Long Term Follow Up of Biatrial Function after Transcatheter Closure of Atrial Septal Defect

Abstract

Abstract Aim and Objectives The aim of the study is to evaluate long term right and left atrial function using volumetric analysis and strain indices in patients who underwent transcatheter atrial septal defect (ASD) device closure more than 3 years ago. Patients and Methods This study included a group of 40 patients diagnosed with ASD who came for regular follow up at congenital heart disease clinic and another group of 40 healthy controls (age and sex matched). Basic transthoracic echocardiographic examination was done to both groups followed by assessment of atrial function using modified simpson’s method to measure right and left atrial volumes and 2D speckle tracking technique to assess biatrial strain in the three different phases (reservoir, conduit and contractile strain). Results In our study the results showed that there is no significant difference between the patients group and control group regarding volumetric analysis. Regarding left atrial (LA) strain values, there was no difference in reservoir and conduit strain while contractile strain was significantly lower in the patients group (p- value=0.047). On the other hand, all right atrial (RA) strain values were significantly lower in the patients group than control group (p-value<0.05). A subgroup analysis based on age at closure showed that patients underwent closure at age less than 15 years old had significantly higher strain values for all right and left strain indices compared to those who underwent ASD closure at age of 15 years old or older. Conclusion ASD closure at earlier age is associated with better outcomes regarding atrial function. Long term follow-up in patients who underwent ASD closure more than 3 years ago showed similar LA strain values to control except for lower contractile strain while RA strain values were significantly lower in the patients group. Patients who underwent closure at age less than 15 years old had almost normal right and left strain values while those who underwent closure equal to or more than 15 years old had impaired strain values. Earlier closure is associated with better reverse remodeling and atrial function can turn into normal in patients treated earlier.