Abstract
Extract: Left ventricular function and volume data from 17 control subjects and 27 young patients with secundum atrial septal defect (ASD) without overt left or right ventricular failure were compared. ASD patients were subdivided in low shunt (Qp/Qs < 2.0) and high shunt (Qp/Qs ≥ 2.0) groups. Mean left ventricular (LV) stroke volume was significantly less in ASD patients (46 ± 16 ml/m2 in the low shunt and 44 ± 9 ml/m2 in high shunt group) compared with control patients (51 ± 13 ml/m2, P < 0.01 and P < 0.02, respectively). There was no significant difference in mean left ventricular end-diastolic volume (LVEDV) between any group of patients (control subjects 67 ± 17 ml/m2; low shunt ASD 66 ± 17 ml/m2, and high shunt ASD 62 ± 12 ml/m2). High shunt ASD had a significantly lower cardiac index compared with control patients (5.0 liters/min/m2 vs. 5.9 liters/min/m2, P < 0.02). Both low shunt and high shunt ASD showed significantly lower stroke work indices than control subjects (42 ± 13 GmM/m2 and 37 ± 8 GmM/m2 compared with 51 ± 14 GmM/m2, P < 0.05 and P <0.001, respectively) but only the high shunt group had a significantly lower peak systolic pressure (94 ± 12 mm Hg vs. 109 ± 11 mm Hg for control patients, P < 0.01). There was no significant difference between the control and ASD groups in LV end-diastolic, mean right atrial, right ventricular end-diastolic, and pulmonary pressures.
External systolic time intervals were compared in 5 control and 12 ASD patients. There was no significant difference between the two groups of patients in absolute values or indices for pre-ejection period, ejection time, or electromechanical systole. However, the ratio of the pre-ejection period index to left ventricular ejection time index (PEPI/LVETI) was significantly higher in ASD patients (P < 0.05).
In young subjects with large shunt ASD, certain indicators of left ventricular function are depressed. Evaluation of PEPI/LVETI may allow noninvasive determination of LV function.
Speculation: Previous studies have shown that left ventricular failure may occur in adults with right ventricular volume overload. The finding of left ventricular dysfunction in children with right ventricular volume overload because of atrial septal defect would confirm the relationship between right ventricular volume overload and secondary functional changes occurring in the left ventricle. Such changes in left ventricular function may be primary or due to alterations in left ventricular geometry because of increased right ventricular enlargement.
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Levin, A., Liebson, P., Ehlers, K. et al. Assessment of Left Ventricular Function in Secundum Atrial Septal Defect: Evaluation by Determination of Volume, Pressure, and External Systolic Time Indices. Pediatr Res 9, 894–899 (1975). https://doi.org/10.1203/00006450-197512000-00005
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DOI: https://doi.org/10.1203/00006450-197512000-00005