Transcatheter Closure Of Atrial Septal Defect Research Articles

Sex differences in outcomes among patients undergoing transcatheter atrial septal defect closure: Do they benefit equally?

Abstract Background Although sex differences in congenital heart disease are prevalent and relevant, there is limited research on their role in atrial septal defect (ASD) closure. We aimed to investigate sex differences in baseline characteristics, procedural and long-term outcomes of patients with transcatheter ASD closure. Methods Data from adult patients undergoing ASD closure between 2005-2016 were retrospectively analyzed. Results Of the 853 patients included, 281 (32.9%) were male and 572 (67.1%) were female. Females were more symptomatic at presentation than males (p < 0.001). Males had a higher frequency of cardiovascular comorbidities than females (p < 0.001). Although echocardiographic right ventricular (RV) diameter relative to body surface area was equal in males and females (2.49 cm/m2 versus 2.57 cm/m2; p = 0.072), males had more RV dysfunction (12.1% versus 7.6%; p = 0.028). In contrast, females had higher RV systolic pressures (39.71 mmHg versus 37.23 mmHg; p = 0.025), and were more likely to have moderate to severe tricuspid regurgitation (15.4% versus 8.9%; p = 0.007). Males had larger defects with use of larger implants (p < 0.05). Procedure-related complications were rare and did not differ by sex. At 12-month follow-up, both male and females showed comparable decreases in RV diameter (-0.57 cm versus -0.59 cm; p = 0.751), RV systolic pressure (-4.57 mmHg versus -6.31 mmHg; p = 0.094), and severity of tricuspid regurgitation (p = 0.173; Figure). After a mean follow-up of 3 years (SD = 5), no significant differences were observed in the incidence of death (incidence rate ratio (IRR) = 0.49 [95% CI 0.27-0.83]; p = 0.402), new onset atrial fibrillation (IRR = 3.22 [95% CI 2.57-3.99]; 0.063), cardioversion or ablation (IRR = 0.40 [95% CI 0.20-0.71], p = 0.335), stroke/TIA (IRR = 0.29 [95% CI 0.12-0.56]; p = 0.745), and pacemaker implantation (IRR = 0.29 [95% CI 0.12-0.57], p = 0.728). Conclusions Although patient profiles differed by sex, procedural and long-term outcomes were comparable, suggesting that transcatheter ASD closure can be safely performed in both males and females.Figure.Sankey Plot

Perioperative Assessment and Clinical Outcomes of Percutaneous Atrial Septal Defect Closure with Three-Dimensional Transesophageal Echocardiography.

To close the atrial septal defect (ASD) with the transcatheter method, correctly defining the defect and selecting the appropriate closure device size are the most critical steps for the procedure's success. Although ASD can be successfully closed under the guidance of three-dimensional (3D) transesophageal echocardiography (TEE) and two-dimensional (2D) TEE, measurement comparisons between different types of defects are still needed. Our study was designed retrospectively. Sixty-one patients who underwent transcatheter ASD closure with 2D TEE and 3D TEE between 2020 and 2024 were included. The patients were divided into three groups according to the defect shape: circular, oval, and complex; and the measurement results, perioperative process, and clinical outcomes were compared in each group. The average age of the patients was 35.05 ± 13.87 years, and 41 (67.2%) were women. The average follow-up period of the patients was 15.3 ± 9.18 months. No statistical significance was observed in the comparison of measurements obtained with 3D TEE and 2D TEE in the circular and oval defect groups. The differences between the minimum defect diameters of complex defects measured by 2D TEE and 3D TEE (p: 0.037), IVC rims (p < 0.001), aortic rims (p: 0.012), and the differences between implanted device dimensions and the maximum defect diameters measured by both methods were compared; statistical significance was observed (p: 0.025). In circular and non-complex oval defects, it has been observed that the size of the closure device selected with 2D TEE or 3D TEE is optimal, and the procedure is practical and feasible. While the closure of complex ASDs with 3D TEE provides reliable and optimal results, using only 2D TEE in complex ASDs may lead to selecting a smaller-sized device.

