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</div> </div> </nav> <h1 id="firstHeading" class="firstHeading mw-first-heading"><span class="mw-page-title-main">Atrioventricular septal defect</span></h1> <div id="p-lang-btn" class="vector-dropdown mw-portlet mw-portlet-lang" > <input type="checkbox" id="p-lang-btn-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-p-lang-btn" class="vector-dropdown-checkbox mw-interlanguage-selector" aria-label="Go to an article in another language. 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class="interlanguage-link-target"><span>العربية</span></a></li><li class="interlanguage-link interwiki-de mw-list-item"><a href="https://de.wikipedia.org/wiki/Atrio-ventrikul%C3%A4rer_Septumdefekt" title="Atrio-ventrikulärer Septumdefekt – German" lang="de" hreflang="de" data-title="Atrio-ventrikulärer Septumdefekt" data-language-autonym="Deutsch" data-language-local-name="German" class="interlanguage-link-target"><span>Deutsch</span></a></li><li class="interlanguage-link interwiki-fr mw-list-item"><a href="https://fr.wikipedia.org/wiki/Canal_atrioventriculaire" title="Canal atrioventriculaire – French" lang="fr" hreflang="fr" data-title="Canal atrioventriculaire" data-language-autonym="Français" data-language-local-name="French" class="interlanguage-link-target"><span>Français</span></a></li><li class="interlanguage-link interwiki-mr mw-list-item"><a href="https://mr.wikipedia.org/wiki/%E0%A4%8F%E0%A4%9F%E0%A5%8D%E0%A4%B0%E0%A4%BF%E0%A4%AF%E0%A5%8B%E0%A4%B5%E0%A5%8D%E0%A4%B9%E0%A5%87%E0%A4%82%E0%A4%9F%E0%A5%8D%E0%A4%B0%E0%A5%80%E0%A4%95%E0%A5%8D%E0%A4%AF%E0%A5%81%E0%A4%B2%E0%A4%B0_%E0%A4%B8%E0%A5%87%E0%A4%AA%E0%A5%8D%E0%A4%9F%E0%A4%B2_%E0%A4%A1%E0%A4%BF%E0%A4%AB%E0%A5%87%E0%A4%95%E0%A5%8D%E0%A4%9F" title="एट्रियोव्हेंट्रीक्युलर सेप्टल डिफेक्ट – Marathi" lang="mr" hreflang="mr" data-title="एट्रियोव्हेंट्रीक्युलर सेप्टल डिफेक्ट" data-language-autonym="मराठी" data-language-local-name="Marathi" class="interlanguage-link-target"><span>मराठी</span></a></li><li class="interlanguage-link interwiki-nl mw-list-item"><a href="https://nl.wikipedia.org/wiki/Atrioventriculair_septumdefect" title="Atrioventriculair septumdefect – Dutch" lang="nl" hreflang="nl" data-title="Atrioventriculair septumdefect" data-language-autonym="Nederlands" data-language-local-name="Dutch" class="interlanguage-link-target"><span>Nederlands</span></a></li><li class="interlanguage-link interwiki-ja mw-list-item"><a href="https://ja.wikipedia.org/wiki/%E5%BF%83%E5%86%85%E8%86%9C%E5%BA%8A%E6%AC%A0%E6%90%8D%E7%97%87" title="心内膜床欠損症 – Japanese" lang="ja" hreflang="ja" data-title="心内膜床欠損症" data-language-autonym="日本語" data-language-local-name="Japanese" class="interlanguage-link-target"><span>日本語</span></a></li><li class="interlanguage-link interwiki-no mw-list-item"><a href="https://no.wikipedia.org/wiki/Atrioventrikul%C3%A6r_septumdefekt" title="Atrioventrikulær septumdefekt – Norwegian Bokmål" lang="nb" hreflang="nb" data-title="Atrioventrikulær septumdefekt" data-language-autonym="Norsk bokmål" data-language-local-name="Norwegian Bokmål" class="interlanguage-link-target"><span>Norsk bokmål</span></a></li><li class="interlanguage-link interwiki-nn mw-list-item"><a href="https://nn.wikipedia.org/wiki/Atrioventrikul%C3%A6r_septumdefekt" title="Atrioventrikulær septumdefekt – Norwegian Nynorsk" lang="nn" hreflang="nn" data-title="Atrioventrikulær septumdefekt" data-language-autonym="Norsk nynorsk" data-language-local-name="Norwegian Nynorsk" class="interlanguage-link-target"><span>Norsk nynorsk</span></a></li><li class="interlanguage-link interwiki-pl mw-list-item"><a href="https://pl.wikipedia.org/wiki/Wsp%C3%B3lny_kana%C5%82_przedsionkowo-komorowy" title="Wspólny kanał przedsionkowo-komorowy – Polish" lang="pl" hreflang="pl" data-title="Wspólny kanał przedsionkowo-komorowy" data-language-autonym="Polski" data-language-local-name="Polish" class="interlanguage-link-target"><span>Polski</span></a></li><li class="interlanguage-link interwiki-pt mw-list-item"><a href="https://pt.wikipedia.org/wiki/Defeito_do_septo_atrioventricular" title="Defeito do septo atrioventricular – Portuguese" lang="pt" hreflang="pt" data-title="Defeito do septo atrioventricular" data-language-autonym="Português" data-language-local-name="Portuguese" class="interlanguage-link-target"><span>Português</span></a></li><li class="interlanguage-link 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For audio VCD, see <a href="/wiki/Video_CD" title="Video CD">Video CD</a>.</div> <div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Medical condition</div><style data-mw-deduplicate="TemplateStyles:r1257001546">.mw-parser-output .infobox-subbox{padding:0;border:none;margin:-3px;width:auto;min-width:100%;font-size:100%;clear:none;float:none;background-color:transparent}.mw-parser-output .infobox-3cols-child{margin:auto}.mw-parser-output .infobox .navbar{font-size:100%}@media screen{html.skin-theme-clientpref-night .mw-parser-output .infobox-full-data:not(.notheme)>div:not(.notheme)[style]{background:#1f1f23!important;color:#f8f9fa}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .infobox-full-data:not(.notheme) div:not(.notheme){background:#1f1f23!important;color:#f8f9fa}}@media(min-width:640px){body.skin--responsive .mw-parser-output .infobox-table{display:table!important}body.skin--responsive .mw-parser-output .infobox-table>caption{display:table-caption!important}body.skin--responsive .mw-parser-output .infobox-table>tbody{display:table-row-group}body.skin--responsive .mw-parser-output .infobox-table tr{display:table-row!important}body.skin--responsive .mw-parser-output .infobox-table th,body.skin--responsive .mw-parser-output .infobox-table td{padding-left:inherit;padding-right:inherit}}</style><table class="infobox ib-medical-condition"><tbody><tr><th colspan="2" class="infobox-above" style="background:#ccc">Atrioventricular septal defect</th></tr><tr><th scope="row" class="infobox-label">Other names</th><td class="infobox-data">Atrioventricular canal defect (AVCD), endocardial cushion defect (ECD)</td></tr><tr style="background-color: #f8f9fa;"><td colspan="2" class="infobox-full-data"><span class="mw-default-size" typeof="mw:File/Frameless"><a href="/wiki/File:Avsd.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/e/e3/Avsd.jpg/220px-Avsd.jpg" decoding="async" width="220" height="285" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/e/e3/Avsd.jpg/330px-Avsd.