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PubMedDate not supplied

[Reconstructive techniques in cutaneous defects of the nasal tip].

Many techniques are used for repairing nasal tip defects. Our own guidelines are reviewed: Small defects often can be closed directly. Lesions of the nasal tip over 0.5 cm in diameter usually require a skin graft or flap. Postauricular, preauricular, and nasolabial full-thickness skin grafts may produce noticeable color or contour differences. The type of local skin flap used depends on defect size: Local rotation-transposition flaps or the nasalis myocutaneous sliding flap described by Rybka are used for defects 2 cm or less in diameter. Rieger and de Marchac frontonasal flaps are used for defects 2-3.5 cm in diameter. Forehead flaps are used for defects of 3.5 cm or more. We prefer Rybka's flap for nasal tip defects less of 2 cm because it has cosmetic advantages: incisions do not deform natural cutaneous crease lines and chronic edema and "dog ears" secondary to rotation-transposition pedicle flaps are avoided. For more extensive defects, we prefer frontonasal or forehead flaps.

Carcinoma↗
PubMed1997

Free composite serratus anterior and rib flaps for tibial composite bone and soft-tissue defect.

Open fracture in the lower extremity often involves composite bone and soft-tissue defects. For patients with extensive segmental bone defects, vascularized fibular transfers can be utilized and are generally accepted as one of the best options for reconstruction of intercalary defects. In some cases, either bilateral tibias and fibulas are fractured or the contralateral fibula is traumatically damaged or absent, precluding free fibular transfer. If an osteocutaneous fibular flap cannot be used to manage such a defect, a composite serratus anterior and rib flap may be considered. Nine composite serratus anterior and rib flaps, with or without latissimus dorsi transfers, were performed in eight patients between August of 1993 and March of 1994. One patient sustained a left knee disarticulation and underwent reconstruction for a right tibial defect. He failed to achieve lower extremity function within 2 years and was considered a failure. One flap failed, and the patient underwent a below-knee amputation. The remaining six patients received seven composite flaps for tibial and calcaneal defects and could ambulate without assistance. Based on this review, we conclude that the composite serratus anterior and rib flap with optional latissimus dorsi muscle can be used for (1) bilateral tibial fibular fractures, (2) contralateral lower limb amputation with fillet of the amputated leg if the leg is present for harvest, (3) contralateral middle-third fracture of the fibula, (4) patients in whom iliac bone is not suitable because of either a bone defect greater than 10 to 12 cm or previous harvest of bone graft, and (5) extensive composite bone and soft-tissue defects.

Adolescent↗
PubMedDate not supplied

Temporal trends in Canadian birth defects birth prevalences, 1979-1993.

The Canadian Congenital Anomalies Surveillance System monitors birth defects reported for stillborns, newborns and infants during the first year of life. Data are available through the 1980s and early 1990s for Ontario, Manitoba and Alberta, and since 1984 for an additional four provinces. Fifty-seven routine monitoring categories and 15 summary categories were examined for temporal trends. Comparing the period 1979-1981 with 1991-1993, the reported birth defect case birth prevalence increased by 0.2% and the total birth defects birth prevalences by 2.5%. The birth prevalence of central nervous system defects decreased by 8.2%; the reported birth prevalence increased for congenital heart defects by 41%, urinary defects by 127%, Down syndrome by 13% and other chromosomal defects by 47%. Further investigation of individual defects would be required to evaluate the degree to which changes in reported birth prevalence reflect changes including the availability and use of specific diagnostic procedures. The work highlights the need to expand the surveillance system to include all affected pregnancies where an anomaly has been detected antenatally.

Canada↗
PubMed1998

Variability of perceived defect size in virtual lung scintigraphy.

UNLABELLED: The diagnosis of pulmonary embolism is based on the presence of mismatched segmental or subsegmental defects. An important axiom is the classification of defect sizes into small, moderate and large. Little information about the recognition and classification of such defects has been published. We undertook a study of the perception of defect size using a model of the virtual scintigraphic anatomy of the lungs to address this issue. METHODS: Segmental anatomy of the lungs was modeled with CT, cadaveric lungs and standard anatomical tests. The emission, scatter and attenuation of photons were modeled within these virtual lungs and the surrounding tissues. Single segmental lesions, each 100% of a segment, were created in eight projections and submitted for blinded reporting by four experienced nuclear medicine physicians to obtain their assessment of the size of each defect on two occasions. RESULTS: Of the 144 defects submitted for reporting, 15% were reported as <25% of a segment, 35% were reported as 25%-75% and 50% were reported as 75%-100%. The accuracy of each reporter and the intraobserver agreement were calculated; the weighted kappa value ranged from 0.34 to 0.60. The segmental defects that were most likely to be underestimated in size were in the right lower lobe. CONCLUSION: It is clear that segmental defect sizes were underestimated, particularly in the right lower lobe. Although the intraobserver agreement in reporting was fair, the accuracy of estimation was only 50%. The variability and inaccuracy might be reduced by the use of a guide to segmental anatomy.

