Echocardiographic evaluation of additional anomalies of the left atrioventricular valve in patients with complete atrioventricular communication
Keywords:
complete atrioventricular communication, left atrioventricular valve, additional anomalies of left atrioventricular valve, echocardiographyAbstract
Background. Despite the continuous improvement of surgical treatment methods for patients with complete atrioventricular communication (AVC), the occurrence of postoperative regurgitation of the left AV valve at different time intervals after correction remains an unresolved problem for 3–13% of them.Objective: to determine the incidence of left AV valve abnormalities in patients with complete AVC and to assess the possibility of transthoracic echocardiography to determine potential anatomical risk factors associated with postoperative complications.
Materials and methods. From January 2014 to December 2018, in the Scientific and Practical Medical Center for Pediatric Cardiology and Cardiac Surgery of the Ministry of Health of Ukraine, 229 patients underwent correction of complete AVC. The average age at the time of correction was 4.8 months (range from 19 days to 5.4 years), the average weight was 4.8 kg (range from 3.1 kg to 23 kg). 107 patients had Down syndrome. The average follow-up period after defect correction was 22.2±4.7 months (range from 7 days to 57 months). We analyzed the incidence of left AV valve abnormalities in patients with complete AVC and their relationship with residual pathology after correction.
Results. Most patients have been diagnosed with relatively simple anatomical forms of complete AVC with two well-developed left and right ventricles and a typical morphology of the common AV valve, which allowed correction with a relatively satisfactory result in the long-term follow-up. In 29.7% of cases, the AV valve morphology was different from that typical for AVC due to the existence of additional abnormalities of the left AV valve, diagnosed with transthoracic echocardiography. Residual pathology after correction was detected in 58 (25.3%) patients, 20 (8.7%) of them were subsequently re-intervention in connection with dysfunction of the left AV valve. A reliable relationship was established between the existence of additional anomalies of the left AV valve and the occurrence of residual pathology of the left AV valve at different time intervals after correction (the area under the curve of the diagnostic value of the additional anomalies of the left AV valve when predicting the residual pathology of the left AV valve was 0.778 (95% CI: 0.598–0.849)). The significance of transthoracic echocardiography in identifying potential anatomical risk factors associated with postoperative complications was assessed (the area under the curve of the diagnostic value of echocardiography for identifying additional abnormalities of the left AV valve was 0.659 (95% CI: 0.527–0.809)).
Conclusions. Transthoracic echocardiography is a modern method for diagnosing the main morphological features of a complete AVC with high sensitivity and specificity. In most cases, the method of transthoracic echocardiography provides a sufficient amount of necessary information to substantiate and plan surgical treatment of AVC, taking into account the main morphological features of the valve and subvalvular apparatus of the common AV valve.
The research was carried out in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the institution's Local Ethics Committee. The informed consent of the child's parents was obtained from the studies.
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