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/e/e3/Avsd.jpg/440px-Avsd.jpg 2x" data-file-width="575" data-file-height="744" /></a></span></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_specialty" title="Medical specialty">Specialty</a></th><td class="infobox-data">Cardiology</td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Signs_and_symptoms" title="Signs and symptoms">Symptoms</a></th><td class="infobox-data">Heart failure; pulmonary hypertension; dyspnea; cyanosis; mitral regurgitation</td></tr><tr><th scope="row" class="infobox-label">Types</th><td class="infobox-data">Partial, Incomplete, Complete, Transitional</td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Risk_factor" title="Risk factor">Risk factors</a></th><td class="infobox-data">Family history of congenital heart disease</td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_diagnosis" title="Medical diagnosis">Diagnostic method</a></th><td class="infobox-data">Ultrasound and echocardiography</td></tr><tr><th scope="row" class="infobox-label">Treatment</th><td class="infobox-data">Open heart surgery</td></tr></tbody></table> <p><b>Atrioventricular septal defect</b> (AVSD) or <b>atrioventricular canal defect</b> (AVCD), also known as "<b>common atrioventricular canal</b>" or "<b><a href="/wiki/Endocardial_cushion" class="mw-redirect" title="Endocardial cushion">endocardial cushion</a> defect</b>" (ECD), is characterized by a deficiency of the <a href="/wiki/Atrioventricular_septum" title="Atrioventricular septum">atrioventricular septum</a> of the <a href="/wiki/Heart" title="Heart">heart</a> that creates connections between all four of its chambers. It is a very specific combination of 3 defects: </p><p>1) <a href="/wiki/Atrial_septal_defect" title="Atrial septal defect">Atrial Septal Defect</a> (ASD), a hole in the wall between the right and left atria; </p><p>2) <a href="/wiki/Ventricular_septal_defect" title="Ventricular septal defect">Ventricular Septal Defect</a> (VSD), a hole in the wall between the right and left ventricles; and </p><p>3) Abnormalities of the mitral and/or tricuspid valves.<sup id="cite_ref-1" class="reference"><a href="#cite_note-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-2" class="reference"><a href="#cite_note-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> </p><p>AVCD is caused by an abnormal or inadequate fusion of the superior and inferior <a href="/wiki/Endocardial_cushions" title="Endocardial cushions">endocardial cushions</a> with the mid portion of the <a href="/wiki/Atrial_septum" class="mw-redirect" title="Atrial septum">atrial septum</a> and the muscular portion of the <a href="/wiki/Ventricular_septum" class="mw-redirect" title="Ventricular septum">ventricular septum</a>.<sup id="cite_ref-:0_3-0" class="reference"><a href="#cite_note-:0-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> Unlike some heart defects, the condition will not resolve over time and most infants must undergo open heart surgery. The surgery to correct this defect is usually successful and most babies do very well post-op.<sup id="cite_ref-:2_4-0" class="reference"><a href="#cite_note-:2-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> </p> <meta property="mw:PageProp/toc" /> <div class="mw-heading mw-heading2"><h2 id="Symptoms_and_signs">Symptoms and signs</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Atrioventricular_septal_defect&action=edit&section=1" title="Edit section: Symptoms and signs"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Symptoms may include difficulty breathing (<a href="/wiki/Dyspnoea" class="mw-redirect" title="Dyspnoea">dyspnea</a>) and bluish discoloration on skin, fingernails, and lips (<a href="/wiki/Cyanosis" title="Cyanosis">cyanosis</a>).<sup id="cite_ref-mayoclinic_5-0" class="reference"><a href="#cite_note-mayoclinic-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> An infant will begin to show signs of congestive heart failure, which can include rapid breathing, feeding problems, slow weight gain, low energy, and cold, clammy sweating.<sup id="cite_ref-:2_4-1" class="reference"><a href="#cite_note-:2-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> Symptoms often appear between 1-2 months of age but can occur earlier in some newborns.<sup id="cite_ref-:2_4-2" class="reference"><a href="#cite_note-:2-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Complications">Complications</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Atrioventricular_septal_defect&action=edit&section=2" title="Edit section: Complications"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Normally, the four chambers of the heart divide oxygenated and de-oxygenated blood into separate pools. When holes form between the chambers, as in AVSD, the pools can mix. Consequently, arterial blood supplies become less oxygenated than normal, causing <a href="/wiki/Ischemia" title="Ischemia">ischemia</a> and cyanosis in distal tissues.<sup id="cite_ref-:0_3-1" class="reference"><a href="#cite_note-:0-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> To compensate, the heart must pump a larger volume of blood to deliver enough oxygen, leading to cardiac enlargement and <a href="/wiki/Ventricular_hypertrophy" title="Ventricular hypertrophy">hypertrophy</a>.<sup id="cite_ref-mayoclinic_5-1" class="reference"><a href="#cite_note-mayoclinic-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> </p><p>The development of pulmonary hypertension is very serious. And this because the <a href="/wiki/Left_ventricle" class="mw-redirect" title="Left ventricle">left ventricle</a> is weakened due to its overuse. When this happens, the pressure backs up into the <a href="/wiki/Pulmonary_veins" class="mw-redirect" title="Pulmonary veins">pulmonary veins</a> and the lungs.<sup id="cite_ref-mayoclinic_5-2" class="reference"><a href="#cite_note-mayoclinic-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> This type of damage is irreversible which is why immediate treatment is recommended after diagnosis.<sup id="cite_ref-ncbi_6-0" class="reference"><a href="#cite_note-ncbi-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Associated_conditions">Associated conditions</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Atrioventricular_septal_defect&action=edit&section=3" title="Edit section: Associated conditions"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/wiki/Down_syndrome" title="Down syndrome">Down syndrome</a> is often associated with AVCD.