Square root sign of left ventricular diastolic pressure curve in atrial septal defect.
The square root (dip and plateau) sign was observed in 7 of 21 adult patients with atrial septal defect (ASD). This study evaluated left ventricular (LV) diastolic filling dynamics and hemodynamic findings in 7 patients (Group 1) with, and 14 patients (Group 2) without the square root sign; 10 normal subjects (Group 3) served as controls. No significant differences were observed in LV end-diastolic and end-systolic volumes, ejection fraction, or left to right shunt. In Group 1, 77% of LV filling was completed in the first half of diastole; this percentage was 49% and 53% in Groups 2 and 3, respectively (both p less than 0.01 versus Group 1). Early diastolic filling velocity (at 20% of diastole) in Group 1 was significantly greater, and late diastolic filling velocity (at 80% and 90% of diastole) was reduced in Group 1 compared to those in Groups 2 and 3 (all p less than 0.05). The average values for right and left ventricular end-diastolic pressures were significantly higher in Group 1 (11 +/- 2 and 10 +/- 4 mmHg, p less than 0.05) than Group 2 (7 +/- 2 and 7 +/- 2 mmHg, p less than 0.05). It is suggested that a constrictive pathophysiology due to 4 chambers interaction or right ventricular constraint may play a role in the genesis of the square root sign in ASD.
Kita
Y
Y
Department of Internal Medicine, Osaka Medical College, Takatsuki, Japan.
Hirota
Y
Y
Saito
T
T
Shimizu
G
G
Kaku
K
K
Kawamura
K
K
D000293:Adolescent; D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity; D001794:Blood Pressure; D003971:Diastole; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000503:physiopathology*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D013318:Stroke Volume; D016277:Ventricular Function, Left