title: Ventricular septal flattening at end systole falsely predicts right ventricular hypertension in patients with ostium primum atrial septal defects.
abstract: OBJECTIVE
  To assess the reliability of ventricular septal position in predicting elevated right ventricular pressure (RVP) in patients with ostium primum atrial septal defects (ASD 1).
  
  
  METHODS
  Echocardiograms of 4 groups were retrospectively analyzed: Patients with ASD 1 and low RVP, patients with ASD 1 and high RVP, and 2 age-matched control groups: one with isolated ostium secundum atrial septal defects (ASD 2), and 1 with normal cardiac findings. End-systolic left ventricular sectional diameters along the midmitral diameter (D1) and a diameter orthogonal to it (D2) were measured off-line by a blinded observer. The ratio D2/D1, the eccentricity index (EI), was calculated; a higher index represents greater septal flattening.
  
  
  RESULTS
  The mean EI in the ASD 1 with low RVP group was significantly higher than both the group with ASD 2 and the healthy control group. The mean EI of the ASD 1 group with high RVP was significantly higher than the mean EI of the ASD 1 group with low RVP, although there was a poor correlation between EI and RVP in this group, r = 0.54.
  
  
  CONCLUSIONS
  The ventricular septum is flatter in the ASD 1 patients with low RVP than in an age-matched control group with ASD 2 and compared with an age-matched control group of healthy subjects, giving a false impression of elevated RVP in the ASD 1 group. Although the mean EI is significantly higher in the ASD 1 group with high RVP than in the group with low RVP, there is a poor correlation between EI and RVP, which limits the reliability of this index.
authors.affiliation: Division of Pediatric Cardiology, Mount Sinai Medical Center, New York, NY 10029, USA.
authors.forename: James C
authors.initials: JC
authors.lastname: Nielsen
authors.forename: Steven A
authors.initials: SA
authors.lastname: Kamenir
authors.forename: Hyun-Sook H
authors.initials: HS
authors.lastname: Ko
authors.forename: Wyman W
authors.initials: WW
authors.lastname: Lai
authors.forename: Ira A
authors.initials: IA
authors.lastname: Parness
mesh_terms: D000367:Age Factors; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004452:Echocardiography; D006344:Heart Septal Defects, Atrial / Q000503:physiopathology*; D006352:Heart Ventricles / Q000503:physiopathology*; D006439:Hemodynamics; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000503:physiopathology; D015588:Observer Variation; D012189:Retrospective Studies; D013599:Systole