ATRIOVENTRICULAR SEPTAL DEFECT

(AVSD)
deficiency of the atrioventricular septum of the heart

Classification:
Partial AVSD = A primum atrial septal defect and cleft mitral valve but no direct
intraventricular communication (ostium primum defect).

Complete AVSD = defects of both the primum atrial septum and inlet ventricular septum and
the presence of a common atrioventricular valve

Incidence and Epidemiology

>Associated to patients with Down’s Syndrome (35-40% DS pts have an AVSD)
>17% of CHD
Pathophysiology:
It is caused by an abnormal or inadequate fusion of the superior and inferior endocardial
cushions with the mid portion of the atrial septum and the muscular portion of the ventricular
septum

 L→R shunting occurs at both atrial and ventricular levels with shunting from LV →RA
(due to absence of AV septum)
PHTN and ↑ tendency to develop PVR leads to R→L shunting which in turn results in
cyanosis (Eisenmenger Syndrome)
 V valvular insufficiency

Signs and Symptoms

>Clinical presentation depends on degree of mitral regurgitation.
>No MR → no significant symptoms
>Severe MR → poor feeding, tachypnea, labored breathing, exercise intolerance
>may trigger CHF in older patients

On auscultation;
>Hyperactive precordium
>Normal/ accentuared 1st heart sound
>Wide, fixed splitting ofS2
>Pulmonary systolic ejection mummur w/ thrill
>Holosystolic mumur @apex w/ radiation to axilla
>Mid diastolic rumbling mumur @ LSB
Differential Diagnoses
 Coronary Sinus Atrial Septal Defects
 Ostium Secundum Atrial Septal Defects
 Partial Anomalous Pulmonary Venous Connection
 Pediatric Mitral Valve Insufficiency
 Pediatric Mitral Valve Prolapse
 Sinus Venosus Atrial Septal Defects

Clinical Examination
1. Chest Xray
>Prominent pulmonary artery segment + dense pulmonary vascular markings
>Cardiac enlargement, especially (RA & RV)

2. Echocardiography
>Diagnostic method of choice

3. MRI
>useful for evaluating shunt severity, expressed quantitatively as the ratio of pulmonary
flow to systemic flow (Qp/Qs).

4. ECG
>Prolonged PR interval
>L axis deviation with Rventricular hypertrophy

Treatment
1. Treatment for CHF is occasionally required if MR cannot be adequately surgically
reduced
2. Surgical: patch closure of the atrial septal defect (ASD), mitral valve annuloplasty, or
cleft closure

*Can also use furosemide, ACEi and digoxin to ease symptoms prior to repair