Objectives: To determine the effects of atrial septal defects (ASD) and their closure on systolic and diastolic right and left ventricular function; and by comparing surgical closure with transcatheter device closure, to establish differences attributable to cardiopulmonary bypass. Design: Cross sectionally guided M mode echocardiographic ventricular long axis function was measured prospectively before and within one week after ASD closure by device in 17 patients and by surgery in 12 patients, and compared with 18 normal subjects. Results: All indices of right ventricular function were impaired after surgery: mean total excursion, −1.89 cm (95% confidence interval (CI), −2.18 to −1.59); peak shortening rate, −9.09 cm/s (−10.82 to −7.35); peak lengthening rate, −9.26 cm/s (−11.09 to −7.43). Total excursion and peak lengthening rate were preserved after device closure, at −0.12 cm (−0.28 to 0.05) and 0.01 cm/s (−2.29 to 2.31), respectively. Left ventricular free wall function was unchanged after closure by either method, while all septal measurements were reduced after closure by either method (changes ranging from −3.51 to −0.32; 95% CI ranging from −4.90 to −0.13). Conclusions: Left ventricular free wall function is unaffected by ASD closure, whereas septal function is impaired, irrespective of the method of closure. Right ventricular function, both systolic and diastolic, is impaired by cardiopulmonary bypass but preserved after device closure. These findings support the transcatheter approach to ASD closure in anatomically suitable defects.

Objective-To identify the eVects of altered ventricular activation during dobutamine stress on left ventricular function in normal subjects and in patients with coronary artery disease, and to distinguish these from an inotropic response. Design-Prospective analysis of 12 lead ECG and echocardiogram at rest and at peak stress. Setting-Tertiary referral centre for cardiac disease equipped with non-invasive facilities for pharmacological stress testing. Methods-22 patients with coronary artery disease were compared with 17 age matched controls. Left ventricular ejection and filling patterns were assessed using Doppler echocardiography. Activation eVects were correlated with relative left ventricular ejection and filling times, and the Z ratio ([left ventricular ejection + filling times]/RR interval). Inotropic response was measured from peak aortic acceleration. Results-In controls, QRS shortened (by 4 ms, p < 0.001), and total ejection and filling periods lengthened (by 2 s/min, p < 0.01 and 5 s/min, p < 0.001, respectively). The Z ratio thus increased and correlated with QRS shortening (r 2 = 0.69). Peak aortic acceleration (PAA) increased by 135%, p < 0.001. In patients, QRS lengthened at peak stress (by 9 ms, p < 0.001). Total ejection and filling times did not change, but Z ratio fell, correlating with QRS prolongation (r 2 = 0.65). Nevertheless, PAA increased by 63%, p < 0.001. Conclusions-Relative ejection and filling times reflect ventricular activation at rest and during stress independent of changes in inotropic state. By contrast, peak aortic acceleration reflects the positive inotropic eVect of dobutamine on the myocardium, regardless of changes in activation. (Heart 2001;85:411-416)

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