Skip to main content
SpringerLink
Log in

Preoperative coupling between right ventricle and pulmonary vasculature is an important determinant of residual symptoms after the closure of atrial septal defect

  • Original Paper
  • Published:
The International Journal of Cardiovascular Imaging Aims and scope Submit manuscript

Abstract

Purposes

The closure of atrial septal defect (ASD) is associated with a significant reduction in right ventricular (RV) overload and an improvement in functional capacity in most adults with ASD. However, a subset of patients remains symptomatic even after closure due to therapeutic delay. To date, no clinically robust preoperative predictor of postoperative residual symptoms has been clearly identified.

Methods

In this study, 120 adult patients with ASD and 39 controls were investigated. As an index of RV myocardial deformation, RV global longitudinal strain (RV-GLS) was evaluated. The degree of coupling between RV and pulmonary artery (PA) was quantified by the tricuspid annular plane systolic excursion (TAPSE) divided by the PA systolic pressure (PASP).

Results

Compared to controls, baseline RV-GLS was significantly greater (− 27 ± 7 vs. − 23 ± 5%, P = 0.02) and TAPSE/PASP ratio was severely impaired (0.8 ± 0.3 vs. 2.1 ± 1.6 mm/mmHg, P < 0.01) in ASD patients. At 6 months after closure, 15 patients (12.5%) remained symptomatic. In patients without residual symptoms, TAPSE/PASP ratio significantly improved from 0.9 ± 0.3 to 1.0 ± 0.6 mm/mmHg (P = 0.02), and RV-GLS normalized (from − 28 ± 11 to − 24 ± 7%, P < 0.01) after closure. However, RV-GLS and TAPSE/PASP ratio showed no significant change in ASD patients with residual symptoms. On multivariate analysis, preoperative TAPSE/PASP ratio (odds ratio [OR] 0.034, 95% confidence interval [CI] 0.000–0.604, P = 0.03) and pulmonary vascular resistance index ([PVRI], OR 1.011, 95% CI 1.000–1.021, P < 0.05) were associated with the postoperative symptomatic status.

Conclusion

In terms of integrated assessment of the RV-PA unit, preoperative TAPSE/PASP ratio and PVRI were important determinants of residual symptoms after ASD closure.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Hoffman JI, Kaplan S (2002) The incidence of congenital heart disease. J Am Coll Cardiol 39:1890–1900

    Article  PubMed  Google Scholar 

  2. Merkus D, de Beer VJ, Houweling B, Duncker DJ (2008) Control of pulmonary vascular tone during exercise in health and pulmonary hypertension. Pharmacol Ther 119:242–263

    Article  CAS  PubMed  Google Scholar 

  3. Van De Bruaene A, La Gerche A, Prior DL, Voigt JU, Delcroix M, Budts W (2011) Pulmonary vascular resistance as assessed by bicycle stress echocardiography in patients with atrial septal defect type secundum. Circ Cardiovasc Imaging 4:237–245

    Article  Google Scholar 

  4. Van De Bruaene A, De Meester P, Buys R, Vanhees L, Delcroix M, Voigt JU, Budts W (2013) Right ventricular load and function during exercise in patients with open and closed atrial septal defect type secundum. Eur J Prev Cardiol 20:597–604

    Article  Google Scholar 

  5. Geva T, Martins JD, Wald RM (2014) Atrial septal defects. Lancet 383:1921–1932

    Article  PubMed  Google Scholar 

  6. Van De Bruaene A, Buys R, Vanhees L, Delcroix M, Voigt JU, Budts W (2011) Regional right ventricular deformation in patients with open and closed atrial septal defect. Eur J Echocardiogr 12:206–213

    Article  Google Scholar 

  7. Heath D, Edwards JE (1958) The pathology of hypertensive pulmonary vascular disease; a description of six grades of structural changes in the pulmonary arteries with special reference to congenital cardiac septal defects. Circulation 18:533–547

