Objectives
The primary objective of this study was to establish “normal” right atrial (RA)-indexed
end-systolic volumes (ESVs) and emptying fraction (EF) in children undergoing ventricular
septal defect (VSD) repair using two-dimensional (2D) transesophageal echocardiography
(TEE). Secondary objectives were to obtain RA-indexed ESV and EF in children with
RA/right ventricular (RV) volume overload (atrial septal defect [ASD]) and RV pressure
overload (tetralogy of Fallot [TOF]) and to determine whether baseline differences
existed in these indices among the three lesions.
Design
A prospective observational study.
Setting
Tertiary referral center and a university level teaching hospital.
Participants
The study comprised 90 children (30 in each cohort) >3 kg and <14 years old admitted
for elective repair of either VSD, TOF, or ASD.
Measurements and Main Results
RA ESV and EF were measured in the midesophageal four-chamber view using the area-length
and the modified Simpson's methods with 2D TEE in the prebypass period. Mean RA- indexed
ESV (area-length method) in the VSD cohort was 24.2 ± 6.7 mL/m2, whereas it was significantly greater in the TOF (31.9 ± 9.8 mL/m2; p = 0.0008) and ASD (52 ± 12.9 mL/m2; p < 0.0001) cohorts. RA EF in the TOF cohort was 48.4% ± 7.6%, which was significantly more
than in the VSD (41.5% ± 11.8%; p = 0.0093) and ASD (39.1% ± 12.3%; p = 0.0008) cohorts.
Conclusions
This was the first study using 2D TEE to measure RA indices in children with and without
right-sided heart dilation undergoing cardiac surgery. In this study, RA, ESV, and
EF were considerably different in children with congenital heart disease causing RV
pressure or volume overload. Additional studies can examine how these values can be
used for risk stratification in this cohort of patients or how they correlate with
measures of ventricular performances.
Key Words
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Article info
Publication history
Published online: April 17, 2021
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