Computer Simulation↗
PubMed1998

[Analysis of the risk of congenital defects in different ethnic groups in Spain].

OBJECTIVE: The frequency of congenital defects is not the same in different populations and ethnic groups. Genetic factors, as well as differences in socio-cultural aspects (such as the frequency of consanguineous couples) between the groups could be responsible for some differences in the prevalence of congenital anomalies. However, some groups are made up of populations which live on the fringe of society in which several circumstances and related factors could increase the risk for congenital defects. PATIENTS AND METHODS: A total of 24,696 malformed infants were studied together with a similar group of controls, separated into the following ethnic groups: Gypsies, black, orientals, Arabic people and whites. Using different models of logistic regression analysis, controlling several factors related to the social-cultural level and with genetic aspects (such as consanguinity), we estimated the risk for 20 different congenital defects in the ethnic groups compared to the white population. RESULTS: The analysis showed that some ethnic groups have an increased risk for some congenital defects and that this increased risk is due to their high level of consanguinity. Other defects are due to different factors related with the low socio-cultural level. However, in black and Arabic people there is a high risk for some congenital defects that is not attributable to those genetic or socio-cultural factors studied. CONCLUSIONS: The results of the present study permit the estimation of the impact of congenital defects in these groups that have low socio-cultural level, as well as the need for health care. This is of great usefulness in establishing the necessary actions to provide proper assistance to prevent congenital defects in these populations.

Congenital Abnormalities↗
PubMed1998

A frequency-doubling perimetric study in normal-tension glaucoma with hemifield defect.

PURPOSE: The authors prospectively compare perimetric results obtained by conventional differential light sensitivity (DLS) perimetry and frequency-doubling perimetry (FDP) in normal-tension glaucoma (NTG) with a hemifield visual field defect, assuming that some of these eyes already have early glaucomatous changes in the "intact" hemifield. METHODS: Eleven eyes of 11 patients with NTG who met the enrollment criteria were studied. Seven eyes had an upper hemifield defect and four had a lower defect, determined by DLS with a Humphrey Field Analyzer (Zeiss-Humphrey, Inc., San Leandro, CA, U.S.A.). Frequency-doubling perimetry and DLS perimetry were conducted less than 7 days apart. To quantitatively detect nerve fiber layer defect (NFLD), scanning laser ophthalmoscopy was also performed. RESULTS: Of the 11 intact hemifields, seven showed NFLD. Of the seven, six also showed visual field defects by FDP. Of the four eyes without NFLD, two showed no defects in the intact hemifield by FDP. The threshold values of FDP and DLS perimetry did not significantly correlate in either the intact or the defective hemifields, or in the total field. The average test time of FDP was approximately 6 minutes. CONCLUSIONS: Frequency-doubling perimetry may detect early glaucomatous visual field defects.

Adult↗
PubMed1997

Evaluation of transforming growth factor beta and bone morphogenetic protein composite on healing of bone defects.

OBJECTIVE: To evaluate the effect of transforming growth factor-beta/bone morphogenetic protein (TGF-beta/BMP) composite on the healing of large segmental bone defects and to discuss the interaction between TGF-beta and BMP during bone repair. METHODS: A 1.5 cm segmental defect was made in the mid-upper part of the radial shaft of 48 adult rabbits. The defects were filled with implants of TGF-beta/carrier, BMP/carrier or TGF-beta/BMP/carrier separately. 120 micrograms of purified bovine TGF-beta and 12 mg of BMP were used in the composite. The defects were examined radiographically and histologically at 4, 8, 12 and 16 weeks post-operation. RESULTS: In the group filled with TGF-beta/BMP composite, the defect areas were bridged at 4 weeks, with callus of uniform radiodensity. Cortices of the cut ends were obscured by new bone. By 16 weeks post-operation, the defects were bridged by uniform new bone and the cut ends of the cortex could not be seen in all groups. In group of BMP/carrier, the defects were filled with more irregular woven bone callus than in other two groups. TGF-beta/BMP implanted defects in animals killed at 16 weeks showed histologically new lamella and woven bone that was formed in continuity with the cut ends of the cortex. Medullar canal was recanalized and contained marrow elements with normal appearance. CONCLUSIONS: These data demonstrate not only the synergistic action between TGF-beta and BMP in the process of bone healing, but also a better effect of TGF-beta/BMP composite than single TGF-beta or BMP on bone repair, especially in the early stage of bone repair process.