Device Closure in Multiple Atrial Septal Defect Secundum Concomitant with Atrial Flutter

This study discusses the case of a 23-year-old male with multiple atrial septal defect (ASD) secundum and atrial flutter who underwent ASD closure using device closure with satisfactory results. The patient recovered successfully and was discharged in good condition. ASD is a congenital heart disease often encountered in adulthood, with various types based on the location of the defect. Device closure of ASDs is one method to address abnormal blood flow, which can also reduce the risk of atrial arrhythmias through a negative remodeling process in the atria and ventricles. ASD closure in cases with multiple ASDs requires special consideration regarding the size, morphology, and distance between defects. Atrial flutter in ASD patients can be resolved with transcatheter ablation. Other studies have shown that device closure of ASDs is associated with a reduced prevalence of atrial tachyarrhythmia in the short to medium term, although atrial flutter/fibrillation and other arrhythmias are common in patients undergoing transcatheter ASD closure. Arrhythmias and conduction disturbances are also associated with ASD.

The Impact of Transcatheter or Surgical Defect Closure on Self-Reported Sleep Quality in Adults with Atrial Septal Defect.

Sleep quality in those with cardiovascular disease is significantly lower than in the general population. This study aimed to explore the effect of transcatheter or surgical closure of atrial septal defect (ASD) on sleep quality. One hundred nineteen adult patients with ASD who underwent transcatheter or surgical closure were included in the study. Sleep quality was investigated prospectively just before defect closure and six months after defect closure. Pittsburgh Sleep Quality Index (PSQI) was used to evaluate sleep quality of these patients. PSQI scores were similar in both groups before the procedure in patients who underwent both transcatheter and surgical closure. The PSQI scores six months after transcatheter closure was significantly improved compared to the PSQI score before transcatheter ASD closure (3.5 ± 2.0 vs. 6.9 ± 3.4, respectively; P<0.001). The PSQI scores six months after surgical ASD closure was significantly improved compared to the PSQI score before surgical closure (4.8 ± 2.1 vs. 7.1 ± 2.0, respectively; P<0.001). Total PSQI scores were also statistically different at six months after transcatheter and surgical closure (3.5 ± 2.0 vs. 4.8 ± 2.1, P=0.014). However, six months after both transcatheter and surgical closure, PSQI scores were significantly decreased in both groups which was more pronounced in patients who underwent transcatheter closure. Transcatheter or surgical closure of the defect may be beneficial in improving the sleep quality of adult patients with ASD. Delayed improvement of sleep quality after surgical closure may be an important advantage for transcatheter closure.

Transcatheter Closure of Secundum Atrial Septal Defects in Pediatric Patients: A 15-Year Single-Center Experience.

Transcatheter closure is the first-line treatment option for hemodynamically significant secundum atrial septal defects (ASDs). This study examines our center's experience with this procedure over the last 15 years. Pediatric patients aged 0-18 years with secundum ASDs who were planned for transcatheter closure in our clinic between January 2007 and January 2023 were retrospectively evaluated. Transcatheter secundum ASD closure was planned for a total of 334 patients during the study period: 191 girls (57.2%) and 143 boys (42.8%). Their mean age was 8.08±3.9 years, and their mean weight was 30±15.6 kg. Defect diameter measured transesophageally ranged from 5 to 35 mm, with a mean of 12.56±4.02 mm. Transesophageal echocardiographic examination revealed a single secundum ASD in 319 patients (95.5%) and multiple secundum ASDs in 15 patients (4.5%). In 11 patients (3.3%), the procedure was terminated before initiating transcatheter ASD closure because of insufficient vena cava rims or a very large ormulti-fenestrated defect. The 323 patients (96.7%) who underwent transcatheter ASD closure had a mean pulmonary artery pressure of 15.1±4.0 mmHg and a mean Qp/Qs ratio of 1.97±0.56. The procedure failed in four patients (1.3%) because of device embolization (n=2) or the inability to properly position the device (n=2). Major complications other than device embolization observed during or after transcatheter closure included anesthetic-induced respiratory depression (n=1) and total atelectasis of the lung (n=1). No new major complications were detected during the patients' long-term follow-up. With appropriate patient and device selection, transcatheter closure is a safe and effective treatment for secundum ASD and should be the first treatment of choice.

