PHONOMECHANOCARDIOGRAPHIC PARAMETERS IN PATIENTS WITH ATRIAL SEPTAL-DEFECT

The purpose of the present study was to noninvasively evaluate left (L V) systolic and diastolic function in patients with atrial septal defe ct (ASD) using the phonomechanocardiogram. We studied 40 patients with atrial septal defect, 16 males and 24 females, ages ranging from 6 to 56 years (mean 21.1 years), consecutively observed before surgery in our institution, during a four year period. We measured the systolic t ime intervals (Q-A2c, Q-S1, ICT, PEP, LVETc, PEP/LVET), the Apex Cardi ographic (ACG) diastolic parameters A2-Oc and A/H and the hemodynamic variables Qp/Qs, Pulmonary Vascular Resistence (PVR)) and Left Ventric ular End Diastolic Pressure (LVEDP). We compared the data with 74 norm al individuals using the Student t-test and linear regression analysis . We found significant Q-S1 lengthening (81.2 +/- 16.4 ms, p < 0. 001) ; PEP, ICT and A2-Oc were significantly reduced (101.2 +/- 21.7 ms, p< 0.001, 20.0 +/- 5.3 ms, p < 0.05 and 117.1 +/- 26.3 ms, p < 0.001, res pectively) and A/H was significantly increased (17.4 +/- 12.1 %, p < 0 .005). Except for the case of Q-S1, where there was a weak positive li near correlation with Qp/Qs (r = 0.37), we found no correlation betwee n the other parameters and Qp/Qs or PVR. Sixty-seven percent of the pa tients had Q-S1 prolongation and a Q-S1> 76.2 ms identified left-right shunts >2 with a positive predictive value of 82%; 62% of the patient s had a reduced A2-Oc and a A2-Oc <110 ms identified shunts >2 with a positive predictive value of 90 %. In conclusion these findings sugges t that left ventricular systolic function is normal in patients with A SD, but there seems to be a left ventricular diastolic dysfunction in these patients.