<sup id="cite_ref-7" class="reference"><a href="#cite_note-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> Other risk factors include: having a parent with a <a href="/wiki/Congenital_heart_defect" title="Congenital heart defect">congenital heart defect</a>, alcohol use while pregnant, uncontrolled <a href="/wiki/Diabetes" title="Diabetes">diabetes</a> treatment during pregnancy and some medications during pregnancy.<sup id="cite_ref-mayoclinic_5-3" class="reference"><a href="#cite_note-mayoclinic-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> </p><p>This type of congenital heart defect is associated with patients with <a href="/wiki/Down_syndrome" title="Down syndrome">Down syndrome</a> (trisomy 21) or <a href="/wiki/Situs_ambiguus" title="Situs ambiguus">heterotaxy syndromes</a>.<sup id="cite_ref-8" class="reference"><a href="#cite_note-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> 45% of children with Down syndrome have congenital heart disease. Of these, 35–40% have AV septal defects.<sup id="cite_ref-9" class="reference"><a href="#cite_note-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> Approximately 40-50% of fetuses diagnosed with AVCD have Down syndrome, and a further 15-20% are associated with other <a href="/wiki/Chromosomal_abnormalities" class="mw-redirect" title="Chromosomal abnormalities">chromosomal abnormalities</a> and syndromes, such as <a href="/wiki/DiGeorge_syndrome" title="DiGeorge syndrome">DiGeorge syndrome</a>.<sup id="cite_ref-:0_3-2" class="reference"><a href="#cite_note-:0-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:1_10-0" class="reference"><a href="#cite_note-:1-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> The remaining 30-40% of cases are not linked to a syndrome, with AVCD observed without other major defects. </p><p>AVCD is also linked with <a href="/wiki/Noonan_syndrome" title="Noonan syndrome">Noonan syndrome</a>.<sup id="cite_ref-:0_3-3" class="reference"><a href="#cite_note-:0-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> The pattern seen in those patients with Noonan syndrome differ from those patients who have <a href="/wiki/Down_syndrome" title="Down syndrome">Down syndrome</a> in that "partial" AVCD is more prevalent in those with NS, whereas those with down syndrome show a prevalence of the "complete" form of AVCD.<sup id="cite_ref-Noonan_11-0" class="reference"><a href="#cite_note-Noonan-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Pathophysiology">Pathophysiology</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Atrioventricular_septal_defect&action=edit&section=4" title="Edit section: Pathophysiology"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-halign-right" typeof="mw:File/Thumb"><a href="/wiki/File:CommonAtrioventricularCanal.svg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/d/d1/CommonAtrioventricularCanal.svg/190px-CommonAtrioventricularCanal.svg.png" decoding="async" width="190" height="190" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/d/d1/CommonAtrioventricularCanal.svg/285px-CommonAtrioventricularCanal.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/d/d1/CommonAtrioventricularCanal.svg/380px-CommonAtrioventricularCanal.svg.png 2x" data-file-width="381" data-file-height="382" /></a><figcaption>Complete AVSD with mixed oxygenated and deoxygenated blood entering both the <a href="/wiki/Aorta" title="Aorta">aorta</a> and the <a href="/wiki/Pulmonary_arteries" class="mw-redirect" title="Pulmonary arteries">pulmonary arteries</a>.</figcaption></figure><p>Defective embryonic formation of the heart results in multiple holes between the <a href="/wiki/Heart_chambers" class="mw-redirect" title="Heart chambers">heart chambers</a>. In AVSD, all four chambers are connected, but the exact characteristics of holes and malformations may vary between patients. Even within the categories of "complete" and "partial" AVSD, multiple morphologies exist, with varying clinical consequences. Clinical and physiological manifestations of disease may also change over time, in response to continued stress.<sup id="cite_ref-:0_3-4" class="reference"><a href="#cite_note-:0-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> </p><div class="mw-heading mw-heading3"><h3 id="Genetic_Relationship">Genetic Relationship</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Atrioventricular_septal_defect&action=edit&section=5" title="Edit section: Genetic Relationship"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Like other congenital heart defects, major associations have been found between AVCD and genes regulating embryonic cell <a href="/wiki/Cilium" title="Cilium">cilia</a>.<sup id="cite_ref-:1_10-1" class="reference"><a href="#cite_note-:1-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> These human cell cilia normally contain receptors for <a href="/wiki/Cell_signaling" title="Cell signaling">signal molecules</a> that regulate the healthy and organized tissue. Dysfunctional cilia can create multiple disease manifestations, leading to broad <a href="/wiki/Syndrome" title="Syndrome">syndromes</a>.<sup id="cite_ref-:1_10-2" class="reference"><a href="#cite_note-:1-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> Chromosome 21 harbors important regulators for cilia, and trisomy 21 (Down syndrome) can de-regulate them.<sup id="cite_ref-12" class="reference"><a href="#cite_note-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Diagnosis">Diagnosis</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Atrioventricular_septal_defect&action=edit&section=6" title="Edit section: Diagnosis"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure typeof="mw:File/Thumb"><a href="/wiki/File:CAVC.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/a/a3/CAVC.png/200px-CAVC.png" decoding="async" width="200" height="150" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/a/a3/CAVC.png/300px-CAVC.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/a/a3/CAVC.png/400px-CAVC.png 2x" data-file-width="500" data-file-height="376" /></a><figcaption>Ultrasound showing a complete atrioventricular septal defect</figcaption></figure> <p>AVSDs can be detected by <a href="/wiki/Auscultation" title="Auscultation">cardiac auscultation</a>; they cause atypical murmurs and loud heart tones. Confirmation of findings from cardiac auscultation can be obtained with a cardiac <a href="/wiki/Medical_ultrasonography" class="mw-redirect" title="Medical ultrasonography">ultrasound</a> (<a href="/wiki/Echocardiography" title="Echocardiography">echocardiography</a> - less invasive) and <a href="/wiki/Cardiac_catheterization" title="Cardiac catheterization">cardiac catheterization</a> (more invasive). It is also possible to diagnose AVSD in-utero via routine <a href="/wiki/Obstetric_ultrasonography" title="Obstetric ultrasonography">fetal ultrasounds</a> or, more conclusively, fetal echocardiograms.