Left Atrial Stiffness Increases after Trans-Catheter Atrial Septal Closure.

Transcatheter atrial septal closures for secundum atrial septal defects (ASD) have demonstrated favorable clinical outcomes. However, the impact of device implantation on the stiffness of the left atrium remains unclear. Patients with secundum ASD undergoing transcatheter closure and follow-up right heart catheterization at six months were included. We investigated the relationship between post-procedural (E/e' ratio)/(LAs strain) ratio, an index of left atrial stiffness, and baseline characteristics, including echocardiographic and hemodynamic parameters. Forty patients were included (median 69 (56, 75) years, 12 men, and pulmonary systemic flow ratio 2.27 (1.96, 2.86)). Trans-catheter ASD closure was successfully performed without any major complications, accompanying a significant reduction in right ventricular to left ventricular size ratio from 1.04 (0.87, 1.13) to 0.74 (0.66, 0.86) (p < 0.01). The (E/e' ratio)/(LAs strain) ratio was markedly elevated the day after the procedure and was further increased 6 months later (before: 0.25 (0.17, 0.34), 1 day later: 0.34 (0.27, 0.50), 6 months later: 0.43 (0.27, 0.76), p < 0.01). The groups with higher (E/e' ratio)/(LAs strain) ratios at 6 months had significantly more severe heart failure conditions including lower cardiac output and higher plasma B-type natriuretic peptides. Patients undergoing transcatheter ASD closure experienced improvement in hemodynamics and clinical symptoms but an elevation in left atrial stiffness post-procedure. The clinical ramifications of this finding, particularly during the longer-term observation period subsequent to ASD closure, warrant further investigation.

Long-term outcomes of transcatheter atrial septal defect closure: a single-center retrospective study.

Transcatheter atrial septal defect (ASD) closure is the primary approach for treating ASD secundum; however, data on long-term outcomes remain limited. This study aimed to elucidate the prevalence of adverse outcomes following transcatheter ASD closure in a diverse population. This retrospective cohort study was conducted at the Songklanagarind Hospital and included patients who underwent transcatheter ASD closure between January 2010 and August 2021. The study included 277 patients who completed follow-up for at least 1 year, with varying ages: <25 years (31%), 25-40 years (19%), 40-60 years (34%), and >60 years (16%). The median follow-up duration was 37 months (interquartile range: 20, 61). The overall mortality rate was 1.8%, and no deaths were attributed to device-related complications. Hospitalization due to heart failure occurred in 0.7% of the cases. Most patients improved or stabilized based on the New York Heart Association functional class. Adverse outcomes included new-onset atrial fibrillation (prevalence: 2.7%) and pulmonary hypertension (prevalence: 0.6%). The resolution of pulmonary hypertension varied among age groups, with 100% resolution in patients <25 years. Multivariate analysis identified male sex, overweight, and history of stroke to be significantly associated with adverse outcomes after transcatheter ASD closure. Transcatheter ASD closure was safe and effective, with age not being a limiting factor for success. Male sex, being overweight, and a history of stroke were associated with adverse outcomes. These findings contribute to our understanding of the long-term outcomes following ASD closure.

Cardiac troponin I release after transcatheter closure of atrial septal defects is associated with supraventricular arrhythmias on early follow-up.

