DOPPLER-ECHOCARDIOGRAPHIC EVALUATION OF LEFT-VENTRICULAR DIASTOLIC FUNCTION AFTER SURGICAL-CORRECTION OF ATRIAL SEPTAL-DEFECT DURING CHILDHOOD

Transmitral flow was studied using Doppler echocardiography with the A /E ratio as a parameter of left ventricular diastolic function in 21 p atients (ages 2.5-30.0 years) who had undergone early surgical correct ion of an isolated secundum type atrial septal defect (ASD) compared t o a healthy cohort of 21 subjects. Pre- and postoperative M-mode recor dings were compared in 12 of the 21 patients to evaluate the effect of operatiofn on interventricular septal motion (IVS) and left ventricul ar (LV) and right ventricular (RV) end-diastolic diameter ratio (LVDD/ RVDD) as parameters of right ventricular volume overload. No significa nt difference in A/E ratio was found between the patient and control g roups. IVS was shown to normalize in 11 of 12 patients postoperatively and to improve from paradox to flattened in 1 of 12. LVDD/RVDD increa sed from 1.26 +/- 0.31 to 2.10 +/- 0.51 (p = 0.0008), with no signific ant difference remaining between the control and patient groups postop eratively. These findings support the conclusion that an intrinsic abn ormality of the left ventricle is not responsible for its diastolic dy sfunction in patients with ASD who develop left ventricular failure, t hereby implicating an acquired abnormality. Mechanical sequelae of rig ht ventricular volume overload were shown to normalize in all patients subsequent to operation in the present study, and therefore cannot be excluded as a cause of left ventricular failure in ASD.