Animals↗
PubMed1998

Prevalence of morphologic defects in spermatozoa from beef bulls.

OBJECTIVE: To determine the overall prevalence of morphologic defects in spermatozoa from beef bulls and to determine whether prevalence varies with the age of the bull. DESIGN: Cross-sectional observational study. ANIMALS: 2,497 beef bulls that were evaluated for breeding soundness in 1994 by 29 practicing veterinarians in a 5-state geographic region. PROCEDURE: Slides of spermatozoa from each bull were made and submitted by practicing veterinarians for morphologic evaluation. One hundred spermatozoa per slide were examined, and each was classified as having 1 of 9 morphologic defects or as normal. RESULTS: 63% of bulls evaluated were 10 to 12 months old, and 20% were 13 to 18 months old. A mean of 70.6% of spermatozoa was classified as normal. Most common defects were proximal droplets (8.4%), distal midpiece reflexes (6.7%), separated heads (5.5%), and distal droplets (3.8%). Other defects were seen < 2% of the time. Bulls 10 to 12 months of age had a higher prevalence of proximal and distal droplet defects than older bulls. CLINICAL IMPLICATIONS: Practitioners conducting breeding soundness evaluations in beef bulls must be aware of common spermatozoal defects. Bulls that are evaluated at a young age will have more defects than older bulls and should be reevaluated, particularly for those defects for which prevalence decreases with age.

Aging↗
PubMed1998

Intrinsic defects in macrophage IL-12 production associated with immune dysfunction in the MRL/++ and New Zealand Black/White F1 lupus-prone mice and the Leishmania major-susceptible BALB/c strain.

We have demonstrated that macrophages (Mphi) from young, prediseased, lupus-prone MRL/++ and New Zealand Black/White F1 mice display defective production of TNF-alpha, IL-1, and IL-6, but normal production of IL-10. In an attempt to determine the potential functional implications of this phenotype for autoimmunity, we demonstrate here that endotoxin-activated Mphi from these lupus-prone mice showed dramatically reduced expression of IL-12, a cytokine essential for Th1 responses that may be defective during lupus. IL-12 production was also reduced by Mphi from the control BALB/c strain, compatible with the concept that a genetically programmed deficit in IL-12 levels may underlie the IL-4-dominated BALB/c response to infection by the parasite Leishmania major. Although both IL-12 and TNF-alpha expression defects by Mphi from lupus-prone strains are expressed rapidly after activation, treatment with each cytokine demonstrated that only TNF-alpha contributes to the subsequent dysregulation of Mphi IL-1 and IL-6 expression in these strains, and that the reduced autocrine activity of defective IL-12 or TNF-alpha levels was not causal to each other. Although the intrinsic defect in IL-12 expression by lupus-prone and BALB/c Mphi may lead to defective Th1 responses, these Mphi responded to the Th1-derived cytokine, IFN-gamma, in a normal fashion suggesting a defective role in the induction, rather than the propagation, of Th1 responses in these mice. Our finding of a conserved intrinsic defect in IL-12 production by Mphi from the two principal mouse models of multigenic lupus provides insight into how excessive humoral responses may develop, and perhaps be prevented, in systemic autoimmune disease.

Animals↗
PubMed1988

Tetralogy of Fallot with obstruction of the ventricular septal defect: spectrum of echocardiographic findings.

