Hostname: page-component-7c8c6479df-nwzlb Total loading time: 0 Render date: 2024-03-18T00:21:40.567Z Has data issue: false hasContentIssue false

Relationship between scooping of the ventricular septum, morphology of the inferior bridging leaflet and electrocardiographic findings in atrioventricular septal defect with common valvar orifice

Published online by Cambridge University Press:  19 August 2008

Kiyoshi Suzuki*
Affiliation:
From the Department of PediatricsSakakibara Heart Institute, Tokyo
Katsuhiko Tatsuno
Affiliation:
Department of Cardiac Surgery, Sakakibara Heart Institute, Tokyo
Shigekazu Mimori
Affiliation:
From the Department of PediatricsSakakibara Heart Institute, Tokyo
Yasuo Murakami
Affiliation:
From the Department of PediatricsSakakibara Heart Institute, Tokyo
Katsuhiko Mori
Affiliation:
From the Department of PediatricsSakakibara Heart Institute, Tokyo
Yukihiro Takahashi
Affiliation:
Department of Cardiac Surgery, Sakakibara Heart Institute, Tokyo
Toshio Kikuchi
Affiliation:
Department of Cardiac Surgery, Sakakibara Heart Institute, Tokyo
*
Dr. Kiyoshi Suzuki, Department of Pediatrics, Sakakibara Mean Institute, 2-5-4 Yoyogi, Shibuya-ku, Tokyo 151, Japan. Tel. 81-3-3375-3111; Fax. 81-3-3375-9218.

Abstract

We described previously that the degree of deficiency of the ventricular septum (scooping) affects electrocardiographic findings in atrioventricular septal defect with separate right and left atrioventricular orifices. The aim of this study was to clarify the clinicomorphological relationships of the degree of scooping, the precise morphology of the atrioventricular valve, and electrocardiographic findings in hearts having a common atrioventricular orifice. In 63 patients with usual atrial arrangement, the outlet, scoop and inlet dimensions of the ventricular septum were measured by biplanar cineangiography and were compared with the body surface area. The scoop/outlet ratio and inlet/outlet ratio were also compared with the body surface area, atrioventricular valvar morphology, electrocardiographic findings, and severity of regurgitation of the atrioventricular valve. The results showed that the three individual dimensions of the septum correlated significantly with the body surface area, even though the scoop/outlet ratio and inlet/outlet ratio did not. A correlation was found between the scoop/outlet ratio and the degree of left axis deviation on the electrocardiogram (r=0.74, p<0.001). In 16 patients with division of the inferior bridging leaflet, there was a lower scoop/outlet ratio than in the remaining 37 with an undivided bridging leaflet (p<0.01). Of 24 patients with counterclockwise rotation in the horizontal loop of the vectorcardiogram, 22 had an undivided inferior bridging leaflet (p<0.01). The morphology of the superior bridging leaflet, in contrast, was not associated with the scoop/outlet ratio, and neither was the severity of valvar regurgitation. We conclude that the degree of scooping of the ventricular septum is related not only to electrocardiographic findings, but also to the morphology of the inferior bridging leaflet in atrioventricular septal defect with common atrioventricular orifice.

