{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T21:08:50Z","timestamp":1792098530227,"version":"4.4.0"},"reference-count":20,"publisher":"Springer Science and Business Media LLC","issue":"11-12","license":[{"start":{"date-parts":[[2020,4,30]],"date-time":"2020-04-30T00:00:00Z","timestamp":1588204800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,4,30]],"date-time":"2020-04-30T00:00:00Z","timestamp":1588204800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100005788","name":"Medical University of Vienna","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100005788","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Wien Klin Wochenschr"],"published-print":{"date-parts":[[2020,6]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec>\n<jats:title>Background<\/jats:title>\n<jats:p>Unrepaired left to right atrial shunt lesions can cause significant right ventricular (RV) volume overload. The parameter pulmonary to systemic shunt volume ratio (Qp:Qs) has been shown to detect even small differences between left and right ventricular stroke volume; however, four parameters are needed for its calculation. This study was carried out to evaluate the accuracy of the single parameter right ventricular outflow tract (RVOT) velocity time integral (VTI) to identify atrial shunt lesions.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>All patients who underwent transesophageal echocardiography (TEE) examination at this institution between 1 January 2013 and 1 January 2018 were retrospectively analyzed. The RVOT-VTI was measured in the transthoracic echocardiography performed immediately before each TEE. The diagnostic accuracy for detection of atrial shunt lesions was tested.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>A\u00a0total of 2797 patients with a median age of 67\u00a0years (interquartile range, IQR\u00a054\u201377 years) were included in the final analysis. A\u00a0total of 113 (4%) patients had a\u00a0relevant atrial shunt lesion. The mean RVOT-VTI of the shunt group was 25\u202fcm (SD\u202f\u00b1\u20098.1\u202fcm) and was significantly higher than that of the non-shunt group with 17\u202fcm (SD\u202f\u00b1\u20094.8\u202fcm) (<jats:italic>p<\/jats:italic>\u202f&lt;\u20090.001). The area under the curve (AUC) was 0.81. A\u00a0total of 106 patients (93.8%) of the shunt group had a\u00a0VTI of \u226516\u202fcm. If the RVOT-VTI was &lt;16\u202fcm, the negative predictive value was 99.3%. If the RVOT-VTI was \u226525\u202fcm, 22% of patients proved to have a\u00a0significant shunt lesion.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusion<\/jats:title>\n<jats:p>In this large retrospective analysis it could be shown that a\u00a0low RVOT-VTI predicted the absence of significant atrial shunt lesions, while a\u00a0high RVOT-VTI predicted the presence. The parameter should be applied in all patients with suspected atrial shunt lesions where calculation of Qp:Qs is impossible.<\/jats:p>\n<\/jats:sec>","DOI":"10.1007\/s00508-020-01659-0","type":"journal-article","created":{"date-parts":[[2020,4,30]],"date-time":"2020-04-30T07:04:03Z","timestamp":1588230243000},"page":"295-300","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Detection of atrial shunt lesions with a\u00a0single echocardiographic parameter"],"prefix":"10.1007","volume":"132","author":[{"given":"Varius","family":"Dannenberg","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georg","family":"Goliasch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Hengstenberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Binder","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harald","family":"Gabriel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Schneider","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,4,30]]},"reference":[{"issue":"5","key":"1659_CR1","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1055\/s-0030-1250491","volume":"59","author":"A