Atrioventricularis Communis Research Articles

Early arrhythmia after cardiac surgery in children with congenital heart disease

Objective. To analyze the frequency and risk factors for arrhythmia in children with congenital heart disease in the early period after cardiac surgery. Materials and methods. A retrospective analysis of the incidence and risk factors for arrhythmia in 285 children who underwent cardiac surgery in the Department of Surgical Treatment of Congenital Heart Diseases in Newborns and Young Children at the Amosov National Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine for the period from 2021 to 2023 was performed. There were 202 children under the age of 18. Results. In the early postoperative period, heart rhythm disturbances occurred in 53 (26.2%) of 202 patients: 28 had supraventricular tachycardia, 16 had bradyarrhythmia (atrioventricular block), 6 had ventricular tachycardia, and 3 had nodal ectopic tachycardia. It was found that plastic surgery of the interventricular and atrial septal defect in isolation or in combination with interventions for other defects (Fallot's tetrad, transposition of the great vessels, atrioventricular communication) and bidirectional and total cavopulmonary anastomoses are associated with a high risk of arrhythmia. Statistically significant (p < 0.05) risk factors for arrhythmia were: lactate level of more than 2 mmol/L, duration of cardiopulmonary bypass more than 185 minutes, duration of aortic clamping more than 67 minutes. Conclusions. Arrhythmia often complicates the course of the early period after cardiac surgery in children and requires timely and correct action. Prolonged cardiopulmonary bypass, aortic constriction, and lactatidosis are risk factors for arrhythmia. Plastic surgery of the interventricular and atrial septal defects, as well as palliative reconstructive heart surgery, are associated with frequent cardiac arrhythmias in the early postoperative period.

Prenatal ultrasound diagnostics of atrioventricular communication in combination with the tetralogy of Fallot in a fetus with Down's syndrome phenotype

This article presents a description of our own case of ultrasound prenatal diagnostics of complex combined heart disease (complete atrioventricular communication in combination with tetralogy of Fallot) at 19–20 weeks of gestation with ultrasound markers of Down's syndrome in fetus. Pregnancy termination was performed at 21 weeks. Prenatal diagnosis was fully confirmed at the fetus autopsy. This publication discusses the frequency, mechanism of occurrence of such a combination of congenital heart defects, prenatal management, methods, timing and efficiency of surgical correction after birth. Complete atrioventricular communication occurs in approximately 1.7–2% patients with tetralogy of Fallot, and tetralogy of Fallot occurs in 5–10% of patients with atrioventricular communication, most often in patients with Down's syndrome. It is believed that tetralogy of Fallot and a complete defect of the atrioventricular septum develop as a result of different mechanisms, but their joint occurrence is recognized as an association. The prevalence of such a combination in Down syndrome indicates the general foundations of its development.Sonographic diagnosis of atrioventricular communication and tetralogy of Fallot is usually not difficult for prenatal screening. Main diagnostic criteria for complete atrioventricular communication at routine ultrasound screening and targeted fetal echocardiography are an abnormal 4-chamber image of the heart in the form of a common atrioventricular junction and a common five-leafed atrioventricular valve. Typical prenatal sonographic signs of the tetralogy of Fallot are a high defect of the interventricular septum, expansion of the aortic root, displacement of the aorta forward and to the right, narrowing of the pulmonary artery at the level of the valve ring from minor to complete atresia, it is also possible reduction the size of the right ventricle and increasing the size of the left ventricle.The combination of atrioventricular communication with the tetralogy of Fallot refers to severe congenital heart defects requiring surgical correction.

Organization of Cardiosurgical Care for Children with Congenital Heart Diseases in Children Under One Year with Determination of Risk Factors of Surgical Treatment

