Overman David M, Dummer Kirsten B, Moga Francis X, Gremmels David B
Division of Cardiac Surgery, The Children's Heart Clinic, Minneapolis, MN 55404, USA.
Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2013;16(1):32-6. doi: 10.1053/j.pcsu.2013.01.009.
Unbalanced atrioventricular septal defect (uAVSD) is a challenging lesion with suboptimal outcomes in the current era. Severe forms of uAVSD mandate univentricular repair with well-documented outcomes. Determining the feasibility of biventricular repair (BVR) in patients with moderate forms of uAVSD is difficult. Ventricular hypoplasia has traditionally formed the cornerstone of defining uAVSD. However, malalignment of the atrioventricular junction and related derangements of the anatomy and physiology of the atrioventricular inflow play a central role in establishing and sustaining a biventricular end state. Atrioventricular valve index, left ventricular inflow index, and right ventricle/left ventricle inflow angle are important recently described measures of inflow physiology. Additional patient anatomic and physiologic factors that impact BVR feasibility undoubtedly exist. A recently launched Congenital Heart Surgeons Society prospective inception cohort study will address these and other issues that impair our ability to predict BVR feasibility in uAVSD.
非平衡性房室间隔缺损（uAVSD）是一种具有挑战性的病变，在当今时代预后欠佳。严重形式的uAVSD需要进行单心室修复，其结果已有充分记录。确定中度形式uAVSD患者进行双心室修复（BVR）的可行性很困难。传统上，心室发育不全一直是定义uAVSD的基石。然而，房室连接的排列不齐以及房室流入道解剖和生理的相关紊乱在建立和维持双心室终末状态中起核心作用。房室瓣指数、左心室流入指数和右心室/左心室流入角是最近描述的重要流入道生理指标。无疑还存在其他影响BVR可行性的患者解剖和生理因素。最近发起的先天性心脏外科医生协会前瞻性起始队列研究将解决这些以及其他影响我们预测uAVSD中BVR可行性能力的问题。
