Pre and postoperative ventricular function in infants and children with right ventricular volume overload

Hemodynamic and ventricular volume parameters were evaluated in 21 patients (24 studies) with total anomalous pulmonary venous return (TAPVR), 11 patients with secundum atrial septal defect (ASD), and eight patients who had complete correction of TAPVR or ASD. Right and left ventricular (RV and LV) volume parameters were calculated according to Simpson's rule and the area length methods, respectively. In infants with TAPVR, RV end-diastolic volume was larger than normal, but RV ejection fraction was significantly less than normal. LV end-diastolic volume and LV ejection fraction were all less than normal in infants with or without pulmonary hypertension, and the values did not correlate with the cardiorespiratory symptoms. In children with TAPVR or ASD, RV end-diastolic volume and output were higher than normal preoperatively and decreased to normal or near normal values postoperatively. The data suggest that pulmonary venous obstruction and/or RV failure are responsible for cardiorespiratory symptoms in infants with TAPVR and early surgical intervention is recommended in these patients.