Type
Original Manuscripts
Copyright
Copyright © Cambridge University Press 1996

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Suzuki, K, Murakami, Y, Tatsuno, K, Takahashi, Y, Kikuchi, T, Mori, K, Mimori, S. Atypical form of atrioventricular septal defect without left axis deviation: relation between morphology and unusual QRS-axis. Br Heart J 1993; 70: 180184.Google Scholar
2. Suzuki, K, Mimori, S, Murakami, Y, Mori, K, Tatsuno, K, Kikuchi, T, Takahashi, Y, Ohtaki, E. The degree of scooping of the interventricular septum influences electrocardiographic findings in atrioventricular septal defect. Cardiol Young 1995; 5: 262266.CrossRefGoogle Scholar
3. Becker, AE, Anderson, RH. Atrioventricular septal defects: What's in a name? J Thorac Cardiovasc Surg 1982; 83: 461469.CrossRefGoogle Scholar
4. Anderson, RH, Baker, EJ, Ho, SY, Rigby, ML, Ebels, T. The morphology and diagnosis of atrioventricular septal defects. Cardiol Young 1991; 1: 290305.Google Scholar
5. Allwork, SP. Anatomical-embryological correlates in atrioventricular septal defect. Br Heart J 1982; 47: 419429.CrossRefGoogle ScholarPubMed
6. Wenink, ACG, Gittenberger-deGroot, AC, Brom, AG. Developmental considerations of mitral valve anomalies. Int J Cardiol 1986; 11: 8598.CrossRefGoogle ScholarPubMed
7. Wenink, ACG, Zevallos, JC. Developmental aspects of atrioventricular septal defects. Int J Cardiol 1988; 18: 6578.CrossRefGoogle ScholarPubMed
8. Macartney, FJ, Rees, PG, Daly, K, Piccoli, GP, Taylor, JFN, De Leval, MR, Stark, J, Anderson, RH. Angiocardiographic appearances of atrioventricular defects with particular reference to distinction of ostium primum atrial septal defect from common atrioventricular orifice. Br Heart J 1979; 42: 640656.Google Scholar
9. Towbin, R, Schwartz, D. Endocardial cushion defects: embryology, anatomy, and angiography. Am J Roentgenol 1981; 136: 157162.Google Scholar
10. Amplatz, K, Moller, JH. Radiology of Congenital Heart Disease. Mosby Year book, St. Louis, 1993.Google Scholar
11. Feldt, RH, DuShane, JW, Titus, JL. The atrioventricular conduction system in persistent common atrioventricular canal defect: correlations with electrocardiogram. Circulation 1970; 42: 437444.Google Scholar
12. Thiene, G, Wenink, ACG, Frescura, C, Wilkinson, JL, Gallucci, V, Ho, SY, Mazzucco, A, Anderson, RH. Surgical anatomy and pathology of the conduction tissues in atrioventricular defects. J Thorac Cardiovasc Surg 1981; 82: 928937.Google Scholar
13. Ongley, PA, Pongpanich, B, Spangler, JG, Feldt, RH. The electrocardiogram in atrioventricular canal. In: Feldt, RH (ed). Atrioventricular Canal Defects. W.B. Saunders, Philadelphia, 1976, pp 5175.Google Scholar
14. Piccoli, GP, Gerlis, LM, Wilkinson, JL, Lozsadi, K, Macartney, FJ, Anderson, RH. Morphology and classification of atrioventricular defects. Br Heart J 1979; 42: 621632.Google Scholar
15. Penkoske, PA, Neches, WH, Anderson, RH, Zuberbuhler, JR. Further observations on the morphology of atrioventricular septal defects. J Thorac Cardiovasc Surg 1985; 90: 611622.Google Scholar
16. Ebels, T, Anderson, RH, Devine, WA, Debich, DE, Penkoske, PA, Zuberbuhler, JR. Anomalies of the left atrioventricular valve and related ventricular septal morphology in atrioventricular septal defects. J Thorac Cardiovasc Surg 1990; 99: 299307.Google Scholar
17. Akiba, T, Becker, AE, Neirotti, R, Tatsuno, K. Valve morphology in complete atrioventricular septal defect: Variability relevant to operation. Ann Thorac Surg 1993; 56: 295299.Google Scholar
18. Ebert, PA, Goor, DA. Complete atrioventricular canal malformation: Further clarification of the anatomy of the common leaflet and its relationship to the VSD in surgical correction. Ann Thorac Surg 1978; 25: 134143.Google Scholar
19. Piccoli, GP, Wilkinson, JL, Macartney, FJ, Gerlis, LM, Anderson, RH. Morphology and classification of complete atrioventricular defects. Br Heart J 1979; 42: 633639.Google Scholar
20. Minich, LA, Snider, AR, Bove, EL, Lupinetti, FM, Vermilion, RP. Echocardiographic evaluation of atrioventricular orifice anatomy in children with atrioventricular septal defect. J Am CollCardiol 1992; 19: 149153.CrossRefGoogle ScholarPubMed
21. Zellers, TM, Zehr, R, Weinstein, E, Leonard, S, Ring, WS, Nikaidoh, H. Two-dimensional and Doppler echocardiogra-phy alone can adequately define preoperative anatomy and hemodynamic status before repair of complete atrioventricular septa! defect in infants < 1 year old. J Am Coll Cardiol 1994; 24: 15651570.Google Scholar
22. Marino, B. Atrioventricular septal defect—anatomic characteristics in patients with and without Down's syndrome. Cardiol Young 1992; 2: 308310.CrossRefGoogle Scholar
23. Marino, B, Akiba, T, Becker, AE, Neirotti, R, Tatsuno, K. Complete atrioventricular septal defect in patients with and without Down's syndrome. Ann Thorac Surg 1994; 57: 16871688.CrossRefGoogle ScholarPubMed