The left ventricle in atrial septal defect: Looking through 3D glasses

Area of Science:

• Cardiology
• Echocardiography
• Pediatric Cardiology

Background:

• Left ventricular (LV) dysfunction is a known complication in atrial septal defect (ASD) patients.
• Real-time three-dimensional echocardiogram (RT3DE) offers advanced assessment of LV wall motion abnormalities in ASD.

Purpose of the Study:

• To identify left ventricular (LV) dyssynchrony in atrial septal defect (ASD) patients.
• To determine factors associated with LV dyssynchrony using real-time three-dimensional echocardiogram (RT3DE).

Main Methods:

• Included 104 patients (aged ≥1 year) with ASD, with or without partial anomalous pulmonary venous drainage (PAPVD).
• Excluded patients with other cardiac defects affecting LV function.
• Utilized 2D echocardiogram (2DE) and RT3DE for LV function assessment; analyzed data using Student's t test and Pearson's correlation.

Main Results:

• LV dyssynchrony was least in children aged 3-5 years; delayed lateral wall excursion increased beyond 5 years or with weight >15 kg.
• Higher time to minimum systolic volume (Tmsv 16-SD) was observed with PAPVD and indexed defect size >40 mm/m², particularly in patients weighing <15 kg.
• RT3DE-derived ejection fraction (EF) was significantly lower than 2DE-derived EF (P < 0.001).

Conclusions:

• Left ventricular dyssynchrony in ASD patients shows age-dependent patterns, with delayed lateral wall excursion emerging after age 5.
• Factors such as PAPVD and larger defect size (indexed >40 mm/m²) are associated with increased time to minimum systolic volume.
• RT3DE provides a more sensitive measure of LV function compared to 2DE in ASD patients.