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 Baseline AVSD Echo Descriptive Analysis
 Baseline AVSD Echo Descriptive Analysis

Baseline AVSD Echo Descriptive Analysis - Description


Fall Work Weekend November 18 2016 James M Meza MD and David M Overman MD Study PI Measures of Inflow Physiology Modified atrioventricular valve index Cohen 1996 and Jegatheeswaran ID: 774935 Download Presentation

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Slide1

Baseline AVSD Echo Descriptive Analysis

Fall Work Weekend

November 18, 2016

James M. Meza, MD and David M. Overman, MD (Study PI)

Slide2

Measures of Inflow Physiology

Modified atrioventricular valve index (Cohen 1996 and Jegatheeswaran, 2010)Portion of AV valve allocated to each ventricular in the subxiphoid saggital ro LAO view Retrospective CHSS study – identified RV/LV inflow angle as best discriminator of unbalance (Cohen, 2013)Angle between the base of the right ventricle and left ventricle free wall using the crest of the ventricular septum as the apex of the angle

Slide3

Measures of Inflow Physiology

Left ventricular inflow index = Secondary inflow diameter/Primary inflow diameter (Swazst, 2011)Primary: level of left AVV annulus Secondary: color inflow jet diameter at level of papillary muscles

Slide4

Present Study

Imaging Core Lab (ICL) has been collecting and reading echoes for 2 years

Descriptive

analysis of baseline diagnostic echoes

Slide5

AVSD Cohort

Inclusion

c

riteria

Diagnosis of or referral with complete AVSD at a CHSS

institution

within

1

st

year

of life

Admitted to CHSS institution

after

January 1, 2012

Age ≤ 365 days at admission for surgery

Atrioventricular and

v

entriculoarterial

concordance

Includes

Tetralogy of

Fallot

and Double

Outlet Right

Ventricle

Exclusion

c

riteria

Partial or Transitional AVSD

Separate

AV valve orifices, restrictive VSD or intact ventricular

septum

TAPVC

or

PAPVC, aortic atresia,

Heterotaxy

First Intervention at a non-CHSS

institution

Slide6

Study Population

328 enrolled patients,149 with echoes read (59%)

 

Mean

Std

Median

IQR

Min-Max

Demographics

 

 

 

 

 

Age at echo

48

68

15

1-83

0-544

Height

51.6

6.3

50.0

48.0-56.0

34.0-67.3

Weight

3.6

1.2

3.3

2.8-4.2

1.3-8.3

BSA

0.2

0.05

0.2

0.2-0.3

0.1-0.4

Slide7

Clinical characteristics

 

Frequency

Complete AVSD (unrestrictive VSD)

100%

AV concordance

100%

VA concordance

100%

Normal pulmonary venous connection

99.5% (193/194)

Normal systemic venous connection

99.5% (193/194)

Additional

Diagnosis

 

Tetralogy of

Fallot

7% (13/194)

Systemic venous anomalies

3% (5/193)

LSVC to CS

7% (13/185)

LSVC Unroofed to LA

0%

Bilateral SVCs

6% (11/183)

Interrupted IVC to RSVC/LSVC

0%

Slide8

Echo Review Protocol

Single reviewer – Cheryl

Fakhoury

111 parameters

Slide9

Atrial and Ventricular Septae

 FrequencyMalalignment of atrial and ventricular septum 15% (25/186)Right (double outlet LA)8% (2/25%)Left (double outlet LA)92% (23/25)Ostium primum ASD 99.5% (193/194)Primum ASD restrictive 2% (4/192)

 

Mean

Std

Median

IQR

Min-Max

ASD size

0.7

0.4

0.6

0.4-0.9

0.1-2.3

Inlet VSD size: From PSSAx (cm)

0.6

0.2

0.6

0.5-0.7

0.2-1.1

Inlet VSD size: From Apical 4 (cm)

0.7

0.2

0.7

0.5-0.8

0.2-1.3

Slide10

Common AV Valve

 

Mean

Std

Median

IQR

Min-Max

Mural leaflet length

1.4

0.4

1.3

1.1-1.6

0.6-2.4

Mural leaflet width

0.9

0.2

0.9

0.7-1.0

0.4-1.5

Total CAVV diameter

2.4

0.4

2.4

2.1-2.7

0.9-3.6

RAVV area

1.7

0.7

1.6

1.2-2.1

0.4-4.8

LAVV area

1.4

0.6

1.2

0.9-1.7

0.4-3.7

Total area

3.1

1.1

3.0

2.2-3.8

1.1-7.9

2D measurement RAVV (apical 4) (cm)

1.4

0.3

1.4

1.2-1.6

0.6-2.3

Color inflow diameter at annulus RAVV (cm)

1.5

0.3

1.5

1.3-1.7

0.9-2.4

Color inflow diameter at mid cavity or at smallest inflow portion RAVV(cm)

0.8

0.2

0.8

0.7-0.9

0.4-1.5

2D measurement LAVV (apical 4) (cm):