Atrial septal defects (ASD) are prevalent congenital heart anomalies found in the adult population. Percutaneous ASD closure has become a routine clinical practice. Elevation of postprocedural transient cardiac biomarkers and exacerbation of supraventricular arrhythmias have been reported in the subject literature. To explore the relationship between cardiac troponin I (cTnI) elevation and supraventricular ectopy (SVE) following percutaneous closure of secundum atrial septal defect (ASD) in adult patients. 600 consecutive patients who underwent successful transcatheter ASD secundum closure were analyzed. Serum levels of cTnI were measured before and within 72 h of device implantation. 24-hour Holter monitoring was performed before the procedure, at 1 month, and at 6 months of follow-up. SVE burden increased 1 month after the procedure (median 1021.00; min.-max. 11.00-29 862.00) compared to baseline values (median 146.00; min.-max. 0-1865.00; p < 0.01). 61.7% of patients demonstrated a cTnI rise exceeding 50% of the upper reference limit within 24 h of the procedure. A statistically significant positive correlation between SVE burden 1 month after the procedure and periprocedural cTnI increase (p < 0.05, r = 0.41) was observed, while cTnI levels significantly correlated with procedure and fluoroscopy time (p < 0.001), device size (p < 0.001) and maximal ASD diameter (p < 0.001). A significant increase of cTnI is noted frequently after transcatheter ASD closure and seems to predict exacerbation in SVE burden on short-term follow up. The independent risk factors of cTnI rise are prolonged procedure duration and larger device sizes.

Arrhythmic Risk and Treatment after Transcatheter Atrial Septal Defect Closure.

Atrial septal defect (ASD) represents the most common congenital heart defect identified in adulthood. Atrial and ventricular geometric remodeling due to intracardiac shunt increase the risk of arrhythmias, especially atrial fibrillation (AF). Clinical, echocardiography, electrocardiogram, and device-related predictors may be used to assess the risk of atrial arrhythmias after ASD closure. The underlying mechanisms in these patients are complex and at least in part independent of the structural remodeling secondary to hemodynamic overload. Device closure of the ASD itself and its timing impact future arrhythmia risk, as well as posing a challenge for when transseptal puncture is required. Sudden cardiac death (SCD) risk is higher than in the general population and an implantable cardioverter-defibrillator (ICD) may be indicated in selected cases.

Abstract 17786: Transcatheter Atrial Septal Defect With Deficient Retro-Aortic Rim Closure Success Rate and Complication is Similar to Other Anatomical Variants: Meta-Analysis

Introduction: Atrial septal defect (ASD) is a common congenital cardiac malformation resulting from incomplete fusion of one of the multiple embryological structures. Though surgical repair when indicated had been the norm, technological advances over the years have led to the current availability of transcatheter closure of the ASD. This alternative approach has been associated with lower complications and mortality but the procedural success and outcome are variable dependent upon anatomical features. Hypothesis: Several reports have linked deficiency of retro-aortic rim to higher complications, particularly aortic erosion in patients undergoing transcatheter ASD closure. Recent retrospective studies have however suggested otherwise. We herein performed meta-analysis of existing data on the success rate and adverse events following transcatheter closure of ASDs in patients with deficient retro-aortic rims (DRAR) in an attempt to provide general recommendations on the optimal approach for this common anatomic variant. Methods: Twelve relevant studies of ASD with DRAR were identified utilizing PubMed. Each of the twelve studies was closely reviewed for major adverse events including cardiovascular mortality, mortality from non-cardiovascular causes, device erosions, device embolization, residual shunting post-ASD repair, and other complications. The incident of each major adverse events was subsequently tabulated. Five of these reports directly compared the failure rates of ASD closure between patients with and without DRAR. A Mantel-Haenszel random effect meta-analysis was performed on these five publications. Results: Of the total 4,621 transcatheter-based approach ASD closures included, the rate of major adverse events was 5.14%. There was no significant difference in the procedural failure rate between those with and without DRAR ( relative risk =1.14, 95% CI[0.39 3.35], p=0.811 ), (heterogeneity, I 2 =74.75%). Conclusions: Our meta-analysis suggests that transcatheter ASD closure could be performed in patients with deficient retro-aortic rim ASD with expected similar rates of adverse events and success rates as in other anatomical variants.