<sup id="cite_ref-:0_3-5" class="reference"><a href="#cite_note-:0-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Classification">Classification</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Atrioventricular_septal_defect&action=edit&section=7" title="Edit section: Classification"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>A variety of different classifications have been used, but the defects are usefully divided into "partial" and "complete" forms. </p> <ul><li>In the partial AVSD, there is a small or partial defect in the interventricular septum, and a primum <a href="/wiki/Atrial_septal_defect" title="Atrial septal defect">atrial septal defect</a>, which is a moderate or large connection between the atria, often featuring <a href="/wiki/Mitral_regurgitation" title="Mitral regurgitation">mitral valve regurgitation</a>.<sup id="cite_ref-:0_3-6" class="reference"><a href="#cite_note-:0-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> Partial AVSD may be asymptomatic in early childhood, but typically progresses by late childhood or adulthood into symptoms of heart failure. The onset of symptoms may be earlier in children with more significant mitral regurgitation.<sup id="cite_ref-:0_3-7" class="reference"><a href="#cite_note-:0-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup></li> <li>In the complete AVSD (CAVSD), there is a large ventricular component beneath either or both the superior or inferior bridging leaflets of the AV valve. The defect involves the whole area of the junction of the upper and lower chambers of the heart, i.e. where the atria join the ventricles. There is a large hole between the lower portion of the atria and the upper or 'inlet' portion of the ventricles and this is associated with a significant abnormality of the valves separating the atria from the ventricles. The valves in effect become a common atrio-ventricular valve, and the severity of the defect depends largely on the supporting attachments of the valve to the ventricles and whether the valve allows dominant flow from the right atrium to right ventricle and from left atrium to left ventricle ("unbalanced" flow). The overall problems are similar to those of <a href="/wiki/Ventricular_septal_defect" title="Ventricular septal defect">VSD</a> but are more complicated. There is an increased flow of blood to the lungs through both the ventricular and atrial components of the defect. In addition, the abnormal <a href="/wiki/Heart_valve" title="Heart valve">atrio-ventricular valve</a> invariably leaks, so that when the ventricles contract, blood flows not only forwards to the body and the lungs, but also backwards into the atria. The back-pressure effect on the atria causes congestion of blood in the left atrium in particular, and this in turn causes congestion in the veins draining the lungs. The effect on the baby is to worsen the heart failure that is associated with an isolated VSD and to hasten the onset of pulmonary hypertension. It should be mentioned that CAVSD is found in approximately one-third of babies who have <a href="/wiki/Down_syndrome" title="Down syndrome">Down syndrome</a>, but it also occurs as an isolated abnormality.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (May 2016)">citation needed</span></a></i>]</sup></li></ul> <div class="mw-heading mw-heading2"><h2 id="Treatment">Treatment</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Atrioventricular_septal_defect&action=edit&section=8" title="Edit section: Treatment"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Treatment is surgical and involves closure of the atrial and ventricular septal defects and restoration of a competent left AV valve as far as is possible. Open surgical procedures require a <a href="/wiki/Heart-lung_machine" class="mw-redirect" title="Heart-lung machine">heart-lung machine</a> and are done with a <a href="/wiki/Median_sternotomy" title="Median sternotomy">median sternotomy</a>. Surgical mortality for uncomplicated ostium primum defects in experienced centers is 2%; for uncomplicated cases of complete atrioventricular canal defect, 4% or less. Certain complications such as <a href="/wiki/Tetralogy_of_Fallot" title="Tetralogy of Fallot">tetralogy of Fallot</a> or highly unbalanced flow across the common AV valve can increase risk significantly.<sup id="cite_ref-13" class="reference"><a href="#cite_note-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-14" class="reference"><a href="#cite_note-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup> </p><p>Infants born with AVSD are generally in sufficient health to not require immediate corrective surgery. If surgery is not required immediately after birth, the newborn will be closely monitored for the next several months, and the operation held-off until the first signs of lung distress or heart failure. This gives the infant time to grow, increasing the size of, and thereby the ease of operation on, the heart, as well as the ease of recovery. Infants will generally require surgery within three to six months, however, they may be able to go up to two years before the operation becomes necessary, depending on the severity of the defect.<sup id="cite_ref-15" class="reference"><a href="#cite_note-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="See_also">See also</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Atrioventricular_septal_defect&action=edit&section=9" title="Edit section: See also"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><a href="/wiki/Atrial_septal_defect" title="Atrial septal defect">Atrial septal defect</a></li> <li><a href="/wiki/Congenital_heart_disease" class="mw-redirect" title="Congenital heart disease">Congenital heart disease</a></li> <li><a href="/wiki/Down_syndrome" title="Down syndrome">Down syndrome</a></li> <li><a href="/wiki/Heart" title="Heart">Heart</a></li> <li><a href="/wiki/Heart_sounds" title="Heart sounds">Heart sounds</a></li> <li><a href="/wiki/Pulmonary_hypertension" title="Pulmonary hypertension">Pulmonary hypertension</a></li> <li><a href="/wiki/Ventricular_septal_defect" title="Ventricular septal defect">Ventricular septal defect</a></li></ul> <div class="mw-heading