Evaluation of the importance of increase in tricuspid and pulmonary flow velocities in diagnosis of atrial septal defect

Aim: The objective of this study is to investigate the importance of the increase in tricuspid and pulmonary flow velocity, in supporting the diagnosis of atrial septal defect (ASD). For this reason, echocardiography and angiography reports in the files of the patients underwent transcatheter closure of ASD in Pediatric Cardiology Department of Gaziantep University Medical Faculty Hospital between the years of 2008 and 2014, were retrospectively reviewed. Materials and Methods: 145 ASD and 145 healthy children as control group were included in the study. In ASD group, the echocardiographic findings of tricuspid flow velocity (TFV), the ratio of tricuspid flow velocity to mitral flow velocity (TFV/MFV), pulmonary flow velocity (PFV) and the ratio of pulmonary flow velocity to aortic flow velocity (PFV/AFV) before and after the closure were compared to that healthy controls. Patients were divided into 3 groups according to the ASD size as small, medium and large. By analyzing the correlation of valve flow velocities to ASD diameter, to ASD diameter/m2 and to the pulmonary-to-systemic flow ratio (Qp/Qs), specificity and sensitivity for the diagnosis of ASD was assessed. Findings: ASD and the healthy control groups were 60.3% girls (n = 88), 39.7% males (n = 57), respectively. Flow velocity values were found to be statistically significantly different in the group of patients before the transcatheter closure to that of the group of patients after the transcatheter closure and the healthy control group (p=0,001). There was an increase in flow velocity parallel to increase in ASD diameter. When we investigated the relavance between TFV and TFV/MFV values before and after the closure to ASD diameter, ASD diameter/m2, and Qp/Qs, there were significant differences in all parameters, which was most prominent in ASD diameter/m2 (p<0,05). There was no significant relavance between the TFV value before the closure to Qp/Qs (p>0,05). When we investigated the relavance between PFV and PFV/AFV values before and after the closure to ASD diameter, ASD diameter/m2, and Qp/Qs, all parameters were found to be statistically different. Increase in TFV has 89.7% sensitivity and 100% specifity in supporting the diagnosis of ASD. All other velocity values were also found to be highly sensitive. Results: Increase in tricuspid and pulmonary flow velocities were significant and reliable parameters for supporting the diagnosis of ASD. Key words: ASD, pulmonary-to-systemic flow rate, tricuspid flow velocity, pulmonary flow velocity.