Improvement of left ventricular systolic function after intervention on right ventricular hemodynamics.

Abstract

Background: The importance of right-left ventricular interactions is increasingly recognized in patients with congenital heart disease. Interventions to improve right ventricular volume/pressure overloading may result in improvement of left ventricular systolic dysfunction. We hypothesized that patients with right ventricular volume or pressure overloading lesions and left ventricular dysfunction would have improvement in left ventricular function following isolated intervention to improve right ventricular hemodynamics.

Methods and results: Patient records were reviewed to identify participants. Patients with left ventricular dysfunction (left ventricular ejection fraction <55% by echocardiogram) who underwent interventions to improve right ventricular volume or pressure overloading conditions were included. Interventions to improve right ventricular volume/pressure overloading conditions included closure of an atrial septal defect (ASD) and pulmonary valve replacement (PVR). Seventeen patients were identified with right ventricular volume or pressure overloading lesions and left ventricular dysfunction who underwent interventions to improve right ventricular hemodynamics. The majority of patients demonstrated improvement in left ventricular function postprocedure. PVR was performed in 12 patients - 11 of whom were for pulmonary insufficiency and one for pulmonary stenosis (four surgical and eight transcatheter). Five patients had closure of an ASD - two of whom were closed with a transcatheter device and three closed surgically. Seven out of nine transcatheter interventions demonstrated improvement in left ventricular function within 24 h.

Conclusion: Patients with left ventricular dysfunction who undergo interventions to alleviate right ventricular volume or pressure overloading lesions can have rapid improvement in left ventricular function.