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. 2022 Feb 21;34(3):431-437.
doi: 10.1093/icvts/ivab263.

Correlation of ventricular septal defect height and outcomes after complete atrioventricular septal defect repair

Laura S Fong  1   2 , David Youssef  2 , Julian Ayer  1   2 , Ian A Nicholson  2 , David S Winlaw  1   2 , Yishay Orr  1   2
Affiliations

Correlation of ventricular septal defect height and outcomes after complete atrioventricular septal defect repair

Laura S Fong et al. Interact Cardiovasc Thorac Surg. .

Abstract

Objectives: There are limited data available on the height of the ventricular component of the septal deficiency (VSD) in patients undergoing complete atrioventricular septal defect (CAVSD) repair. VSD height may influence optimal choice of repair strategy with potential consequences for long-term outcomes. We aimed to measure VSD height using 2-dimensional echocardiography and review its association with postoperative outcomes.

Methods: We retrospectively reviewed the preoperative echocardiograms of 45 consecutive patients who underwent CAVSD repair between May 2010 and December 2015 at a single centre. VSD height and left ventricular length on the four-chamber view were measured. Demographic details and early and late outcomes including reoperation and long-term survival were studied.

Results: Twenty patients underwent modified single-patch repair and 25 patients underwent double-patch repair of CAVSD. VSD height in the modified single-patch group ranged from 4.2 to 11.7 mm and in the double-patch group ranged from 5.1 to 14.9 mm. Nine patients had a deep 'scoop' with a VSD height of >10 mm, (7 double patch, 2 modified single patch). VSD height did not correlate with a specific Rastelli classification. There was no significant difference in the VSD height (P = 0.51) or the VSD height-to-left ventricular length ratio (P = 0.43) between the 2 repair groups. There was no 30-day mortality. Eight patients required reoperation; however, VSD height was not a significant predictor of reoperation (hazard ratio 0.95, 95% confidence interval 0.69-1.33; P = 0.08).

Conclusions: There was no correlation between VSD height and risk of reoperation after CAVSD repair. A deep ventricular scoop is uncommon in CAVSD patients.

Keywords: Atrioventricular septal defect; Complete atrioventricular canal; Complete atrioventricular septal defect.

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Figures

Figure 1:
Figure 1:
Demonstration of measurements of the VSD height and LV length measured using 2-dimensional echocardiography on four-chamber view. LV: left ventricular; VSD: ventricular septal defect.
Figure 2:
Figure 2:
(A) Graphical representation of VSD height and LV length in complete atrioventricular septal defect patients stratified by repair technique. (B) VSD height stratified by need for reoperation and complete atrioventricular septal defect repair type. LV: left ventricular; VSD: ventricular septal defect. Double patch (red diamond) and modified single patch (blue circle).
Figure 3:
Figure 3:
(A) Graphical representation of VSD height-to-LV length ratio stratified by CAVSD repair technique. (B) VSD height in CAVSD patients stratified by Rastelli class and repair technique; CAVSD: complete atrioventricular septal defect; LV: left ventricular; VSD: ventricular septal defect. Double patch (red diamond) and modified single patch (blue circle).
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References

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