Reappraisal of Left Ventricular to Right Atrial (LV-RA) Shunt in Pediatric Patients With Isolated Perimembranous Ventricular Septal Defect

Weng, Ken‐Pen; Huang, Shih-Chang; Lin, Chu-Chuan; Huang, Shiang‐Fen; Kuan, Yu‐Hsiang; Ger, Luo‐Ping; Hsieh, Kai‐Sheng

doi:10.1253/circj.cj-08-0113

Cited by 5 publications

(1 citation statement)

References 22 publications

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“…Using TEE, the most significant findings are RA and RV dilatation, the presence of a small defect in the atrioventricular portion of the interventricular septum in the parasternal four-chamber view, and high velocity flow toward the RA in the parasternal four-chamber view and parasternal short-axis view on Doppler imaging. This has been termed the "bank-shot sign" (Weng et al, 2008), referring to the fact that the curved flow pattern at the LV site of the aneurysm had the appearance of a bank-shot in basketball (Figure 1). As LV systolic pressure is much higher than RA pressure, shunting across LV-RA occurs mainly in systole and maybe trivial, while LV pressure is only slightly higher in diastole (Vallakati et al, 2012).…”

Section: Characteristic Of Echocardiography In Lvras Groupmentioning

confidence: 99%

Higher Incidence of Atrial Fibrillation in Left Ventricular-to-Right Atrial Shunt Patients

et al. 2020

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Background: The possible association between atrial fibrillation (AF) and left ventricular-to-right atrial shunt (LVRAS) has never been reported yet. The present study investigated the incidence of AF in LVRAS.Methods: This was a retrospective study of consecutive patients undergoing echocardiography at a single tertiary center. Clinical data, laboratory results and echocardiography parameters such as right atrial area (RAA), right ventricular end diastolic diameter (RVDD) and left atrial diameter (LAD) were compared between LVRAS group and non-LVRAS patients, and between AF and non-AF patients. Propensity score matching was performed to decrease the effect of confounders. Logistic regression analysis and mediation analysis were used to estimate the relationship between LVRAS and AF.Results: A total of 3,436 patients were included, and the incidence of LVRAS was 1.16% (n = 40). The LVRAS group had significantly larger RAA, RVDD and LAD compared with non-LVRAS group. Those who suffered from AF showed larger RAA, RVDD and LAD compared with those who maintained sinus rhythm. Multivariable logistic regression showed that gender (OR: 0.608), age (OR: 1.048), LAD (OR: 1.111), mean pulmonary artery blood pressure (mPAP, OR: 1.023), TR (OR: 2.309) and LVRAS (OR: 12.217) were significant factors for AF. RAA could partially mediate the relationship between LVRAS and AF according to the result of mediation analysis.Conclusions: Our study suggested that LVRAS, TR, LAD, mPAP, age and male were risk factors for AF. RA enlargement might underlie mechanism in the higher incidence of AF in LVRAS patients. These findings should be confirmed in larger prospective studies.

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Section: Characteristic Of Echocardiography In Lvras Groupmentioning

confidence: 99%

Higher Incidence of Atrial Fibrillation in Left Ventricular-to-Right Atrial Shunt Patients

et al. 2020

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Ventricular Septal Defect

Mavroudis

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Anderson

2023

Pediatric Cardiac Surgery

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Evaluation of Ventricular Septal Defect with Special Reference to the Spontaneous Closure Rate, Subaortic Ridge, and Aortic Valve Prolapse II

et al. 2017

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The medical records of 2283 patients with ventricular septal defect (VSD) were reviewed to determine spontaneous closure, left ventricular-to-right atrial shunt, subaortic ridge, and aortic valve prolapse. One thousand eight hundred and twenty-three patients had been followed 1 month to 26 years (median 4 years) by echocardiography. Most of 460 patients could not be followed due to transportation of the institution. VSD was perimembranous in 68.8% (1255), trabecular muscular in 21.7% (395), muscular outlet in 6% (109), muscular inlet in 2.6% (48), and doubly committed subarterial in 0.9% (16). Defect size was classified in 66.8% (1218) as small, in 15.7% (286) as moderate, and in 17.5% (319) as large. VSD closed spontaneously in 18.8% (343 of 1823 patients) by ages 40 days to 24.9 years (median, 1.8 years). One hundred fifty-seven of 1255 perimembranous defects (12.5%) and 167 of 395 trabecular muscular defects (42%) closed spontaneously (p < 0.001). Defect size became small in 306 (16.8%) of patients with VSD at a median of 2.5 years. Aneurysmal transformation was detected in 32.9% (600), left ventricular-to-right atrial shunt in 9.7% (176), subaortic ridge in 2.6% (48) of 1823 patients who were followed. In 381 (20.9%) of the 1823 patients, the VSD had been closed by a surgical or transcatheter technique. Surgery is required in one-fifth of patients with subaortic ridge or aortic valve prolapse. In conclusion, isolated VSDs are usually benign abnormalities that tend to shrink and close spontaneously.

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Reappraisal of Left Ventricular to Right Atrial (LV-RA) Shunt in Pediatric Patients With Isolated Perimembranous Ventricular Septal Defect

Cited by 5 publications

References 22 publications

Higher Incidence of Atrial Fibrillation in Left Ventricular-to-Right Atrial Shunt Patients

Higher Incidence of Atrial Fibrillation in Left Ventricular-to-Right Atrial Shunt Patients

Ventricular Septal Defect

Evaluation of Ventricular Septal Defect with Special Reference to the Spontaneous Closure Rate, Subaortic Ridge, and Aortic Valve Prolapse II

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