Comparative observation of changes in natriuretic peptides before and after interventional therapy for congenital heart disease

OBJECTIVE: To explore changes in the plasma atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) in patients with left-to-right shunt congenital heart disease (CHD) before and in the early stage after interventional occlusion and to evaluate the clinical significance. METHODS: Among 97 patients with left-to-right shunt CHD undergoing interventional occlusion, 34 cases had a VSD (ventricular septal defect), 35 cases had an ASD (atrial septal defect), and 28 cases had PDA (patent ductus arteriosus). Another 20 normal adults formed the control group. An ELISA was used to determine the plasma ANP and BNP levels before and on the third day after the operation to evaluate their correlations with cardiac functions and the defect size. RESULTS: The plasma ANP and BNP levels of patients with left-to-right shunt CHD were increased compared with those of the normal control group (P&lt; 0.01), and the plasma ANP and BNP levels were decreased on the third day after interventional occlusion compared with the preoperative levels (P&lt; 0.05). The plasma ANP and BNP levels were correlated with the New York Heart Association (NYHA) grade, left ventricular ejection fraction and defect diameter (P&lt; 0.05). CONCLUSION: Patients with left-to-right congenital heart disease exhibit activation of ANP and BNP, which can be alleviated in the early stage after intervention occlusion. Left-to-right shunt congenital heart disease is given priority over atrial septal defect (ASD), ventricular septal defect (VSD) and patent ductus arteriosus (PDA). Early traditional methods included repair or correction by open heart surgery under extracorporeal circulation (also known as cardiopulmonary bypass, CPB). However, interventional therapy has become a developing trend for the treatment of congenital heart disease since 1967, when Porstmann et al. [1]. reported the transcatheter closure of ASD for the first time. The application of the AMPLATZER occluder, which is a simple and feasible method, has improved the safety of the treatment and enabled the therapeutic effect to reach ideal levels. The natriuretic peptide (NP) family consists of the atrial natriuretic polypeptide (ANP), the brain natriuretic peptide, which is also known as the B type natriuretic peptide (BNP), the C type natriuretic peptide (CNP), the renal natriuretic peptide (RNP) and the D type natriuretic peptide (DNP). These family members are similar in structure, have strong natriuretic, diuretic and vasodilative effects and antagonize the activity of the renin-angiotensin-aldosterone system (RAAS) and the sympathetic nerve. Together, the natriuretic peptides sensitively and specifically reflect the ventricular function state. Although all types of congenital heart disease differ in anatomical structure, they all contain the common features of heart failure. This study detected changes in the serum ANP and BNP levels in patients with left-to-right shunt congenital heart disease before and on the third day after interventional occlusion to evaluate the early changes in left-to-right shunt congenital heart disease after interventional occlusion through neuroendocrine.

Single tertiary center experience using Gore Cardioform Atrial Septal Defect Occluder for secundum atrial septal defect closure with a focus on deficient rims.