Background: Congenital heart defects are represented by numerous nosological forms. Today is known to be more than 90 variants of congenital heart defects (СHD) and their combinations. In the structure of the CHD 1st place occupies the defect of the interstitial septum, which according to various authors is 30-50% of all congenital defects of the heart, 2nd place - open arterial duct (10%), defect of the interstitial artery, interstitial defect, tetrad Fallo, transposition of main vessels, atrioventricular communication do not exceed 5-7% of each defect. The share of the remaining congenital malformations of the heart is less than 1-2%. Aim: To study the factors of the condition and organization of cardiac surgery to children with congenital heart defects Center for Perinatology and Pediatric Cardiac Surgery. Methods: From November 20, 2011 to December 29, 2018, the Center for Perinatology and Pediatric Cardiac Surgery treated 1,098 children aged 1 year, 175 of whom were newborns (15.9%). Of the last 27 were restricted to conservative treatment. Eight (29.6%) of these patients died from hypoxia and / or cardiac insufficiency, which were incompatible with life, as well as from congenital pathology of other organs and systems. In the remaining 148 (81.7%) cases, various surgical interventions were performed. Results: The comparison of the risk group shows that there was no difference between them in the structure of the main critical CHD. He drew attention to the fact that the increase in the number of risk factors (RF) was associated with an increase in the number of obstructive lesions of the left ventricle and aortic arch. The difference between the groups RF (0) -RF (3), RF (0) -RF (4), RF (2) -RF (3) and RF (2) -RF (4) according to the number of these patients was reliable (r) <0.05). Thus, this pathology was the most dangerous in relation to the accompanying problem. As the number of risk factors increased naturally, the number of patients in the corresponding groups decreased, and the level of mortality increased. Considering all the variants of the outcome (recurrence of postoperative complications, lethality), the most weighted isolated risk factors were “artificial ventilation”, “ intrauterine infection” and “Inconsistency”, with the exception of the 2nd, 2nd and 3rd versions, respectively. 5- 9.9 times. The most dangerous in this aspect are “Syndromes”, “GIEP”. Conclusion: Risk factors are predictors of specific postoperative complications: outbreaks of encephalopathy occur in cerebral complications in 5.4% of newborns, intrauterine infection, 30%, and 30% of coronary heart disease. Assessment of the significance of the origin of non-surgical factors determines the most “weak link”, and proves the necessity of the mandatory use of algorithms and protocols of individual congenital anomalies of congenital heart disease and congenital heart disease.

Ехокардіографічна оцінка додаткових аномалій лівого атріовентрикулярного клапана у пацієнтів з повною атріовентрикулярною комунікацією

Ехокардіографічна оцінка додаткових аномалій лівого атріовентрикулярного клапана у пацієнтів з повною атріовентрикулярною комунікацією

Results of Hemodynamic Correction in Patients with Double Outlet Right Ventricle

Aim. To analyze results of hemodynamic correction in surgical treatment of double outlet right ventricle (DORV).&#x0D; Маterials and methods. For the period from January 1996 to September 2017, 31 (6.03 % of total number of patients with DORV) patients underwent hemodynamic correction of DORV. The age of the patients ranged from 1 to 19 years (71.2 ± 50.5 months on the average). The weight of the patients ranged from 9 to 41 kg (19.6 ± 11.3 kg on the average). Of these, 19 (61.3 %) were male patients and 12 (38.7 %) were female patients. The overwhelming majority (25 (80.6 %)) of the patients were diagnosed with transposition-type DORV. The anatomy of DORV with non-committed ventricular septal defect was observed in 5 (16.1 %) patients. In one patient (3.1 %), the anatomy of DORV (in the form of tetralogy of Fallot) was combined with tricuspid valve atresia.&#x0D; Results. The main reasons of hemodynamic correction in 16 (51.6 %) cases was LV hypoplasia. In 2 cases it was combined with tricuspid valve (TV) straddling, and in 2 cases it was an integral part of the unbalanced form of complete atrio-ventricular communication (AVC). In one case (3.1 %), the unbalanced form of complete AVC was combined with a mixed form of the common ventricle. The mixed form of the common ventricle was the reason of hemodynamic correction in 9 (29 %) patients. In 2 (6.2 %) cases, hemodynamic correction was performed due to the anatomy of the RV hypoplasia. In the remaining 2 patients, anatomy of the common ventricle was not diagnosed, but a combination of other concomitant defects was a contraindication to biventricular correction. Palliative operations (Blalock-Taussig shunt, BTS) as the first stage of correction were performed in 16 (51.6 %) patients. In 2 patients with LV outflow tract obstruction, systemic-pulmonary anastomosis was applied in combination with plastic repair of the great vessel roots using the proprietary technique for elimination of the left ventricular outflow tract (LVOT) stenosis. Bidirectional cavopulmonary anastomosis (BCPA) was applied in 29 (93.5 %) cases. Of these, 4 (13.8 %) patients subsequently underwent total cavopulmonary anastomosis (TCPA) procedure. Two patients with good hemodynamic parameters underwent TCPA without prior palliative procedures.&#x0D; Conclusion. Palliative surgery as the first stage to hemodynamic correction is accompanied by significant improvement in hemodynamic parameters of patients. Application of BCPA as the second stage of hemodynamic correction provides good results and is required to prepare the patient for TCPA. The long-term period is characterized by improvement in the quality of life in patients with complex DORV. In the long-term period, 85.2 % of patients are classified as NYHA FC I.

