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surgical strategies used to repair an AVSD and show you what to look for on a post-operative echo, if you suspect a complication.",{"id":215,"name":216},1,"Course previews",[218,229,234,242],{"type":219,"data":220},"video",{"readDurationInSeconds":221,"video":222},263,{"platform":223,"name":224,"url":225,"size":226},"YouTube","Recognizing common post repair complications","https:\u002F\u002Fwww.youtube.com\u002Fwatch?v=GGeWupUsTb0",{"width":227,"height":228},200,113,{"type":230,"data":231},"free_text",{"readDurationInSeconds":232,"text":233},13.333333333333334,"\u003Cp> \u003Cstyle type=\"text\u002Fcss\">\u003C!--td {border: 1px solid #ccc;}br {mso-data-placement:same-cell;}--> \u003C\u002Fstyle> An atrioventricular septal defect (AVSD) can be successfully repaired by a skilled surgeon—but what happens if things go wrong afterwards? In this video, from our Echo Masterclass: Adult Congenital Heart Disease course, we'll take you through the reasoning behind the surgical strategies used to repair an AVSD and show you what to look for on a post-operative echo, if you suspect a complication.\u003C\u002Fp>",{"type":235,"data":236},"cta",{"readDurationInSeconds":237,"text":238,"buttonText":239,"buttonUrl":240,"teachIllustration":241},4.533333333333333,"Start the first chapter of our Echo Masterclass: Adult Congenital Heart Disease course for free","Start chapter 1 now","https:\u002F\u002Fwww.medmastery.com\u002Fuser\u002Fregister?target=%2Fcourses%2Fecho-masterclass-adult-congenital-heart-disease","https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F99f55ef6-225d-4e3e-85fd-d9fb56d621df",{"type":230,"data":243},{"readDurationInSeconds":244,"title":245,"text":246},150.93333333333334,"Video Transcript","\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-107b74ed-7fff-46e7-0f1b-a83f77787c44\">[00:00:00]\u003C\u002Fb> Repair of atrial ventricular septal defect or AVSD is largely guided by the extent of the septal defect, the morphology of the atrioventricular valve, and the size of the ventricles. Surgery for partial AVSD will involve patching the atrial septal defect. Percutaneous septal occluders are not suitable for this type of atrial septal defect as there is no inferior rim for anchoring the device. The close proximity of the defect to the valves of the AV node\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-107b74ed-7fff-46e7-0f1b-a83f77787c44\">[00:00:30]\u003C\u002Fb> is also not favorable to house a device. Repair of the left AV valve is also undertaken usually by stitching together the two most anterior leaflets to bicuspidize the left AV valve. In the image on the left, the echo bright area on the valve is a suture. This valve has already been repaired. The image on the right shows that the regurgitation remains in the same location as the repair. The extent of the regurgitation is better seen in a long-axis view in this patient. As well as leaking, sometimes these repaired\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-107b74ed-7fff-46e7-0f1b-a83f77787c44\">[00:01:00] \u003C\u002Fb>valves might become stenotic due to scarring of the leaflets so this needs to be carefully checked. Repairing a complete AVSD requires a lot of handy work from the surgeon. There are a number of strategies used to repair this lesion. The approach is based on the anatomy and sometimes requires a complicated Fontan-type of repair. However, I will describe one popular method called the 2-patch repair technique. AVSD patch is cut to the right shape and size and is then saw onto the ventricular septum, taking care to avoid sutures too close to the AV\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-107b74ed-7fff-46e7-0f1b-a83f77787c44\">[00:01:30] \u003C\u002Fb>node, then a pericardial ASD patch is cut to size and suited to the top of the VSD patch. At this point, the surgeon ensures there are no leaks anywhere, no residual atrial or ventricular septal defect nor leaking from either ventricle to either atrium. The left valve is then repaired suturing together the commissure and then finally the right AV valve is repaired if required. With that many