Motiwala","year":"2011","unstructured":"Motiwala\u00a0A, Fatimi\u00a0SH, Akhtar\u00a0N, Perveen\u00a0S, Khan\u00a0MZ, Atiq\u00a0M. Patients with congenital atrial septal defects: effect of age at repair and defect size on pulmonary artery pressures prior to repair. Thorac Cardiovasc Surg. 2011;59(5):281\u20136.","journal-title":"Thorac Cardiovasc Surg"},{"key":"1659_CR2","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1016\/j.jpeds.2017.07.037","volume":"190","author":"RL Geggel","year":"2017","unstructured":"Geggel\u00a0RL. Clinical detection of hemodynamically significant isolated secundum atrial septal defect. J\u00a0Pediatr. 2017;190:261\u2013264.e1.","journal-title":"J Pediatr"},{"issue":"6","key":"1659_CR3","doi-asserted-by":"publisher","first-page":"682","DOI":"10.1136\/hrt.2006.098848","volume":"93","author":"PM Engelfriet","year":"2007","unstructured":"Engelfriet\u00a0PM, Duffels\u00a0MG, Moller\u00a0T, Boersma\u00a0E, Tijssen\u00a0JG, Thaulow\u00a0E, et\u00a0al. Pulmonary arterial hypertension in adults born with a\u00a0heart septal defect: the Euro heart survey on adult congenital heart disease. Heart. 2007;93(6):682\u20137.","journal-title":"Heart"},{"key":"1659_CR4","unstructured":"EUROCAT. Special report: congenital heart defects in europe 2000\u20132005. 2009. http:\/\/www.eurocat-network.eu\/content\/Special-Report-CHD.pdf. Accessed 12 May 2019."},{"issue":"1","key":"1659_CR5","doi-asserted-by":"publisher","first-page":"34","DOI":"10.15420\/icr.2018.33.2","volume":"14","author":"JP Giblett","year":"2019","unstructured":"Giblett\u00a0JP, Abdul-Samad\u00a0O, Shapiro\u00a0LM, Rana\u00a0BS, Calvert\u00a0PA. Patent foramen ovale closure in 2019. Interv Cardiol. 2019;14(1):34\u201341.","journal-title":"Interv Cardiol"},{"issue":"2","key":"1659_CR6","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1253\/circj.67.112","volume":"67","author":"H Muta","year":"2003","unstructured":"Muta\u00a0H, Akagi\u00a0T, Egami\u00a0K, Furui\u00a0J, Sugahara\u00a0Y, Ishii\u00a0M, et\u00a0al. Incidence and clinical features of asymptomatic atrial septal defect in school children diagnosed by heart disease screening. Circ\u00a0J. 2003;67(2):112\u20135.","journal-title":"Circ J"},{"issue":"8","key":"1659_CR7","doi-asserted-by":"publisher","first-page":"910","DOI":"10.1016\/j.echo.2015.05.015","volume":"28","author":"FE Silvestry","year":"2015","unstructured":"Silvestry\u00a0FE, Cohen\u00a0MS, Armsby\u00a0LB, Burkule\u00a0NJ, Fleishman\u00a0CE, Hijazi\u00a0ZM, et\u00a0al. Guidelines for the echocardiographic assessment of atrial septal defect and patent foramen ovale: from the American society of echocardiography and society for cardiac angiography and interventions. J\u00a0Am Soc Echocardiogr. 2015;28(8):910\u201358.","journal-title":"J Am Soc Echocardiogr"},{"issue":"2","key":"1659_CR8","doi-asserted-by":"publisher","first-page":"537","DOI":"10.1016\/S0735-1097(10)80128-7","volume":"17","author":"I Kronzon","year":"1991","unstructured":"Kronzon\u00a0I, Tunick\u00a0PA, Freedberg\u00a0RS, Trehan\u00a0N, Rosenzweig\u00a0BP, Schwinger\u00a0ME. Transesophageal echocardiography is superior to transthoracic echocardiography in the diagnosis of sinus venosus atrial septal defect. J\u00a0Am Coll Cardiol. 