Localization of Regurgitant Common Atrioventricular Valve Commissures in Atrioventricular Septal Defects Using Color Flow Doppler Echocardiography
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Authors
Yanock, Christa M.
Issue Date
1992
Type
Thesis
Language
en_US
Keywords
Alternative Title
Abstract
The commissures of the five-leaflet common atrioventricular (A V) valve
characteristic of the atrioventricular septal defect (AVSD) can be seen en face
using a subcostal 2-dimensional echocardiographic imaging plane. If color flow
Doppler is superimposed on this view, regurgitant AV valve flow can be
localized to the specific incompetent commissure. To determine the accuracy of
this technique, all children (n=8) undergoing surgical repair of an AVSD from
January 1, 1992 to March 25, 1992 were prospectively studied using 2-
dimensional and color Doppler echo cardiography. The comparisons were made
with surgical observation of the regurgitant commissure determined after injection
of saline. The patients ranged in age from 3 months to 39 years, weight from
5.7 kg to 55.0 kg, BSA from 0.26 m2 to 1.45 m2.
Three patients had a single orifice valve and five had a 2-orifice common AV valve. Ventricular hypoplasia
did not occur in any of the patients. The regurgitant commissures were
determined using a subcostal imaging plane where the plane of sound was
rotated to see the AV valve en face. Color flow Doppler was superimposed on
this view and commissures where regurgitant flow occurred were located. Five
patients had regurgitant flow preoperatively at the commissure between the
antero-superior and anterior bridging leaflets, 5 between the left mural and the
posterior bridging leaflets, 0 between the posterior bridging and the right mural
leaflets, 0 between the right mural and the antero-superior leaflets, and 4
between the anterior bridging and posterior bridging leaflets. With the
echo cardiographic techniques, 11 of 15 commissures with regurgitant flow were
correctly identified. The echocardiographic techniques allowed correct
identification of regurgitant flow with a 100% sensitivity and 89% specificity.
The positive predictive valve of this technique was 73%. There was no
correlation between orifice number, ventricular hypoplasia, or commissural
location and the determination of the location of regurgitant flow. Thus, in
patients with an AVSD, the regurgitant commissure can be located by adding
color flow Doppler to the subcostal en face 2-dimensional imaging plane.
Description
vii, 40 p.
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