Tetralogy of Fallot with a restrictive ventricular septal defect and suprasystemic right ventricular pressure is an uncommon anomaly with a high mortality rate. In previous studies, the identity of the tissue obstructing the ventricular septal defect has usually not been determined preoperatively. This report describes the echocardiographic and anatomic features in 4 patients with a restrictive ventricular septal defect among 269 patients with tetralogy of Fallot undergoing surgical repair. Echocardiography determined the presence and identity of the obstructing tissue in all four patients. In one patient, the defect was small in association with marked septal hypertrophy. In three patients, accessory or excessive tricuspid valve tissue obstructed the defect in a manner similar to spontaneous closure of isolated membranous ventricular septal defects. Autopsy and catheterization findings are also presented of an additional case with a unique mechanism of obstruction by a tricuspid valve with Ebstein's anomaly. In patients with tetralogy of Fallot, recognition of an obstructed ventricular septal defect is important because it appears to have a poor prognosis.

Echocardiography↗
PubMed2005

Biventricular repair in children with atrioventricular septal defects and a small right ventricle: anatomic and surgical considerations.

OBJECTIVE: We sought to characterize morphology and to evaluate a strategy of using biventricular repair in patients with a small right ventricle and an unbalanced atrioventricular septal defect. METHODS: Thirty-eight children with a small right ventricle and an atrioventricular septal defect underwent operative therapy. Thirty-two had biventricular repair, and 6 had single-ventricle palliation. A small right ventricle was defined on the basis of echocardiographic measurements expressed as the atrioventricular valve index (ie, right atrioventricular valve/left atrioventricular valve area) and as the ratio of right ventricular to left ventricular length. Validation of measurements in patients with a small right ventricle and an atrioventricular septal defect was achieved by comparison with balanced case-matched control subjects with atrioventricular septal defects. RESULTS: Children with a small right ventricle and an atrioventricular septal defect had a lower atrioventricular valve index (mean, 0.41 +/- 0.1 vs 0.52 +/- 0.1 [control], P < .0001) and lower right ventricular/left ventricular length ratio (0.78 +/- 0.1 vs 0.99 +/- 0.17 [control], P < .0001). Children with a small right ventricle undergoing single-ventricle palliation had the smallest right ventricular dimensions. There were 4 operative deaths. Three patients with a small right ventricle and an atrioventricular septal defect who underwent biventricular repair and had an atrioventricular valve index of less than 0.50 required early reoperation for right ventricular inadequacy. A restrictive atrial fenestration was created in 11 infants. Survival at 10 years was 87% for patients undergoing biventricular repair versus 100% for control subjects (P = .042). CONCLUSIONS: Extending the use of biventricular repair in properly selected patients with a small right ventricle and an atrioventricular septal defect is feasible. An atrial fenestration improves the physiologic tolerance to repair in selected patients. The use of biventricular repair in children with atrioventricular valve indexes of less than 0.50 requires caution.

Cardiac Surgical Procedures↗
PubMed1990

Comparative roles of intraoperative epicardial and early postoperative transthoracic echocardiography in the assessment of surgical repair of congenital heart defects.

In 94 consecutive patients undergoing surgical repair of congenital heart defects the results of intraoperative (after cardiopulmonary bypass) epicardial two-dimensional and Doppler color flow imaging were compared with those of sequential transthoracic echocardiography performed within 24 h of surgery and again before hospital discharge to define the precise role of intraoperative imaging. In 6 of 7 patients with a residual defect requiring immediate surgical revision, intraoperative imaging correctly identified the defect; spectral Doppler imaging underestimated or did not identify a residual outflow tract gradient in 17 patients. Left atrioventricular (AV) valve regurgitation after repair of complete AV septal defect was underestimated in three patients. Although intraoperative documentation of good ventricular function was usually associated with a good outcome, in three patients poor systemic ventricular function after cardiopulmonary bypass was not associated with early mortality. A minor degree of shunting around the patch was a common finding on epicardial and early postoperative imaging and persisted at the time of hospital discharge in 17 of 46 patients who had undergone patch closure of a ventricular septal defect as part of the surgical procedure. Additional trabecular septal defects were missed on color flow imaging after cardiopulmonary bypass in three patients, one of whom required subsequent reoperation. Although intraoperative two-dimensional and color flow imaging permitted the recognition of the majority of residual defects requiring immediate revision, residual outflow obstruction or AV valve regurgitation was usually underestimated.

Child↗
PubMed2002

Spectrum and outcome of atrioventricular septal defect in fetal life.

