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Relationship between electrocardiographic signs and shunt volume in atrial septal defect
Junpei Somura1, Masao Nakagawa1, Masami Ukiami1
1Department of Pediatrics, Shiga University of Medical Science, Otsu, Japan.
Insights
Electrocardiographic signs like right bundle branch block and negative T-waves correlate with shunt magnitude in children with atrial septal defects (ASD). These findings help assess hemodynamics and guide treatment decisions for ASD patients.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Medical Imaging
Background:
- Atrial septal defects (ASD) are common congenital heart conditions.
- Assessing shunt hemodynamics is crucial for managing ASD patients.
- Electrocardiography (ECG) is a non-invasive tool for cardiac evaluation.
Purpose of the Study:
- To investigate the correlation between ECG findings and shunt magnitude in pediatric ASD.
- To determine if specific ECG abnormalities predict hemodynamics in ASD.
- To evaluate the impact of surgical repair on ECG signs and shunt size.
Main Methods:
- Retrospective analysis of 100 pediatric ASD patients undergoing cardiac catheterization.
- Correlation of ECG parameters with pulmonary/systemic blood flow ratio (Qp/Qs).
- Comparison of pre-operative and post-operative ECGs in 63 patients.
Main Results:
- A higher Qp/Qs ratio was observed in patients with right bundle branch block (RBBB) and isolated negative T-waves.
- Patients with Qp/Qs ratio ≤ 1.5 did not exhibit both RBBB and isolated negative T-wave.
- Prevalence of RBBB and isolated negative T-waves significantly decreased after surgical repair.
Conclusions:
- RBBB and isolated negative T-waves in precordial leads are reliable indicators of a high Qp/Qs ratio in ASD.
- These ECG findings correlate with hemodynamics and shunt magnitude in pediatric ASD.
- ECG signs can aid in non-invasively assessing shunt severity in ASD patients.
Background:
The aim of this study was to determine whether electrocardiographic signs correlate with hemodynamics and the magnitude of the intracardiac shunt in children with ostium secundum atrial septal defects (ASD).
Methods:
A total of 100 ASD patients (median age, 6 years 4 months; 54 girls) underwent cardiac catheterization between August 1980 and April 2010. We retrospectively investigated the relationship between electrocardiographic signs and the pulmonary/systemic blood flow ratio (Qp/Qs) in these patients. We also compared 63 postoperative electrocardiograms with those recorded before surgery.
Results:
The mean Qp/Qs ratio of the 100 patients was 2.46 ± 0.81 (range, 1.1-5.0). The Qp/Qs ratio in patients with and without right bundle branch block (RBBB) was 2.57 ± 0.82 (n = 73) and 2.15 ± 0.72 (n = 27), respectively (P = 0.016). The Qp/Qs ratio in patients with and without isolated negative T-wave was 2.85 ± 0.87 (n = 38) and 2.22 ± 0.68 (n = 62), respectively (P = 0.0003). None of the patients with low Qp/Qs ratio (Qp/Qs ratio ≤ 1.5) had both RBBB and isolated negative T-wave. The prevalence of these two signs decreased from 73.0% (n = 46) and 36.5% (n = 23) to 15.9% (n = 10) and 15.9% (n = 10) after surgical repair, respectively.
Conclusions:
RBBB and isolated negative T-wave in the precordial leads are well correlated with high Qp/Qs ratio in ASD patients.
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