successful operation on a common atrium.

Misra

Thakur²,

Bhandari³

1987

Heart

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SUMMARY A patient who had had successful operation for a common atrium subsequently developed subaortic stenosis and regurgitation several years later. The diagnosis of subaortic lesion was confirmed by echocardiography. This case shows that the left ventricular outflow tract gradient should be measured before operation for common atrium and that after operation such cases should be examined by cross sectional echocardiography at follow up visits. The electrocardiogram currently shows nodal rhythm at a rate of 60 beats per minute and increased right and left venticular forces in addition to left axis deviation with a counterclockwise depolarisation sequence and right bundle branch block pattern.The chest x ray shows a mild increase in the cardiothoracic ratio compared with that seen in the film taken two years after operation. The present M mode echocardiographic findings show mild dilatation of the left ventricular cavity with thickening of the interventricular septum and left ventricular free wall, fine diastolic fluttering of the anterior mitral leaflet with thickening, and systolic fluttering of the anterior (right coronary) cusp of the aortic valve with partial premature closure. The posterior (noncoronary) cusp could not be satisfactorily imaged (fig la and b). The cross sectional echocardiogram in the parasternal long axis view showed dense echoes in the left ventricular outflow tract just below the aortic valve. There was very little variation in these echoes with the phases of cardiac cycle (fig 2).The above findings confirm the presence of subaortic stenosis and regurgitation. These were 531 on 11 May 2018 by guest. Protected by copyright.

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“…Os corações com esta anomalia apresentam , ainda , outras características morfológicas, como encurtamento da via de saída do ventrículo esquerdo, configuração anormal da via de saída do ventrículo esquerdo e perda da posição em cunha, da aorta, entre as válvas atrioventriculares [5][6][7] 12, 16,34,35,39,41 ,67,[89][90][91]93,104, lOS ,118,128,129,131 ; há aumento de ambos os ventrículos.…”

Section: • Presença De Uma Valva Atrioventricular úNi-unclassified

Análise dos fatores de risco na correção cirúrgica do defeito septal atrioventricular de forma total

Saadi

Shore²,

Lincoln³

1993

Rev Bras Cir Cardiovasc

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I RBCCV SAADI , E. K. ; SHORE, D.; LINCOLN, C. -Análise dos fatores de risco na correção cirúrgica do defeito septal atrioventricular de forma total. Rev. Bras. Gir. Gardiovasc., 8(2): 136-151, 1993. RESUMO: Pacientes com defeito septal atrioventricular de forma total (DSAVT) freqüentemente apresentam insuficiência cardíaca intratável e hipertensão arterial pulmonar nos primeiros meses de vida, e apenas uma minoria sobrevive sem tratamento cirúrgico precoce . Por essa razão, indica-se a correção definitiva para alterar favoravelmente a história natural da doença. Entretanto, vários fatores são responsáveis pela alta mortalidade cirúrgica. O presente trabalho estuda a experiência na correção cirúrgica do DSAVT com o objetivo de identificar alguns fatores de risco estatisticamente significativos para a ocorrência de morte operatória. Analisaram-se, retrospectivamente, 52 pacientes submetidos, entre janeiro de 1974 e dezembro de 1990, a cirurgia definitiva para correção de DSAVT no Royal Brompton and National Heart and Lung Institute, sendo estudadas as seguintes variáveis: idade , peso, sexo , ano da operação, presença de síndrome de Down , grau de regurgitação da valva AV, bandagem prévia do tronco pulmonar, presença de anomalias associadas, pressão sistólica pulmonar, duplo orifício mitral, classificação do defeito segundo Rastelli , emprego de parada circulatória e técnica de correção (1 x 2 retalhos) . Todos os fatores foram avaliados isoladamente, mediante a análise univariada. Para determinar quais os fatores que , independentemente da ação de outros, contribuíram significativamente para maior mortalidade cirúrgica, foi utilizada a análise multivariada com regressão logística. A análise multivariada demonstrou que o baixo peso na época da operação e a técnica de correção com um retalho aumentam significativamente a mortalidade cirúrgica.DESCRITORES: defeito septal atrioventricular, cirurgia, fatores de risco. INTRODUÇÃO ca, geralmente composta por 5 ou 6 cúspides 5 , 7 , 12, 56 O defeito septal atrioventricular de forma total (DSAVT) é uma cardiopatia congênita complexa caracterizada por:• Deficiência no septo atrial imediatamente acima das valvas atrioventriculares.• Deficiência na via de entrada do septo ventricular, com a presença de comunicação interventricular. • Presença de uma valva atrioventricular úni-Os corações com esta anomalia apresentam , ainda , outras características morfológicas, como encurtamento da via de saída do ventrículo esquerdo, configuração anormal da via de saída do ventrículo esquerdo e perda da posição em cunha, da aorta, entre as válvas atrioventriculares [5][6][7] 12, 16,34,35,39,41 ,67,[89][90][91]93,104, lOS ,118,128,129,131 ; há aumento de ambos os ventrículos.Vários são os estudos, na literatura, referentes

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Anatomic and functional “obstruction” of the outflow tract in atrioventricular septal defects with separate valve orifices (“ostium primum atrial septal defect”): An echocardiographic study

Cited by 41 publications

References 9 publications

Surgical treatment results of secondary tunnel‐like subaortic stenosis after congenital heart disease operations: A 7‐year, single‐center experience in 25 patients

Surgical treatment results of secondary tunnel‐like subaortic stenosis after congenital heart disease operations: A 7‐year, single‐center experience in 25 patients

Development of subaortic stenosis and regurgitation several years after successful operation on a common atrium.

Análise dos fatores de risco na correção cirúrgica do defeito septal atrioventricular de forma total

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