1991;17(2):537\u201342.","journal-title":"J Am Coll Cardiol"},{"issue":"1","key":"1659_CR9","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.echo.2014.10.003","volume":"28","author":"RM Lang","year":"2015","unstructured":"Lang\u00a0RM, Badano\u00a0LP, Mor-Avi\u00a0V, Afilalo\u00a0J, Armstrong\u00a0A, Ernande\u00a0L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American society of echocardiography and the European association of cardiovascular imaging. J\u00a0Am Soc Echocardiogr. 2015;28(1):1\u201339.e14.","journal-title":"J Am Soc Echocardiogr"},{"issue":"13\u201314","key":"1659_CR10","doi-asserted-by":"publisher","first-page":"413","DOI":"10.1007\/s00508-018-1330-3","volume":"130","author":"M Schneider","year":"2018","unstructured":"Schneider\u00a0M, Binder\u00a0T. Echocardiographic evaluation of the right heart. Wien Klin Wochenschr. 2018;130(13\u201314):413\u201320.","journal-title":"Wien Klin Wochenschr"},{"issue":"8","key":"1659_CR11","first-page":"689","volume":"34","author":"R De Simone","year":"1989","unstructured":"De Simone\u00a0R, Iarussi\u00a0D, Haberbosch\u00a0W, Scialdone\u00a0A, Irace\u00a0L, Iacono\u00a0A. Clinical usefulness of the Doppler-echocardiographic method for evaluating intracardiac shunts. Combined Doppler and hemodynamic study. Cardiologia. 1989;34(8):689\u201394.","journal-title":"Cardiologia"},{"issue":"1","key":"1659_CR12","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1016\/S0735-1097(84)80445-3","volume":"3","author":"J Vargas Barron","year":"1984","unstructured":"Vargas Barron\u00a0J, Sahn\u00a0DJ, Valdes-Cruz\u00a0LM, Lima\u00a0CO, Goldberg\u00a0SJ, Grenadier\u00a0E, et al. Clinical utility of two-dimensional doppler echocardiographic techniques for estimating pulmonary to systemic blood flow ratios in children with left to right shunting atrial septal defect, ventricular septal defect or patent ductus arteriosus. J\u00a0Am Coll Cardiol. 1984;3(1):169\u201378.","journal-title":"J Am Coll Cardiol"},{"issue":"1","key":"1659_CR13","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1161\/01.CIR.69.1.73","volume":"69","author":"A Kitabatake","year":"1984","unstructured":"Kitabatake\u00a0A, Inoue\u00a0M, Asao\u00a0M, Ito\u00a0H, Masuyama\u00a0T, Tanouchi\u00a0J, et\u00a0al. Noninvasive evaluation of the ratio of pulmonary to systemic flow in atrial septal defect by duplex Doppler echocardiography. Circulation. 1984;69(1):73\u20139.","journal-title":"Circulation"},{"issue":"23","key":"1659_CR14","doi-asserted-by":"publisher","first-page":"2915","DOI":"10.1093\/eurheartj\/ehq249","volume":"31","author":"H Baumgartner","year":"2010","unstructured":"Baumgartner\u00a0H, Bonhoeffer\u00a0P, De Groot\u00a0NM, de Haan\u00a0F, Deanfield\u00a0JE, Galie\u00a0N, et al. ESC Guidelines for the management of grown-up congenital heart disease (new version 2010). Eur Heart\u00a0J. 2010;31(23):2915\u201357.","journal-title":"Eur Heart J"},{"issue":"14","key":"1659_CR15","first-page":"e637","volume":"139","author":"KK Stout","year":"2019","unstructured":"Stout\u00a0KK, Daniels\u00a0CJ, Aboulhosn\u00a0JA, Bozkurt\u00a0B, Broberg\u00a0CS, Colman\u00a0JM, et\u00a0al. 2018 AHA\/ACC guideline for the management of adults with congenital heart disease: executive summary: a report of the American college of cardiology\/American heart association task force on clinical practice guidelines. Circulation. 2019;139(14):e637\u2013e97.","journal-title":"Circulation"},{"issue":"9","key":"1659_CR16","first-page":"549","volume":"38","author":"JY Beigbeder","year":"1989","unstructured":"Beigbeder\u00a0JY, Wittenberg\u00a0O, Messner Pellenc\u00a0P, Voisin\u00a0M, Gallay\u00a0P, Grolleau\u00a0R, et al. Evaluation of the left-to-right shunt in interatrial septal defects (ostium secundum) using Doppler echocardiography. Apropos of 12 cases. Ann Cardiol Angeiol (Paris). 