The data on the use of Gore Cardioform Septal Occluder (GCA; W. L. Gore and Associates, Inc.) for atrial septal defect (ASD) with deficient rims is limited. All patients evaluated by transesophageal echocardiogram (TEE) for ASD occlusion were included. TEE planes at 35°, 0°, and 90° were assessed for anterior-superior (AS) and posterior (P), anterior-inferior (AI) and posterior-superior (PS), as well as superior (S) and inferior (I) rims. ASD size >20 mm, and rims less than 5 mm were defined as large and deficient, respectively. We included patients who had a procedural failure along with the patients in whom the procedure was not attempted after echocardiogram in the unsuccessful group. In 148 patients, the median weight, age, and ASD size were 36 kg (range, 8-60 kg), 11.8 years (range, 1-60 years), and 14.2 ± 8.28 mm, respectively. One or more deficient rims were noted in 112 of 148 (75.7%): 99 (67%) AS, 36 (24%) P, 17 (11%) AI, 30 (20%) PS, 26 (18%) S, and 33 (22%) I. ASD closure was performed in 115 (78%) patients. The procedure was successful in 111 (96.5%) patients with procedural failure in 4 (3.4%) patients. Multiple deficient rims were associated with reduced procedural success (OR 0.36, 95% CI, 0.25-0.56). On multivariate analysis deficient P, PS, and I rims were associated with an unsuccessful group (P = .001, .046, and .005, respectively). Complications included 1 device embolization, 1 vascular injury, and 5 arrhythmias. Transcatheter closure of ASDs with deficient rims is feasible using GCA. Large ASDs with deficient P, PS, and I rims were associated with unsuccessful closure. Risk stratification and comprehensive evaluation of ASD rims is vital for the use of GCA.

Residual shunt and microthrombosis associated with new-onset migraine after transcatheter atrial septal defect closure.

Residual shunt and microthrombosis associated with new-onset migraine after transcatheter atrial septal defect closure.

Atrial Septal Defect with Paroxysmal Atrial Tachyarrhythmia in Middle Age Soldier Patient: A Case Report

Highlights: 1. ASD closure is still recommendable in late middle-aged patients, especially one that is combined with arrhythmias management. 2. ASD closure after age 40 seems to not affect the frequency of arrhythmia development during follow up. - Background: Atrial septal defects (ASDs) are frequently asymptomatic and can remain undiagnosed until adulthood. Atrial tachyarrhythmias are not uncommon seen in patients with ASDs. Atrial fibrillation and atrial flutter are relatively rare in childhood, but become more prevalent with increasing age at time of repair or closure. Case Summary: The present case was an active duty 50-year-old male soldier, referred to the arrhythmia division of Gatot Soebroto Army Hospital with palpitations and physical intolerance. Holter examination and electrophysiology study revealed atrial tachyarrhythmias. Transesophageal echocardiography was performed before radiofrequency catheter ablation, and unexpectedly found left to right shunt ostium secundum ASD. Right heart catheterization confirmed left to right shunt ASD with high flow-low resistance. He then underwent paroxysmal atrial tachyarrhythmias catheter ablation, followed by percutaneous transcatheter ASD closure using occluder device without fluoroscopy within six months. Both the procedures went well without any complications. His symptoms had improved during follow up, although he had episode of rapid paroxysmal atrial fibrillation on holter evaluation six months later. Conclusion: We conclude that ASD closure is still recommendable even in late middle age patients combined with arrhythmias management.

Mitral regurgitation outcomes after transcatheter atrial septal defect closure

BackgroundWorsening mitral regurgitation (MR) is a complication of intervention for atrial septal defect (ASD). Little is known about mitral valve (MV) characteristics associated with worsening MR. We aimed to elucidate MR outcomes and predictors of worsening MR after transcatheter ASD closure. MethodsWe analyzed changes in MR from prior to transcatheter ASD closure to 6 months after the procedure and predictors of worsening MR via baseline transthoracic echocardiography in 238 patients (64.7% females; mean age, 53 ± 22 years). ResultsWorsening MR was defined as worsening to moderate in patients with less than or equal to mild MR at baseline or vena contracta width increasing of ≥2 mm by 6-month follow-up in patients with moderate MR. Worsening MR was observed in 29 patients (12.2%). The associated echocardiographic findings were pseudoprolapse, hamstringing, stiffness, and anteroposterior and intercommissural mitral annulus diameter in the univariable logistic regression analysis (all P < 0.05). Multivariable analysis after adjusting for age; long-standing persistent atrial fibrillation; and ASD size showed that models combining MV leaflet findings such as pseudoprolapse or hamstringing, or anterior leaflet stiffness with the ratio of the sum of anterior and posterior leaflet lengths to intercommissural mitral annulus diameter were statistically significant for predicting worsening MR (R2 = 0.393, P < 0.001 and R2 = 0.385, P < 0.001, respectively). ConclusionsWorsening MR after transcatheter ASD closure might depend on MV leaflet findings and annulus size in patients with long-standing persistent atrial fibrillation.

