Ventricularmyocardial deformation in adults after early surgical repair of atrial septal defect

Aims It is unknown whether right-ventricular (RV) volume overload caused by an atrial septal defect (ASD) still has its effect on RV deformation long after repair.We evaluated RV and left-ventricular (LV) deformation beyond 30 years after surgical ASD repair in childhood, and studied relationships with conventional diagnostic parameters. Methods and results In this prospective study,we included 102 subjects: 51 patients with repairedASD(39% male, age 43.3±4.9 years, age at repair 7.9±3.6 years) and 51 healthy controls of similar age and sex. All subjects underwent echocardiography and electrocardiography. Additionally, ASD patients underwent cardiac magnetic resonance imaging (CMR), bicycle ergometry, and NT-proBNP measurement. With speckle-tracking echocardiography, we analysed peak systolic longitudinal strain of the RV lateral wall, LV lateral wall, and septum. RV lateral wall global longitudinal strain (GLS) was lower in patients (-20.4±2.7%) than controls (-26.8±4.2%, P < 0.001), due mainly to decreased apical strain (-19.3±6.2 vs. -28.8±8.3%, P < 0.001). RV lateral wall GLS correlated with CMR-derived RV and LV end-diastolic volumes (ρ = 0.49, P = 0.014; ρ = 0.53, P = 0.005), and with RV and LV end-systolic volumes (ρ = 0.43, P = 0.034; ρ = 0.46, P = 0.019). LV GLS was similar between patients and controls (P = 0.144). No significant correlations were found with NT-proBNP or exercise capacity. Conclusion Although ASD repair was already performed in childhood, RV longitudinal strain, especially of the apical segment, is decreased in patients 35 years after surgery. This suggests that RV function has still been affected in the long run, probably due to the early RV volume overload, but possibly also as sequel of surgery.

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