Echocardiographic evaluation of patients with primary pulmonary hypertension before and after atrial septostomy

Objectives: To characterize the early changes in right ventricular [right v entricle (RV)]geometry and function, as assessed by two-dimensional (2-D) a nd Doppler echocardiography, after balloon-dilation atrial septostomy (BDAS ) in patients with severe primary pulmonary hypertension (PPH). Background. Survival in PPH is to a great extent dependent on the functional status of the RV. BDAS recently has been shown to improve functional class and hemod ynamics in patients with PPH nonresponsive to conventional vasodilator trea tment. Methods: Ten patients with severe PPH who underwent BDAS were studie d with transthoracic and transesophageal 2-D and Doppler echocardiography. RV dimensions were measured in the apical four-chamber view. Continuous-wav e Doppler echocardiography was used to obtain peak velocity of tricuspid re gurgitation. Transesophageal echocardiography (TEE) primarily was used for the follow-up of the atrial septal defects (ASDs). Results: In the early po st-BDAS studies, right atrial and ventricular dimensions significantly decr eased in all patients (P < 0.05). Global right ventricular wall motion (RVW M) also improved. RV percent change in area after septostomy inversely corr elated with the changes in RV systolic area (r = -0.75; P < 0.05) and also with the baseline (preprocedure) values of RV Percent change in area (r = - 0.77; P < 0.05). Neither RV wall thickness nor the degree of tricuspid regu rgitation were modified significantly after the procedure. Conclusions: BDA S in the setting of severe PPH results in moderate and salutary changes in geometry and function of the RV as assessed by 2-D echocardiography. These changes mainly appear to be the result of the decompression effect of atria l septostomy.