The outcome of biventricular (BV) repair for right-dominant unbalanced atrioventricular
canal has remained poor, because it is difficult to predict left ventricular (LV)
adequacy before surgery. Our aim was to determine whether preoperative echocardiographic
parameters, specifically analysis of color inflow into the LV, would predict survival
after BV repair in patients with right-dominant unbalanced atrioventricular canal.
Subjects with right-dominant unbalanced atrioventricular canal diagnosed from 1994
to 2007 were included. The echocardiographic parameters were analyzed blinded to the
palliation strategy and survival. The LV inflow index (LVII) was calculated as the
secondary color inflow diameter indexed to the left atrioventricular valve (AVV) annulus
diameter. Univariate analysis, survival analysis, and multivariate modeling with stepwise
logistic regression were performed. Of the 45 subjects, 23 (51%) underwent single
ventricle (SV) palliation and 22 (49%) underwent BV repair. Of the 23 who underwent
SV palliation, 15 (65%) survived compared to 18 (82%) of 22 who underwent BV repair
(p = 0.34). In the BV group, a greater LVII predicted survival (R2 = 0.46, p = 0.03).
No subjects with a LVII <0.5 survived BV repair. Mortality in the BV group was associated
with younger age at initial surgery (p <0.01) and abnormal left AVV morphology (p
= 0.02). Of the BV subjects with a patent ductus arteriosus at the initial operation
(n = 11), the nonsurvivors were more likely to have retrograde flow in the transverse
arch (p <0.01). In the BV group, reoperation within 30 days of the initial repair
was strongly associated with mortality (p <0.01). In conclusion, in cases of mild
or moderate LV hypoplasia, a greater LVII predicted survival after BV repair in patients
with right-dominant unbalanced atrioventricular canal. We propose incorporation of
the LVII into the echocardiographic assessment of these patients.
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Article Info
Publication History
Accepted:
August 17,
2010
Received in revised form:
August 17,
2010
Received:
May 24,
2010
Identification
Copyright
© 2011 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
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- Right-Dominant Unbalanced Atrioventricular Canal and Genetic SyndromesAmerican Journal of CardiologyVol. 108Issue 10
- PreviewWe read the interesting report by Szwast et al1 in a recent issue of The American Journal of Cardiology. The investigators analyzed the predictors of survival after biventricular repair in patients with right-dominant unbalanced atrioventricular canal. Regarding the presence of genetic syndromes among 45 patients analyzed in the study, only 6 (13.3%) had trisomy 21, and all underwent successful biventricular repair.1 These data confirm previous observations on the prevalence of left ventricular hypoplasia in children with non–Down syndrome atrioventricular canal2 and the general good surgical prognosis in children with atrioventricular canal and Down syndrome.
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