Abstract
SummaryBackgroundUnrepaired left to right atrial shunt lesions can cause significant right ventricular (RV) volume overload. The parameter pulmonary to systemic shunt volume ratio (Qp:Qs) has been shown to detect even small differences between left and right ventricular stroke volume; however, four parameters are needed for its calculation. This study was carried out to evaluate the accuracy of the single parameter right ventricular outflow tract (RVOT) velocity time integral (VTI) to identify atrial shunt lesions.MethodsAll patients who underwent transesophageal echocardiography (TEE) examination at this institution between 1 January 2013 and 1 January 2018 were retrospectively analyzed. The RVOT-VTI was measured in the transthoracic echocardiography performed immediately before each TEE. The diagnostic accuracy for detection of atrial shunt lesions was tested.ResultsA total of 2797 patients with a median age of 67 years (interquartile range, IQR 54–77 years) were included in the final analysis. A total of 113 (4%) patients had a relevant atrial shunt lesion. The mean RVOT-VTI of the shunt group was 25 cm (SD ± 8.1 cm) and was significantly higher than that of the non-shunt group with 17 cm (SD ± 4.8 cm) (p < 0.001). The area under the curve (AUC) was 0.81. A total of 106 patients (93.8%) of the shunt group had a VTI of ≥16 cm. If the RVOT-VTI was <16 cm, the negative predictive value was 99.3%. If the RVOT-VTI was ≥25 cm, 22% of patients proved to have a significant shunt lesion.ConclusionIn this large retrospective analysis it could be shown that a low RVOT-VTI predicted the absence of significant atrial shunt lesions, while a high RVOT-VTI predicted the presence. The parameter should be applied in all patients with suspected atrial shunt lesions where calculation of Qp:Qs is impossible.Electronic supplementary materialThe online version of this article (10.1007/s00508-020-01659-0) contains supplementary material, which is available to authorized users.
Highlights
Unrepaired atrial left to right shunt lesions can lead to significant right heart volume overload
A Transthoracic echocardiography (TTE) examination (which included a pulsed-wave (PW) Doppler signal in the right ventricular outflow tract (RVOT)) on the same day or in close time interval before the transesophageal echocardiography (TEE) was warranted for inclusion
Between 1 January 2013 and 1 January 2018 a total of 4442 TEE examinations were performed at this department
Summary
Unrepaired atrial left to right shunt lesions can lead to significant right heart volume overload. Symptoms such as palpitations, chest pain and shortness of breath are caused by right heart failure and usually occur at a relatively late stage with already dilated right ventricular dimensions and often pulmonary hypertension [1,2,3]. It is crucial to discover early signs of left to right shunts before symptoms develop. The most common atrial left-to-right shunts include the following defects: ostium secundum atrial septal defect (ASD II), sinus venosus defect (SVD), ostium primum atrial septal defect (ASD I), coronary sinus defect and anomalous pulmonary venous connection [4]. Transthoracic echocardiography (TTE) is the firstline imaging modality applied when there is suspi-
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