Congenital Heart Surgeon
Society Atrioventricular
Septal Defect prospective
inception cohort
Webinar Series
uAVSD Echo Core Lab Members
•
Michael Quartermain mquarter@wakehealth.edu
•
Luc Mertens luc.mertens@sickkids.ca
•
Meryl Cohen cohenm@email.chop.edu
•
David Gremmels DGremmels@chc-pa.org
•
Gina Baffa gbaffa@NEMOURS.ORG
CHSS Data Center Staff
•
Bill Williams bill.williams@sickkids.ca
•
Christopher Caldarone christopher.caldarone@sickkids.ca
•
Maulik Baxi maulik.baxi@sickkids.ca
•
Veena Sivarajan veena.sivarajan@sickkids.ca
•
Susan McIntyre susan.mcintyre@sickkids.ca
David Overman DOverman@chc-pa.org
Study protocol
• Acquire images on enrolled subjects at set
time intervals
• Submit to virtual core lab
• Measurements will be performed by core lab
Timing of Echo Studies
• 3 Echocardiograms per patient
1. Pre-operative study (most complete diagnostic
study, discretion of site)
2. Pre-discharge post-op study (or 30 days post-op,
whichever first)
3. Late post-op (6-12 months)
Additional echoes for identified
re-interventions
•
– AV valve replacement or resection of subAS
– Pts with initial PA band or other “non- definitive” palliation
– Would require additional 3 studies (pre, post and late)
– CHSS to develop triggers for participating centers to upload
echo studies when due
– Echo reports for late studies (>12 months) will be sent
directly from centers to CHSS Data Center (Echo Reporting
Form pending)
Inclusion Criteria
• Diagnosis of or referral with complete AVSD at a CHSS
member institution within first year of life.
– Includes TOF and Double Outlet Right Ventricle with
complete AVSD
• Atrioventricular and Ventriculoarterial concordance
(with the exception of DORV).
• Informed written consent.
• Note: we are including heterotaxy and TAPVC/PAPVC
Exclusion Criteria
• Partial or Transitional AVSD.
– Separate AV valve orifices
– Non-existent ventricular septal defect
• Aortic Atresia
• First Intervention at a non-CHSS institution
ASD views
ASD subcostal
ASD views
VSD
Image additional VSDs
AVVI: SC en face view of AVV
AVVI
Morphometric Analysis of Unbalanced Common Atrioventricular Canal Using Two-Dimensional
Echocardiography
MERYL S. COHEN, MD, MARSHALL L. JACOBS, MD, PAUL M. WEINBURG, MD, FACC, JACK RYCHIK, MD, FACC
Philadelphia, Pennsylvania
(J Am Coll Cardiol 1996;28: 1017-23)
• Atrioventricular Valve Index (AVVI)
– Subcostal LAO view
– Measure area of common AV valve apportioned over each
ventricle
– LAVV:RAVV or RAVV:LAVV
AVVI UAVSD
AVVI
CHSS Lookback
• Modified AVVI
– LAVV:Total AVV
0.5
Right dominant
Left Dominant
Overman DM, et al. WJSPCHS 1(1), Sept 2008
Apica 4 Ch view
APICAL 4-Chamber
LV 2-chamber
LV 3-Chamber
Sweep through LAVV +RAVV
LAVVR + RAVVR
RAVVR
RV inflow
LV inflow
Left AV Valve Index (LVII)
Szwast AL, et al. Am J Cardiol 2011;107:103–109
RV/LV Inflow Angle - Balanced
154°
RV/LV Inflow - Unbalanced
154°
82°
Other measurements
Papillary muscles
Parachute-like with one dominant papillary muscle group
LVOT views
LVOT
LVOT measurements
LVOTO- describe mechanism
Doppler gradient
RVOT
PA branches
Ductal cut
Aortic arch
Pulmonary veins
Systemic Venous anomalies
3-D if available (subcostal)
3-D if available (apical 4)
Further information
• Two additional webinars in March
• Online information via the CHSS website:
– http://www.chssdc.org/studies
• Ongoing open forum with Echo core and Data
Center
Summary
• There are no unique or novels views
• Focus on high quality, complete sweeps with particular
attention to:
– Subcostal (Left anterior oblique)
– Apical 4 chamber on inlet region and secondary inflow
– LV outflow tracts from multiple views
• 3D when available
Questions ?
• Thank you for your participation