1989;38(9):549\u201354.","journal-title":"Ann Cardiol Angeiol (Paris)"},{"issue":"10","key":"1659_CR17","first-page":"674","volume":"78","author":"H Stern","year":"1989","unstructured":"Stern\u00a0H, Vogel\u00a0M, Emmrich\u00a0P, Buhlmeyer\u00a0K. The accuracy of Doppler echocardiography determination of shunt volume in children with isolated atrial septal defect and left-right shunt. Z\u00a0Kardiol. 1989;78(10):674\u20139.","journal-title":"Z Kardiol"},{"issue":"7","key":"1659_CR18","doi-asserted-by":"publisher","first-page":"685","DOI":"10.1016\/j.echo.2010.05.010","volume":"23","author":"LG Rudski","year":"2010","unstructured":"Rudski\u00a0LG, Lai\u00a0WW, Afilalo\u00a0J, Hua\u00a0L, Handschumacher\u00a0MD, Chandrasekaran\u00a0K, et\u00a0al. Guidelines for the echocardiographic assessment of the right heart in adults: a\u00a0report from the American society of echocardiography endorsed by the European association of echocardiography, a\u00a0registered branch of the European society of cardiology, and the Canadian society of echocardiography. J\u00a0Am Soc Echocardiogr. 2010;23(7):685\u2013713. quiz 86\u20138.","journal-title":"J Am Soc Echocardiogr"},{"issue":"3","key":"1659_CR19","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1093\/ehjci\/jev014","volume":"16","author":"RM Lang","year":"2015","unstructured":"Lang\u00a0RM, Badano\u00a0LP, Mor-Avi\u00a0V, Afilalo\u00a0J, Armstrong\u00a0A, Ernande\u00a0L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American society of echocardiography and the European association of cardiovascular imaging. Eur Heart J Cardiovasc Imaging. 2015;16(3):233\u201370.","journal-title":"Eur Heart J Cardiovasc Imaging"},{"issue":"3","key":"1659_CR20","doi-asserted-by":"publisher","first-page":"379","DOI":"10.1016\/j.ijcard.2007.04.044","volume":"126","author":"P Engelfriet","year":"2008","unstructured":"Engelfriet\u00a0P, Meijboom\u00a0F, Boersma\u00a0E, Tijssen\u00a0J, Mulder\u00a0B. Repaired and open atrial septal defects type II in adulthood: an epidemiological study of a\u00a0large European cohort. Int J Cardiol. 2008;126(3):379\u201385.","journal-title":"Int J Cardiol"}],"container-title":["Wiener klinische Wochenschrift"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00508-020-01659-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00508-020-01659-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00508-020-01659-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,4,30]],"date-time":"2021-04-30T00:19:34Z","timestamp":1619741974000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00508-020-01659-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,4,30]]},"references-count":20,"journal-issue":{"issue":"11-12","published-print":{"date-parts":[[2020,6]]}},"alternative-id":["1659"],"URL":"https:\/\/doi.org\/10.1007\/s00508-020-01659-0","relation":{},"ISSN":["0043-5325","1613-7671"],"issn-type":[{"value":"0043-5325","type":"print"},{"value":"1613-7671","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,4,30]]},"assertion":[{"value":"14 December 2019","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 April 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 April 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"V.\u00a0Dannenberg, G.\u00a0Goliasch, C.\u00a0Hengstenberg, T.\u00a0Binder, H.\u00a0Gabriel, and M.\u00a0Schneider declare that they have no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}