Atrioventricular junction symmetry in children with different anatomical variants of atrioventricular communication: echocardiographic parameters

Atrioventricular (AVC) communication is a group of congenital heart diseases with common atrioventricular connection. The symmetry of the connection and, as a result, anatomy and physiology of atrio-ventricular infl ow plays the key role in possibility of double-ventricle correction in this anomaly. Nowadays there is tendency to mix new concepts with described parameters that characterize AVC in one whole guidelines. The ultimate pathway has to be the one that minimizes morbidity and mortality outcomes. In the article author present the correlation between main cardiac echocardiography measurements, that characterize the symmetry of atrioventriculat connection (atrioventricular valves indexes, left ventricle inflow index, inflow angle between left and right ventricles) and their correlation with size of common atrio-ventricular valve and ventricle’s size. Key words: unbalanced atrioventricular communication, atrioventricular valve index, left ventricular flow index, inflow angle between right and left ventricles, ventricular cavity index.

SURGICAL TREATMENT OF COMPLETE (INTERMEDIATE) FORM OF ATRIOVENTRICULAR COMMUNICATION IN CHILDREN

Analysis of surgical treatment of 91 patients with atrioventricular communication, operated in the Republican Scientific and Practical Center for Pediatric Surgery from 2008 to 2016. An algorithm of a surgical treatment method for atrioventricular communication is presented. Due to the impossibility of performing a radical correction (patient weight less than 3 kg, pulmonary hypertension of III-IV degree), pulmonary artery banding is performed as the first stage of CHD correction.

УСПЕШНОЕ ПРИМЕНЕНИЕ V-A ЭКМО В ДЕТСКОЙ КАРДИОХИРУРГИИ: СЛУЧАЙ ИЗ ПРАКТИКИ

Despite the world experience in the use of extracorporeal membrane oxygenation (ECMO), the lethality among&nbsp;cardiac patients receiving ECMO ranges from 50 to 60%. The possibility to conduct ECMO in the Republican&nbsp;Scientific and Practical Center for Pediatric Surgery appeared in 2016.&nbsp;We present a clinical case of the successful use of ECMO in a patient aged 10 months after the second stage&nbsp;of correction of congenital heart disease: atrioventricular communication, complete form.&nbsp;ECMO is an effective method of cardiopulmonary function prophylaxis, which reduces the risk of multiple&nbsp;organ dysfunction. Timely initiation of the procedure increases the likelihood of a successful outcome.

Health condition analysis in adults with surgically corrected congenital heart defect (on the example of atrioventricular canal defect)

The estimation of the surgery was carried out, the most common forms of the disorder, which occur after surgical treatment in adult patients with atrioventricular communication, were determined. The aim of research was to investigate the main clinical and echocardiography changes occurred in adults after surgery directed to atrioventricular communication for the further dispensary system improvement. Methods. Retrospective analysis of the spread of congenital heart disease - atrioventricular communication in 12 adults aged 18-28 years treated in Municipal Institution Lviv Regional Children's Hospital during 2009-2016. Statistical methods included relative and average values calculation, their average errors, the assessment of the probability of difference between the obtained results in the comparable groups using Student's t test. Results. It was found that both men and women after atrioventricular communication surgical treatment in childhood had poor quality of life due to physical and emotional condition worsening. Significant part of the patients still suffered from mitral and tricuspid insufficiency, heart failure of 1-2 degree, pulmonary artery regurgitation of 1 degree, and chamber hypertrophy. Conclusion. The mentioned group of patients needs lifelong medical care by specialists (cardiologists, surgeons, psychologists, physitians and other) for timely qualified care, prescriptions determination, and reoperations within optimal terms

Cлучай успешного протезирования митрального клапана через 55 лет после коррекции частичной атриовентрикулярной коммуникации на «сухом» сердце

Cлучай успешного протезирования митрального клапана через 55 лет после коррекции частичной атриовентрикулярной коммуникации на «сухом» сердце

Evaluation of the efficiency of one-stage and two-stage correction of the full form of atrioventricular communication complicated by pulmonary hypertension

Evaluation of the efficiency of one-stage and two-stage correction of the full form of atrioventricular communication complicated by pulmonary hypertension