OBJECTIVES OF THE STUDY: to analyse the features and outcomes of different types of atrioventricular septal defects, detected during fetal life, as compared to postnatal data. MATERIAL AND METHODS: We analysed retrospectively the data concerning 82 fetuses with atrioventricular septal defect, diagnosed from 19 through 37 weeks gestation with a median of 26 weeks. In 46 cases (56.1%), the diagnosis has been made before the age of 24 weeks. RESULTS: Characteristics of the series--in 44 fetuses the atrioventricular septal defect was not associated with other cardiac anomalies, while 38 fetuses had a more complex form. Chromosomal anomalies were present in 33 of the fetuses (40.2%), more frequently in cases without associated intracardiac defects (56.8%). Trisomy 21 occurred in just over one quarter the series, and in 43.2% of cases without associated defects. In addition, 11% of fetuses had trisomy 18, and one had trisomy 13. Extracardiac anomalies were present in 12 of the fetuses (14.6%), more frequently in cases without associated abnormalities. Of fetuses with more complex defects, 46.4% had hypoplasia of the left ventricle and aorta. Complete atrioventricular block was present in 10 of the fetuses (12.2%), mainly in fetuses with other malformations, and particularly with left isomerism. Recurrence of congenital heart disease was observed in 5 of the fetuses (6.1%). OUTCOME: In 25 instances (30.5%) the parents opted for termination of pregnancy. Of 57 cases that continued through pregnancy, 9 fetuses died prior to term (15.8%), 32 died postnatally (56.13%) and only 16 fetuses (28.1%) survived. Overall, the mortality was higher in cases with associated malformations, in those with heart failure or those with atrioventricular block. Cardiac surgery was performed in 19 infants, with 5 dying postoperatively, and one late. CONCLUSIONS: Our data show a high prevalence of atrioventricular septal defect associated with other malformations when diagnosed during fetal life. This combination is less frequently associated with chromosomal and extracardiac anomalies, but more often with obstructive lesions of the left heart and with atrioventricular block. The association results in a less favourable outcome.

Cardiac Surgical Procedures↗
PubMed2004

Long-term survival in children with atrioventricular septal defect and common atrioventricular valvar orifice in Sweden.

BACKGROUND: The survival for patients with atrioventricular septal defect has improved markedly over the last decades and, during the same period, the survival of children with Down's syndrome has also increased. The aim of our study was to investigate long-term survival in patients having atrioventricular septal defect with common valvar orifice, but without associated significant congenital heart defects, in the setting of Down's syndrome, comparing the findings to those in chromosomally normal children with the same malformation. METHODS AND RESULTS: In a population-based retrospective study, we scrutinised the medical records from 801 liveborn children with atrioventricular septal defect born in Sweden during the period 1973 through 1997. Data on gender, presence or absence of Down's syndrome, associated congenital heart defects, date of birth, operation and death were recorded and followed up until 2001. An isolated atrioventricular septal defect with common atrioventricular valvar orifice was present in 502 children, of whom 86% had Down's syndrome. We found a significant reduc tion over time in age at operation, and in postoperative mortality at 30 days, from 28 to 1%. Using a multiple logistic regression model, we found no significant differences in mortality between genders, nor between those with or without Down's syndrome. Early corrective surgery could not be identified as a significant independent factor for survival. The 5-year postoperative survival in patients with Down's syndrome increased from 65% over the period from 1973 through 1977, to about 90% in the period 1993 through 1997, and the same trend was observed in chromosomally normal patients. CONCLUSIONS: Survival in uncomplicated atrioventricular septal defect with common atrioventricular valvar orifice has greatly increased, and surgical correction is now equally successful in patients with Down's syndrome and chromosomally normal patients, and for both genders. Death in connection with surgery is no longer the major threat, and focus must now be on long-term follow-up.

Child↗
PubMed2000

Nuchal translucency and congenital heart defects: heart failure or not?

OBJECTIVE: To determine whether heart failure is the mechanism underlying the association between increased fetal nuchal translucency and congenital heart defects. METHODS: Retrospective analysis of the types of congenital heart defect observed in fetuses with increased nuchal translucency and those with normal nuchal scans. Retrospective quantitative analysis of cardiac size and left ventricular ejection fraction in fetuses with ventricular septal defects or the hypoplastic left heart syndrome. RESULTS: Eighty-three fetuses with congenital heart defects had undergone nuchal screening of which 51 had increased nuchal translucency and 32 had normal nuchal translucency. A wide variety of different congenital cardiac lesions with different hemodynamic effects were observed in fetuses with increased nuchal translucency and those with normal nuchal scans. Defects primarily characterized by left heart obstruction, right heart obstruction and septal defects occurred in both groups. All measurements of cardiothoracic ratio and left ventricular ejection fraction fell within the normal range and there was no significant difference between fetuses with increased nuchal translucency and those with normal nuchal scans. CONCLUSIONS: No specific type of congenital heart lesion is associated with increased nuchal translucency. The contention that heart failure explains the association between congenital heart defects and increased nuchal translucency is not supported by this study.

