Transcatheter Atrial Septal Defect Closure Before Versus After Adulthood.

Abstract

ObjectivesTo evaluate the long-term outcome of patients who underwent percutaneous transcatheter closure of secundum atrial septal defects during teenage life versus adulthood.MethodsThe study included 100 patients with secundum type ASD who were treated by transcatheter closure of their defects 2–5 years before enrollment. The study population was subdivided into 2 equal groups: group 1 who underwent transcatheter closure during teenage life (13–19 years) and group 2 who underwent transcatheter closure after the age of 30 years. The two groups were compared according to resting 12 lead ECG, 24-h Holter ECG and transthoracic echocardiographic findings (Right ventricular size and functions, right atrial size, etc.)ResultsThe study population showed female predominance. The average follow up period was similar in both groups. Adult patients had more frequent right bundle branch block morphology in their resting 12 lead ECG than teenagers (69% versus 45% respectively, p < 0.01). The incidence of arrhythmias encountered in Holter ECG was also significantly higher in the adult group. Premature atrial contractions (PAC) were present in 10 patients (20%) in adult group while 3 patients (6%) had PACs in teenagers’ group with p < 0.01. The mean PAC burden was also higher in the adult group (9% versus 1.3%, p < 0.001). Paroxysmal AF lasting more than 30 seconds was found in 6 patients (12%) in the adult group while 1 patient in teenagers developed AF, p < 0.01. Regarding transthoracic echocardiography, adult patients showed significantly larger RV diameter, indexed RA area, indexed LA volume and more LV diastolic dysfunction. RV systolic functions were better in the teenage group as measured by 2D echocardiography. Adult patients with higher age, bigger defect size and device size had more abnormal ECG and echocardiographic findings.ConclusionEarly trans-catheter closure of secundum ASD during teenage life yields better right ventricular systolic function, better right ventricular size and less incidence of atrial arrhythmia.