mw-heading2"><h2 id="References">References</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Atrioventricular_septal_defect&action=edit&section=10" title="Edit section: References"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist"> <div class="mw-references-wrap mw-references-columns"><ol class="references"> <li id="cite_note-1"><span class="mw-cite-backlink"><b><a href="#cite_ref-1">^</a></b></span> <span class="reference-text"><style data-mw-deduplicate="TemplateStyles:r1238218222">.mw-parser-output cite.citation{font-style:inherit;word-wrap:break-word}.mw-parser-output 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a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output .cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;color:var(--color-error,#d33)}.mw-parser-output .cs1-visible-error{color:var(--color-error,#d33)}.mw-parser-output .cs1-maint{display:none;color:#085;margin-left:0.3em}.mw-parser-output .cs1-kern-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}@media screen{.mw-parser-output .cs1-format{font-size:95%}html.skin-theme-clientpref-night .mw-parser-output .cs1-maint{color:#18911f}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output 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"Congenital heart diseases in children with Noonan syndrome: An expanded cardiac spectrum with high prevalence of atrioventricular canal". <i>The Journal of Pediatrics</i>. <b>135</b> (6): 703–706. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1016%2FS0022-3476%2899%2970088-0">10.1016/S0022-3476(99)70088-0</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/10586172">10586172</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Pediatrics&rft.atitle=Congenital+heart+diseases+in+children+with+Noonan+syndrome%3A+An+expanded+cardiac+spectrum+with+high+prevalence+of+atrioventricular+canal&rft.volume=135&rft.issue=6&rft.pages=703-706&rft.date=1999-12&rft_id=info%3Adoi%2F10.1016%2FS0022-3476%2899%2970088-0&rft_id=info%3Apmid%2F10586172&rft.aulast=Marino&rft.aufirst=B&rft.au=Digilio%2C+MC&rft.au=Toscano%2C+A&rft.au=Giannotti%2C+A&rft.au=Dallapiccola%2C+B&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAtrioventricular+septal+defect" class="Z3988"></span></span> </li> <li id="cite_note-12"><span class="mw-cite-backlink"><b><a href="#cite_ref-12">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFGalatiSullivanPhamEspinosa2018" class="citation journal cs1">Galati DF, Sullivan KD, Pham AT, Espinosa JM, Pearson CG (September 2018). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6557141">"Trisomy 21 Represses Cilia Formation and Function"</a>. <i>Developmental Cell</i>. <b>46</b> (5): 641–650.e6. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1016%2Fj.devcel.2018.07.008">10.1016/j.devcel.2018.07.008</a>. <a href="/wiki/PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6557141">6557141</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/30100262">30100262</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Developmental+Cell&rft.atitle=Trisomy+21+Represses+Cilia+Formation+and+Function&rft.volume=46&rft.issue=5&rft.pages=641-650.e6&rft.date=2018-09&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC6557141%23id-name%3DPMC&rft_id=info%3Apmid%2F30100262&rft_id=info%3Adoi%2F10.1016%2Fj.devcel.2018.07.008&rft.aulast=Galati&rft.aufirst=DF&rft.au=Sullivan%2C+KD&rft.au=Pham%2C+AT&rft.au=Espinosa%2C+JM&rft.au=Pearson%2C+CG&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC6557141&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAtrioventricular+septal+defect" class="Z3988"></span></span> </li> <li id="cite_note-13"><span class="mw-cite-backlink"><b><a href="#cite_ref-13">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFKirklinBarratt-Boyes1986" class="citation book cs1">Kirklin J, Barratt-Boyes B, eds. (1986). <i>Cardiac Surgery</i>. New York: Wiley. pp. 463–497.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Cardiac+Surgery&rft.place=New+York&rft.pages=463-497&rft.pub=Wiley&rft.date=1986&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAtrioventricular+septal+defect" class="Z3988"></span></span> </li> <li id="cite_note-14"><span class="mw-cite-backlink"><b><a href="#cite_ref-14">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFMarxFyler2006" class="citation book cs1">Marx GR, Fyler DC (2006). "Endiocardial Cusion Defects". In Keane JF, Lock JE, Fyler DC (eds.). <i>Pediatric Cardiology</i> (2nd ed.). Philadelphia: Saunders-Elsevier. pp. 663–674. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-1-4160-2390-6" title="Special:BookSources/978-1-4160-2390-6"><bdi>978-1-4160-2390-6</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Endiocardial+Cusion+Defects&rft.btitle=Pediatric+Cardiology&rft.place=Philadelphia&rft.pages=663-674&rft.edition=2nd&rft.pub=Saunders-Elsevier&rft.date=2006&rft.isbn=978-1-4160-2390-6&rft.aulast=Marx&rft.aufirst=GR&rft.au=Fyler%2C+DC&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAtrioventricular+septal+defect" class="Z3988"></span></span> </li> <li id="cite_note-15"><span class="mw-cite-backlink"><b><a href="#cite_ref-15">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFHayLevinSondheimerDeterding2007" class="citation book cs1">Hay WW, Levin MJ, Sondheimer JM, Deterding RR (2007). <i>Current pediatric diagnosis & treatment</i> (18th ed.). New York: Lange Medical Books/McGraw-Hill, Medical Pub. Division. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-07-146300-3" title="Special:BookSources/978-0-07-146300-3"><bdi>978-0-07-146300-3</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Current+pediatric+diagnosis+%26+treatment&rft.place=New+York&rft.edition=18th&rft.pub=Lange+Medical+Books%2FMcGraw-Hill%2C+Medical+Pub.