measurement of systemic cardiac output at rest and exercise in patients with atrial septal defect

Introduction: Low cardiac output syndrome is one of the postoperative complications that are associated with significant morbidity and mortality after surgical closure of atrial septal defect (ASD) with small-sized left ventricle (LV). This study investigated whether preoperative left ventricular end-diastolic volume index (LVEDVi) could accurately predict low cardiac output syndrome (LCOS) after surgical closure of ASD with small-sized LV.Method: This retrospective cohort study involved adult ASD patients with small-sized LV from January 2018 to December 2019 in National Cardiovascular Center Harapan Kita. Preoperative MRI data to assess the left and right ventricle volume were collected. A bivariate analysis using independent Student's t-test was done. Diagnostic test using receiver operating characteristic (ROC) curve was also done to obtain the area under the curve (AUC) value. The best cutoff point was determined by Youden's index.Result: Fifty-seven subjects were involved in this study [age (mean ± SD) 32.56 ± 13.15 years; weight (mean ± SD) 48.82 ± 12.15 kg]. Subjects who had post-operative LCOS (n = 30) have significantly lower LVEDVi (45.0 ± 7.42 ml/m2 vs. 64.15 ± 13.37 ml/m2; p < 0.001), LVEDV (64.6 ± 16.0 ml vs. 85.9 ± 20.7 ml; p < 0.001), LVSV (38.97 ± 11.5 ml vs. 53.13 ± 7.5 ml; p < 0.001), and LVSVi (27.28 ± 8.55 ml/m2 vs. 37.42 ± 5.35 ml/m2; p < 0.001) compared to subjects who did not have post-operative LCOS (n = 27). ROC analysis showed that the best AUC was found on LVEDVi (AUC 95.3%; 95% confidence interval: 90.6–100%). The best cutoff value for LVEDVi to predict the occurrence of LCOS after surgical closure of ASD was 53.3 ml/m2 with a sensitivity of 86.7% and a specificity of 85.2%.Conclusion: This study showed that preoperative LVEDVi could predict LCOS after surgical closure of ASD with small-sized LV with a well-defined cutoff. The best cutoff value of LVEDVi to predict the occurrence of LCOS after surgical ASD closure was 53.5 ml/m2.

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ROLE OF DOPPLER ECHOCARDIOGRAPHY FOR ASSESSING RIGHT VENTRICULAR CARDIAC OUTPUT IN PATIENTS WITH ATRIAL SEPTAL DEFECT

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(19)31202-1 ◽

2019 ◽

Vol 73 (9) ◽

pp. 594

Author(s):

Vidhushei Yogeswaran ◽

Rahul Kanade ◽

Camilo Mejia ◽

Alexander Egbe

Keyword(s):

Cardiac Output ◽

Right Ventricular ◽

Atrial Septal Defect ◽

Doppler Echocardiography ◽

Septal Defect

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Noninvasive Cardiac Output Measurement at Rest and During Exercise in Pediatric Patients After Interventional or Surgical Atrial Septal Defect Closure

Pediatric Cardiology ◽

10.1007/s00246-012-0239-2 ◽

2012 ◽

Vol 33 (7) ◽

pp. 1109-1114 ◽

Cited By ~ 3

Author(s):

Gesa Wiegand ◽

Wolfhard Binder ◽

Heidi Ulmer ◽

Renate Kaulitz ◽

Joachim Riethmueller ◽

...

Keyword(s):

Cardiac Output ◽

Atrial Septal Defect ◽

Pediatric Patients ◽

Septal Defect ◽

Cardiac Output Measurement ◽

Defect Closure ◽

Atrial Septal Defect Closure ◽

Output Measurement ◽

Noninvasive Cardiac Output

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Left ventricular unloading during extracorporeal membrane oxygenation – Impella versus atrial septal defect: A simulation study

The International Journal of Artificial Organs ◽

10.1177/0391398820906840 ◽

2020 ◽

Vol 43 (10) ◽

pp. 663-670

Author(s):

Arianna Di Molfetta ◽

Iki Adachi ◽

Gianfranco Ferrari ◽

Maria Giulia Gagliardi ◽

Gianluigi Perri ◽

...

Keyword(s):

Cardiac Output ◽

Arterial Pressure ◽

Extracorporeal Membrane Oxygenation ◽

Atrial Septal Defect ◽

Septal Defect ◽

Left Ventricular ◽

Systolic Volume ◽

Membrane Oxygenation ◽

Venoarterial Extracorporeal Membrane Oxygenation ◽

End Systolic Volume

Background: Atrial septal defect and Impella have been proposed for left ventricular unloading in venoarterial extracorporeal membrane oxygenation patients. This work aims at evaluating the haemodynamic changes in venoarterial extracorporeal membrane oxygenation patients after Impella implantation or atrial septal defect realization by a simulation study. Methods: A lumped parameter model of the cardiovascular system was adapted to this study. Atrial septal defect was modelled as a resistance between the two atria. Venoarterial extracorporeal membrane oxygenation and Impella were modelled starting from their pressure-flow characteristics. The baseline condition of a patient undergoing venoarterial extracorporeal membrane oxygenation was reproduced starting from haemodynamic and echocardiographic data. The effects of different atrial septal defect size, Impella and venoarterial extracorporeal membrane oxygenation support were simulated. Results: Impella caused an increment of mean arterial pressure up to 67%, a decrement in mean pulmonary arterial pressure up to 8%, a decrement in left ventricular end systolic volume up to 11% with a reduction up to 97% of left ventricular cardiac output. Atrial septal defect reduces left atrial pressure (19%), increases right atrial pressure (22%), increases mean arterial pressure (18%), decreases left ventricular end systolic volume (11%), increases right ventricular volume (33%) and decreases left ventricular cardiac output (55%). Conclusion: Impella has a higher capability in left ventricular unloading during venoarterial extracorporeal membrane oxygenation in comparison to atrial septal defect with a lower right ventricular overload.

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