1.2

0.2

1.2

1.1-1.4

0.6-1.8

Color inflow diameter at annulus (cm)

1.3

0.3

1.3

1.1-1.5

0.4-2.1

Color inflow diameter at mid cavity or at smallest inflow portion (cm)

0.7

0.2

0.7

0.6-0.8

0.1-1.9

Distance between two papillary muscles: (cm)

1.2

0.3

1.2

1.0-1.5

0.5-2.0

Slide11

Inflow Characteristics

 MeanStdMedianIQRMin-MaxmAVVI 0.450.100.440.39-0.510.18-0.69RV inflow – LV inflow angle 91.015.889.080.0-101.352.1-132.1Left ventricular inflow index 0.50.10.50.5-0.60.3-1.2

 

Frequency

Right-dominant

22% (42/194)

Balanced

53% (108/194)

Left dominant

5% (9/194)

Unable to determine (no

mAVVI

)

21% (41/194)

Slide12

Slide13

Slide14

Slide15

 FrequencyCommon AV Valve Regurgitation  Trivial 6% (11/194)Mild68% (132/194)Moderate22% (42/194)Severe5% (9/194)Left AV Valve regurgitation  None11% (22/193)Trivial 18% (35/193)Mild62% (120/193)Moderate8% (15/193)Severe1% (1/193)Right AV Valve regurgitation  None2% (4/193)Trivial 30% (57/193)Mild50% (97/193)Moderate15% (29/193)Severe3% (6/193)Rastelli Type  A79% (66/84)B2% (2/84)C19% (16/84)Papillary muscle abnormality32% (56/189)Too close30% (17/56)One hypoplastic 70% (39/56)Parachute0% Double orifice LAVV0.6% (1/160)

Slide16

Right Ventricle

 Frequency RV hypoplasia None88% (170/194)Trivial3% (6/194)Mild4% (7/194)Moderate4% (8/194)Severe1% (3/194)RV systolic dysfunction None97% (188/193)Mild2% (4/193)Moderate1% (1/193)Apex-forming RV 93% (179/192)

Mean

Std

Median

IQR

Min-Max

RV Area in End - Diastole (4 chamber view) (cm2)

4.3

1.5

4.0

3.2-5.3

1.5-8.3

RV Area in End - Systole (4 chamber view) (cm2)

2.8

1.0

2.7

2.1-3.4

0.8-5.6

Right Ventricle Fractional Area Change (Calculated field) (%)

35.3

7.7

34.5

30.7-39.1

0-75.9

RV length From AV Valve to apex (at end of QRS complex) (cm)

2.8

0.5

2.8

2.5-3.2

1.5-4.2

RV width (from the crest of the septum- RV side- to the free wall) (cm)

1.6

0.4

1.5

1.3-1.8

0.3-2.5

Slide17

Pulmonic Valve

MeanStdMedianIQRMin-MaxPV Annulus in systole (cm)1.00.21.00.9-1.10.3-1.4

Frequency

 

PV stenosis

 

None

90% (170/194)

Trivial

0.5% (1/194)

Mild

4% (7/194)

Moderate

4% (8/194)

Severe

1.5% (3/194)

PV regurgitation

 

None

39% (75/194)

Trivial

47% (91/194)

Mild

14% (28/194)

Slide18

RVOT

MeanStdMedianIQRMin-MaxPeak gradient (mmHg)36.527.427.215.2-54.46.9-109.8Mean gradient (mmHg)22.117.818.77.5-34.14.1-70.1

Frequency

 

RVOT Obstruction

9% (16/183)

Subvalvar

44% (7/16)

Valvar

13% (2/16)

Supravalvar

6% (1/16)

Diffuse

38% (6/16)

Slide19

Left Ventricle

Frequency

 

LV hypoplasia

 

None

90% (174/194)

Trivial

0.5% (1/194)

Mild

3% (6/194)

Moderate

3% (6/194)

Severe

3.5% (7/194)

Apex-forming LV

94% (181/192)

LV dysfunction Systolic

 

None

95% (183/192)

Mild

3% (6/192)

Moderate

1% (2/192)

Severe

1% (1/192)

Slide20

Left Ventricle

Mean

Std

Median

IQR

Min-Max

LVEDD (cm)

1.8

0.5

1.8

1.6-2.1

0.5-3.4

LVESD (cm)

1.1

0.3

1.1

0.9-1.3

0.3-2.5

LVEF (%)

71.1

9.3

72.0

65.8-78.0

33.3-92.9

LV area in End-Diastole (4 chamber view): (cm2)

4.4

1.7

4.4

3.3-5.5

0.9-8.8

LV area in End-Systole (4 chamber view): (cm2)

2.4

0.9

2.3

1.8-3.0

0.6-5.1

Left Ventricle Fractional Area Change (calculated field): (%)

43.3

7.5

43.5

39.6-48.0

18.4-63.4

LV length from AVV to apex (at end of QRS complex) (cm)