+Division&rft.date=2007&rft.isbn=978-0-07-146300-3&rft.aulast=Hay&rft.aufirst=WW&rft.au=Levin%2C+MJ&rft.au=Sondheimer%2C+JM&rft.au=Deterding%2C+RR&rfr_id=info%3Asid%2Fen.wikipedia.org%3AAtrioventricular+septal+defect" class="Z3988"></span></span> </li> </ol></div></div> <div class="mw-heading mw-heading2"><h2 id="External_links">External links</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Atrioventricular_septal_defect&action=edit&section=11" title="Edit 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style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0;color:black;">Classification</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"><div style="position:relative; float:right; font-size:0.8em;"><a href="https://www.wikidata.org/wiki/Q390211" class="extiw" title="d:Q390211">D</a></div><div class="hlist" style="text-align:left;"><ul><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/ICD-10" title="ICD-10">10</a></b>: <a rel="nofollow" class="external text" href="https://icd.who.int/browse10/2019/en#/Q21.2">Q21.2</a></li><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/List_of_ICD-9_codes" title="List of ICD-9 codes">9-CM</a></b>: <a rel="nofollow" class="external text" href="http://www.icd9data.com/getICD9Code.ashx?icd9=745.6">745.6</a></li><li><b><a href="/wiki/Medical_Subject_Headings" title="Medical Subject Headings">MeSH</a></b>: <a rel="nofollow" class="external text" href="https://meshb.nlm.nih.gov/record/ui?ui=D004694">D004694</a></li><li><b><a href="/wiki/Diseases_Database" title="Diseases Database">DiseasesDB</a></b>: <a rel="nofollow" class="external text" href="http://www.diseasesdatabase.com/ddb31910.htm">31910</a></li></ul></div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0;color:black;">External resources</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"><div class="hlist" style="text-align:left;"><ul><li><b><a href="/wiki/EMedicine" title="EMedicine">eMedicine</a></b>: <a rel="nofollow" class="external text" href="https://emedicine.medscape.com/med/670-overview">med/670</a></li></ul></div></div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Congenital_heart_defects" style="padding:3px"><table class="nowraplinks mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><style data-mw-deduplicate="TemplateStyles:r1239400231">.mw-parser-output .navbar{display:inline;font-size:88%;font-weight:normal}.mw-parser-output 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.navbar{display:none!important}}</style><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Congenital_heart_defects" title="Template:Congenital heart defects"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Congenital_heart_defects" title="Template talk:Congenital heart defects"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Congenital_heart_defects" title="Special:EditPage/Template:Congenital heart defects"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Congenital_heart_defects" style="font-size:114%;margin:0 4em"><a href="/wiki/Congenital_heart_defect" title="Congenital heart defect">Congenital heart defects</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Heart_septal_defect" title="Heart septal defect">Heart septal defect</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Aortopulmonary_septal_defect" title="Aortopulmonary septal defect">Aortopulmonary septal defect</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Double_outlet_right_ventricle" title="Double outlet right ventricle">Double outlet right ventricle</a> <ul><li><a href="/wiki/Taussig%E2%80%93Bing_syndrome" title="Taussig–Bing syndrome">Taussig–Bing syndrome</a></li></ul></li> <li><a href="/wiki/Transposition_of_the_great_vessels" title="Transposition of the great vessels">Transposition of the great vessels</a> <ul><li><a href="/wiki/Dextro-Transposition_of_the_great_arteries" title="Dextro-Transposition of the great arteries">dextro</a></li> <li><a href="/wiki/Levo-Transposition_of_the_great_arteries" title="Levo-Transposition of the great arteries">levo</a></li></ul></li> <li><a href="/wiki/Persistent_truncus_arteriosus" title="Persistent truncus arteriosus">Persistent truncus arteriosus</a></li></ul> <ul><li><a href="/wiki/Aortopulmonary_window" title="Aortopulmonary window">Aortopulmonary window</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Atrial_septal_defect" title="Atrial septal defect">Atrial septal defect</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Sinus_venosus_atrial_septal_defect" title="Sinus venosus atrial septal defect">Sinus venosus atrial septal defect</a></li> <li><a href="/wiki/Lutembacher%27s_syndrome" title="Lutembacher's syndrome">Lutembacher's syndrome</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Ventricular_septal_defect" title="Ventricular septal defect">Ventricular septal defect</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Tetralogy_of_Fallot" title="Tetralogy of Fallot">Tetralogy of Fallot</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a class="mw-selflink selflink">Atrioventricular septal defect</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Ostium_primum_atrial_septal_defect" title="Ostium primum atrial septal defect">Ostium primum</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Consequences</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Cardiac_shunt" title="Cardiac shunt">Cardiac shunt</a> <ul><li><a href="/wiki/Cyanotic_heart_disease" class="mw-redirect" title="Cyanotic heart disease">Cyanotic heart disease</a></li></ul></li> <li><a href="/wiki/Eisenmenger_syndrome" title="Eisenmenger syndrome">Eisenmenger syndrome</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Valvular_heart_disease" title="Valvular heart disease">Valvular heart disease</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%">Right</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Pulmonary_valve" title="Pulmonary valve">pulmonary valves</a> <ul><li><a href="/wiki/Pulmonary_valve_stenosis" title="Pulmonary valve stenosis">stenosis</a></li> <li><a href="/wiki/Pulmonary_valve_insufficiency" class="mw-redirect" title="Pulmonary valve insufficiency">insufficiency</a></li> <li><a href="/wiki/Absent_pulmonary_valve_syndrome" title="Absent pulmonary valve syndrome">absence</a></li></ul></li> <li><a href="/wiki/Tricuspid_valve" title="Tricuspid valve">tricuspid valves</a> <ul><li><a href="/wiki/Tricuspid_atresia" title="Tricuspid atresia">atresia</a></li> <li><a href="/wiki/Tricuspid_regurgitation" title="Tricuspid regurgitation">regurgitation</a></li> <li><a href="/wiki/Tricuspid_valve_stenosis" title="Tricuspid valve stenosis">stenosis</a></li> <li><a href="/wiki/Ebstein%27s_anomaly" title="Ebstein's anomaly">Ebstein's anomaly</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Left</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Aortic_valve" title="Aortic valve">aortic valves</a> <ul><li><a href="/wiki/Aortic_valve_stenosis" class="mw-redirect" title="Aortic valve stenosis">stenosis</a></li> <li><a href="/wiki/Aortic_insufficiency" class="mw-redirect" title="Aortic insufficiency">insufficiency</a></li> <li><a href="/wiki/Bicuspid_aortic_valve" title="Bicuspid aortic valve">bicuspid</a></li></ul></li> <li><a href="/wiki/Mitral_valve" title="Mitral valve">mitral valves</a> <ul><li><a href="/wiki/Mitral_stenosis" title="Mitral