Doppler echocardiographic evaluation of left ventricular diastolic function after surgical correction of atrial septal defect during childhood

Abstract

Transmitral flow was studied using Doppler echocardiography with the A/E ratio as a parameter of left ventricular diastolic function in 21 patients (ages 2.5-30.0 years) who had undergone early surgical correction of an isolated secundum type atrial septal defect (ASD) compared to a healthy cohort of 21 subjects. Pre- and postoperative M-mode recordings were compared in 12 of the 21 patients to evaluate the effect of operation on interventricular septal motion (IVS) and left ventricular (LV) and right ventricular (RV) end-diastolic diameter ratio (LVDD/RVDD) as parameters of right ventricular volume overload. No significant difference in A/E ratio was found between the patient and control groups. IVS was shown to normalize in 11 of 12 patients postoperatively and to improve from paradox to flattened in 1 of 12. LVDD/RVDD increased from 1.26 +/- 0.31 to 2.10 +/- 0.51 (p = 0.0008), with no significant difference remaining between the control and patient groups postoperatively. These findings support the conclusion that an intrinsic abnormality of the left ventricle is not responsible for its diastolic dysfunction in patients with ASD who develop left ventricular failure, thereby implicating an acquired abnormality. Mechanical sequelae of right ventricular volume overload were shown to normalize in all patients subsequent to operation in the present study, and therefore cannot be excluded as a cause of left ventricular failure in ASD.

Remodelling after surgical repair of atrial septal defects within the oval fossa

“…This contrasts to a study where ventricular diastolic function was completely normal in patients operated during childhood. 12 These authors have found no mechanical sequels of right ventricular volume overload in the follow-up after repair. The data in our patients differ considerably, with diastolic dysfunction of the left ventricle occurring in half of our patients.…”

“…When repair is performed electively while patients are young, right ventricular hypertrophy and dilation may often resolve within six months to one year after operation. 11,12 It has been suggested that the decrease in right ventricular size correlates with the length of follow-up. 13 Our data show that almost always there is a postoperative regression of cavity size.…”

“…3,12 In 25 children undergoing repair at a median age of 6.8 years, a significant immediate postoperative decrease was noted in the size of the right atrium and right ventricle, with the greatest decrease occurring in the first postoperative year, and no significant change being found in the later follow-up. 12 Incomplete remodelling of the right ventricle, therefore, is common after repair, and difficult to prevent. One other study has suggested that the upper age limit may be as low as 3 years, with only surgical correction within the first three years of life leading to rapid and complete normalization of right ventricular size.…”

Transcatheter closure of atrial septal defect preserves right ventricular function

“…3 22 Abnormal septal motion occurs in the majority (up to 86%) of patients with an ASD, 17 19 but this appears to resolve with exercise 23 24 and after surgical repair. 25 Following surgical repair of an ASD, echocardiographic assessment suggests an increase in left ventricular volume, 25 and in one study left ventricular function was normal both before and one year after repair. 8 Persistence of right ventricular dilatation after ASD repair is commonly reported, 8 affecting more than 80% of patients up to five years after repair.…”

Comparison of cardiac function in children after surgical and Amplatzer occluder closure of secundum atrial septal defects

“…Systolic and diastolic dysfunction among children with congenital heart defects in pre and postoperative periods is a well-known problem, described by a number of investigators [7][8][9][10][11][12][13]. These alterations depend on various factors, e.g., relaxation, contractility, compliance and filling of the atria and ventricles [14][15][16].…”