    Article  CAS  PubMed  Google Scholar 

  8. Heath D, Helmholz HF Jr, Burchell HB, Dushane JW, Kirklin JW, Edwards JE (1958) Relation between structural change in the small pulmonary arteries and the immediate reversibility of pulmonary hypertension following closure of ventricular and atrial septal defects. Circulation 18:1167–1174

    Article  CAS  PubMed  Google Scholar 

  9. Rabinovitch M, Keane JF, Norwood WI, Castaneda AR, Reid L (1984) Vascular structure in lung tissue obtained at biopsy correlated with pulmonary hemodynamic findings after repair of congenital heart defects. Circulation 69:655–667

    Article  CAS  PubMed  Google Scholar 

  10. Webb G, Gatzoulis MA (2006) Atrial septal defects in the adult: recent progress and overview. Circulation 114:1645–1653

    Article  PubMed  Google Scholar 

  11. Murphy JG, Gersh BJ, McGoon MD, Mair DD, Porter CJ, Ilstrup DM, McGoon DC, Puga FJ, Kirklin JW, Danielson GK (1990) Long-term outcome after surgical repair of isolated atrial septal defect. Follow-up at 27 to 32 years. N Engl J Med. 323:1645–1650

    Article  CAS  PubMed  Google Scholar 

  12. Du ZD, Koenig P, Cao QL, Waight D, Heitschmidt M, Hijazi ZM (2002) Comparison of transcatheter closure of secundum atrial septal defect using the Amplatzer septal occluder associated with deficient versus sufficient rims. Am J Cardiol 90:865–869

    Article  PubMed  Google Scholar 

  13. La Gerche A, Heidbuchel H, Burns AT, Mooney DJ, Taylor AJ, Pfluger HB, Inder WJ, Macisaac AI, Prior DL (2011) Disproportionate exercise load and remodeling of the athlete’s right ventricle. Med Sci Sports Exerc 43:974–981

    Article  PubMed  Google Scholar 

  14. Barron AJ, Wensel R, Francis DP, Malik I (2012) The role for cardiopulmonary exercise testing in patients with atrial septal defects: a review. Int J Cardiol 161:68–72

    Article  PubMed  Google Scholar 

  15. Baumgartner H, Bonhoeffer P, De Groot NM, de Haan F, Deanfield JE, Galie N, Gatzoulis MA, Gohlke-Baerwolf C, Kaemmerer H, Kilner P, Meijboom F, Mulder BJ, Oechslin E, Oliver JM, Serraf A, Szatmari A, Thaulow E, Vouhe PR, Walma E (2010) Task Force on the Management of Grown-up Congenital Heart Disease of the European Society of C, Association for European Paediatric C and Guidelines ESCCfP. ESC Guidelines for the management of grown-up congenital heart disease (new version 2010). Eur Heart J. 31:2915–2957

    Article  PubMed  Google Scholar 

  16. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA (2005) Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 18:1440–1463

    Article  PubMed  Google Scholar 

  17. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, Lancellotti P, Muraru D, Picard MH, Rietzschel ER, Rudski L, Spencer KT, Tsang W, Voigt JU (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 16:233–270

    Article  PubMed  Google Scholar 

  18. Nagueh SF, Smiseth OA, Appleton CP, Byrd BF 3rd, Dokainish H, Edvardsen T, Flachskampf FA, Gillebert TC, Klein AL, Lancellotti P, Marino P, Oh JK, Alexandru Popescu B, Waggoner AD, Houston T, Oslo N, Phoenix A, Nashville T, Hamilton OC, Uppsala S, Ghent Liege B, Cleveland O, Novara I, Rochester M, Bucharest R, St. Louis M. (2016) Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 17:1321–1360

    Article  PubMed  Google Scholar 

  19. Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, Solomon SD, Louie EK, Schiller NB (2010) Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 23:685–713

    Article  PubMed  Google Scholar 

  20. Frea S, Bovolo V, Bergerone S, D’Ascenzo F, Antolini M, Capriolo M, Canavosio FG, Morello M, Gaita F (2012) Echocardiographic evaluation of right ventricular stroke work index in advanced heart failure: a new index? J Card Fail 18:886–893

