The left ventricle in atrial septal defect: Looking through 3D glasses

Objectives To identify left ventricular ( LV ) dyssynchrony and associated factors in atrial septal defect ( ASD ) patients, using real time three‐dimensional echocardiogram ( RT 3 DE ). Background Left ventricular dysfunction has been observed in ASD . Few studies have utilized RT 3 DE to assess LV wall‐motion abnormality in ASD . Methods Patients aged ≥1 year with ASD , with or without partial anomalous pulmonary venous drainage ( PAPVD ), were included over 1 year. Additional cardiac defects or abnormalities independently affecting LV function were excluded. 2 DE and RT 3 DE ‐derived LV function data were recorded. Student's t test and Pearson's correlation were used for analysis. Results Of 104 patients (69 females) aged 1–57 years, ostium secundum ASD was present in 97 and sinus venosus ASD in 7. Maximum excursion increased significantly with age, weight, and body surface area ( P < 0.001). Majority of children (58%) aged 3–5 years showed no delay in segmental excursion. Lateral wall excursional delay was greater beyond 5 years or with weight > 15 kg (42% as compared to 20% in <15 kg). In patients weighing < 15 kg, time to minimum systolic volume (Tmsv 16‐ SD ) was higher with PAPVD and with indexed defect size > 40 mm/m 2 , though not statistically significant. As compared to EF estimation by 2 DE , EF derived using RT 3 DE was significantly lower ( P < 0.001). Conclusion Left ventricular dyssynchrony is least between 3 and 5 years. Beyond 5 years, delayed lateral wall excursion is seen. With an indexed defect size exceeding 40 mm/m 2 , and in the presence of PAPVD , time to minimum systolic volume is higher.