Anatomy vs. shunt fraction: haemodynamic consequences in atrial septal defects and partial anomalous pulmonary venous connection—a comprehensive CMR study

Jacquemyn, X; Van De Bruaene, A; Budts, W; Dresselaers, T; Bogaert, J

doi:10.1093/ehjci/jeaf001

Congenital heart disease

Anatomy vs. shunt fraction: haemodynamic consequences in atrial septal defects and partial anomalous pulmonary venous connection—a comprehensive cardiovascular magnetic resonance (CMR) study

Eur Heart J Cardiovasc ImagingPublished 6 Jan 2025single-centre retrospective study

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Authors' conclusion

Despite phenotypic differences, no specific anatomical influences were found, suggesting that outcomes in isolated ASD, isolated PAPVC, and ASD-associated PAPVC are mainly driven by the degree of shunting.

Study context

Population: Patients with isolated atrial septal defect (ASD), isolated partial abnormal pulmonary venous connection (PAPVC), or ASD-associated PAPVC from a CMR registry (2002–24), compared with control subjects with normal CMR findingspatients included, plus 40 control subjects · isolated ASD 64 · isolated PAPVC 18 · ASD-associated PAPVC 28
Participants: 110 patients

Exposure: Patients were compared with a 40 control subjects with normal CMR findings
Controlsn = 40
Isolated ASDn = 64
Isolated PAPVCn = 18
ASD-associated PAPVCn = 28
Outcome: Left ventricular EDVs indexed to BSA

Main finding

As reported in the abstract

Controls80range 75–90 · mL/m²

Isolated ASD71range 57–79 · mL/m²

Isolated PAPVC71range 63–80 · mL/m²

ASD-associated PAPVC64range 57–72 · mL/m²

P across groups: P < 0.001

Observational data: associations, not effects.

Further findings

Right ventricular EDVs/BSA

Controls82 mL/m²range 74–88

Isolated ASD110 mL/m²range 101–127

Isolated PAPVC150 mL/m²range 120–165

ASD-associated PAPVC154 mL/m²range 128–181

Outcome	Controls	Isolated ASD	Isolated PAPVC	ASD-associated PAPVC
Qp/Qs ratio	0.99 (range 0.95–1.01)	1.49 (range 1.34–1.67)	1.96 (range 1.55–2.40)	2.15 (range 1.81–2.64)

Right ventricular end-diastolic volumes (EDVs)/body surface area (BSA) — P across groups: P < 0.001
Qp/Qs ratio — P across groups: P < 0.001

Modulating factors for cardiac chambers or great vessels geometry, ventricular function, or flow patterns between patient groups

No significant modulating factors were found

Original publication

Anatomy vs. shunt fraction: haemodynamic consequences in atrial septal defects and partial anomalous pulmonary venous connection—a comprehensive CMR study. Eur Heart J Cardiovasc Imaging. Published 6 January 2025. doi:10.1093/ehjci/jeaf001

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