stenosis">stenosis</a></li> <li><a href="/wiki/Mitral_regurgitation" title="Mitral regurgitation">regurgitation</a></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li>Underdeveloped <a href="/wiki/Heart_chamber" class="mw-redirect" title="Heart chamber">heart chambers</a> <ul><li><a href="/wiki/Hypoplastic_right_heart_syndrome" title="Hypoplastic right heart syndrome">right</a></li> <li><a href="/wiki/Hypoplastic_left_heart_syndrome" title="Hypoplastic left heart syndrome">left</a></li> <li><a href="/wiki/Uhl_anomaly" title="Uhl anomaly">Uhl anomaly</a></li></ul></li> <li><a href="/wiki/Dextrocardia" title="Dextrocardia">Dextrocardia</a></li> <li><a href="/wiki/Levocardia" title="Levocardia">Levocardia</a></li> <li><a href="/wiki/Cor_triatriatum" title="Cor triatriatum">Cor triatriatum</a></li> <li><a href="/wiki/Crisscross_heart" title="Crisscross heart">Crisscross heart</a></li> <li><a href="/wiki/Brugada_syndrome" title="Brugada syndrome">Brugada syndrome</a></li> <li><a href="/wiki/Coronary_artery_anomaly" title="Coronary artery anomaly">Coronary artery anomaly</a></li> <li><a href="/wiki/Anomalous_aortic_origin_of_a_coronary_artery" title="Anomalous aortic origin of a coronary artery">Anomalous aortic origin of a coronary artery</a></li> <li><a href="/wiki/Ventricular_inversion" title="Ventricular inversion">Ventricular inversion</a></li></ul> </div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Medicine" style="padding:3px"><table class="nowraplinks hlist mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231"><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Medicine" title="Template:Medicine"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Medicine" title="Template talk:Medicine"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Medicine" title="Special:EditPage/Template:Medicine"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Medicine" style="font-size:114%;margin:0 4em"><a href="/wiki/Medicine" title="Medicine">Medicine</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Medical_specialty" title="Medical specialty">Specialties</a><br />and<br /><a href="/wiki/Subspecialty" title="Subspecialty">subspecialties</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Surgery" title="Surgery">Surgery</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Cardiac_surgery" title="Cardiac surgery">Cardiac surgery</a></li> <li><a href="/wiki/Cardiothoracic_surgery" title="Cardiothoracic surgery">Cardiothoracic surgery</a></li> <li><a href="/wiki/Endocrine_surgery" title="Endocrine surgery">Endocrine surgery</a></li> <li><a href="/wiki/Eye_surgery" title="Eye surgery">Eye surgery</a></li> <li><a href="/wiki/General_surgery" title="General surgery">General surgery</a> <ul><li><a href="/wiki/Colorectal_surgery" title="Colorectal surgery">Colorectal surgery</a></li> <li><a href="/wiki/Digestive_system_surgery" title="Digestive system surgery">Digestive system surgery</a></li></ul></li> <li><a href="/wiki/Neurosurgery" title="Neurosurgery">Neurosurgery</a></li> <li><a href="/wiki/Oral_and_maxillofacial_surgery" title="Oral and maxillofacial surgery">Oral and maxillofacial surgery</a></li> <li><a href="/wiki/Orthopedic_surgery" title="Orthopedic surgery">Orthopedic surgery</a></li> <li><a href="/wiki/Hand_surgery" title="Hand surgery">Hand surgery</a></li> <li><a href="/wiki/Otorhinolaryngology" title="Otorhinolaryngology">Otolaryngology</a> <ul><li><small>ENT</small></li></ul></li> <li><a href="/wiki/Pediatric_surgery" title="Pediatric surgery">Pediatric surgery</a></li> <li><a href="/wiki/Plastic_surgery" title="Plastic surgery">Plastic surgery</a></li> <li><a href="/wiki/Reproductive_surgery" title="Reproductive surgery">Reproductive surgery</a></li> <li><a href="/wiki/Surgical_oncology" title="Surgical oncology">Surgical oncology</a></li> <li><a href="/wiki/Organ_transplantation" title="Organ transplantation">Transplant surgery</a></li> <li><a href="/wiki/Trauma_surgery" title="Trauma surgery">Trauma surgery</a></li> <li><a href="/wiki/Urology" title="Urology">Urology</a> <ul><li><a href="/wiki/Andrology" title="Andrology">Andrology</a></li></ul></li> <li><a href="/wiki/Vascular_surgery" title="Vascular surgery">Vascular surgery</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Internal_medicine" title="Internal medicine">Internal<br />medicine</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Allergy" title="Allergy">Allergy</a> / <a href="/wiki/Immunology" title="Immunology">Immunology</a></li> <li><a href="/wiki/Angiology" title="Angiology">Angiology</a></li> <li><a href="/wiki/Cardiology" title="Cardiology">Cardiology</a></li> <li><a href="/wiki/Endocrinology" title="Endocrinology">Endocrinology</a></li> <li><a href="/wiki/Gastroenterology" title="Gastroenterology">Gastroenterology</a> <ul><li><a href="/wiki/Hepatology" title="Hepatology">Hepatology</a></li></ul></li> <li><a href="/wiki/Geriatrics" title="Geriatrics">Geriatrics</a></li> <li><a href="/wiki/Hematology" title="Hematology">Hematology</a></li> <li><a href="/wiki/Hospital_medicine" title="Hospital medicine">Hospital medicine</a></li> <li><a href="/wiki/Infectious_diseases_(medical_specialty)" title="Infectious diseases (medical specialty)">Infectious diseases</a></li> <li><a href="/wiki/Nephrology" title="Nephrology">Nephrology</a></li> <li><a href="/wiki/Oncology" title="Oncology">Oncology</a></li> <li><a href="/wiki/Pulmonology" title="Pulmonology">Pulmonology</a></li> <li><a href="/wiki/Rheumatology" title="Rheumatology">Rheumatology</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Obstetrics_and_gynaecology" title="Obstetrics and gynaecology">Obstetrics and<br />gynaecology</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Gynaecology" title="Gynaecology">Gynaecology</a></li> <li><a href="/wiki/Gynecologic_oncology" title="Gynecologic oncology">Gynecologic oncology</a></li> <li><a href="/wiki/Maternal%E2%80%93fetal_medicine" title="Maternal–fetal medicine">Maternal–fetal medicine</a></li> <li><a href="/wiki/Obstetrics" title="Obstetrics">Obstetrics</a></li> <li><a href="/wiki/Reproductive_endocrinology_and_infertility" title="Reproductive endocrinology and infertility">Reproductive endocrinology and infertility</a></li> <li><a href="/wiki/Urogynecology" title="Urogynecology">Urogynecology</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Medical_diagnosis" title="Medical diagnosis">Diagnostic</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Radiology" title="Radiology">Radiology</a> <ul><li><a