title: Effect of patient age at surgical intervention on long-term right ventricular performance in atrial septal defect.
abstract: Controversy exists about the influence of patient age on the benefit of surgery in atrial septal defect (ASD). Tissue Doppler echocardiography (TDE) when applied to atrioventricular annuli provides variables reliably reflecting the performance of the corresponding ventricle. We sought to investigate the effect of timing of surgery on biventricular functions by comparing the conventional echocardiography variables and TDE profiles of right and left atrioventricular annuli in patients treated at various ages. Conventional echocardiography and TDE analysis of mitral and tricuspid annuli were performed in 20 controls and 61 patients who underwent surgical ASD closure 2.8 +/- 2.5 years before the study. Standard parameters included were right and left-sided dimensions, estimated pulmonary artery pressure, ejection fraction, and tricuspid annular motion amplitude. TDE variables were systolic, early and late diastolic peak velocities at tricuspid lateral-and mitral-annulus at lateral and septal corners. Two subsets of patients who underwent surgery before (group 1, n = 20) and after 25 years (group 2, n = 41) formed our subgroups. Peak systolic TDE velocity and tricuspid annular motion amplitude had the lowest value in group 2 (P < 0.01 and <0.02, respectively). Late diastolic TDE velocity was significantly lower in group 2 compared to group 1 (P < 0.05). Increased right ventricular and atrial dimensions (P < 0.001 for both) and the estimated pulmonary artery pressure (P < 0.03) were the conventional measurements discriminating group 2 from group 1. The TDE profile of the mitral annulus was similar between the groups. These results suggest that delayed ASD closure is a relatively less effective procedure to restore secondary right ventricular dysfunction, as demonstrated by significantly different TDE measurements reflecting right ventricular longitudinal contraction and relaxation.
authors.affiliation: Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul, Turkey.
authors.forename: Seden
authors.initials: S
authors.lastname: Celik
authors.forename: Batuhan
authors.initials: B
authors.lastname: Ozay
authors.forename: BahadIr
authors.initials: B
authors.lastname: Dagdeviren
authors.forename: Sevket
authors.initials: S
authors.lastname: Gorgulu
authors.forename: Aydin
authors.initials: A
authors.lastname: Yildirim
authors.forename: Nevzat
authors.initials: N
authors.lastname: Uslu
authors.forename: Bülent
authors.initials: B
authors.lastname: Ketenci
authors.forename: Mehmet
authors.initials: M
authors.lastname: Eren
authors.forename: Haldun
authors.initials: H
authors.lastname: Akgoz
authors.forename: Murat
authors.initials: M
authors.lastname: Demirtas
authors.forename: Tuna
authors.initials: T
authors.lastname: Tezel
mesh_terms: D000328:Adult; D000367:Age Factors; D001783:Blood Flow Velocity; D018619:Echocardiography, Doppler, Pulsed; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D011184:Postoperative Period; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging; D016278:Ventricular Function, Right