The Impact of Transcatheter Atrial Septal Defect Closure on Ventricular Repolarization Parameters in Children: Results from a 15-Year Single-Center Tertiary Care Experience

The Impact of Transcatheter Atrial Septal Defect Closure on Ventricular Repolarization Parameters in Children: Results from a 15-Year Single-Center Tertiary Care Experience

Update on Transcatheter Device Closure of Congenital Septal Defects.

The goal of this paper is to review currently available devices for closure of atrial septal defects (ASDs) and ventricular septal defects (VSDs). Favorable results from the ASSURED trial resulted in FDA approval for the most recently developed device for transcatheter ASD closure in the United States. Further studies are required to assist in the development or approval of safe devices for transcatheter perimembranous VSD closure in pediatric patients. Device closure is the less invasive and preferred management option for many ASDs, with multiple studies demonstrating lower complication rates, shorter hospital stays, and lower mortality than surgical repair. Complex ASDs that make device closure more difficult include large defects, rim deficiencies, fenestrated defects, multiple defects, and the presence of pulmonary arterial hypertension. Device closure has also become an accepted alternative to surgery for some types of ventricular septal defects VSDs, though challenges and limitations remain. Future innovations including novel devices and techniques are needed to further expand on the types of defects that can be safely closed via transcatheter approach.

Transcatheter closure of atrial septal defect in the elderly: a systematic review and meta-analysis

ObjectiveDespite the establishment of transcatheter closure as the treatment of choice in adults with secundum atrial septal defects (ASDs), the effectiveness of this approach in the elderly is disputed. This...

Left ventricular diastolic function in adult patients with an atrial septal defect and its age-dependent changes over time after transcatheter closure of the defect

