Abnormalities of left ventricular function and geometry in adults with an atrial septal defect

Popio, Kenneth A.; Gorlin, Richard; Teichholz, Louis E.; Cohn, Peter F.; Bechtel, David; Herman, Michael V.

doi:10.1016/0002-9149(75)90480-4

Cited by 103 publications

(30 citation statements)

References 22 publications

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“…34,35 Thus, it has been demonstrated that torsional deformation is a sensitive indicator of LV function. Global LV systolic function has been shown to be impaired in ASD [8][9][10]36,37 and we also found that the LVEF in patients with ASD was lower than that of normal controls. Moreover, our results showed that a lower EF in patients with ASD was associated with reduced LV torsion values.…”

Section: Discussionsupporting

confidence: 65%

Left Ventricular Torsion in Patients With Secundum Atrial Septal Defect

Dong

Zhang

Shu

et al. 2009

Circ J

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he secundum atrial septal defect (ASD) is a common form of congenital heart disease accounting for approximately 10% of children and 30% of adult patients with congenital cardiac defects. [1][2][3][4][5][6][7] Previous studies have demonstrated that right ventricular (RV) volume overload is associated with adverse left ventricular (LV) function in patients with ASD. [8][9][10] Recently, assessment of LV rotation has become an important approach for quantifying LV function. [11][12][13][14][15][16][17][18][19][20][21][22][23][24] However, to the best of our knowledge there are no data available to date on the impact of RV volume overload on LV twist in patients with ASD. The recent development of 2-dimensional (D) ultrasound speckle tracking imaging (STI) has allowed LV torsional deformation to be evaluated noninvasively with validation against sonomicrometry and tagged magnetic resonance imaging (MRI). 25,26 In the present study, we sought to analyze LV twisting and untwisting using the novel STI method in adult patients with ASD. Methods Study SampleWe enrolled 45 asymptomatic adults (28±9 years, 13 males) with ASD. Inclusion criteria included age ≥18 years, isolated secundum ASD, evidence of RV volume overload and evidence of shunt on transthoracic echocardiogram. Patients were excluded if they were clinically unstable, were not in sinus rhythm at the time of echocardiographic examination, or had inadequate echocardiographic assessment. The ASD group was compared with an age-and sex-matched control group of normal subjects (n=45, 27±10 years, 13 males). The Institutional Review Board of the hospital approved the study, and all study participants provided informed consent before participation. Echocardiographic StudiesPatients were imaged in a supine position using a GE Vivid 7 ultrasound system with a M3S probe (1.7-3.4 MHz). The 2D grayscale images were acquired in the standard parasternal and apical views at a frame rate of 80-100 frames/s, and 3 cardiac cycles were recorded. Care was taken to obtain parasternal circular short-axis tomograms at basal (identified by the mitral valve) and apical (no papillary muscles noted) levels. All images were stored digitally for subsequent offline analysis. Conventional Echocardiographic AnalysisThe analysis was performed offline by a single observer without knowledge of hemodynamic data, using commercially available 2D strain software (Echopac PC, version 7.0, GE Vingmed Ultrasound, Horten, Norway). LV volumes (end-diastolic volume (EDV), end-systolic volume (ESV), and ejection fraction (EF)) were measured according to the recent guidelines of the American Society of Echocardiography. 27 Analysis of Twist MechanicsThe time interval from the R wave on the ECG to aortic

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Section: Discussionsupporting

confidence: 65%

Left Ventricular Torsion in Patients With Secundum Atrial Septal Defect

Dong

Zhang

Shu

et al. 2009

Circ J

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“…When the IVS has returned to its normal anterior convex curvature, it contracts inward toward the LV free wall, and at endsystole the size and shape of the left ventricle are normal. Normal inward contraction of the IVS in the late portion of systole in patients with ASD has been seen by contrast left ventriculography in studies performed by Popio et al 5 and by Mueller et al 8 They probably did not see the abnormal diastolic curvature because they used the LAO projection without caudal angulation.9 Meyer et al3 suggested the paradoxical motion of the septum was due to the anterior systolic motion of the whole heart. An exaggerated anterior swing of the left ventricle during systole was not evident from the LAO projection in our subjects, suggesting that this is not a major mechanism for paradoxical IVS motion.…”

Section: Discussionmentioning

confidence: 96%

The mechanism of abnormal septal motion in atrial septal defect: pre- and postoperative study by radionuclide ventriculography in adults.

