The intervention timing in atrial septal defect (ASD) or pulmonary valvular stenosis (PVS) is more
dependent on symptoms than right ventricular (RV) damage in clinical practice. RV long-axis function is sensitive
in revealing RV myocardial dysfunction. We evaluate the impact of different chronic loading conditions on RV
long-axis function and its relationship to patients' symptoms in ASD or PVS.
Transthoracic echocardiography was performed in normals (n=39) and patients with isolated secundumASD(
n=45) or PVS (n=38). RVvolume- and pressure-overloadingwere de
finedas the ratioofRV/leftventricular
≥0.5 and RV systolic pressure ≥40mmHg, respectively. RV long-axis
dysfunction was de
fined as M-mode tricuspid annular plane systolic excursion (TAPSE) b1.6 cm. New York
Heart Association (NYHA) functional class and other symptoms (decreased exercise tolerance, palpitation and
chest pain) were recorded.
Thirty-nine (32.0%) had normal loading (Group 1; 39 normals); 24 (19.6%) had isolated volumeoverloading
(Group 2; all ASDs); 21 (17.2%) had isolated pressure-overloading (Group 3; 21 PVSs) and 38
(31.1%) had both overloading conditions (Group 4; 21 ASDs and 17 PVSs). RV long-axis dysfunction in abnormal
loading groups were zero (0%, Group 2), 21 (100%, Group 3) and 22 (57.8%, Group 4) (
Group 3 were more symptomatic (NYHA functional class 2.5±0.6 versus 1.6±0.5, p
b0.05) and had lower
TAPSE (1.6±0.4 versus 3.0±0.7 cm, p
b0.05) than Group 2. RV long-axis dysfunction was the strongest predictor
of the presence of symptoms (odds ratio=9.298, p
Chronic volume-overloading accentuates while pressure-overloading attenuates RV long-axis excursion
and its impairment was associated with the presence of symptoms.