The impact of surgical repair on left ventricular outflow tract in atrioventricular septal defect with common atrioventricular valve orifice
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Chandiramani, Ashwini and Bader, Vivian and Finlay, Emma and Lilley, Stuart and Young, David and Peng, Ed (2023) The impact of surgical repair on left ventricular outflow tract in atrioventricular septal defect with common atrioventricular valve orifice. JTCVS Open, 14. pp. 385-395. ISSN 2666-2736 (https://doi.org/10.1016/j.xjon.2022.11.023)
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Abstract
Objective: Although a narrow left ventricular outflow tract in atrioventricular septal defect is related to its intrinsic morphology, the contribution from the repair technique remains to be quantified. Methods: A total of 108 patients with an atrioventricular septal defect with a common atrioventricular valve orifice were divided into 2 groups: 2-patch (N = 67) and modified 1-patch (N = 41) repair. The left ventricular outflow tract morphometric was analyzed by quantifying the degree of disproportion between subaortic and aortic annular dimensions (disproportionate morphometrics ratio was defined as ≤ 0.9). Z-scores (median, interquartile range) were further analyzed in a subset of 80 patients with immediate preoperative and postoperative echocardiography. A total of 44 subjects with ventricular septal defects served as controls. Results: Before repair, 13 patients (12%) with an atrioventricular septal defect had disproportionate morphometrics (vs 6 [14%] ventricular septal defect P = .79), but the subaortic Z-score (−0.53, −1.07 to 0.06) was lower than the ventricular septal defect (0.07, −0.57 to 1.17; P < .001). After repair, both 2-patch (8 [12%] preoperatively vs 25 [37%] postoperatively; P = .001) and modified 1-patch (5 [12%] vs 21 [51%], P < .001) procedures showed a greater degree of disproportionate morphometrics. Both 2-patch (postoperatively −0.73, −1.56 to 0.08 vs preoperatively −0.43, −0.98 to 0.28; P = .011) and modified 1-patch (−1.42, −2.63 to –0.78 vs −0.70, −1.18 to −0.25; P = .001) procedures also demonstrated lower subaortic Z-scores postrepair. The postrepair subaortic Z-scores were lower in the modified 1-patch group (–1.42 [−2.63 to −0.78]) compared with the 2-patch group (–0.73 [−1.56 to 0.08]; P = .004). Low postrepair subaortic Z-scores (<−2) were observed in 12 patients (41%) in the modified 1-patch group and 6 patients (12%) in the 2-patch group (P = .004). Conclusions: Surgical correction resulted in greater disproportionate morphometrics seen immediately postrepair. The impact on the left ventricular outflow tract was observed in all repair techniques, with a greater burden seen after modified 1-patch repair. Video Abstract: This morphometric study in AVSD with common atrio-ventricular valve orifice confirmed further derangements of LV outflow tract morphometrics immediately after surgical repair. This morphometric study in AVSD with common atrio-ventricular valve orifice confirmed further derangements of LV outflow tract morphometrics immediately after surgical repair.
ORCID iDs
Chandiramani, Ashwini, Bader, Vivian, Finlay, Emma, Lilley, Stuart, Young, David
ORCID: https://orcid.org/0000-0002-3652-0513 and Peng, Ed;
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Item type: Article ID code: 83951 Dates: DateEventJune 2023Published23 January 2023Published Online28 November 2022AcceptedNotes: Journal 'pre-proof' first published online 18 January 2023 Subjects: Medicine Department: Faculty of Science > Mathematics and Statistics Depositing user: Pure Administrator Date deposited: 31 Jan 2023 15:47 Last modified: 11 Nov 2024 13:46 Related URLs: URI: https://strathprints.strath.ac.uk/id/eprint/83951