Open AccessUsefulness of anatomic parameters derived from two‐dimensional echocardiography for estimating magnitude of left to right shunt in patients with atrial septal defect
Author(s) -
Chen C.,
Kremer P.,
Schroeder E.,
Rodewald G.,
Bleifeld W.
Publication year - 1987
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.4960100604
Subject(s) - medicine , shunt (medical) , cardiology , foramen secundum , septum secundum , right to left shunt , heart septal defect , patent foramen ovale , migraine
The ability of two‐dimensional echocardiography (2DE) to quantitate the atrial septal defect size and left‐to‐right shunt magnitude was examined in 75 adult patients with simple ostium secundum atrial septal defect (ASD) with left‐to‐right shunts of 19–92% of systemic flow as determined by oximetry. The ASD was visualized in 71 of 75 (95%) patients utilizing subcostal 2DE, and the end‐systolic atrial septal defect diameters in subcostal 2DE (ASDe) were measured. The maximal diameters of ASD measured during operation (ASDop) were obtained in 45 of these patients, who then underwent surgical ASD repair. The correlation between ASDe and ASDop was high (r=0.91, p<0.001), indicating accuracy of quantitating defect size via subcostal 2DE approach. However, the correlation between the left‐to‐right shunt magnitude and ASDe was only fair (r=0.76, p<0.01). In large ASDe the shunts varied greatly, while in small ASDe the shunts increased proportionally with increasing sizes of ASD. In addition, the ratio of left‐to‐right ventricular diameter (RVD/LVD) was determined. The RVD/LVD correlated relatively well with the shunt magnitudes (r=0.83, p<0.001). Using the two new echocardiographic parameters of ASDe and RVD/LVD, a high percentage (85%) of patients with a large left‐to‐right shunt requiring surgical closure can be identified. All 43 patients with ASDe >2.0 cm and RVD/LVD >1.1 had a left‐to‐right shunt >40%. In conclusion: (1) ostium secundum atrial septal defect size can be reliably quantitated by subcostal 2DE, and (2) ASDe >2.0 cm and RVD/LVD >1.1 are highly predictive of a left‐to‐right shunt >40%.