Three-Dimensional Ultrasound Findings in Cornelia de Lange Syndrome: A Case Report

Introduction. The objective is to report a case of Cornelia de Lange syndrome (CdLS) diagnosed by detailed observations using three-dimensional sonography. Case Report. A 33-year-old healthy multipara was referred to our hospital at 34-week gestation after severe fetal growth restriction, congenital heart anomaly, and antebrachium abnormality were diagnosed during the third trimester. Further sonography diagnosis on cardiac abnormalities diagnosed the existence of ventricular septal defect in the outflow tract, atrioventricularis communis, and truncus arteriosus communis where the pulmonary artery branched from the common arterial trunk. As for abnormalities of the forearms, ectrodactylia and monodactylism were suspected and the abnormalities were observed sterically by using three-dimensional sonography. A 1986 g (1.07 percentile) male newborn was delivered by assisted breech extraction at 37-week gestation. After birth, from characteristic facies including bushy eyebrow, broad nasal bridge, micrognathia, and abnormalities of the forearms (ectrodactylia and monodactylism), the case was diagnosed with CdLS. Conclusion. Through detailed observation including abnormalities of fingers, we could exemplify this very rare disease as an antenatal diagnoses for fetal growth retardation.

Achieving Excellence

Achieving Excellence

Invited commentary

Today’s treatment of complex congenital cardiovascular defects of the right ventricular outflow tract, such as hypoplastic, stenotic right ventricular outflow tract, or the pulmonary artery in tetralogy of Fallot, are far from optimal as generally nonviable patch materials are used. This results in repeated surgical intervention for two reasons. First, the patch reconstruction and the absence of a functional pulmonary valve will lead to right ventricular failure, increased tricuspid valve regurgitation, and ventricular arrhythmias. Second, material degeneration will result in obstructive pannus overgrowth and calcification after implantation. Tissue engineering can overcome these disadvantages using a biodegradable scaffold that can be in vitro or in vivo re-cellularized to allow regeneration, remodeling, and growth potential. The present study by Fujimoto and colleagues [1Fujimoto K.L. Guan J. Oshima H. Sakai T. Wagner W.R. In vivo evaluation of a porous, elastic biodegradable patch for reconstructive cardiac procedures.Ann Thorac Surg. 2007; 83: 648-654Abstract Full Text Full Text PDF PubMed Scopus (106) Google Scholar] compared an elastomeric, biodegradable polyester urethane urea (PEUU) patch with a generally used expanded polytetrafluoroethylene (e-PTFE) patch implanted into the right ventricular outflow tract. This study, performed in the rat model, showed the superiority of the PEUU patches compared with the e-PTFE patches. The PEUU material showed high elasticity and strength and porous scaffold, allowing host fibroblast to grow into the scaffold and active synthesize collagen. In contrast there was no host cell ingrowth in the e-PTFE patch. Furthermore the PEUU scaffold was nearly completely absorbed after 12 weeks of implantation. Therefore the authors need to be congratulated for this performed study as the goal of tissue engineering has almost been completely achieved. Regeneration and remodelling potential of this biodegradable patch has been proven. Future studies will be needed, eventually in the larger animal model, to show growth potential as suggested by the authors. The impact of the biodegradable patch implanted into the right ventricular outflow tract needs to be discussed. At this early stage of right ventricular outflow tract treatment, pulmonary allografts show fast tissue degeneration and (due to the absence of viability) an outgrowth of the valve size by the patient after a short period of time. Therefore patch reconstruction of the right ventricular outflow tract is generally used to bridge the patient until a reasonable valve size can be implanted. Quality of life is limited for the patient until a valve has been implanted not to overestimate the right ventricular function. For this reason, tissue engineering should concentrate on developing a valve with regeneration, remodeling, and growth potential to overcome patch reconstruction and to allowing one-stage surgical treatment. The area of interests for biodegradable patch use would be more of those complex congenital heart diseases without the need of a valve function such as repair of complete atrioventricular communication, the Fontan procedure, enlargement of the aorta in the Norwood I procedure, or complex repair of coarctation of the thoracic aorta. In Vivo Evaluation of a Porous, Elastic, Biodegradable Patch for Reconstructive Cardiac ProceduresThe Annals of Thoracic SurgeryVol. 83Issue 2PreviewSeveral synthetic materials have been used for cardiac reconstruction in patients with complex congenital heart defects. These materials are not viable, do not grow with children, and may necessitate reoperation. We report here on the cardiac implantation of a recently developed, degradable porous material designed to facilitate cellular ingrowth during the healing process. Full-Text PDF

