Interatrial-pressure relationships after closure of atrial septal defects in man.

RECENTLY Watkins and Gross' described a clinical syndrome that followed surgical closure of atrial septal defects in some of their patients. This syndrome consisted of the retention of fluid and a gain in weight during the early postoperative period. At times there followed tenderness in the right upper quadrant of the abdomen, hepatomegaly, and roentgenographic evidence of pulmonary congestion and enlargement of the left atrium. They attributed this syndrome to transient left ventricular failure resulting from the increased work load imposed on the left ventricle by the correction of the left-to-right shunt through the atrial septal defect. Hickler and Goodale2 described a fall in the right ventricular and a rise in the left atrial or pulmonary artery wedge pressure accompanied by an increase in the left ventricular stroke work after closure of atrial septal defects; these studies suggest the hemodynamic potentials for the subsequent development of left ventricular failure. Left ventricular failure following closure of an atrial septal defect has been recognized clinically in only 1 of the series of 85 patients operated on by the atrial-well technic at the Mayo Clinic. This series was therefore reviewed in order to determine whether certain physiologic data, obtained during operation, might clarify the hemodynamic response of the heart to closure of the atrial septal defect. From the total group were selected all cases in which sufficient hemodynamic data had been obtained for evaluation of left and right atrial pressure changes effected by closure of the atrial septal