Abstract
BackgroundThe trans-catheter closure of atrial septal defect (ASD) usually has a rapid impact on biventricular remodelling and functions. Whether the transcatheter closure of ASD at early childhood or at adulthood age would affect the improvement in biventricular dimensions and functions remains an area of active research.ResultsThis prospective observational study enrolled 70 subjects (50 ASD cases and 20 control subjects). Tissue Doppler imaging (TDI) and strain (S) were performed for the control group and ASD patients at baseline and at 24 h and 1 month after ASD device closure. The total ASD group was subdivided into two subgroups: group-1—children and adolescent with ASD, who underwent transcatheter closure at age ≤ 19 years; group-2—adult who underwent ASD device closure at age > 19 years old. The right and left ventricular global longitudinal systolic strain (RV/LV-GLS) and RV free wall longitudinal strain (RV free wall LS) showed a significant decline after 24 h of device closure (RVGLS-P = 0.001, LVGLS-P = 0.048, RV free wall LS-P < 0.001). However, after a 1-month follow-up, the LVGLS increased in comparison with 24 h changes after device closure (P = 0.038). The baseline mean value of RV free wall LS of G2 was significantly lower than G1 value (P < 0.001). There was no statistically significant difference between the 2 age subgroups regarding biventricular GLS and RV free wall LS changes after device closure. The changes in LV diastolic function immediately and after 1 month of device closure showed a statistically significant change in e′ and its delta change value in group-2 in comparison with its baseline values and to group-1 delta changes (P = 0.002, P = 0.011, P = 0.019, respectively).ConclusionThe ASD transcatheter closure reduced biventricular global and RV free wall longitudinal systolic strain within 1 day of intervention and was associated with a short-term improvement in the LV-GLSS after a 1-month duration. The progressive increase in LV preload results in its strain growth and reduction in diastolic function after transcatheter ASD closure. The older age at the time of ASD device closure was associated with a significant decrease in the RV free wall LS and septal e′ velocity towards abnormality.
Highlights
The trans-catheter closure of atrial septal defect (ASD) usually has a rapid impact on biventricular remodelling and functions
Baseline and early standard echocardiographic changes post-ASD device closure Transcatheter closure of ASDs was successfully performed in all patients using the Amplatzer Septal Occluder devices without any significant complications
There was a significant increase in RVEDD, Right ventricle (RV)/Left ventricle (LV) ratio, Tricuspid annular plane systolic excursion (TAPSE), RV systolic pressure (RVSP) and Qp/Pulmonary flow-to-systemic flow shunt ratio (Qs) in ASD cases more than the control subjects’
Summary
The trans-catheter closure of atrial septal defect (ASD) usually has a rapid impact on biventricular remodelling and functions. Clinical research in cardiac mechanics is moving from short- and long-axis LV and RV function and ejection fraction to two- and three-dimensional (2D and 3D) ventricular deformation studies (strain and strain rate quantification) [2]. The impact of device closure on LV systolic and diastolic function according to the age of ASD patient at the time of closure is still under investigation. For these reasons, the researchers sought to measure RV and LV haemodynamic changes with 2D transthoracic echocardiography (TTE) and strain quantification in ASDs before and after transcatheter closure with particular emphasis on the assessment of biventricular function and dimensional changes between the different age groups
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