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

2. uAVSD Echo Core Lab Members
Michael Quartermain
Luc Mertens
Meryl Cohen
David Gremmels
Gina Baffa
CHSS Data Center Staff
Bill Williams
Bill DeCampli
Veena Sivarajan
Principal Investigator:
David Overman

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. 1 year post-operative study

5. Inclusion Criteria Diagnosis of complete AVSD
Admitted to a CHSS institution for surgery after January 1, 2012
Age < 365 days at admission for surgery
Atrioventricular and Ventriculoarterial concordance (includes TOF and DORV).
Informed written consent.

6. Exclusion Criteria Partial or Transitional AVSD.
Separate AV valve orifices
Non-existent ventricular septal defect
Aortic Atresia
Total or Partial Anomalous Pulmonary Venous Drainage (TAPVC or PAPVC)
Heterotaxy
First Intervention at a non-CHSS institution

7. ASD views

8. ASD subcostal

9. ASD views

10. VSD

11. Image additional VSDs

12. AVVI: SC en face view of AVV

13. AVVI Atrioventricular Valve Index (AVVI) Subcostal LAO view
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 1996;28: )
Atrioventricular Valve Index (AVVI)
Subcostal LAO view
Measure area of common AV valve apportioned over each ventricle
LAVV:RAVV or RAVV:LAVV

14. AVVI UAVSD

15. AVVI

16. CHSS Lookback Modified AVVI LAVV:Total AVV 0.5
Right dominant Left Dominant
Overman DM, et al. WJSPCHS 1(1), Sept 2008

17. Apica 4 Ch view

18. APICAL 4-Chamber

19. LV 2-chamber

20. LV 3-Chamber

21. Sweep through LAVV +RAVV

22. LAVVR + RAVVR

23. RAVVR

24. RV inflow

25. LV inflow

26. Left AV Valve Index (LVII)
Szwast AL, et al. Am J Cardiol 2011;107:103–109

27. RV/LV Inflow Angle - Balanced
154°

28. RV/LV Inflow - Unbalanced
154°
82°

29. Other measurements

30. Papillary muscles
Parachute-like with one dominant papillary muscle group

31. LVOT views

32. LVOT

33. LVOT measurements

34. LVOTO- describe mechanism

35. Doppler gradient

36. RVOT

37. PA branches

38. Ductal cut

39. Aortic arch

40. Pulmonary veins

41. Systemic Venous anomalies

42. 3-D if available (subcostal)

43. 3-D if available (apical 4)

44. Further information Two additional webinars in March
Online information via the CHSS website:
Ongoing open forum with Echo core and Data Center

45. 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

46. Questions ?
Thank you for your participation