Right Atrial Mechanics Long-Term after Biventricular Repair of Pulmonary Atresia or Stenosis with Intact Ventricular Septum

• Published in: Echocardiography (Mount Kisco, N.Y.) Vol. 33; no. 4; pp. 586 - 595
• Main Authors: To, Ashley Hoi-man, Lai, Clare Tik-man, Wong, Sophia J., Cheung, Yiu-fai
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01.04.2016
• Subjects: Adolescent; Adult; atrial function; Atrial Function, Right; Echocardiography - methods; Female; Heart Atria - diagnostic imaging; Heart Defects, Congenital - complications; Heart Defects, Congenital - diagnostic imaging; Heart Defects, Congenital - surgery; Humans; Longitudinal Studies; Male; P-wave indices; Pulmonary Atresia - complications; Pulmonary Atresia - diagnostic imaging; Pulmonary Atresia - surgery; pulmonary atresia with intact ventricular septum; pulmonary stenosis; Treatment Outcome; Ventricular Dysfunction, Right - diagnostic imaging; Ventricular Dysfunction, Right - etiology; Ventricular Dysfunction, Right - surgery; Young Adult; atrial function; P-wave indices; pulmonary stenosis; pulmonary atresia with intact ventricular septum
• ISSN: 0742-2822; 1540-8175; 1540-8175
• DOI: 10.1111/echo.13121

Background This study tested the hypothesis that right atrial (RA) mechanics are altered in patients after repair of pulmonary atresia with intact ventricular septum (PAIVS) and pulmonary stenosis (PS) and to explore their relationships with right ventricular (RV) diastolic function and P‐wave indices. Methods Thirty‐six adult patients, 16 with PAIVS and 20 with PS patients, and 20 age‐matched healthy subjects were studied. Right atrial mechanics were assessed using speckle tracking echocardiography (STE) with quantification of positive, negative, and total strain, and strain rates at ventricular systole (aSRs), early diastole (aSRed), and atrial contraction (aSRac). Right ventricular diastolic function was assessed by Doppler interrogation and STE. Maximum P‐wave duration and P‐wave dispersion were measured. Results Compared with controls, PAIVS and PS patients had significantly lower RA positive and total strain, aSRs and aSRed (all P < 0.05). Parameters of RV diastolic function including transtricuspid early (E) and late (A) diastolic inflow velocities, E/A ratio, early diastolic tricuspid annular velocity (e), early to late diastolic annular velocity ratio, E/e ratio, and RV early diastolic strain rate were found to correlate significantly with RA positive and total strain and aSRed (all P < 0.05). Maximum P‐wave duration and P‐wave dispersion increased progressively across control, PS, and PAIVS groups (P for trend <0.001). Both P‐wave indices correlated negatively with RA positive strain, total strain, and aSRed (all P < 0.05). Conclusion Impairment of RA mechanics occurs in patients long term after repair of PAIVS and PS and is associated with RV diastolic dysfunction, longer P‐wave duration, and greater P‐wave dispersion.