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.
A prospective observational study.
Tertiary referral center and a university level teaching hospital.
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.
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.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Cardiothoracic and Vascular Anesthesia
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Left atrial volume in the prediction of first ischemic stroke in an elderly cohort without atrial fibrillation.Mayo Clin Proc. 2004; 79: 1008-1014
- Usefulness of left atrial volume in predicting first congestive heart failure in patients >or = 65 years of age with well-preserved left ventricular systolic function.Am J Cardiol. 2005; 96: 832-836
- Left atrial volume, geometry, and function in systolic and diastolic heart failure of persons >or =65 years of age (the Cardiovascular Health Study).Am J Cardiol. 2006; 97: 83-89
- Left atrial volume: A powerful predictor of survival after acute myocardial infarction.Circulation. 2003; 107: 2207-2212
- Normal reference ranges for left and right atrial volume indexes and ejection fractions obtained with real-time three-dimensional echocardiography.Eur J Echocardiogr. 2009; 10: 738-744
- Echocardiographic reference ranges for normal cardiac chamber size: Results from the NORRE study.Eur Heart J Cardiovasc Imaging. 2014; 15: 680-690
- Recommendations for cardiac chamber quantification by echocardiography in adults: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.J Am Soc Echocardiogr. 2015; 28: 1-39
- Pathophysiology of congenital heart disease in the adult: Part I: Shunt lesions.Circulation. 2008; 117: 1090-1099
- Left-to-right shunt lesions.Pediatr Clin North Am. 1999; 46: 355-368
- Abnormal right atrial performance in surgically repaired tetralogy of Fallot: German Competence Network for Congenital Heart Defects investigators.J Am Coll Cardiol. 2015; 65: 1292A
- Validation of right atrial area as a measure of right atrial size and normal values of in healthy pediatric population by two-dimensional echocardiography.Pediatr Cardiol. 2018; 39: 892-901
- Transesophageal echocardiography in monitoring, guiding, and evaluating surgical repair of congenital cardiac malformations in children.Cardiol Young. 2007; 17: 301-306
- Recommendations for quantification methods during the performance of a pediatric echocardiogram: A report from the Pediatric Measurements Writing Group of the American Society of Echocardiography Pediatric and Congenital Heart Disease Council.J Am Soc Echocardiogr. 2010; 23: 465-495
- Geometric method for measuring body surface area: A height-weight formula validated in infants, children, and adults.J Pediatr. 1978; 93: 62-66
- Everything you never wanted to know about statistics.Discovering statistics using IBM SPSS statistics, ed 4. Sage, Thousand Oaks, CA2013: 40-88
- Relation of right atrial volume, systemic venous dimensions, and flow patterns to right atrial pressure in infants and children.Am J Cardiol. 2017; 119: 1473-1478
- Reference values for atrial size and function in children and young adults by cardiac MR: A study of the German competence network congenital heart defects.J Magn Reson Imaging. 2011; 33: 1028-1039
- Right atrial mechanics provide useful insight in pediatric pulmonary hypertension.Pulm Circ. 2018; 82045893218754852
- Implications of atrial volumes in surgical corrected tetralogy of Fallot on clinical adverse events.Int J Cardiol. 2019; 283: 107-111
Published online: April 17, 2021
© 2021 Elsevier Inc. All rights reserved.