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Congenital Heart Surgeon Society Atrioventricular Septal Defect prospective inception cohort

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Congenital Heart Surgeon Society Atrioventricular Septal Defect prospective inception cohort Webinar Series LVOT measurements LVOTO- describe mechanism Doppler ... – PowerPoint PPT presentation

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Title: Congenital Heart Surgeon Society Atrioventricular Septal Defect prospective inception cohort


1
Congenital Heart Surgeon Society Atrioventricular
Septal Defect prospective inception cohort
  • Webinar Series

2
  • uAVSD Echo Core Lab Members
  • Michael Quartermain mquarter_at_wakehealth.edu
  • Luc Mertens luc.mertens_at_sickkids.ca
  • Meryl Cohen cohenm_at_email.chop.edu
  • David Gremmels DGremmels_at_chc-pa.org
  • Gina Baffa gbaffa_at_NEMOURS.ORG
  • CHSS Data Center Staff
  • Bill Williams bill.williams_at_sickkids.ca
  • Christopher Caldarone christopher.caldarone_at_sickki
    ds.ca
  • Maulik Baxi maulik.baxi_at_sickkids.ca
  • Veena Sivarajan veena.sivarajan_at_sickkids.ca
  • Susan McIntyre susan.mcintyre_at_sickkids.ca
  • David Overman DOverman_at_chc-pa.org?

3
Study protocol
  • Acquire images on enrolled subjects at set time
    intervals
  • Submit to virtual core lab
  • Measurements will be performed by core lab

4
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)

5
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 (gt12 months) will
    be sent directly from centers to CHSS Data Center
    (Echo Reporting Form pending)

6
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

7
Exclusion Criteria
  • Partial or Transitional AVSD.
  • Separate AV valve orifices
  • Non-existent ventricular septal defect
  • Aortic Atresia
  • First Intervention at a non-CHSS institution

8
ASD views
9
ASD subcostal
10
ASD views
11
VSD
12
Image additional VSDs
13
AVVI SC en face view of AVV
14
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 199628 1017-23)
  • Atrioventricular Valve Index (AVVI)
  • Subcostal LAO view
  • Measure area of common AV valve apportioned over
    each ventricle
  • LAVVRAVV or RAVVLAVV

15
AVVI UAVSD
16
AVVI
17
CHSS Lookback
  • Modified AVVI
  • LAVVTotal AVV
  • 0.5
  • Right dominant Left Dominant
  • Overman DM, et al. WJSPCHS 1(1), Sept 2008

18
Apica 4 Ch view
19
APICAL 4-Chamber
20
LV 2-chamber
21
LV 3-Chamber
22
Sweep through LAVV RAVV
23
LAVVR RAVVR
24
RAVVR
25
RV inflow
26
LV inflow
27
Left AV Valve Index (LVII)
Szwast AL, et al. Am J Cardiol 2011107103109
28
RV/LV Inflow Angle - Balanced
154
29
RV/LV Inflow - Unbalanced
154
82
30
Other measurements
31
Papillary muscles
Parachute-like with one dominant papillary muscle
group
32
LVOT views
33
LVOT
34
LVOT measurements
35
LVOTO- describe mechanism
36
Doppler gradient
37
RVOT
38
PA branches
39
Ductal cut
40
Aortic arch
41
Pulmonary veins
42
Systemic Venous anomalies
43
3-D if available (subcostal)
44
3-D if available (apical 4)
45
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

46
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

47
Questions ?
  • Thank you for your participation
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