Background: There are no echocardiographic (echoCG) criteria to predict whether adult patients with an atrial septal defect (ASD) will develop post-procedural left ventricular (LV) failure after the defect closure.&#x0D; Aim: To evaluate the LV diastolic function before and after the intervention in ASD patients depending on their age and, based on this, to identify potential echoCG risk factors for the development of acute heart failure immediately after the ASD closure.&#x0D; Materials and methods: This retrospective study included 69 patients with the mean age of 44.2 14.5 years and 57 (82.6%) being women. The patients were divided into 2 age groups: group 1 included 39 (56.5%) patients aged 18 to 49 years (mean SD, 35.4 9.4 years) and group 2, 30 (43.5%) patients aged 50 to 74 years (mean SD, 60.1 6.1 years). The characteristics of the ASD, heart chambers and LV diastolic function were assessed with transthoracic and transesophageal echoCG. The indexed indicators of the left atrial (LA) and LV volumes were measured before the intervention and in the postoperative period and compared. LV diastolic function was assessed by the e lateral (determined by tissue Doppler imaging, TDI) and E/e ratio (reference values 10 cm/s and 8, respectively).&#x0D; Results: The indexed LA volume at baseline in the second group was slightly higher than in the first one (27.6 9.8 ml/m2 and 25.4 7.1 ml/m2; p = 0.311), whereas there was no between-group difference in the baseline indexed LV volume parameters (41.8 7.9 ml/m2 and 42.4 8.6 ml/m2, respectively; p = 0.768). Immediately after the closure of the ASD, LV diastolic function deteriorated. In the patients below 50 years of age, this difference was non-significant, despite significant changes in the E/e values (from 7.6 3.6 to 9.9 4.1; p = 0.012). In the second age group, this parameter increased significantly (from 9.2 5.7 to 13.1 4.3, respectively; p = 0.005). The TDI index (e lateral) decreased in both groups: in the group 1, from 11.9 2.5 to 9.1 2.2 (p 0.001) and in the group 2, from 9.3 3.6 to 7.9 1.6 (p = 0.061). Two patients of the elderly group, in whom sings of LV failure were identified immediately after the defect closure, by echoCG showed the lowest TDI values (е lateral) (7.8 and 8.0 cm/sec before closure and 6.4 and 7.0 cm/sec thereafter), as well as the highest values E/e before closure (13.4 and 13.1, respectively). In the long-term (12.5 6.5 months on average), the E/e index decreased in both age groups, compared to that in the early postoperative period, approaching the preoperative parameters (group 50 years of age: 7.6 3.6 9.9 4.1 8.7 4.8, group 50 years of age, 9.2 5.7 13.1 4.3 10.8 5.6). The TDI e indicators also shifted close to their initial values, increasing from 9.1 2.2 to 11.6 1.9 in the group 50 years of age and from 7.9 1.6 to 8.9 2.8 in the group 50 years of age. In the long-term, the LA volume index in both groups was unchanged, compared to its baseline values. The indexed LV end diastolic volume and end diastolic diameter increased significantly at one year after the ASD closure in both groups; however, they did not fall outside the reference ranges, and the LV systolic function indicators remained at the same level.&#x0D; Conclusion: LA volumes and LV function demonstrated the expected positive remodeling after the transcatheter ASD closure. Potential echoCG risk factors for the development of acute heart failure immediately after the ASD closure were identified. These were low baseline rates of early diastolic velocity of the mitral ring (TDI e lateral) of less than 8.0 cm/sec and high LV filling pressure (E/e) of more than 13 in the patients with ASD.

Comparison of Short-Term Outcomes of Transcatheter versus Surgical Closure of Atrial Septum Defect at a Tertiary Cardiac Care Facility

Objective: To compare the short-term outcomes of transcatheter versus surgical closure of atrial septal defect (ASD) at a tertiary cardiac care facility in South Punjab, Pakistan.&#x0D; Study Design: Prospective comparative study.&#x0D; Place and Duration of the Study: Department of Paediatric Cardiology and Paediatric Cardiac Surgery, Chaudhary Pervez Elahi Institute of Cardiology, Multan Pakistan, from Jul 2019 to Jun 2021.&#x0D; Methodology: A total of 110 patients with moderate to large isolated secundum ASDs without severe pulmonary hypertension and planned to undergo closure of secundum ASD by either surgical approach or device closure were included. All surgical and transcatheter procedures were performed adopting standard techniques. Intra-procedural or post-procedural outcomes were noted.&#x0D; Results: In a total of 110 patients, 59(53.6%) underwent transcatheter closure of ASD, while surgical closure was done in the remaining 51(46.4%) patients. Post-procedural complications were significantly more in the Surgical Closure Group in comparison to the Transcatheter Closure Group, [14(27.5%) vs 5(8.5%) (p=0.026)]. None of the cases in the Transcatheter Closure Group required inotropes in the post-procedure period in comparison to 24(47.1%) cases (p&lt;0.001). The total cost of treatment was significantly higher in transcatheter closure patients compared to surgical closure patients (1504±60.4 US$ versus 1448±75.4 US$, p&lt;0.001). Overall, successful closure was noted in 108(98.2%) cases. No mortality was recorded.&#x0D; Conclusion: Overall, short-term outcomes of transcatheter ASD closure were comparable to the surgical approach, but patients with transcatheter ASD closure had significantly less duration of hospitalization and low rates of post-procedural complications.Keywords: Atrial septum defect, Mortality, Surgical closure, Transcatheter closure.