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The transition from anatomies that are capable of sustaining biventricular physiology to those that cannot is obscure, resulting in uneven application of surgical strategy and excess mortality. Imprecise assessments of ventricular competence have dominated clinical decision making in this regard. Malalignment of the atrioventricular junction and its attendant derangement of inflow physiology is a critical factor in determining the feasibility of biventricular repair in the setting of unbalanced atrioventricular septal defect. The atrioventricular valve index accurately identifies unbalanced atrioventricular septal defect and also brings into focus a zone of transition from anatomies that can support a biventricular end state and those that cannot. <\/jats:p>","DOI":"10.1177\/2150135110363024","type":"journal-article","created":{"date-parts":[[2010,4,13]],"date-time":"2010-04-13T21:32:02Z","timestamp":1271194322000},"page":"91-96","source":"Crossref","is-referenced-by-count":35,"title":["Unbalanced Atrioventricular Septal Defect: Definition and Decision Making"],"prefix":"10.1177","volume":"1","author":[{"given":"David M.","family":"Overman","sequence":"first","affiliation":[{"name":"Division of Pediatric Cardiac Surgery, The Children's Heart Clinic, Children's Hospitals and Clinics of Minnesota, MN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeanne M.","family":"Baffa","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, The Nemours Cardiac Center, 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