Evaluation of Left Ventricular Rotational Deformation by Non-Conventional Echocardiography Before and After Transcatheter Closure of Large Secundum Atrial Septal Defects in Children

Abstract

Introduction: Atrial septal defects (ASD) are a common congenital heart disease which causes increased volume overload of the right side of the heart that leads to impairment of LV performance. LV torsion is a three dimensional (3D) performance, so it cannot be assessed accurately by the 2D speckle tracking method. Aim of the work: The purpose of this study was to evaluate left ventricular (LV) rotational & torsional deformation in large ASD patients undergoing transcatheter ASD device closure using 4D speckle tracking Imaging (STI). Methods: All patients who underwent transcatheter device closure of large ostium secundum ASD were included in the study. We assessed LV torsion in large ostium secundum ASD patients pre and post device closure by using 4D speckle tracking echocardiography. Results: A total of 20 patients with large ostium secundum ASD (11 females and 9 males) were included in this study. The mean age was 6.1± 3.5 years and the mean ASD size was 17.95 ± 5.45 mm. LV peak basal clockwise rotation improved significantly in post transcatheter closure (-6.96 ± 2.65˚ before vs. -10.32 ± 4.11˚after closure, P=0.005), and shortened time to peak clockwise rotation (345.15 ± 124.72 ms before vs. 282.25 ± 82.96 ms after closure, P = 0.021). There was no significant difference in apical rotational parameters including peak counterclockwise rotation (4.82 ± 3.44˚ before vs. 6.16 ± 3.38˚ after closure) and time to the peak (250.05 ± 69.17 ms before vs 252.45 ± 60.06 ms after closure (P >0.05 for both). LV twist (11.39 ± 3.81˚ before vs. 17.56 ± 7.18 ˚after closure, P = 0.001) and torsion (2.13 ± 0.79˚/cm before vs. 3.07 ± 1.27 ˚/cm after closer, P = 0.010) were significantly improved in patients with large ASD after the device closure, mainly as the result of improvement of LV basal rotation. Conclusion: After large ASD device closure there is increased peak LV twisting and torsion that were mainly attributed to the improved peak systolic clockwise basal rotation while the apical rotation remained unchanged