Atrioventricular septal defect surgery

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Surgery

The image below shows repair of the atrioventricular cleft in a case of atrioventricular septal defect.

The image below shows repair of the mitral cleft in a case of atrioventricular septal defect.

2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines[1]

2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines^[1]

Therapeutic Recommendations for Atrioventricular Septal Defect

Class I
1. Surgery for severe left atrioventricular valve regurgitation is recommended per GDMT indications for mitral regurgitation.(Level of Evidence: C-LD)
2.Surgery for primary repair of atrioventricular septal defect or closure of residual shunts in adults with repaired atrioventricular septal defect is recommended when there is a net left-to-right shunt (Qp:Qs ≥1.5:1), PA systolic pressure less than 50% systemic and pulmonary vascular resistance less than one third systemic. (Level of Evidence: C-EO)

Class IIa
1.Operation for discrete LVOT obstruction in adults with atrioventricular septal defect is reasonable with a maximum gradient of 50 mm Hg or greater, a lesser gradient if HF symptoms are present, or if concomitant moderate-to-severe mitral or AR are present. (Level of Evidence: C-EO)

Class IIb
1.Surgery for primary repair of atrioventricular septal defect or closure of residual shunts in adults with repaired atrioventricular septal defect may be considered in the presence of a net left-to-right shunt (Qp:Qs ≥1.5:1), if PA systolic pressure is 50% or more systemic, and/or pulmonary vascular resistance is greater than one third systemic. (Level of Evidence: C-EO)

2008 ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease (DO NOT EDIT)[2]

2008 ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease (DO NOT EDIT)^[2]

Recommendations for Surgical Therapy (DO NOT EDIT)^[2]

Class I
“1. Surgeons with training and expertise in CHD should perform operations for AVSD.(Level of Evidence: C)”
“2. Surgical reoperation is recommended in adults with previously repaired AVSD with the following indications:”
“a. Left AV valve repair or replacement for regurgitation or stenosis that causes symptoms, atrial or ventricular arrhythmias, a progressive increase in LV dimensions, or deterioration of LV function. (Level of Evidence: B)”
“b. LVOT obstruction with a mean gradient greater than 50 mm Hg or peak instantaneous gradient greater than 70 mm Hg, or a gradient less than 50 mm Hg in association with significant mitral regurgitation or AR. (Level of Evidence: B)”
“c. Residual/recurrent ASD or VSD with significant left-to-right shunting (refer to Section 2.0, Atrial Septal Defect, and Section 3.0, Ventricular Septal Defect). (Level of Evidence: B)”

References

↑ Stout KK, Daniels CJ, Aboulhosn JA, Bozkurt B, Broberg CS, Colman JM; et al. (2019). “2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines”. J Am Coll Cardiol. 73 (12): 1494–1563. doi:10.1016/j.jacc.2018.08.1028. PMID 30121240.
↑ ^2.0 ^2.1 Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA; et al. (2008). “ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons”. J Am Coll Cardiol. 52 (23): e1–121. doi:10.1016/j.jacc.2008.10.001. PMID 19038677.

Template:WH Template:WS CME Category::Cardiology

[pmid30121240-1] Stout KK, Daniels CJ, Aboulhosn JA, Bozkurt B, Broberg CS, Colman JM; et al. (2019). “2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines”. J Am Coll Cardiol. 73 (12): 1494–1563. doi:10.1016/j.jacc.2018.08.1028. PMID 30121240.

[pmid19038677-2] 2.0 ^2.1 Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA; et al. (2008). “ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons”. J Am Coll Cardiol. 52 (23): e1–121. doi:10.1016/j.jacc.2008.10.001. PMID 19038677.

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