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The comparative relationships between locations of the papillary muscles and electrophysiologic QRS axis in patients with atrioventricular septal defect and common as opposed to separate orifices in the valve guarding the common atrioventricular junction

Published online by Cambridge University Press:  18 April 2016

Liying Low ,
Salim F. Idriss ,
Robert H. Anderson ,
Charles Maynard ,
Galen Wagner  and
Nina Hakacova
Liying Low
Affiliation:
Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
Salim F. Idriss
Affiliation:
Duke University Medical Center, Divisions of Cardiology and Pediatric Cardiology, Durham North Carolina, United States of America
Robert H. Anderson
Affiliation:
Institute of Genetic Medicine, Newcastle University, Newcastle-upon-Tyne, United Kingdom
Charles Maynard
Affiliation:
Department of Health Services University of Washington Seattle, Washington, United States of America
Galen Wagner
Affiliation:
Duke University Medical Center, Divisions of Cardiology and Pediatric Cardiology, Durham North Carolina, United States of America
Nina Hakacova*
Affiliation:
Children’s Heart Centre, Children’s University Hospital, Lund, Sweden
*
Correspondence to: Associate Professor N. Hakacova, MD, PhD, Children’s Heart Centre, Barnhjärtcentrum, Skane University Hospital, SE-221-85 Lund, Sweden. Tel: +46 4 617 3309; Fax: +46 4 610 8150; E-mail: nina.hakacova@gmail.com
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Abstract

Background

Knowledge regarding factors that influence deviation of the QRS axis is important when seeking to differentiate between physiological and pathological changes. We hypothesised that, in contrast to those patients with an atrioventricular septal defect and common atrioventricular junction permitting only atrial shunting, those associated with ventricular shunting would show no relationship between the positions of the papillary muscles and the degree of the leftward deviation of the QRS axis.

Methods

We compared the positions of endocardial origin of the papillary muscles, and the frontal plane QRS axis, in patients with atrioventricular septal defects and common atrioventricular junction permitting exclusively atrial as opposed to atrial and ventricular shunting.

Results

We analysed 18 patients with atrial and ventricular shunting and 23 patients with exclusively atrial shunting. The correlation coefficient between the ratio of distances of the papillary muscles from the mid-septum and the amount of leftward deviation in the frontal plane QRS axis was 0.1 (p=0.4) in those with ventricular shunting and 0.26 (p=0.01) in those with exclusively atrial shunting.

Conclusions

In contrast to patients with the so-called primum form of atrioventricular septal defect, in whom the locations of the papillary muscles correlate with the degree of QRS axis, such relationships are lacking in patients with defects permitting both atrial and ventricular shunting. It may be, therefore, that the presence of ventricular shunting and/or their younger age causes pressure overload, which negates the leftward QRS forces caused by the abnormally positioned papillary muscles.

Keywords

QRS axispapillary musclesatrioventricular septal defect
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 2 , March 2017 , pp. 261 - 266
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Copyright
© Cambridge University Press 2016 

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