Echocardiographic analysis of ventricular geometry and function during repair of congenital septal defects Joseph P Hart, MD, Santos E Cabreriza, BA,

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Echocardiographic analysis of ventricular geometry and function during repair of congenital septal defects Joseph P Hart, MD, Santos E Cabreriza, BA, Rowan F Walsh, MD, Beth F Printz, MD, PhD, Brianne F Blumenthal, BA, David K Park, BS, April J Zhu, BS, Cecily G Gallup, BA, Alan D Weinberg, MS, Daphne T Hsu, MD, Ralph S Mosca, MD, Jan M Quaegebeur, MD, Henry M Spotnitz, MD The Annals of Thoracic Surgery Volume 77, Issue 1, Pages 53-60 (January 2004) DOI: 10.1016/S0003-4975(03)01328-6

Fig 1 Representative end-diastolic transesophageal echocardiography image illustrates vectors utilized to measure D1 (perpendicular to the interventricular septum) and D2 (parallel to the septum). The Annals of Thoracic Surgery 2004 77, 53-60DOI: (10.1016/S0003-4975(03)01328-6)

Fig 2 Representative TEE short-axis LV images immediately before and after CPB for ASD closure. Prerepair images are on the left and postrepair images are on the right. Upper panels contain end-diastolic images and lower panels contain end-systolic images. The RV is oriented to the left in each image. Septal flattening results in an elliptical LV prerepair. This resolves after ASD closure. Planimetry demonstrates increased postoperative EFa in this patient. (ASD = atrial septal defect; CPB = cardiopulmonary bypass; EFa = area ejection fraction; LV = left ventricular; TEE = transesophageal echocardiography.) The Annals of Thoracic Surgery 2004 77, 53-60DOI: (10.1016/S0003-4975(03)01328-6)

Fig 3 Representative epicardial short-axis LV images immediately before and after CPB for VSD closure. Prerepair images are on the left and postrepair images are on the right. Upper panels contain end-diastolic images and lower panels contain end-systolic images. The septum appears hypertrophied. After VSD closure, there is a decrease in both LV geometry and EDA. Planimetry demonstrates decreased postoperative EFa in this patient. (CPB = cardiopulmonary bypass; EDA = end-diastolic area; EFa = area ejection fraction; LV = left ventricular; VSD = ventricular septal defect.) The Annals of Thoracic Surgery 2004 77, 53-60DOI: (10.1016/S0003-4975(03)01328-6)

Fig 4 Time course of LV geometry before and after ASD closure. Panel 1 was obtained by transthoracic echocardiography 1 week preoperatively. Panels 2 and 3 were obtained by intraoperative TEE immediately before and after cardiopulmonary bypass (CPB) for ASD closure. Panel 4 was obtained by transthoracic echocardiography 5 months postoperatively. Septal distortion seen in the first two panels is improved immediately and late after surgery. (ASD = atrial septal defect; CPB = cardiopulmonary bypass; EFa = area ejection fraction; LV = left ventricular; TEE = transesophageal echocardiography.) The Annals of Thoracic Surgery 2004 77, 53-60DOI: (10.1016/S0003-4975(03)01328-6)

Fig 5 Perioperative EDA changes. Brackets indicate standard errors. The CHD groups are defined on the x-axis. Prerepair data are represented by black bars; postrepair data are represented by white bars. *p less than 0.05 versus prerepair within the same group. EDA increased significantly in the ASD group and fell in the VSD group. (ASD = atrial septal defect; CHD = congenital heart disease; EDA = end-diastolic area; VSD = ventricular septal defect.) The Annals of Thoracic Surgery 2004 77, 53-60DOI: (10.1016/S0003-4975(03)01328-6)

Fig 6 Similar to Figure 5, indicating effects of surgery on intraoperative area ejection fraction. EFa increased significantly after CPB in the ASD group and decreased in the VSD group. (ASD = atrial septal defect; CPB = cardiopulmonary bypass; EFa = area ejection fraction; VSD = ventricular septal defect.) The Annals of Thoracic Surgery 2004 77, 53-60DOI: (10.1016/S0003-4975(03)01328-6)

Fig 7 Change in EDA, as a percent of preoperative EDA along the x-axis is related to change in EFa, as a percent of preoperative EFa on the y-axis. A linear relationship exists for the combined data from 18 patients (r2 = 0.80, p < 0.0001). Group means are represented by large open symbols, with brackets indicating group standard errors. There is a significant linear correlation between changes in ejection fraction and EDA. (EDA = end-diastolic area; EFa = area ejection fraction.) The Annals of Thoracic Surgery 2004 77, 53-60DOI: (10.1016/S0003-4975(03)01328-6)