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The Impact of Surgical Repair on Left Ventricular Outflow Tract in Atrioventricular Septal Defect with Common Atrioventricular Valve Orifice

  • Ashwini Chandiramani
    Affiliations
    Department of General (Internal) Medicine, Aberdeen Royal Infirmary, Aberdeen, Scotland, United Kingdom
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  • Vivian Bader
    Affiliations
    Department of Paediatric Cardiac Surgery, Royal Hospital for Children, Glasgow, Scotland, United Kingdom
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  • Emma Finlay
    Affiliations
    Department of Cardiac Physiology and Echocardiography, Royal Hospital for Children, Glasgow, Scotland, United Kingdom
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  • Stuart Lilley
    Affiliations
    Department of Cardiac Physiology and Echocardiography, Royal Hospital for Children, Glasgow, Scotland, United Kingdom
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  • David Young
    Affiliations
    Department of Mathematics and Statistics, University of Strathclyde, Greater Glasgow and Clyde, United Kingdom
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  • Ed Peng
    Correspondence
    Corresponding author contact (post print): Mr WK Ed Peng, Honorary Senior Clinical Lecturer University of Glasgow, Consultant Cardiac Surgeon, Scottish Paediatric Cardiac Service, Royal Hospital for Children Glasgow| Queen Elizabeth University Hospital, New Office Block, 1345 Govan Rd, Glasgow G51 4TF, UK. Phone: +44-141 451 6541, Fax: +44-141 201 2215,
    Affiliations
    Department of Paediatric Cardiac Surgery, Royal Hospital for Children, Glasgow, Scotland, United Kingdom

    College of Medical, Veterinary and Life Sciences, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, United Kingdom
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Open AccessPublished:January 18, 2023DOI:https://doi.org/10.1016/j.xjon.2022.11.023
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      Abstract

      Objective

      Although a narrow left ventricular outflow tract (LVOT) in atrioventricular septal defect (AVSD) is related to its intrinsic morphology, the contribution from repair technique remains to be quantified.

      Methods

      108 AVSD patients with common atrio-ventricular valve orifice were divided into 2 groups: two-patch (N=67) and modified 1-patch (N=41) repair. LVOT morphometric was analysed by quantifying the degree of disproportion between subaortic:aortic annular dimensions (disproportionate morphometrics ratio was defined as ≤ 0.9). Z-scores (median, interquartile range) were further analysed in a subset of 80 patients with immediate pre- and post-operative echocardiography. 44 subjects with VSD served as controls.

      Results

      Pre-repair, 13(12%) AVSD had disproportionate morphometrics (vs 6(14%) VSD p=0.79); but subaortic Z-score (-0.53, -1.07 - 0.06) was lower than VSD (0.07, -0.57 - 1.17; p<0.001). Post-repair, both two-patch (8(12%) pre-op vs 25(37%) post-op; p=0.001) and modified 1-patch (5(12%) vs 21(51%), p<0.001) showed greater degree of disproportionate morphometrics. Both two-patch (post-op -0.73, -1.56 - 0.08 vs pre-op -0.43, -0.98 - 0.28; p=0.011) and modified 1-patch (-1.42, -2.63-(-0.78) vs -0.70, -1.18 - (-0.25); p=0.001) also had lower subaortic z-scores post-repair. The post-repair subaortic z-scores were lower in modified 1-patch [-1.42 (-2.63 - (-0.78)] compared to two-patch [-0.73 (-1.56 - 0.08); p=0.004]. Low post-repair subaortic Z-scores (under -2) were observed in 12(41%) modified 1-patch and 6(12%) two-patch (p=0.004).

      Conclusions

      Surgical correction resulted in greater disproportionate morphometrics seen immediately post-repair. The impact on the LV outflow tract was observed in all repair techniques, with a greater burden seen following modified 1-patch repair.

      Graphical abstract

      Keywords

      Glossary of Abbreviations:

      AV (Atrioventricular), AVSD (Atrioventricular septal defect), CAVVO (Common AV valve orifice), LAVV (Left AV valve), LVOT (Left ventricular outflow tract), LVOTO (Left ventricular outflow tract obstruction), VSD (Ventricular Septal Defect)