sutures, there's quite a few things to look for on the postoperative echos. Just like in partial AVSD, there can be\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-107b74ed-7fff-46e7-0f1b-a83f77787c44\">[00:02:00] \u003C\u002Fb>a residual atrial septal defect or left atrioventricular valve dysfunction. The arrow pointing to the echo bright area on the valve is denoting a suture. This valve has already been repaired but the color flow shows that the regurgitation remains in the same location as the repair. The extent of regurgitation is better seen in the long axis view on this patient. As well as leaking, sometimes these repaired valves might become stenotic due to the scarring of the leaflets so the forward flow needs to be carefully checked, but sometimes the jets can get very, very\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-107b74ed-7fff-46e7-0f1b-a83f77787c44\">[00:02:30] \u003C\u002Fb>tricky. Here is a patient post-repair with a jet entering the right atrium. If this is tricuspid regurgitation then it suggests significant pulmonary hypotension. If this is not tricuspid regurgitation, then what is it? Where does it come from? And is it bad? Well, if there's pulmonary hypotension, there should be other signs, right? Yes, septal flattening and we could cross-check the pulmonary artery pressure by using the PR Doppler signal. These images don't really support a diagnosis of\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-107b74ed-7fff-46e7-0f1b-a83f77787c44\">[00:03:00]\u003C\u002Fb> pulmonary hypotension. The septum looks to be in its normal position and it doesn't look like the right ventricle is very dilated. So if that signal isn't tricuspid regurgitation, what is it? If we look at the origin of the jet, it's actually coming from the left ventricle into the right atrium. It is the left AV valve regurgitation which crosses the residual atrial septal defect that explains the high velocity and the systolic timing. It's very important to look carefully at the origin of the jets in these patients because the high velocity\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-107b74ed-7fff-46e7-0f1b-a83f77787c44\">[00:03:30] \u003C\u002Fb>could easily be misdiagnosed as pulmonary hypotension. Heart block is common in these patients, so keep an eye out for that too. All that surgical origami involved in a complete atrioventricular septal defect repair means the potential for unusual residual jets is high, but with echo superpowers, we can establish if these are concerning or not. It is important to check the area of patch repairs at the atrial septum and ventricular septum. Check the function of the atrioventricular valves and finally, assess the elongated left ventricular outflow jet. It should remain\u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cb id=\"docs-internal-guid-107b74ed-7fff-46e7-0f1b-a83f77787c44\">[00:04:00] \u003C\u002Fb>widely patent.\u003C\u002Fp>",{"courses":248,"showAwardsBelow":48},[249],{"id":250,"isFreeCmeCourse":251,"title":252,"type":253,"specialization":254,"teachers":256,"cmeCredits":258,"teacherIllustration":241,"backgroundImage":259,"relativeUrl":260,"lastChanged":261,"created":262,"description":263,"relativeURL":260,"meta":264},6085,false,"Echo Masterclass: Adult Congenital Heart Disease","course",[255],"Ultrasound",[257],"Cathy West, M.Sc FASE",4,"https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F99f55ef6-fa12-46f3-aba5-e25a0fc8c8bf","\u002Fcourses\u002Fecho-masterclass-adult-congenital-heart-disease","1767452488","1550522966","Flustered at the thought of performing an adult congenital echo? Don’t be. In this course, you’ll learn about the lesions associated with common types of defects as well as common surgical repair complications. Explore the hemodynamics of intracardiac defects, master key assessment strategies such as the sequential segmental approach, and know what to leave out of the echo report.",{"duration":265,"quizzes":266,"lessons":267},9005,9,45,{"id":269,"name":257,"image":270,"profession":271,"relativeUrl":274,"specializations":275},6084,"https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F9c43cf02-db49-423a-be2c-a9044279efc4",{"name":272,"description":273},"Cardiac