Right ventricular function in adult atrial septal defect: Preoperative and postoperative assessment and clinical implications

Abstract

Right ventricular function was assessed with gated cardiac blood pool scanning in 20 adult patients with an atrlal septal defect. All patients had scans both before and 6 or more months after surgical repair of the defect. Clinical findings, pre- and postoperative course and cardiac catheterization data were correlated with scan findings. In all 20 patients, the right ventricle was dilated preoperatively. In nine patients (aged 18 to 42 years, mean 25), right ventricular wall motion was normal preoperatively. All nine were asymptomatic and had normal sinus rhythm. Their pulmonary to systemic flow ratio ranged between 2:1 and 5:1, pulmonary arterial systolic pressure between 18 and 30 mm Hg and right ventricular end-diastolic pressure between 0 and 8 mm Hg. After repair of the atrlal septal defect, all nine remained asymptomatic, right ventricular size decreased dramatically and wall motion was normal. In the remaining 11 patients (aged 36 to 63 years, mean 52), there was moderate to severe preoperatlve right ventricular hypokinesia. All had preoperatlve symptoms (functional class II and III, New York Heart Association); six had atrial fibrillation and five had normal sinus rhythm; seven had clinical heart failure. Pulmonary to systemic flow ratio ranged between 1.7:1 and 5.0:1, pulmonary arterial pressure between 26 and 70 mm Hg and right ventricular end-diastolic pressure between 4 and 16 mm Hg. Symptoms were lessened and right ventricular size and function improved postoperatively in these 11 patients. Unlike those with normal preoperatlve right ventricular wall motion, however, only 1 of the 11 had normal postoperative right ventricular function and became asymptomatic.