Regional myocardial velocities and isovolumic contraction acceleration before and after device closure of atrial septal defects: A color tissue Doppler study

doi:10.1016/j.ahj.2004.09.052

American Heart Journal

Volume 150, Issue 2, August 2005, Pages 294-301

https://doi.org/10.1016/j.ahj.2004.09.052 Get rights and content

Background

The study analyzed the effect of atrial septal defect (ASD) device closure on regional wall motion in the right (RV) and left ventricles (LV) using color tissue Doppler imaging (TDI). Atrial septal defect closure results in acute volume unloading of the RV. For unknown reasons, some patients develop acute left-sided heart failure postintervention.

Methods

Color TDI was performed in 39 pediatric ASD and 75 age-matched controls. Regional wall motion in 5 LV and 1 RV segment were analyzed before, immediately after, and 24 hours after interventional ASD closure. Off-line postprocessing of echocardiographic data was used to determine myocardial velocities and acceleration during isovolumic contraction (IVA). Isovolumic contraction acceleration is the slope of the upstroke of the isovolumic contraction wave (IVA = peak velocity/acceleration time).

Results

At baseline, patients with ASD had significantly higher RV systolic velocities than controls. Isovolumic contraction acceleration was similar in patients with ASD and controls. In the catheterization laboratory postintervention, conventional function parameters remained stable but systolic myocardial velocities decreased significantly in all segments. Diastolic velocities fell in LV segments but not in the RV. In contrast to velocities, IVA was stable during ASD device closure. On follow-up at 24 hours, myocardial velocities had normalized.

Conclusions

Device closure of ASD results to an acute transient decrease of regional myocardial velocities in the LV and RV, whereas the load-insensitive marker isovolumic acceleration remained stable. Therefore, the velocity changes may represent a response to altered left and right ventricular loading conditions. Color TDI is a sensitive tool to analyze ventricular mechanics.

Section snippets

Methods

The study design was to enroll consecutive patients younger than 21 years who underwent successful device closure of an atrial communication (ASD) at The Children's Hospital (Denver, Colo). The 39 pediatric patients all had secundum-type ASDs. The research protocol was approved by the Institutional Review Board. Informed consent and assent were obtained.

Clinical patient characteristics

The clinical characteristics of the 39 patients are summarized in Table I. Patients had a median age of 8 years with a range from 1.1 to 19 years. All children had a hemodynamically significant secundum-type ASD with at least mild right ventricular dilatation. The age-matched control group consisted of 75 healthy children from the outpatient clinic with a normal cardiac status including echocardiogram. These controls were deemed to have a normal cardiac status by a pediatric cardiologist after

Discussion

This tissue Doppler study found significant alterations of right and left ventricular regional mechanics in the catheterization laboratory immediately after interventional closure of an ASD. All changes were subclinical and resolved within 24 hours after the procedure. To our knowledge, there is only 1 previous literature report on myocardial velocities after ASD device closure.¹³ In that study, no change in myocardial velocities was found on the day after intervention in 7 patients. Those

