Echocardiographic assessment of obstructive lesions in atrioventricular septal defects

Objectives We sought to determine the accuracy of transthoracic echocardiog raphy (TTE) in identifying risk factors in patients with an atrioventricula r septal defect (AVSD). Background Atrioventricular septal defect is a common lesion, and many deci sions about it are based on echocardiography alone. The identification of a ssociated left-sided inflow and outflow obstructive lesions is important, a s they are responsible for mortality and morbidity. Methods Between 1983 to 1998, 549 patients with AVSD underwent repair. The TTE findings were correlated with surgery, angiocardiography, autopsy or po stoperative TTE. Papillary muscle measurements were made in those with eith er a left ventricular outflow tract (LVOT) or left ventricular inflow abnor mality and compared with those measurements from control subjects. Measurem ents of the LVOT were made in patients with an identified LVOT abnormality. Results There were 63 missed lesions, decreasing over time. Double-orifice left atrioventricular valve (DOLAVV) and nonobstructive chordae in the LVOT were more often missed. Reoperation was performed to address a missed lesi on in 2 of 68 patients. Two Of 55 patients died of reasons related to a mis sed lesion. In 67% of patients, DOLAVV was missed. Abnormal papillary muscl e angles were seen with either a LVOT abnormality or DOLAVV. High insertion of the anterolateral papillary muscle was a risk factor for death or resid ual LVOT obstruction. Abnormal LVOT measurements were found in patients wit h tunnel obstruction and those with an acquired subaortic ridge. Conclusions Transthoracic echocardiography provides accurate preoperative i nformation on AVSD. (J Col Cardiol 2001;38:253-61) (C) 2001 by the American College of Cardiology.