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Left ventricular function in adults with atrial septal defect
Insights
Secundum atrial defect can cause subnormal left ventricular ejection fraction and abnormal wall motion. Nitroglycerin improved ejection fraction, suggesting these abnormalities may be primary, not shunt-related.
Area of Science:
- Cardiology
- Cardiovascular Physiology
Background:
- Secundum atrial defect (SAD) is a common congenital heart condition.
- Left ventricular (LV) function in SAD patients requires further investigation.
Purpose of the Study:
- To analyze left ventricular systolic function and wall motion in patients with secundum atrial defect.
- To investigate the effect of nitroglycerin on LV function in SAD patients.
Main Methods:
- Cardiac catheterization was performed on 16 SAD patients.
- Analysis focused on end-systolic and mid-ejection LV parameters.
- Eight patients underwent restudy after sublingual nitroglycerin administration.
Main Results:
- Mean ejection fraction was subnormal (57 ± 8%) compared to controls (71 ± 10%).
- Elevated end-diastolic volumes were observed in 8 patients.
- Nitroglycerin improved ejection fraction from 54% to 70% and normalized hypokinetic areas.
Conclusions:
- Patients with secundum atrial defect exhibit impaired left ventricular systolic function.
- LV wall motion abnormalities in SAD may be primary, independent of shunt size.
- Nitroglycerin demonstrates potential therapeutic benefit in improving LV function in SAD.
Abstract:
Sixteen patients with secundum atrial defect were catheterized giving emphasis to the analysis of the left ventricle at end systole and mid-ejection. The mean ejection fraction of the group was subnormal 57 + 8% when compared with 30 normal patients (71 + 109) P less than .005. Eight patients showed elevated end-diastolic volumes (156 + 10cc) when compared to our normal group (95% + 10cc) P less than .005. A total of 32 hypokinetic and 35 tardokinetic areas were found. Eight patients were restudied after nitroglycerin (0.4 mg sublingually) with an improvement in the ejection fraction from 54% to 70% (P less than .005) and normalization of most of the hypokinetic areas. No correlation was found between total ejection fraction or total systolic wall motion and the shunt size. Probably these left ventricular wall motion abnormalities are primary and not due to the shunt size.