    Article  PubMed  Google Scholar 

  21. Guazzi M, Bandera F, Pelissero G, Castelvecchio S, Menicanti L, Ghio S, Temporelli PL, Arena R (2013) Tricuspid annular plane systolic excursion and pulmonary arterial systolic pressure relationship in heart failure: an index of right ventricular contractile function and prognosis. Am J Physiol Heart Circ Physiol 305:H1373-1381

    Article  CAS  PubMed  Google Scholar 

  22. Mor-Avi V, Lang RM, Badano LP, Belohlavek M, Cardim NM, Derumeaux G, Galderisi M, Marwick T, Nagueh SF, Sengupta PP, Sicari R, Smiseth OA, Smulevitz B, Takeuchi M, Thomas JD, Vannan M, Voigt JU, Zamorano JL (2011) Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE/EAE consensus statement on methodology and indications endorsed by the Japanese Society of Echocardiography. J Am Soc Echocardiogr 24:277–313

    Article  PubMed  Google Scholar 

  23. Ho KK, Pinsky JL, Kannel WB, Levy D (1993) The epidemiology of heart failure: the Framingham Study. J Am Coll Cardiol 22:6a–13a

    Article  CAS  PubMed  Google Scholar 

  24. Takaya Y, Akagi T, Kijima Y, Nakagawa K, Sano S, Ito H (2015) Long-term outcome after transcatheter closure of atrial septal defect in older patients: impact of age at procedure. JACC Cardiovasc Interv 8:600–606

    Article  PubMed  Google Scholar 

  25. Engelfriet P, Meijboom F, Boersma E, Tijssen J, Mulder B (2008) Repaired and open atrial septal defects type II in adulthood: an epidemiological study of a large European cohort. Int J Cardiol 126:379–385

    Article  PubMed  Google Scholar 

  26. Cossio-Aranda J, Zamora KD, Nanda NC, Uzendu A, Keirns C, Verdejo-Paris J, Martinez-Rios MA, Espinola-Zavaleta N (2016) Echocardiographic correlates of severe pulmonary hypertension in adult patients with ostium secundum atrial septal defect. Echocardiography 33:1891–1896

    Article  PubMed  Google Scholar 

  27. Negishi K, Borowski AG, Popovic ZB, Greenberg NL, Martin DS, Bungo MW, Levine BD, Thomas JD (2017) Effect of Gravitational Gradients on Cardiac Filling and Performance. J Am Soc Echocardiogr 30:1180–1188

    Article  PubMed  Google Scholar 

  28. Wright L, Negishi K, Dwyer N, Wahi S, Marwick TH (2017) Afterload Dependence of Right Ventricular Myocardial Strain. J Am Soc Echocardiogr 30(676–684):e1

    Google Scholar 

Download references

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan

    Makiko Suzuki, Kensuke Matsumoto, Yusuke Tanaka, Kentaro Yamashita, Ayu Shono, Keiko Sumimoto, Nao Shibata, Shun Yokota, Makiko Suto, Kumiko Dokuni, Hidekazu Tanaka, Hiromasa Otake & Ken-ichi Hirata

Authors
  1. Makiko Suzuki
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kensuke Matsumoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yusuke Tanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kentaro Yamashita
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ayu Shono
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Keiko Sumimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Nao Shibata
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Shun Yokota
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Makiko Suto
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Kumiko Dokuni
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Hidekazu Tanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Hiromasa Otake
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Ken-ichi Hirata
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kensuke Matsumoto.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest to declare.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Suzuki, M., Matsumoto, K., Tanaka, Y. et al. Preoperative coupling between right ventricle and pulmonary vasculature is an important determinant of residual symptoms after the closure of atrial septal defect. Int J Cardiovasc Imaging 37, 2931–2941 (2021). https://doi.org/10.1007/s10554-021-02282-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10554-021-02282-4

Keywords

Search

Navigation