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2020, Diastology: Clinical Approach to Heart Failure with Preserved Ejection Fraction
Diastolic function is linked to clinical outcomes. Yet, the clinical assessment of diastolic function, particularly in children, and particularly in those with congenital heart disease, remains persistently challenging. While the principles and tools to assess diastolic dysfunction in children are similar to adults, they also differ in important ways. This chapter will review developmental aspects of diastolic dysfunction in children, how diastolic function in children differs from that in adults, the pathophysiology and diagnosis of diastolic dysfunction in children, and specifically in children with congenital heart disease, including volume and pressure-loading lesions, pediatric cardiomyopathies, congenital heart disease predominantly affecting the right ventricle, pulmonary hypertension, and single-ventricle physiology. We will detail the central challenges to accurate characterization of diastolic dysfunction in children and review how emerging directions may provide solutions to these challenges.
Exercise capacity and cardiac function after surgical closure of ventricular septal defect - Is there unrecognized long-term morbidity?
2015, International Journal of Cardiology
Adult survivors of congenital heart disease form a continuously growing population, as each successive cohort graduating from pediatric care expands the total number of patients worldwide. Consequently, there is an increasing interest and study of their late pathophysiology, the understanding of which can only truly be understood during very long-term follow-up. Indeed, we have already learned that, for some patient groups, hitherto unexpected problems may only develop decades after surgery. Consequently, many patients require careful follow-up in ACHD clinics throughout life. However, in the most frequent congenital heart disease, ventricular septal defect (VSD), most guidelines recommend that specialized follow-up in ACHD clinics may only be indicated for those patients with significant residual anatomic problems, or overt pulmonary hypertension. Indeed, the late outcome for patients undergoing ‘uncomplicated’ repair in childhood has been described as benign. However, recent data suggest that such characterization may be premature. Several studies have described abnormalities of right ventricular structure and function which, in turn, may be directly related to abnormal functional capacity when formally tested. Furthermore, the longer-term implications of e.g. right bundle branch block and chronotropic incompetence continue to be explored. In this review we will examine these emerging data, and discuss whether amendments to the international guidelines for these patients' may be justified.
Disrupted right ventricular force-frequency relationships in adults operated for ventricular septal defect as toddlers: Abnormal peak force predicts peak oxygen uptake during exercise
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Citation Excerpt :
Most non-invasive methods to determine ventricular contractile function are highly sensitive to loading conditions. IVA measurements are not sensitive to loading, they correlate closely with invasive measures [13,14], and this index has high reproducibility [13,14,19,20]. On the other hand, a couple of studies have argued that IVA is less preload-independent than initially suggested [21,22].
Recent studies have shown markedly reduced functional capacity in long-term survivors of ventricular septal defect (VSD), and in order to explore possible mechanisms, we performed non-invasive assessment of ventricular force–frequency relationships during exercise in adults operated for VSD in early childhood.
We conducted a prospective study at a tertiary referral center. Patients (n = 23) and healthy controls (n = 20) underwent continuous Doppler-echocardiographic imaging during supine bicycle ergometry. The cycling workload was individually and manually incremented during the test session in response to heart rate. The heart was imaged in an apical 4-chamber view, and color-coded myocardial velocities were recorded. Post hoc, peak systolic velocity and isovolumetric acceleration (IVA) were blindly determined in the basal ventricular segments.
VSD-operated patients differed markedly in all right ventricular endpoints compared with controls. IVA was lower prior to the test, 70 ± 30 cm/s² vs. 150 ± 60 cm/s² among controls, and during the entire test session ending at a heart rate of 160 beats/min; 140 ± 50 cm/s² vs. 300 ± 30 cm/s², p < 0.01 at both points. A similar pattern was revealed in terms of peak right ventricular systolic velocity. Left ventricular and septal measurements showed a similar, although less significant, tendency with a clearly lower left ventricular optimum heart rate among patients: 140 beats/min vs. 154 beats/min among controls. In the diseased cohort biventricular force–frequency relationships were directly correlated to peak oxygen uptake.
VSD repair in early childhood is associated with disruption of the right ventricular force–frequency relationship, which may contribute to the previously observed reduction in functional capacity.
Assessment of pulmonary artery pressure and right ventricular function in children with adenotonsillar hypertrophy using different parameters
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Citation Excerpt :
In all three patient groups, they have shown that while significant decrease in Em, Am and Sm velocity was observed, the IVV and IVA did not change; and they reported that it is an index that provides advantage in diseases, like congenital cardiac anomalies, which may form pressure/volume load on RV, because IVA does not require adaptation according to the RV geometry, RV volume calculation is not required, is independent of preload and is easily measurable [31]. Pauliks et al. [37] reported, in their study including 39 children with ASD, that before and after a catheter device closure operation, unlike other myocardial velocities, IVA has not changed and is independent of volume overload. Frigiola et al. [38] found lower IVA values compared to controls in 124 operated tetralogy of Fallot patients (21 ± 11.4 years) and showed a decrease in IVA with increasing degree of pulmonary insufficiency.
