Regular monitoring for symptoms and screening with an ECG are important to evaluate for conduction See Section 3.3 for recommendations on who should perform surgeries, cardiac catheterization, and other procedures in these patients; Section 3.4 for recommendations on diagnostic evaluation; Sec- tion 4.1.1 for recommendations on primum ASD; Section 4.4.6 for evaluation and management of se- vere PAH and Eisenmenger syndrome associated with AVSD; and Table 15 for routine testing and follow-up intervals. Recommendation-Specific Supportive Text 1. Invasive hemodynamic assessment still has an im- portant role as a confirmatory tool and for the evaluation of pulmonary vasoreactivity, which does carry prognostic significance for adults with shunts. 2. Although the left atrioventricular valve in an AVSD malformation is not anatomically the same as a mitral valve, one can extrapolate the criteria for consideration of left atrioventric- ular valve surgery from the VHD guideline for mitral regurgitation and mitral stenosis.S4.1.4-1 In extrapolating these criteria, there are impor- tant potential differences in this patient popula- tion compared with those with acquired mitral valve disease. There are anatomic differences in position of the annulus, papillary muscles and the morphology of the LVOT, which is an anterior, narrow, and potentially obstructed structure, such that congenital surgical exper- tise is needed. Patients with an AVSD have typically had at least 1 prior attempt to repair the AVSD, have different risks of arrhythmia, and may have other anatomic lesions (eg, sub- aortic stenosis [subAS]). 