Three-Dimensional Echocardiography in the Evaluation of Right Ventricular Global and Regional Systolic Function in Patients with Atrial Septal Defect before and after Percutaneous Closure.

Abstract

To evaluate right ventricular (RV) global and regional systolic function in patients with atrial septal defect (ASD) before and after percutaneous closure using real time three-dimensional echocardiography (RT3DE). RT3DE was performed in 81 patients with ASD within 24 hours before and after percutaneous closure to obtain RV global and regional ejection fraction (EF) in three compartments (inflow, body, and outflow). RV fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), peak tricuspid systolic velocity (S), and pulmonary vascular resistance (PVR) were recorded. Forty matched normal adults were included as controls. When compared with controls, RV global and regional EF were decreased in preclosure patients (P < 0.001). FAC was lower while TAPSE and S were higher in preclosure patients than in controls (P < 0.05). After closure, RV systolic function parameters were all reduced (P < 0.001). Regional EF in the body compartment was the lowest among the three compartments in ASD patients (P < 0.05). Procedural percentage changes of RV global EF and regional EF in the inflow compartment were lower than those of two-dimensional systolic function parameters (P < 0.05). RV global and regional EF in the inflow compartment were negatively correlated with PVR in patients after closure (r = -0.601, -0.543, P < 0.001). RV global and regional systolic functions are impaired in open and closed ASD. RT3DE-derived systolic function parameters are negatively correlated with RV after load. RT3DE has potential value in the evaluation of RV systolic function in patients with ASD.