href="/wiki/Interventional_radiology" title="Interventional radiology">Interventional radiology</a></li> <li><a href="/wiki/Neuroradiology" title="Neuroradiology">Neuroradiology</a></li> <li><a href="/wiki/Nuclear_medicine" title="Nuclear medicine">Nuclear medicine</a></li></ul></li> <li><a href="/wiki/Pathology" title="Pathology">Pathology</a> <ul><li><a href="/wiki/Anatomical_pathology" title="Anatomical pathology">Anatomical</a></li> <li><a href="/wiki/Clinical_pathology" title="Clinical pathology">Clinical pathology</a></li> <li><a href="/wiki/Clinical_chemistry" title="Clinical chemistry">Clinical chemistry</a></li> <li><a href="/wiki/Cytopathology" title="Cytopathology">Cytopathology</a></li> <li><a href="/wiki/Medical_microbiology" title="Medical microbiology">Medical microbiology</a></li> <li><a href="/wiki/Transfusion_medicine" title="Transfusion medicine">Transfusion medicine</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Addiction_medicine" title="Addiction medicine">Addiction medicine</a></li> <li><a href="/wiki/Adolescent_medicine" title="Adolescent medicine">Adolescent medicine</a></li> <li><a href="/wiki/Anesthesiology" title="Anesthesiology">Anesthesiology</a> <ul><li><a href="/wiki/Obstetric_anesthesiology" title="Obstetric anesthesiology">Obstetric anesthesiology</a></li> <li><a href="/wiki/Neurosurgical_anesthesia" title="Neurosurgical anesthesia">Neurosurgical anesthesiology</a></li></ul></li> <li><a href="/wiki/Aviation_medicine" title="Aviation medicine">Aviation medicine</a></li> <li><a href="/wiki/Dermatology" title="Dermatology">Dermatology</a></li> <li><a href="/wiki/Disaster_medicine" title="Disaster medicine">Disaster medicine</a></li> <li><a href="/wiki/Diving_medicine" title="Diving medicine">Diving medicine</a></li> <li><a href="/wiki/Emergency_medicine" title="Emergency medicine">Emergency medicine</a> <ul><li><a href="/wiki/Mass_gathering_medicine" title="Mass gathering medicine">Mass gathering medicine</a></li></ul></li> <li><a href="/wiki/Evolutionary_medicine" title="Evolutionary medicine">Evolutionary medicine</a></li> <li><a href="/wiki/Family_medicine" title="Family medicine">Family medicine</a> / <a href="/wiki/General_practice" title="General practice">General practice</a></li> <li><a href="/wiki/Hospital_medicine" title="Hospital medicine">Hospital medicine</a></li> <li><a href="/wiki/Intensive_care_medicine" title="Intensive care medicine">Intensive care medicine</a></li> <li><a href="/wiki/Medical_genetics" title="Medical genetics">Medical genetics</a></li> <li><a href="/wiki/Narcology" title="Narcology">Narcology</a></li> <li><a href="/wiki/Neurology" title="Neurology">Neurology</a> <ul><li><a href="/wiki/Clinical_neurophysiology" title="Clinical neurophysiology">Clinical neurophysiology</a></li></ul></li> <li><a href="/wiki/Occupational_medicine" title="Occupational medicine">Occupational medicine</a></li> <li><a href="/wiki/Ophthalmology" title="Ophthalmology">Ophthalmology</a></li> <li><a href="/wiki/Oral_medicine" title="Oral medicine">Oral medicine</a></li> <li><a href="/wiki/Pain_management" title="Pain management">Pain management</a></li> <li><a href="/wiki/Palliative_care" title="Palliative care">Palliative care</a></li> <li><a href="/wiki/Pediatrics" title="Pediatrics">Pediatrics</a> <ul><li><a href="/wiki/Neonatology" title="Neonatology">Neonatology</a></li></ul></li> <li><a href="/wiki/Phlebologist" class="mw-redirect" title="Phlebologist">Phlebology</a></li> <li><a href="/wiki/Physical_medicine_and_rehabilitation" title="Physical medicine and rehabilitation">Physical medicine and rehabilitation</a> (PM&R)</li> <li><a href="/wiki/Preventive_healthcare" title="Preventive healthcare">Preventive medicine</a></li> <li><a href="/wiki/Prison_healthcare" title="Prison healthcare">Prison healthcare</a></li> <li><a href="/wiki/Psychiatry" title="Psychiatry">Psychiatry</a> <ul><li><a href="/wiki/Addiction_psychiatry" title="Addiction psychiatry">Addiction psychiatry</a></li></ul></li> <li><a href="/wiki/Radiation_therapy" title="Radiation therapy">Radiation oncology</a></li> <li><a href="/wiki/Reproductive_medicine" title="Reproductive medicine">Reproductive medicine</a></li> <li><a href="/wiki/Sexual_medicine" title="Sexual medicine">Sexual medicine</a> <ul><li><a href="/wiki/Venereology" title="Venereology">Venereology</a></li></ul></li> <li><a href="/wiki/Sleep_medicine" title="Sleep medicine">Sleep medicine</a></li> <li><a href="/wiki/Sports_medicine" title="Sports medicine">Sports medicine</a></li> <li><a href="/wiki/Organ_transplantation" title="Organ transplantation">Transplantation medicine</a></li> <li><a href="/wiki/Tropical_medicine" title="Tropical medicine">Tropical medicine</a> <ul><li><a href="/wiki/Travel_medicine" title="Travel medicine">Travel medicine</a></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Medical_education" title="Medical education">Medical<br />education</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Medical_school" title="Medical school">Medical school</a></li> <li><a href="/wiki/Bachelor_of_Medicine,_Bachelor_of_Surgery" title="Bachelor of Medicine, Bachelor of Surgery">Bachelor of Medicine, Bachelor of Surgery</a></li> <li><a href="/wiki/Bachelor_of_Medical_Sciences" title="Bachelor of Medical Sciences">Bachelor of Medical Sciences</a></li> <li><a href="/wiki/Master_of_Medicine" title="Master of Medicine">Master of Medicine</a></li> <li><a href="/wiki/Master_of_Surgery" title="Master of Surgery">Master of Surgery</a></li> <li><a href="/wiki/Doctor_of_Medicine" title="Doctor of Medicine">Doctor of Medicine</a></li> <li><a href="/wiki/Doctor_of_Osteopathic_Medicine" title="Doctor of Osteopathic Medicine">Doctor of Osteopathic Medicine</a></li> <li><a href="/wiki/MD%E2%80%93PhD" title="MD–PhD">MD–PhD</a> <ul><li><a href="/wiki/Medical_Scientist_Training_Program" title="Medical Scientist Training Program">Medical Scientist Training Program</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Related topics</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Alternative_medicine" title="Alternative medicine">Alternative medicine</a></li> <li><a href="/wiki/Allied_health_professions" title="Allied health professions">Allied health</a></li> <li><a href="/wiki/Molecular_oncology" title="Molecular oncology">Molecular oncology</a></li> <li><a href="/wiki/Nanomedicine" title="Nanomedicine">Nanomedicine</a></li> <li><a href="/wiki/Personalized_medicine" 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