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Left ventricular rotation and right–left ventricular interaction in congenital heart disease: the acute effects of interventional closure of patent arterial ducts and atrial septal defects*

  • Kai T. Laser (a1), Nikolaus A. Haas (a1), Markus Fischer (a1), Sheeraz Habash (a1), Franziska Degener (a1), Christian Prinz (a1), Hermann Körperich (a2), Eugen Sandica (a1) and Deniz Kececioglu (a1)...



Left ventricular rotation is physiologically affected by acute changes in preload. We investigated the acute effect of preload changes in chronically underloaded and overloaded left ventricles in children with shunt lesions.


A total of 15 patients with atrial septal defects (Group A: 7.4 ± 4.7 years, 11 females) and 14 patients with patent arterial ducts (Group B: 2.7 ± 3.1 years, 10 females) were investigated using 2D speckle-tracking echocardiography before and after interventional catheterisation. The rotational parameters of the patient group were compared with those of 29 matched healthy children (Group C).


Maximal torsion (A: 2.45 ± 0.9°/cm versus C: 1.8 ± 0.8°/cm, p < 0.05), apical peak systolic rotation (A: 12.6 ± 5.7° versus C: 8.7 ± 3.5°, p < 0.05), and the peak diastolic torsion rate (A: −147 ± 48°/second versus C: −110 ± 31°/second, p < 0.05) were elevated in Group A and dropped immediately to normal values after intervention (maximal torsion 1.5 ± 1.1°/cm, p < 0.05, apical peak systolic rotation 7.2 ± 4.1°, p < 0.05, and peak diastolic torsion rate −106 ± 35°/second, p < 0.05). Patients in Group B had decreased maximal torsion (B: 1.8 ± 1.1°/cm versus C: 3.8 ± 1.4°/cm, p < 0.05) and apical peak systolic rotation (B: 8.3 ± 6.1° versus C: 13.9 ± 4.3°, p < 0.05). Defect closure was followed by an increase in maximal torsion (B: 2.7 ± 1.4°/cm, p < 0.05) and the peak diastolic torsion rate (B: −133 ± 66°/second versus −176 ± 84°/second, p < 0.05).


Patients with chronically underloaded left ventricles compensate with an enhanced apical peak systolic rotation, maximal torsion, and quicker diastolic untwisting to facilitate diastolic filling. In patients with left ventricular dilatation by volume overload, the peak systolic apical rotation and the maximal torsion are decreased. After normalisation of the preload, they immediately return to normal and diastolic untwisting rebounds. These mechanisms are important for understanding the remodelling processes.


Corresponding author

Correspondence to: K. T. Laser, MD, Center for Congenital Heart Defects, Heart and Diabetes Center, Northrhine-Westfalia, Ruhr-University of Bochum, Georgstr 11, D-32545 Bad Oeynhausen, Germany. Tel: +49 (0)5731 97 3637; Fax: +49 (0)5731 97 2131; E-mail:


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This paper was presented at Poster 45th Annual Meeting of the Association for European Paediatric Cardiology, May 18–21, 2011 Granada, Spain; and Oral presentation 47th Annual meeting of the Japanese Society of Pediatric Cardiology and Cardiac Surgery, 2011 Fukuoka, Japan



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