Our aim was comparison of preoperative and postoperative right ventricular functions of children with adenotonsillar hypertrophy (ATH) who have findings of upper airway obstruction, using new echocardiographic parameters.
Forty-one children who have admitted to our hospital with symptoms suggestive of upper airway obstruction, whose history and physical examination findings suggest upper airway obstruction and who have undergone adenoidectomy/adenotonsillectomy and 40 healthy children, all of whom between 2 and 12 years of age, were included in the study. Patient group was evaluated by pulsed wave tissue Doppler echocardiography as well as with conventional echocardiography before the operation and 6 months after the operation.
Of 41 children in study group, 26 (63.4%) had adenotonsillectomy and 15 (36.6%) had adenoidectomy. Tricuspid annular plane systolic excursion (TAPSE) was significantly lower in preoperative group compared to control group (18.46 ± 1.67, 19.77 ± 1.62; p = 0.000, respectively). Myocardial performance index (MPI) was significantly higher in preoperative group than postoperative and control group (0.40 ± 0.07, 0.36 ± 0.06, 0.35 ± 0.07; p = 0.032, respectively). Tricuspid isovolumic acceleration (TIVA) was significantly lower in preoperative group than preoperative and control group (2.97 ± 0.8, 3.43 ± 0.7, 3.43 ± 0.9; p = 0.020, respectively). Disappearance of this difference was found between postoperative and control groups (p = 0.984). Pulmonary acceleration time (PAcT) was found to be significantly lower in preoperative group compared to postoperative and control group (109.68 ± 18.03, 118.93 ± 17.46, 120.0 ± 14.07; p = 0.010, respectively). Mean pulmonary artery pressure (mPAP) was significantly higher in preoperative group than control group (29.64 ± 8.11, 24.95 ± 6.33; p = 0.010, respectively). In postoperative group mPAP was found to be similar to control group (25.48 ± 7.85, 24.95 ± 6.33; p = 0.740, respectively).
TAPSE, PAcT, MPI and TIVA are useful markers for evaluation of preoperative and postoperative ventricular function in children with ATH who have findings of upper airway obstruction. We think that using these practical and easy-to perform parameters may be relevant for evaluation and postoperative follow-up of patients with ATH who have findings of upper airway obstruction. Besides adenotonsillectomy is a beneficial treatment option for these patients.
The value of isovolumic acceleration for the assessment of right ventricular function in acute pulmonary embolism
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The aim of this study was to assess the value of tricuspid annulus myocardial isovolumic acceleration (IVA) in the assessment of right ventricular function in patients with acute pulmonary embolism (PE).
Fifteen patients (mean age 60.6±11.3 years) with acute PE were enrolled and a control group was formed of 15 patients with a similar mean age (60.3±11.5). Patients who were diagnosed with acute PE by thoracic computed tomography angiography underwent transthoracic echocardiography at the time of diagnosis and at one month after diagnosis.
In the control group IVA was 2.8±0.2 m/s², while in the acute PE group, it was 2.0±0.1 m/s² at the time of diagnosis and 2.9±0.1 m/s² at the end of the first month. When IVA values of acute PE patients at the end of the first month were compared with their initial values and those of the control group, they had normalized (control and acute PE p<0.0001; control and PE at one-month follow-up p=0.983).
In our study, IVA was shown to be a reliable marker of right ventricular systolic function in patients with acute PE.
O objetivo deste estudo consiste em determinar o valor do tempo de aceleração isovulométrica miocárdica do anel tricúspide (IVA) na avaliação da função ventricular direita em doentes com embolia pulmonar (EP) aguda.
Quinze doentes (idade média 60,6 ± 11,3 anos) com EP aguda foram incluídos no nosso estudo e o grupo controle foi constituído por 15 doentes com idade média semelhante (60,3 ± 11,5). Após o diagnóstico de EP aguda por angiotomografia torácica computorizada, os doentes foram avaliados com ecocardiografia transtorácica, na altura do diagnóstico e no final do primeiro mês após o diagnóstico.
Enquanto o valor do IVA foi de 2,8± 0,2 no grupo controle, no grupo com EP aguda foi 2,0± 0,1 na altura do diagnóstico e 2,9 ±0,1 no final do primeiro mês. Quando comparamos os valores de IVA dos doentes com EP aguda no final do primeiro mês com os valores iniciais e os valores do grupo controle, verificou-se que tinham normalizado (controle e EP aguda p <0,0001; controle e EP após um mês de seguimento p =0,983).
No nosso estudo o IVA revelou-se um marcador adequado da função sistólica ventricular direita em doentes com EP aguda.
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Clinical InvestigationValvular and Congenital Heart DiseaseRegional myocardial velocities and isovolumic contraction acceleration before and after device closure of atrial septal defects: A color tissue Doppler study

Background

Methods

Results

Conclusions

Section snippets

Methods

Clinical patient characteristics

Discussion

Ann Thorac Surg

Ultrasound Med Biol

J Am Soc Echocardiogr

Am J Cardiol

Comparison of acute effects of right ventricular hemodynamics of surgical versus interventional closure of atrial septal defects

Cardiol Young

Some immediate hemodynamic consequences of closure of atrial septal defects of the secundum type

Circulation

Acute left heart failure after interventional occlusion of an atrial septal defect

Z Kardiol

Abnormal left heart function after operation of atrial septal defect

Br Heart J

Doppler echocardiographic evaluation of left ventricular diastolic function after surgical correction of atrial septal defect during childhood

Pediatr Cardiol

Masked left ventricular restriction in elderly patients with atrial septal defects: a contraindication for closure?

Catheter Cardiovasc Interv

Acute left ventricular failure after transcatheter closure of a secundum atrial septal defect in a patient with coronary artery disease: a critical reappraisal

Catheter Cardiovasc Interv

Regional myocardial function—a new approach

Eur Heart J

Clinical Investigation
Valvular and Congenital Heart Disease
Regional myocardial velocities and isovolumic contraction acceleration before and after device closure of atrial septal defects: A color tissue Doppler study