Left Atrial Dysfunction in Children with Repaired Pulmonary Artery Atresia with Ventricular Septal Defect: A...

Area of Science:

• Cardiology
• Medical Imaging
• Pediatric Cardiology

Background:

• The left atrium (LA) plays a crucial role beyond left ventricular filling.
• Pulmonary artery atresia with ventricular septal defect (PA/VSD) is a complex congenital heart defect requiring surgical repair.
• Assessing residual cardiac function post-repair is vital for long-term patient management.

Purpose of the Study:

• To evaluate left atrial (LA) volume and function in pediatric patients with repaired PA/VSD using cardiac magnetic resonance (CMR).
• To identify potential early indicators of diastolic dysfunction in this patient population.

Main Methods:

• Prospective recruitment of 31 pediatric patients with repaired PA/VSD and 30 healthy controls.
• Utilized CMR for comprehensive assessment of LA volume and function, including ejection fraction (EF), strain, and strain rate during reservoir, conduit, and pump phases.
• Employed cardiac function analysis software for detailed measurements.

Main Results:

• Patients with repaired PA/VSD exhibited significantly decreased maximal LA volume index compared to controls.
• Significantly lower LA reservoir strain and strain rate, conduit strain and strain rate, booster pump strain rate, total EF, and passive EF were observed in the PA/VSD group.
• Even in patients with preserved but lower right ventricular EF (<50%), reduced LA reservoir strain, reservoir strain rate, and pump strain rate were noted compared to those with higher RVEF (≥50%).

Conclusions:

• Repaired PA/VSD is associated with altered LA function, detectable even when biventricular EF is preserved.
• These functional changes may serve as an early marker for left ventricular diastolic dysfunction.
• CMR is effective in detecting early-stage LA dysfunction, potentially before anatomical changes like LA enlargement become apparent.