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Abnormalities of left ventricular function and geometry in adults with an atrial septal defect. Ventriculographic,
Insights
Adults with atrial septal defects have smaller left ventricular volumes and abnormal septal motion. These findings suggest decreased left ventricular distensibility in patients with ostium secundum atrial septal defects.
Area of Science:
- Cardiology
- Cardiovascular Physiology
Background:
- Ostium secundum atrial septal defect (ASD) is a common congenital heart anomaly.
- Understanding its impact on left ventricular (LV) function is crucial for patient management.
Purpose of the Study:
- To analyze left ventricular function and motion in adults with ostium secundum ASD.
- To compare LV parameters between ASD patients and healthy individuals.
Main Methods:
- Biplane cineangiography and echocardiography were used to assess LV function.
- Key parameters included end-diastolic volume index, stroke volume index, and ejection fraction.
- Ventricular septal motion was specifically evaluated.
Main Results:
- Patients with ASD exhibited a smaller cardiac index (3.6 vs. 4.5 L/min/m2) and LV end-diastolic volume index (56 vs. 76 ml/m2) compared to controls.
- Stroke volume index was also significantly reduced in ASD patients (40 vs. 52 ml/m2).
- Early systolic bulging of the ventricular septum was observed in 10 of 12 ASD patients.
Conclusions:
- The left ventricle in patients with atrial septal defects is subnormal in volume.
- Abnormal sequence of septal contraction and apparent decreased distensibility characterize the LV in ASD.
- These findings highlight distinct functional alterations in the left ventricle due to ASD.
Abstract:
Left ventricular function and motion in 12 adults with an ostium secundum atrial septal defect were analyzed utilizing biplane cineangiography. Values for left ventricular end-diastolic volume index, stroke volume index, ejection fraction, left ventricular end-diastolic pressure and mean rate of circumferential fiber shortening were compared with values in an age-matched group of 11 normal subjects. Comparisons of ventriculographic and echocardiographic data were also made in 5 patients and 10 control subjects. Cardiac index was smaller in patients than in the normal subjects (3.6 vs. 4.5 liters/min per m2, P less than 0.01). Although left ventricular end-diastolic pressure was similar (8 mm Hg in both groups), the end-diastolic volume index was significantly smaller in patients than in normal subjects (56 vs. 76 ml/m2, P less than 0.05). Stroke volume index was also significantly smaller in patients (40 vs. 52 ml/m2, P less than 0.01). The two groups had similar values for ejection fraction (65 +/- 2 percent [standard error of the mean] in patients vs. 68 +/- 2 percent in normal subjects), circumferential fiber shortening velocity (1.67 +/- 0.13 vs. 1.81 +/- 0.15 circumferences/sec.), heart rate (91 +/- 7 vs. 90 +/- 5 beats/min) and mean systemic arterial pressure (92 +/- 5 vs. 87 +/- 3 mm Hg). Early systolic bulging of the upper ventricular septum toward the right ventricle was seen in 10 of 12 patients with an atrial septal defect but in no normal subject. Echocardiographic data supported these findings. No other abnormalities of motion were consistently noted. It is concluded that the left ventricle of patients with an atrial septal defect is subnormal in volume and abnormal in sequence of contraction of the septum and is characterized by apparent decreased distensibility.