Angiocardiographic appearances of atrioventricular defects with particular reference to distinction of ostium primum atrial septal defect from common atrioventricular orifice.

Abstract

sUMMARY Preoperative distinction between common atrioventricular orifice and ostium primum atrial septal defect may be difficult.To improve diagnostic accuracy, the right and left ventricular angiocardiograms were reviewed 'blind' in 92 patients with atrioventricular defects. The true diagnosis was known from necropsy or -surgery in 60. Angiocardiograms had been obtained in various projections with or without craniocaudal tilt. Those features thought to distinguish between common orifice and ostium primum were coded, together with the ventricular systolic pressures.Computerised discriminant function analysis identified the following distinguishing features: (1) right ventricular systolic pressure; (2) immediate right ventricular outflow tract opacification from the left ventricle; (3) identification of the anterior attachment of the mitral component; (4) recognition of a single straddling atrioventricular orifice; (5) passage of contrast medium above or below the anterior or posterior bridging leaflets.Feature (3) indicates that in contrast to classic teaching the direct septal attachment of the mitral component does not contribute to the 'gooseneck' in complete atrioventricular defects. The significance of (4) and (5) is that they may be identified from right as well as left ventriculography, and are more likely to be identified in oblique than standard projections. Computerisation produced a correct diagnosis in 92 per cent ofknown cases, and determined precise probabilities of diagnosis in the remainder.The angiographic abnormalities which characterise atrioventricular defects were first described in a classic paper by Baron et al. (1964). These authors ,clearly described the manner in which the abnormal septal attachment of the mitral valve in this condition produces, in the frontal angiocardiogram, the appearance of the 'gooseneck' deformity of the left ventricular outflow tract. It was 10 years before ' Blieden and his colleagues (1974) correctly pointed out that the deformity present was not simply one of the gooseneck (left ventricular outflow tract) but also of the goose (deficiency of the diaphragmatic wall of the left ventricle), but these authors continued to relate the angiocardiographic appearances to the left ventricular septum rather than to its free wall.The logic of these arguments seems clear when applied to the partial defect (ostium primum atrial septal defect). However, it was difficult to understand how the same reasoning could be applied to the diastolic appearances of the complete defect (common atrioventricular orifice), since here there is rarely any direct attachment of the bridging anterior atrioventricular leaflet to the crest of the septum. Such a direct attachment is necessary to visualise atrioventricular leaflets angiocardiographically since it is essential to have a pronounced difference in 40

Assessment of atrioventricular septal defects by two dimensional echocardiography.

“…I and 2. shunting, as well as atrioventricular incompetence.' [9][10][11][12][13][14][15][16][17][18][19][20][21] Our echocardiographic observations, however, support in qualitative fashion the original pathological observation of Bharati and Lev'0 that hearts exist in which the degree of right or left ventricular dominance cannot readily be explained on haemodynamic grounds (Fig. 9).…”

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

“…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.…”