What is the clinical evidence from this study?

Study design: Cohort. Population: complete atrioventricular septal defect (n=356). Intervention: Atrioventricular valve index (AVVI). Primary outcome: Surgical strategy (biventricular repair, univentricular repair, pulmonary artery banding, or death before surgery).

What does this research mean for the field?

The atrioventricular valve index (AVVI) effectively discriminates between balanced and unbalanced atrioventricular septal defects and strongly correlates with anatomic substrate and subsequent surgical repair strategies. Novelty: ClaimNovelty.METHODOLOGICAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

Validate the atrioventricular valve index (AVVI) to distinguish balanced from unbalanced complete atrioventricular septal defects (AVSD) and characterize its relationship with surgical strategies and patient outcomes.

September 1, 2026CirculationOpen Access

Echocardiographic Definition and Surgical Decision-Making in Unbalanced Atrioventricular Septal Defect

Q: What are the key findings of this study?

Atrioventricular valve index (AVVI) effectively characterizes balanced versus unbalanced AVSD, with AVVI <0.19 uniformly resulting in univentricular repair.

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Key result

AVVI distinguishes balanced from unbalanced AVSD, with scores <0.19 uniformly predicting univentricular repair.

n=356

Why the study?

Exact criteria defining the limits of unbalanced atrioventricular septal defect were not available.

Does the echocardiographic atrioventricular valve index (AVVI) predict surgical strategy and outcomes in infants with complete atrioventricular septal defect?

Population

356 infants with complete AVSD at 4 CHSS institutions (AVVI measured in 315)

Comparison

Balanced vs unbalanced AVSD across ranges of AVVI

Design

Multicenter retrospective cohort study

Follow-up

12 months after diagnosis

Authors

AJAnusha JegatheeswaranCleveland Clinic CPChristian PizarroAmerican Heart Association CCChristopher A. CaldaroneCardiac Surgery

Discussion

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Implication

The atrioventricular valve index (AVVI) is a useful echocardiographic tool to characterize the transition between balanced and unbalanced AVSD, correlating strongly with anatomic substrate and surgical decision-making.

Key Points

Validate the atrioventricular valve index (AVVI) to distinguish balanced from unbalanced complete atrioventricular septal defects (AVSD) and characterize its relationship with surgical strategies and patient outcomes.
Reviewed diagnostic echocardiograms and clinical records of 356 infants with complete AVSD across 4 Congenital Heart Surgeons' Society (CHSS) institutions (2000–2006), calculating AVVI in 315 patients.
Classified defects as unbalanced if AVVI was ≤0.4 (right-dominant) or ≥0.6 (left-dominant), and used competing risks analysis to model four surgical endpoints and develop a predictive nomogram.
Patients with balanced AVSD (0.4 < AVVI < 0.6) predominantly received biventricular repair, whereas those with AVVI < 0.19 uniformly underwent univentricular repair.
An intermediate range (0.19 ≤ AVVI ≤ 0.39) exhibited heterogeneous surgical strategies (both univentricular and biventricular repair) along with a disproportionate number of deaths.
Predicted 12-month post-diagnosis outcomes were 86% biventricular repair, 7% univentricular repair, 1% pulmonary artery banding, 1% death without surgery, and 5% alive without surgery.

Study Design

Type

Cohort (n=356)

Multicenter

Yes

Structured PICO

Does the echocardiographic atrioventricular valve index (AVVI) predict surgical strategy and outcomes in infants with complete atrioventricular septal defect?

Population

356 infants with complete atrioventricular septal defect from 4 institutions, evaluated to characterize the association of atrioventricular valve index with surgical strategies and outcomes.

Exposure

Echocardiographic measurement of atrioventricular valve index (AVVI) to classify balanced versus unbalanced AVSD and guide surgical strategy.

Outcome

Surgical strategy (biventricular repair, univentricular repair, pulmonary artery banding) and death before surgery.hard clinical

Cite This Study

Jegatheeswaran et al. (2010) conducted a cohort in complete atrioventricular septal defect (n=356). Atrioventricular valve index (AVVI) was evaluated on Surgical strategy (biventricular repair, univentricular repair, pulmonary artery banding, or death before surgery). Atrioventricular valve index (AVVI) effectively characterizes balanced versus unbalanced AVSD, with AVVI <0.19 uniformly resulting in univentricular repair.

synapsesocial.com/papers/6a96ece151271341f338e37c https://doi.org/10.1161/circulationaha.109.925636

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Echocardiographic Definition and Surgical Decision-Making in Unbalanced Atrioventricular Septal Defect

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

Echocardiographic Definition and Surgical Decision-Making in Unbalanced Atrioventricular Septal Defect

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

Also Consider

Also Consider