0123: Right ventricular form and function after surgical closure of atrial septal defect

Abstract

Surgical closure of ASD is a safe and effective means of eliminating interatrial shunting. The response of the right heart by age to this intervention is incompletely understood. We sought to assess the right heart’s response by echocardiographic parameter over a five-year follow-up period. Twenty-one consecutive patients had a surgical closure for ASD (09 sinus venosus and 12 defect with rim deficiency).We define two groups, group 1 formed with patients aged under 12 years at the moment of the surgery and group 2 with patients aged over 12 years old. The patients were assessed with echocardiography, before the procedure and at 1, 2 and 5 years. The mean ASD size was 26±7.4mm. The difference between the two groups at one year was significant, four-chamber right ventricular (RV) size (21 vs. 25mm/m 2 ), paradoxical septal motion (38% vs. 50%), right atrial length(24 vs. 27mm/m 2 ), RV fractional area change (RVFAC) (38% vs. 34%), tricuspid lateral annular systolic velocity (S’) (11 vs. 9cm/s), RV dP/dt (530 vs. 380), isovolumic velocity and isovolumic acceleration[IVA] (3.4 vs. 2.2 m/s 2 ), and echocardiographically determined pulmonary artery systolic pressure decreased significantly and was maintained at 5 years follow-up only in group 1. At 5 years, 39% of patients had persistent RV enlargement in group 2. Right heart morphology undergoes rapid improvement within one year of defect closure in young patients (<12 years) while patients aged over 12 years had less improvement and persistent RV enlargement or pulmonary hypertension, or both, at five year.