2.9

0.5

2.9

2.5-3.3

1.3-4.1

LV width (from crest of septum- LV side- to free wall) (cm)

1.6

0.4

1.6

1.3-1.8

0.4-2.6

Slide21

LVOT

Frequency Left Ventricular Outflow Tract Obstruction3% (5/193)LVOTO level of stenosis Sub-valvar80% (4/5)Valvar20% (1/5)LVOTO Type of Subvalvar Stenosis Tunnel 100% LVOTO Type of Supravalvar Stenosis Discrete25% Diffuse 75%

Mean

Std

Median

IQR

Min-Max

Smallest LVOT diameter in systole (cm)

0.7

0.2

0.7

0.6-0.8

0.3-1.1

Peak gradient (mmHg)

5.0

2.2

4.8

2.9-7.3

2.9-7.3

Mean gradient (mmHg)

2.3

1.3

2.3

1.3-3.2

1.3-3.2

Slide22

Aortic Valve

Mean

Std

Median

IQR

Min-Max

Aortic Annulus in systole (cm)

0.8

0.2

0.8

0.7-0.9

0.3-1.3

Aortic root in systole (cm)

1.0

0.2

1.1

0.9-1.2

0.6-1.5

Sinotubular

junction in systole (cm)

0.8

0.2

0.8

0.7-0.9

0.4-1.2

Slide23

Aortic Valve

 

Frequency

Aortic Valve Thickening

 

None

92% (178/193)

Trivial

2% (4/193)

Mild

3% (6/193)

Moderate

3% (5/193)

Number of Leaflets

 

Bi

6% (9/148)

Tri

94% (139/148)

Stenosis

 

None

96% (184/191)

Mild

2% (3/191)

Moderate

2% (4/191)

Regurgitation

 

None

67% (129/194)

Trivial

29% (57/194)

Mild

4% (8/194)

Slide24

Aorta

Mean

Std

Median

IQR

Min-Max

Ascending Aorta (measured from parasternal LA view in systole,

just

above the ST junction): (cm)

0.8

0.1

0.9

0.8-0.9

0.4-1.2

Transverse Arch (cm)

0.5

0.1

0.5

0.4-0.6

0.2-1.0

Isthmus (cm)

0.4

0.1

0.4

0.3-0.5

0.2-0.7

Descending aorta (cm)

0.6

0.03

0.6

0.6-0.6

0.6-0.6

Peak Arch gradient (mmHg)

11.1

10.0

6.8

4.8-14.6

1.1-42.0

Mean Arch gradient (mmHg)

6.1

5.6

3.7

2.2-8.5

0.6-22.0

Slide25

Aorta

Frequency

 

Coarctation present

18% (29/158)

Location of coarctation

 

Transverse

7% (2/27)

Isthmus

93% (25/27)

Interrupted Arch

0%

Flow direction in ascending arch:

 

Antegrade

100%

Flow direction in transverse arch:

 

Antegrade

95% (181/190)

Retrograde

1% (2/190)

Bidirectional

4% (7/190)

Slide26

Ductus Arteriosus

Frequency

 

Ductus patent

61% (116/189)

Ductal flow restrictive

55% (62/113)

Ductal flow in systole

 

Left to right

3% (3/98)

Right to left

97% (95/98)

Ductal flow in diastole

 

Left to right

99% (114/115)

Right to left

1% (1/115)

Slide27

Correlating inflow physiology and ventricular geometry

Slide28

Correlations of mAVVI with other indices of inflow physiology

 

Pearson

Correlation

Coefficient

P-value

LVII

0.28

0.001

RV/LV inflow angle

0.12

0.13

Slide29

Correlations – mAVVI and measures of ventricular geometry

 

Pearson

Correlation

Coefficient

P-value

Color inflow diameter at RAVV annulus

-0.29

0.001

Color inflow diameter at LAVV annulus

0.41

< 0.0001

RV end diastolic area

-0.31

0.0001

LV end diastolic area

0.43

< 0.0001

Slide30

Correlations – RV/LV inflow angle and measures of ventricular geometry

 

Pearson

Correlation

Coefficient

P-value

Color inflow diameter at RAVV annulus

-0.40

< 0.0001

Color inflow diameter at LAVV annulus

-0.36

< 0.0001

RV end diastolic area

0.08

0.26

LV end diastolic area

0.12

0.11

Slide31

Correlations – LVII and measures of ventricular geometry

 

Pearson

Correlation

Coefficient

P-value

Color inflow diameter at RAVV annulus

-0.26

0.002

RV end diastolic area

-0.10

0.22

LV end diastolic area

0.16

0.04

Slide32

Next steps

Exploring impact of septal angulation on ventricular geometry

Exploring mural leaflet sizes and

ventricular

geometry

Abnormalities of LAVV apparatus

and ventricular geometry

Slide33

THANK YOU

james.meza@sickkids.ca

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