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Long-term follow-up study after closure of secundum atrial septal defect in children: an echocardiographic study
Insights
Serial echocardiography in children with atrial septal defects reveals persistent right ventricular dilation post-surgery. Early surgical closure may prevent long-term ventricular abnormalities.
Area of Science:
- Pediatric Cardiology
- Cardiac Surgery
- Echocardiography
Background:
- Secundum atrial septal defect (ASD) causes chronic right ventricular (RV) overload.
- RV dilation and dysfunction can occur due to shunting and growth.
- The long-term effects of ASD on ventricular function require further investigation.
Purpose of the Study:
- To assess the impact of chronic RV overload on ventricular function in children with isolated secundum ASD.
- To evaluate changes in RV and left ventricular (LV) function before and after surgical closure of ASD.
Main Methods:
- Serial echocardiography in 51 children with isolated secundum ASD.
- Measurements included RV dimensions, LV dimensions, and systolic time intervals.
- Data analyzed preoperatively and up to 5 years postoperatively.
Main Results:
- RV dilation increased with growth in younger children (<0.5 m2 BSA) and was persistent post-surgery in over 80% of patients.
- RV ejection time/preejection time ratio improved post-surgery but remained abnormal in some.
- LV dimensions were normal; LV function showed high shortening fraction in 44% post-operation.
Conclusions:
- Persistent RV dilation after surgical ASD closure may result from chronic preoperative changes.
- Abnormal LV shortening fraction post-surgery suggests potential geometric or filling abnormalities.
- Surgical closure within the first 3 years of life may prevent these cardiac abnormalities.
Abstract:
Serial echocardiography was performed in 51 children with isolated secundum atrial septal defect before and after surgery to measure the effects of chronic right ventricular overload on ventricular function. Right ventricular dilation increased dramatically with growth and with size of the left to right shunt only in the youngest children (body surface area less than 0.5 m2). A lesser effect of growth and no significant effect of shunt size were noted in older children. Although an initial decrease in right ventricular size occurred in the first 3 months after operation, persistent right ventricular dilation remained up to 5 years after closure of the interatrial defect in more than 80 percent of patients. Preoperatively, the ratio of the right ventricular preejection period to ejection time was significantly less than that of normal children. This ratio increased dramatically after operation, exceeding normal values early in the postoperative period in 18 of 48 children and persisting in 6 of 22 after 3 months. Left ventricular dimensions were normal early and late after operation. Left ventricular function was apparently normal, although an exceptionally high shortening fraction was noted in 22 (44 percent) of 51 children after operation. Aortic systolic time interval ratios decreased after operation from high normal to low normal values. It is hypothesized that the persistent enlargement of the right ventricle after operation may be due to the chronic preoperative dilation secondary to chronic interatrial shunting. The abnormally high shortening fraction after operation may result from an abnormal left ventricular geometric configuration or abnormality of filling. It is suggested that surgical closure of the atrial defect in the first 3 years of life may prevent these abnormalities.