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Chapter 5 - Unbalanced Atrioventricular Septal Defect

from Section 1 - Left-to-Right Shunts

Published online by Cambridge University Press:  09 September 2021

By
Lori Q. Riegger
Edited by
Laura K. Berenstain  and
James P. Spaeth
Laura K. Berenstain
Affiliation:
Cincinnati Children's Hospital Medical Center
James P. Spaeth
Affiliation:
Cincinnati Children's Hospital Medical Center
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Summary

An atrioventricular septal defect is a defect in the center of the heart consisting of a common atrioventricular valve, a primum atrial septal defect, and an inlet ventricular septal defect. When the common valve is not positioned equally over both ventricles it is called an unbalanced atrioventricular septal defect. This unbalance leads to a decreased inflow of blood to one of the ventricles, and that ventricle and outflow tract are often hypoplastic. The degree of unbalance can vary widely, ranging from mild, which in effect is similar to a large ventricular septal defect, to severe, which can often involve a hypoplastic ventricle and dependence on a patent ductus arteriosus to provide adequate flow to the affected circulation. This chapter discusses the anesthetic management of a 1-day-old patient with trisomy 21 and an unrepaired, unbalanced atrioventricular septal defect undergoing a laparoscopic repair of duodenal atresia. Anesthetic concerns regarding patients with trisomy 21, physiologic changes with laparoscopic surgery and implications of an unbalanced atrioventricular septal defect are all examined in detail.

Keywords

complete atrioventricular septal defectDown syndromeduodenal atresialeft-to-right shuntnoncardiac surgerypneumoperitoneumsingle-ventricle palliationtrisomy 21unbalanced atrioventricular septal defect
Type
Chapter
Information
Congenital Cardiac Anesthesia
A Case-based Approach
 , pp. 25 - 32
Publisher: Cambridge University Press
Print publication year: 2021

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References

References

Owens, G. E., Gomez-Fifer, C., Gelehrter, S., et al. Outcomes for patients with unbalanced atrioventricular septal defects. Pediatr Cardiol 2009; 30: 431–5.CrossRefGoogle ScholarPubMed
Craig, B. Atrioventricular septal defect: from fetus to adult. Heart 2006; 48: 1879–85.Google Scholar

Suggested Reading

Backer, C. L. and Mavroudis, C. Atrioventricular canal defects. In Mavroudis, C., and Backer, C. L., eds., Pediatric Cardiac Surgery. Oxford: Wiley Blackwell, 2013; 342–60.Google Scholar
Cetta, F., Minich, L. L., Maleszewski, J. J., et al. Atrioventricular septal defects. In Allen, H., Driscoll, D. J., Shaddy, R. E., et al. eds. Moss and Adams’ Heart Disease in Infants, Children and Adolescents, 8th ed. Philadelphia: Lippincott Williams & Wilkins, 2013; 691–712.Google Scholar
Mitchell, M. E., Litwin, S. B., and Tweddell, J. S. Complex atrioventricular canal. Semin Thorac Cardiovasc Surg Pediatr Card Surg Ann 2007; 10: 32–41.CrossRefGoogle Scholar
Nicolson, S. C., Steven, J. M., Diaz, L. K., et al. Anesthesia for the patient with a single ventricle. In Andropoulos, D. B., Stayer, S., Mossad, E. B. et al. eds. Anesthesia for Congenital Heart Disease, 3rd ed. Hoboken, NJ: John Wiley & Sons, 2015; 567–97.Google Scholar
Sassalos, P., Si, M. S., Ohye, R. G., et al. Atrioventricular septal defects. In Ungerleider, R. M., Meliones, J. N., McMillan, K. N., et al. eds. Critical Heart Disease in Infants and Children, 3rd ed. Philadelphia, Mosby Elsevier, 2019; 606–14.Google Scholar

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