Shapoval L. Complex echocardiography as an isolated method for assessing the morpho-functional features of atrioventricular communication and the results of surgical correction

The dissertation is devoted to a new direction of solving the problem of effective complex ultrasound diagnostics of atrioventricular communication in the pre- and postnatal periods, which is important for radiological diagnostics, pediatric cardiology and cardiac surgery. In the modern era of pediatric cardiac surgery, prenatal diagnosis is part of the standards of treatment of patients with congenital heart disease. Atrioventricular communication is no exception, as this defect is one of the most common congenital heart defects diagnosed prenatally. Based on the obtained data, the prognostic value of isolated and combined AVC and concomitant congenital malformations in the pre- and postnatal periods was determined. The influence of existing hemodynamic complications in the fetus with AVC on the course of pregnancy was studied. Practical echocardiographic criteria for assessing the common AV valve complex are proposed. Improvement of transthoracic 2D echocardiography was performed by introducing and implementing an algorithm for estimating the common atrioventricular valve complex, as evidenced by excellent diagnostic value: the sensitivity of the method was 94.9%, specificity - 85.7%, diagnostic accuracy - 91.9%. Recommendations for assessing the degree of symmetry of the atrioventricular junction have been developed. Echocardiographic parameters characterizing the symmetry of the atrioventricular junction have been found to be poorly correlated or not correlated at all. In determining the tactics of surgical treatment in a group of patients with unbalanced atrioventricular communication, morphometric analysis should be interpreted together with an assessment of the degree of joint atrioventricular valve insufficiency and the size of the ventricular septal defect. Concomitant defects can also change the physiology of this anomaly and should also be taken into account when choosing the optimal tactics of surgical treatment. Echocardiographic criteria for diagnosing complex anatomical disorders of the common AV valve complex are substantiated, taking into account the prognostic value of detected anomalies or abnormalities at follow up 6-12 months after discharge. The introduction of a new algorithm for assessing the common AV valve complex allowed to plan for each patient the optimal tactics and / or technique of surgical treatment at the stage of preoperative echocardiography and to assess the immediate and long-term outcome of correction with greater prognostic efficiency.