Interventricular septal motion and left ventricular function in patients with atrial septal defect

Abstract

In order to assess whether the paradoxical motion of the interventricular septum seen in patients with atrial septal defect (ASD) is due to a true abnormality in septal contraction, eight patients with ASD (age, 1.6-17 years) and eight age-matched control patients were studied using qualitative and quantitative two-dimensional (2D) and M-mode echocardiography. 2-D-echocardiographic images recorded from the parasternal short-axis projection at the level of the papillary muscles and 2D-directed M-mode tracings at this level were obtained. Comprehensive wall motion analysis of the left ventricular (LV) endocardial and epicardial borders was performed using both fixed reference and center of mass (floating reference) models. Our results indicate that interventricular septal wall motion and function are normal in patients with ASD. The apparent "paradoxical" motion is due to excessive anterior motion of the entire left ventricle, and is present only when a fixed reference system is used to assess myocardial motion, but is not present when a center of mass (floating reference system) is employed. Left ventricular function assessed by % area and perimeter change, mean radial shortening fraction, and mean radial wall thickening (2D) as well as LV shortening fraction and septal and posterior wall thickening (M-mode) was not significantly different between the two groups. Standard M-mode tracings can therefore be used to assess LV function despite this apparent abnormal septal motion.

Transcatheter closure of atrial septal defect preserves right ventricular function

“…7 Conventional indices of ventricular function have largely been derived from assessment of short axis changes in the basal segment, which is maintained by the circumferential muscle layer. [8][9][10] There is increasing evidence that the function of the longitudinal component of myocardial fibres is specifically disturbed by ischaemia, 11 conduction abnormalities, or other diseases. 12 These fibres are subendocardial in location, and form the main bulk of the muscle that controls the function of the right ventricle.…”

Assessment of interventricular septal motion by cross-sectional echocardiography in patients with isolated atrial septal defects within the oval fossa

“…7 In this study, however, the authors did not examine, first, whether the motion of the interventricular septum was influenced by the amount of left-to-right shunt through the defect and, second, whether the motion of the interventricular septum was different after closure of the defect. 7 Our data not only demonstrate normal interventricular septal motion in patients with an atrial septal defect but, furthermore, we could not detect an influence of the size of the shunt, that is, the amount of right ventricular volume load on motion of the interventricular septum, when applying a floating system for analysis of wall motion. Thirdly, we could demonstrate that, when using a fixed system for analysis, paradoxical septal motion may apparently persist after closure of the defect.…”

“…By applying methods of evaluating left ventricular function, which are independent of right ventricular volume load, 11 and thus potentially more accurate, left ventricular function in children with atrial defect was found to be normal in our group of patients as well as in the literature. 7 A recent study has suggested that the paradoxical septal motion in patients with an atrial septal defect in the oval fossa may be an artifact caused by the use of a fixed reference system of M-mode echocardiographic analysis of left ventricular function. 7 In this study, however, the authors did not examine, first, whether the motion of the interventricular septum was influenced by the amount of left-to-right shunt through the defect and, second, whether the motion of the interventricular septum was different after closure of the defect.…”

“…7 A recent study has suggested that the paradoxical septal motion in patients with an atrial septal defect in the oval fossa may be an artifact caused by the use of a fixed reference system of M-mode echocardiographic analysis of left ventricular function. 7 In this study, however, the authors did not examine, first, whether the motion of the interventricular septum was influenced by the amount of left-to-right shunt through the defect and, second, whether the motion of the interventricular septum was different after closure of the defect. 7 Our data not only demonstrate normal interventricular septal motion in patients with an atrial septal defect but, furthermore, we could not detect an influence of the size of the shunt, that is, the amount of right ventricular volume load on motion of the interventricular septum, when applying a floating system for analysis of wall motion.…”

“…5 ' 6 By applying different techniques for analysis of left ventricular wall motion to patients with atrial septal defect, the question has recently been raised as to whether paradoxical septal motion is a real or an artificial anomaly. 7 The purpose for our study was to examine whether movement of the interventricular septum in patients with volume-loaded right ventricles prior to closure of an atrial septal defect is different from the septal motion after surgical closure.…”