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Joseph P. Hart
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Right arrow Congenital - acyanotic

Ann Thorac Surg 2004;77:53-60
© 2004 The Society of Thoracic Surgeons

Original article: cardiovascular

Echocardiographic analysis of ventricular geometry and function during repair of congenital septal defects

Joseph P. Hart, MDa, Santos E. Cabreriza, BAa, Rowan F. Walsh, MDa, Beth F. Printz, MD, PhDb, Brianne F. Blumenthal, BAa, David K. Park, BSa, April J. Zhu, BSa, Cecily G. Gallup, BAa, Alan D. Weinberg, MSc, Daphne T. Hsu, MDb, Ralph S. Mosca, MDa,a, Jan M. Quaegebeur, MDa, Henry M. Spotnitz, MDa*

a Department of Surgery, Columbia College of Physicians and Surgeons, New York, New York, USA
b Department of Pediatrics, Columbia College of Physicians and Surgeons, New York, New York, USA
c Department of Biostatistics, Columbia University College of Physicians and Surgeons, New York, New York, USA

Accepted for publication June 23, 2003.

* Address reprint requests to Dr Spotnitz, Department of Surgery, Columbia University College of Physicians & Surgeons, 622 W 168th St, PH 14-103, 14th Fl, New York, NY 10032, USA.
e-mail: hms2{at}columbia.edu

BACKGROUND: This study investigated changes in left ventricular (LV) geometry and systolic function after corrective surgery for atrial (ASD) and ventricular septal defects (VSD).

METHODS: Transesophageal LV short-axis echocardiograms were recorded before and after operative repair of ASD (n = 11) and VSD (n = 7). Preload was measured using LV end-diastolic area indexed for body surface area. Measurements of septal-freewall (D1) and anterior-posterior (D2) endocardial diameters were used to assess LV symmetry from D1/D2. Systolic indices included stroke area, area ejection fraction, and fractional shortening.

RESULTS: Preload, stroke area, area ejection fraction, and fractional shortening of D1 increased after ASD repair but decreased after VSD repair (p < 0.05). End-diastolic symmetry increased after ASD closure and decreased after VSD closure (p < 0.05). Increases in stroke area and ejection fraction after ASD correction primarily reflected increased shortening of D1. A positive correlation was found overall between percent change in end-diastolic area (EDA) and percent change in area ejection fraction (r2 = 0.80, p < 0.0001, n = 18).

CONCLUSIONS: Preload was the primary determinant of changes in LV function in this series of ASD and VSD repairs. Intraoperative changes in position of the interventricular septum affected systolic and diastolic LV symmetry and septal free wall shortening. Additional studies are needed to define changes in afterload and contractility as well as diastolic compliance and systolic mechanics.




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