Atrio-Ventricular Septal Defect (AVSD)

What is Atrio-Ventricular Septal Defect (AVSD/AVCD)?

Complete AVSD is characterized by common annulus instead of two separate mitral and tricuspid annuluses with defect in atrial and ventricular septums (ASD and VSD) along with cleft in valve leaflet.

Partial AVSD is characterized by two separate annuluses with defect only in atrial septum (ASD) with cleft in mitral valve leaflet.

Intermediate and transitional varieties of AVSDs are in between of these two varieties.

Associated heart lesions with AVSD?

AVSD can be associated with narrowing in vessel that supplies blood to the lungs known as pulmonary stenosis; isomeric heart; Down syndrome (genetic problem) etc.

Clinical presentation of AVSD?

It depends on size of VSD and associated lesions as well as on severity of mitral regurgitation (MR).

If size of VSD is small and MR is mild, child is generally asymptomatic, and only systolic murmur will be there on examination by a pediatrician.

If size of VSD is moderate (neither small nor big), child may have history of poor weight gain, cough and cold etc. with mild MR

In large sized VSD with severe MR, child generally presents at 1-2 months of age with complaints of cough, cold, difficulty in breathing, poor weight gain, sweating over forehead.

If severe pulmonary stenosis is present with VSD then above symptoms are absent, instead child shall be very blue especially on crying. In mild pulmonary stenosis, child may have signs of large VSD.

Diagnosis of AVSD?

For diagnosing AVSD, Echocardiography is mandatory for confirming the disease. Echo is a non-invasive test that is without pain. Echo is done from chest.Generally in small child, echo needs to be done when child sleeps.

Timing of closure of AVSD?

After confirming the size of VSD, associated lesions as well as severity of mitral regurgitation, we can plan further treatment.

If size of VSD is small with mild MR, then we do follow-up of child at periodic interval. When MR is severe with dilatation of left atrium and ventricle, then we need to operate the child for correction of ASD, VSD and MR.

If moderate sized VSD,then it generally associated with left heart dilatation, then we should close the ASD, VSD and repair the cleft in mitral valve by 6 months - 1 year of age.

In large sized VSD: we close ASD/VSD and repair the cleft by 3-6 months of age.

If associated with severe pulmonary stenosis, then child may require early surgery in the form of BT shunt, or else we shall follow the child and operate by 1 year of age.

Can we correct AVSD by medications?

No; surgery is the only option.

How do we surgery for AVSD?

Surgery is done by opening the chest in midline. We repair the ASD/VSD, cleft in mitral valve and make two separate leaflets for each ventricle.

How we should do follow-up after surgery?

After 3 days for wound dressing, then 1, 3, 6, 12 months after surgery.

Is surgery safe in small child?

Yes, we need to operate early otherwise child may be inoperable early especially in cases where child is having Down’s syndrome.