sonographer","Cathy is the former Principal Echocardiography Technician at the Royal Brompton Hospital in London. Currently she works as a cardiac scientist at Royal Brisbane and Women's Hospital in Brisbane Australia.","\u002Fteachers\u002Fcathy-west-msc-fase",[255],180,"3m",[279,305,324],{"id":280,"title":281,"text":282,"image":283,"author":291,"path":299,"readDuration":300,"readDurationFormatted":277,"internal":301},1350,"How to Recognize INOCA (ANOCA) on an Exercise Stress Test ","Angina, abnormal stress test, clean coronaries—that's INOCA (or ANOCA), and it carries real risk. Learn to recognize and report it with exercise stress ECG.",{"alt":284,"title":285,"size":286,"location":288},"Illustration of the heart's coronary vasculature showing large coronary arteries and the extensive network of smaller vessels affected in INOCA (ischemia with nonobstructive coronary arteries).","",{"width":287,"height":287},1200,{"bucket":289,"key":290},"public-drupal-medmastery-assets-production","\u002F2026-05\u002FC17(1)_magazine image_0.png",{"id":292,"title":293,"relativeURL":294,"image":295,"professionLong":296,"profession":297,"weight":258},1563,"Franz Wiesbauer, MD MPH","\u002Fteachers\u002Ffranz-wiesbauer-md-mph","https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F9c43cef0-41ee-4005-9e4a-d8711c816401","Franz is the founder and CEO of Medmastery. He is an internist with a specialization in cardiology and a master’s in public health from Johns Hopkins University.",{"name":298},"Internist","\u002Fmagazine\u002Fexercise-stress-ecg-inoca",141,{"created":302,"updated":303,"published":304},1778115738,1778118425,1778118255,{"id":306,"title":307,"text":308,"image":309,"author":315,"path":317,"readDuration":318,"readDurationFormatted":319,"internal":320},1348,"Hyperlipidemia screening: who, when, & what to measure","Testing for hyperlipidemia can help you mitigate your patients' cardiovascular risk. Learn who to screen and when, which measures to request, and how to stratify risk.",{"alt":310,"title":285,"size":311,"location":313},"Lipid panel blood sample tubes used to test for hyperlipidemia in a laboratory setting",{"width":312,"height":312},600,{"bucket":289,"key":314},"\u002F2026-04\u002FC121_magazine image.png",{"id":292,"title":293,"relativeURL":294,"image":295,"professionLong":296,"profession":316,"weight":258},{"name":298},"\u002Fmagazine\u002Ftest-for-hyperlipidemia",246,"5m",{"created":321,"updated":322,"published":323},1777403036,1777572381,1777412421,{"id":325,"title":326,"text":327,"image":328,"author":333,"path":342,"readDuration":343,"readDurationFormatted":344,"internal":345},1347,"Outpatient care for COPD exacerbations","Most acute COPD exacerbations can be managed with outpatient treatment. Learn how to treat mild and moderate COPD exacerbations—and when to escalate care.",{"alt":329,"title":285,"size":330,"location":331},"Older patient using a handheld nebulizer to inhale bronchodilator medication during an acute COPD exacerbation",{"width":312,"height":312},{"bucket":289,"key":332},"\u002F2026-04\u002FC133(4)_ exacerbations_magazine image.png",{"id":334,"title":335,"relativeURL":336,"image":337,"professionLong":338,"profession":339,"weight":341},5365,"Siamak Moayedi, MD","\u002Fteachers\u002Fsiamak-moayedi-md","https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F9c43cf02-1064-4074-817b-0eb5de6ded74","Professor and Director of Medical Student Education, University of Maryland and Course Director, Essential and Critical Procedures, Emergency Medicine.",{"name":340},"Emergency medicine physician",1533,"\u002Fmagazine\u002Facute-copd-exacerbation-treatment",191,"4m",{"created":346,"updated":347,"published":348},1776705362,1776710540,1776710541,{"seo":350,"og":352},{"title":351,"description":213},"Recognizing common post-repair complications | Medmastery",{"title":351,"description":213,"image":353},{"alt":285,"title":285,"size":354,"location":357},{"width":355,"height":356},1042,586,{"bucket":289,"key":358},"\u002Fmigrated-images\u002FScreen Shot 2019-03-28 at 1.36.32 pm.png",{"id":360,"created":361,"updated":362,"published":361},298,1553780363,1655189586]