The Double Patch Repair for Complete Atrioventricularis Communis

This article is a review of our experience with the two-patch repair of complete atrioventricularis communis. From October 1988 through December 2005, 222 infants and children underwent surgery. There were six early (2.7%) and six late (2.7%) deaths. Reoperation was required in 22 patients (10%) for residual or recurrent mitral regurgitation or stenosis, subaortic stenosis, repair of a ventricular septal defect with or without pulmonary stenosis, placement of a right heart valved conduit, and/or placement of a permanent cardiac pacemaker. All patients survived second operations and no child required early or late mitral valve replacement. The two-patch repair is a reliable surgical technique resulting in low mortality and a low need for reoperation.

Fifty Years of Open Heart Surgery at the Mayo Clinic

Fifty Years of Open Heart Surgery at the Mayo Clinic

Cardiac Arrhythmias – Part III Narrow Complex Tachycardia

Narrow complex tachycardia usually refers to an abnormality of cardiac rhythm involving the tissues of the sinus node, atrial tissue, the atrioventricular node or an accessory atrioventricular communication. Although atrial fibrillation is the most common supraventricular arrhythmia, the term “supraventricular tachycardia” conventionally refers to the group of rhythm disturbances encompassing sinus tachycardia (appropriate and inappropriate), atrial tachycardia, atrial flutter, atrioventricular nodal reciprocating tachycardia (AVNRT) and atrioventricular reciprocating tachycardia (AVRT) including the Wolff Parkinson White syndrome (WPW). Atrial fibrillation is beyond the scope of this article which focuses on the diagnosis and acute management of the patient presenting with one of these common causes of a regular, narrow complex tachycardia.

The Past 50 Years of Cardiovascular Surgery

The Past 50 Years of Cardiovascular Surgery

Defeito do septo atrioventricular forma total associado a tricuspidização da valva atrioventricular esquerda na infância

Entre maio de 1987 e dezembro de 1996, o reparo do defeito do septo atrioventricular, forma total (DSAVT), com duplo retalho de pericárdio bovino e tricuspidização da valva atrioventricular (VAV) esquerda, foi realizado em 34 pacientes consecutivos com mortalidade global de 5 (14,7%) pacientes (pac.). Grupo I: abaixo de 6 meses (m) com 12 pac. (1 óbito; 8,3%); Grupo II: entre 7m e 12m, com 15 pac. (4 óbitos; 26,6%) e Grupo III: entre 1 e 5 anos (a) com 7 pac. sem óbitos. Ocorreram 2 óbitos tardios (1 por Insuficiência mitral residual + insuficiência cardíaca congestiva e outro por pneumonia + insuficiência respiratória). Duas crianças receberam implante de marcapasso definitivo (após 45 dias e 4 anos). Nenhum paciente foi reoperado, apesar de mais 2 apresentarem insuficiência da VAV esquerda e 1 VAV direita, controlada clinicamente, e as restantes encontram-se nos graus I e II da New York Heart Association (NYHA). Apesar de 29 pacientes apresentarem peso abaixo de 10 kg, utilizou-se circulação extracorpórea (CEC) e hipotermia a 25°C sem parada circulatória total. Iniciou-se o reparo pela zona de "aposição" da VAV única com um ou dois pontos em "x", mantendo tricúspide. Sutura-se o primeiro retalho de pericárdio bovino (PB) em forma de "gota", insinuando-o entre as cordas do lado direito do septo; a seguir, sutura-se o segundo retalho, fazendo uma aposição concomitante com a VAV única, septando-se, desta forma, as quatro cavidades. As vantagens desta técnica são: preservação da integridade valvar, maior durabilidade funcional da VAV esquerda, menor possibilidade de reoperação mesmo em pacientes mais jovens e que devem ser preferencialmente operados em torno de 6º mês de vida.

Prenatal diagnosis of a partial 8p

The index patient is a female fetus in which prenatal diagnosis of 8p trisomy was established after amniocentesis at 16 weeks of gestation. This fetus was the unbalanced product of a maternal translocation of 5q/8p (karyotype: 46,XX,t(5;8)(q35;p11). Internal malformations include an anomalous lobature of the right lung, a little and high atrio-ventricular communication, and an anomaly in the number and shape of the aortic semilunar valves. The possible relationship between the phenotype and the chromosomal abnormality is briefly discussed.