Heart Defects, Congenital↗
PubMed2002

Risk of specific birth defects in relation to chlorination and the amount of natural organic matter in the water supply.

To assess the effect of water chlorination by-products on specific birth defects, the authors conducted a nationwide cross-sectional study of 285,631 Norwegian births in 1993-1998. Risks of birth defects according to four chlorination by-product exposure categories were compared on the basis of chlorination (yes/no) and level of water color (mg Pt/liter), representing the amount of natural organic matter: high (chlorination, < or =20), medium (chlorination, 10-19.9), and low (chlorination, <10) exposure, with no chlorination and low color (<10) as the reference category. In logistic regression analysis, the risks of any birth defect (adjusted odds ratio (OR) = 1.13, 95% confidence interval (CI): 1.01, 1.25) and of cardiac (adjusted OR = 1.37, 95% CI: 1.00, 1.89), respiratory system (adjusted OR = 1.89, 95% CI: 1.00, 3.58), and urinary tract (adjusted OR = 1.46, 95% CI: 1.00, 2.13) defects were significantly associated with exposure (medium and high combined). Regarding risk of specific birth defects, only that for ventricular septal defects was significantly elevated, with an exposure-response pattern, yielding adjusted odds ratios of 1.63 (95% CI: 1.02, 2.58) for the medium and 1.81 (95% CI: 1.05, 3.09) for the high exposure categories. Furthermore, risk of neural tube defects was related to high color (adjusted OR = 2.60, 95% CI: 1.30, 5.26).

Adult↗
PubMed1994

Increasing incidence of ventricular septal defects caused by improved detection rate.

In a population-based study in children born alive during the 10-year period from 1982 to 1991 (n = 22,810), ventricular septal defects (VSDs) were diagnosed in 127 cases, an incidence of 5.6 per 1000. The incidence was significantly higher in the cohort of children born during the 6-year period from 1986 to 1991 than among those born in the preceding 4-year period, 1982-1985 (6.5 and 4.0 per 1000 respectively; p < 0.05). The increase was caused entirely by an increased detection rate of small defects in the muscular part of the interventricular septum after introducing echocardiography as a standard method for investigating suspect congenital heart defects in the neonatal period. This also explained entirely an increase in the total incidence of congenital heart defects to 10.6 per 1000 in the last period from 8.4 per 1000 in the first, although this increase was not significant (p > 0.05). More children born in 1986-1991 had spontaneous closure of their VSDs (75.5%) than those born in 1982-1985 (51.5%) (p < 0.05). In 69.3% of patients the VSDs closed during the first year of life. For the cohort born in 1986-1991, 84.6% of the defects located in the muscular part of the septum closed spontaneously. Small defects in the muscular part of the interventricular septum with spontaneous closure in early life may represent the tail of a normal developmental process, and not defects in the sense of malformations.

Cohort Studies↗
PubMed1982

Assessment of atrioventricular septal defects by two dimensional echocardiography.

Ninety-six patients with an atrioventricular septal defect were assessed by two dimensional echocardiography. Forty-eight patients were judged as having two discrete valve orifices. In this group, 37 had an intact ventricular septum and 11 a ventricular septal defect. Two patterns of attachment of the valve leaflets to the interventricular septum were noted. Forty-eight patients had a common valve orifice. In 29 patients there was absence of tethering of the anterior bridging leaflet to the interventricular septum. A further 19 had varying degrees of tethering of the anterior bridging leaflet. A ventricular septal defect was identified under the anterior bridging leaflet in all cases. In 58 cases where the posterior bridging leaflet was identified, a ventricular septal defect was visualised in eight and missed in two. Seventy-eight patients had an ostium primum defect, 12 a common atrium, and a further six an intact interatrial septum. Two dimensional echocardiography provides in depth morphological information about the type of atrioventricular defect and can correctly identify the presence of a ventricular septal defect beneath the anterior or posterior bridging leaflet, unless it exists between short crowded chordae.

Child↗

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