Hung¹,

Uren²,

Richmond³

et al. 1981

Circulation

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SUMMARY The mechanism of abnormal interventricular septal wall (IVS) motion in atrial septal defect (ASD) was studied by radionuclide cineventriculography before and within 2 weeks of ASD closure in 11 adult patients. Pre-and postoperative right ventricular/left ventricular volume ratio (RV/LV volume), LV peak filling rate (PFR) and LV ejection fraction (EF) were measured and compared with measurements in 13 normal adults.In normal subjects the configuration of the left ventricle was ovoid in diastole and the IVS curvature was convex toward the right ventricle. In all 11 ASD patients increased RV volume caused the IVS either to flatten during diastole or reverse its normal direction of curvature, becoming convex toward the left ventricle and resulting in a crescentic LV configuration. In early systole the IVS bulged anteriorly as the left ventricle reassumed its normal ovoid configuration and thereafter contracted normally. Postoperatively, RV volume decreased and both diastolic LV configuration and diastolic IVS curvature returned to normal in nine of the 11 patients. Postoperatively, mean RV/LV volume (± SD) decreased (3.6 ± 0.5:1 preop vs 2.1 ± 0.8:1 postop, p < 0.001; normal subjects 1.3 ± 0.1:1), PFR increased (2.13 ± 0.57/sec vs 3.16 1.19/sec,p < 0.01; normal subjects 2.92 ± 1.28/sec) and EF was unchanged (0.62 ± 0.12 vs 0.69 ± 0.09; NS; normal subjects 0.66 ± 0.08). In three older patients a low LV EF returned to normal postoperatively.Systolic anterior IVS motion in ASD is caused by an initial abnormal curvature of the IVS during diastole to accommodate increased RV volume, and the IVS curvature returns to normal when this is relieved. The increased RV/LV volume ratio decreases and indexes of LV filling and ejection may improve early after ASD closure in adults.ALTHOUGH paradoxical systolic anterior motion of the interventricular septal wall (IVS) is an echocardiographic finding in atrial septal defect (ASD),' its cause is uncertain.3-6 It has been reported to be caused by exaggerated systolic anterior motion of the Received July 23, 1979; revision accepted May 30, 1980. Circulation 63, No 1, 1981 entire heart,3 posterior displacement of the septum from right ventricular (RV) overload7 or anterior septal displacement at the onset of systole.' Weyman et al.,7 using short-axis cross-sectional echocardiography, suggested the abnormal septal motion was due to a change in the diastolic shape of the left ventricle caused by RV volume overload. Contrast left ventriculography in the left anterior oblique (LAO) projection has not shown these changes,6' 8 but foreshortening of the left ventricular (LV) cavity is imaged in this view, and changes in IVS and LV shape may be obscured.9 Equilibrium-gated radionuclide cineventriculography using a slant-hole collimator allows sufficient

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“…19,20 Pirau ASD akan menyebabkan underfilling dari ventrikel kiri dan overload volume dari ventrikel kanan yang akan mengganggu gerakan ventrikel. 21,22 Oleh karena itu, pada pasien dengan pirau ASD yang cukup signifikan, ventrikel kanan akan melebar dan septumnya akan berdeviasi ke ventrikel kiri yang akan menyebabkan kompresi pada ventrikel kiri. 23 Dengan kata lain, ASD mencerminkan suatu volume overload kronis dari ventrikel kanan yang pada akhirnya akan menyebabkan penurunan preload ventrikel kiri dengan cara menurunkan pengisian ventrikel yang dapat memengaruhi fungsi ventrikel kanan maupun kiri.…”

Section: Pembahasanunclassified

“…23 Dengan kata lain, ASD mencerminkan suatu volume overload kronis dari ventrikel kanan yang pada akhirnya akan menyebabkan penurunan preload ventrikel kiri dengan cara menurunkan pengisian ventrikel yang dapat memengaruhi fungsi ventrikel kanan maupun kiri. 24,25 Karena mekanisme tersebut, fungsi sistolik dan diastolik dapat terganggu secara mekanik, 21 serta akan terjadi perubahan geometri ventrikel kiri yang akan berujung pada menurunnya ejeksi fraksi.…”

