Right atrial function with speckle tracking echocardiography: Do we really need it?

Atrial septal defect (ASD) is one of the most common congenital cardiac anomalies presenting in adulthood. ASD is characterized by a defect in the interatrial septum that allows pulmonary venous return from the left atrium to pass directly to the right atrium. The magnitude of the left-toright shunt across the ASD depends on the defect size, the relative compliance of the ventricles, and the relative resistance of both the pulmonary and the systemic circulation. The three major types of atrial septal defect (ostium secundum, ostium primum and sinus venosus) account for 10% of all congenital heart defects and as much as 20-40% of congenital heart disease presenting in adulthood. In general, elective closure is recommended for all ASDs with evidence of right ventricular (RV) overload or with a clinically significant shunt (pulmonary flow [Qp] to systemic flow [Qs] ratio >1.5). Lack of symptoms is not a contraindication for repair. At any age, ASD closure is followed by symptomatic improvement and regression of RV size. Ostium secundum ASD may be closed with a variety of catheter-implanted occlusion devices rather than by direct surgical closure with cardiopulmonary bypass. Compared