Effect Of Atrial Septal Defect Closure Research Articles

Effect of ASD closure on right ventricular function using 3D echocardiography

Atrial septal defect (ASD) is the most common adult congenital heart disease. The left-to-right shunt causes a right ventricular (RV) volume overload. Only little is known about RV remodeling after ASD closure. We aimed to assess RV function using 2D, 3D echocardiography and 3D RV strain before and 1 month after ASD closure. We prospectively included in this monocentric study 9 patients with secundum ASD who underwent percutaneous closure between September 2019 and January 2020. 2D and 3D Echocardiography were performed in all patients before and 1-month after closure. While we initially planned to collect echocardiographic data 3- and 6-months after ASD closure, the COVID-19 pandemic made this impossible. All patients gave their informed consent to the study. Clinical and ultrasound data were collected and anonymized. 3D RV echocardiographic sequences were analyzed by semi-automatic software (Tomtec 4D RV Function, Unterschleissheim, Germany) and output meshes were post-processed to extract regional deformation. Patients’ mean age was 31.0 ± 12.3 years, 44.4% were female. Mean ASD diameter was 16.6 ± 7.4 mm. RV end diastolic diameter and right atrial (RA) area were significantly larger than normal values and decreased significantly after ASD closure (45.8 ± 4.9 vs. 37.8 ± 5.7 mm; P = 0.0009 and 21.4 ± 4.2 vs. 16.3 ± 2.7 cm2; P = 0.01, respectively). 3D RV volumes were significantly lower after ASD closure; respectively 156.3 ± 61.7 vs. 82.9 ± 17.40 mL, P = 0.02 for end diastolic volume and 59.4 ± 19.3 vs. 32.6 ± 9.2 mL, P = 0.01 for end systolic volume. RV function decreases after ASD closure as illustrated by TAPSE (23.3 ± 6.0 vs. 29.1 ± 4.2 mm, P = 0.03) as well as 3D RV strain with a significantly decreased in area strain, longitudinal strain as well as circumferential strain (respectively P = 0.006, P = 0.009 and P = 0.02) (Fig. 1). After percutaneous ASD closure, we demonstrate a decrease in RV function in all strain components using 3D strain. This decrease in RV strain probably illustrates the decrease in RV parietal stretch related to the normalization of RV loading conditions. 3D strain can be useful to assess the RV function evolution in response to different loading conditions.

Assessment of Left Ventricular Function and Mitral Regurgitation Severity Early After Percutaneous Device Closure of the Atrial Septal Defect.

Atrial septal defect (ASD) is one the most prevalent forms of congenital heart disease in adults. Closure of ASDs eliminates left-to-right shunt and reduces right heart volumes, but the effects of ASD closure, on the left ventricle (LV) and mitral valve competence are somewhat inconsistent. Therefore, we designed this study to evaluate the early effect of percutaneous closure of ASD on LV function and mitral regurgitation (MR) severity. In this prospective study, we enrolled 32 patients with ASD secundum who underwent percutaneous device closure in Tehran Heart Center. We used transthoracic and transesophageal echocardiography (TEE) before the procedure and TTE 24 hours after the procedure, then compared obtained LV parameters before and after the procedure. LV end-diastolic diameter (LVEDD) increased significantly from 44.8 ± 2.4 to 45.8 ± 2.8 (P < 0.001). LV end-systolic diameter (LVESD) also increased but was statistically insignificant (P = 0.063) and LV ejection fraction (LVEF) remained nearly unchanged. Highest alteration was in right ventricular systolic pressure (12.4% decrease; P < 0.001) and mitral early Doppler/tissue Doppler velocity ratio (E/E') (9.7% increase; P = 0.010). The change in MR severity was insignificant using Wilcoxon signed-rank test (P = 0.157). We concluded that systolic functions do not change immediately. However, LVEDD and E/E' will increase immediately, resulting from the passage of all blood from the LA into the LV in the early diastole just after closure. We also observed the positive effect of device closure on reducing right ventricular systolic pressure, and at least it does not worsen MR early after the procedure.

Optimization of Echo Views for Percutaneous Device Closure of Pediatric Atrial Septal Defect through the Femoral Vein Guided by Transthoracic Echocardiography without Radiation.

Objectives This study aimed to explore the selection of views for transthoracic echocardiography-guided transfemoral puncture for the device closure of pediatric atrial septal defect (ASD) without radiation. Methods Sixty children (29 males and 31 females) were diagnosed with a central ASD, normal heart function, and no other intracardiac deformity. All procedures were performed in a surgical operating room (without radiological equipment) under basic anesthesia; the femoral vein pathway and guidance by only transthoracic echocardiography were used to complete the device closure of the ASD. The subcostal acoustic window and parasternal aorta short-axis views were used to guide the extra stiff wire and catheter into the left atrium. All procedures were performed under the subcostal biatrial section. The sheath entered the left atrium, and the apical four-chamber view was used to monitor the delivery and release of the occluder. Results Successful closure of the ASD was achieved in all cases. The operating time from the end of the puncture to the release of the occluder was 10.36 ± 3.57 minutes. No other incisions were needed in 60 cases. No occluders were removed, and no residual shunt or pericardial effusions were detected after the procedures, during the non-ICU stay time. The average hospital stay was 2.19 ± 0.58 days. Conclusion The accurate selection of transthoracic echocardiographic views can better ensure the safety and effectiveness of ASD closure through the femoral vein without radiation in children.