Section: Pembahasanunclassified

Hubungan antara Nilai Red Cell Distribution Width dan Fungsi Ventrikel Kiri pada Anak dengan Penyakit Jantung Bawaan Asianotik

Pratama

Widjaja

Salimo

2017

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Latar belakang. Abnormalitas fungsi sistolik dan diastolik dari ventrikel kanan dan kiri banyak ditemukan pada pasien dengan PJB asianotik. Di Indonesia, fasilitas untuk menilai fungsi ventrikel kiri berupa ekokardiografi tidak selalu tersedia di rumah sakit perifer sehingga diperlukan penanda lain sebagai alternatif, di antaranya, red cell distribution width (RDW). Tujuan. Menganalisis hubungan nilai RDW dan fungsi ventrikel kiri (ejeksi fraksi, fraksi pemendekan dan rasio E/A) pada anak dengan PJB asianotik di RSUD Dr. Moewardi Surakarta. Metode. Penelitian observasional analitik dengan desain cross sectional, subjek 33 anak PJB asianotik. Hubungan antara kadar RDW dan parameter fungsi ventrikel kiri dianalisis menggunakan uji korelasi Spearman. Hasil. Di antara 33 subjek terdapat 17 laki-laki (51,5%). Didapatkan jenis PJB asianotik VSD (ventricle septal defect) 10 pasien (30,3%), ASD (atrial septal defect) 15 pasien (45,5%) dan PDA (patent ductus arteriosus) 8 pasien (24,2%). RDW berkorelasi signifikan dengan rasio E/A pada PJB asianotik secara keseluruhan (r -0,342; p=0,026). Pada VSD dan PDA, RDW tidak berkorelasi dengan parameter fungsi ventrikel kiri apapun. Namun pada ASD, RDW berkorelasi signifikan dengan ejeksi fraksi (r -0,491; p=0,032). Kesimpulan. Didapatkan hubungan antara RDW dengan parameter fungsi ventrikel kiri, terutama rasio E/A pada pasien PJB asianotik. Selain itu, juga terdapat hubungan antara RDW dengan ejeksi fraksi pada pasien ASD. Sari Pediatri 2017;18 (5) Objective.To analyze the relationship between RDW values and left ventricular function (ejection fraction, shortening fraction and E/A ratio) in children with acyanotic congenital heart disease in Dr. Moewardi Hospital, Surakarta. Method. This is an analytical observational study with cross sectional design in 33 acyanotic congenital hearth disease children. The relationship between RDW values and parameters of left ventricular function were analyzed using Spearman correlation test. Results. Of the 33 subjects there were 17 (51.5%) male. Acyanotic CHD consisted of: ventricular septal defect (VSD) 10 patients (30.3%), atrial septal defect (ASD) 15 patients (45.5%), and patent ductus arteriosus (PDA) 8 patients (24.2%). Overall, the RDW value significantly correlated with the E / A ratio in cyanotic CHD patients (r -0.342; p=0.026). In VSD and PDA, RDW is not correlated with any of left ventricular function parameters. However, in ASD, RDW significantly correlated with ejection fraction (r -0.491; p=0.032). Conclusion. We found a relationship between RDW and the parameters of left ventricular function, especially the E/A ratio, in patients with acyanotic CHD . We also found a relationship between RDW with ejection fraction in patients with ASD. Sari Pediatri 2017;18(5):339-44

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Abnormalities of left ventricular function and geometry in adults with an atrial septal defect

Cited by 103 publications

References 22 publications

Left Ventricular Torsion in Patients With Secundum Atrial Septal Defect

Left Ventricular Torsion in Patients With Secundum Atrial Septal Defect

The mechanism of abnormal septal motion in atrial septal defect: pre- and postoperative study by radionuclide ventriculography in adults.

Hubungan antara Nilai Red Cell Distribution Width dan Fungsi Ventrikel Kiri pada Anak dengan Penyakit Jantung Bawaan Asianotik

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