Percutaneous device closure of atrial septal defect results in very early and sustained changes of right and left heart function (original) (raw)
Related papers
Anadolu Kardiyoloji Dergisi/The Anatolian Journal of Cardiology, 2014
Objective: The main purpose of present study was to investigate the impact of percutaneous closure of atrial septal defect (ASD) on right ventricular (RV) systolic function assessed by tricuspid annular isovolumic myocardial acceleration (IVA) that is independent of preload and afterload changes. Methods: A prospective cohort study was designed involving twenty five patients with secundum type ASD whom were successfully closed percutaneously between 2009 and 2011. Standard transthoracic echocardiography and tissue Doppler imaging were performed in all patients 12 to 24 hours before and one month after closure. Paired t test was performed to determine the statistical significance of variables before and after closure. Results: Significant decreases were observed in RV end-diastolic diameter, RV/left ventricular (LV) end-diastolic diameter ratio, right ventricular systolic myocardial velocity (Sm), right ventricular early myocardial velocity (Em) and right ventricular late myocardial velocity (Am) in the control echocardiography in the first month when compared with pre-procedure values. While significant increase was observed after procedure in right ventricular IVA (3.4±1.3 m/sec 2 vs. 4.2±1.8 m/sec 2 , p=0.001), no significant change was observed in right ventricular global performance index, in right ventricular Em/Am ratio and left ventricular ejection fraction. Conclusion: Percutaneous closure of ASD resulted in recovery of right ventricular function as early as 1 month after closure.
Background: Atrial septal defect (ASD) represents a common congenital heart malformation, cause of right ventricle (RV) volume overload, pulmonary hypertension, atrial arrhythmias, and paradoxical emboli. Percutaneous closure represents the treatment of choice for ASD. However, it is still difficult to associate symptoms to the success of ASD treatment. Objective: To investigate any possible correlation between transthoracic echocardiography (TTE) findings and patients' symptoms after ASD treatment. Materials and Methods: Thirty patients (mean age 49 ± 17 years; 10 younger ≤40 years and 20 > 40 years) underwent percutaneous closure of ASD type ostium secundum. Every patient underwent clinical examination, electrocardiogram (ECG) and TTE before procedure and at 1, 6, and 12 months after procedure and a multichoice questionnaire to collect patients' symptoms and complain severity. Statistical analysis: Continuous variables were summarized by means and standard deviation. Estimates of occurrence of events were expressed as percentages. Comparison between mean follow-ups was achieved using paired t-test sample. Results: At end of follow-up, TTE showed a decrease of RV dimensions (34.4 vs 37.5 mm preclosure; P = 0.01), pulmonary artery systolic pressure (PAPs 28.4 vs 39.5 mmHg; P = 0.00003), atrial dimensions (51 vs 56 mm; P = 0.085), and of right myocardial performance index (MPI; 0.39 vs 0.42; P = 0.05). PAPs was significantly reduced in group more than 40-yearsold (P = 0.00004), while the reduction was not significant in the less or equal than 40 years of age (P = 0.08) group because the baseline value was significantly lower. Many patients after procedure complained headache, insomnia, palpitations, fatigue, and dyspnea; but no cardiac morphological abnormalities related to symptoms were found. Conclusions: Our data showed a great improvement in symptoms and positive cardiac remodeling after closure of ASD, more effective in elderly patients compared to younger patients. The symptoms are not correlated with the principal disease or procedure.
Journal of Cardiothoracic and Vascular Anesthesia, 2013
Background: Percutaneous closure of atrial septal defects (ASDs) should potentially reduce right heart volumes by removing left-to-right shunting. Due to ventricular interdependence, this may be associated with impaired left ventricular filling and potentially function. Furthermore, atrial changes post-ASD closure have been poorly understood and may be important for understanding risk of atrial arrhythmia post-ASD closure. Cardiovascular magnetic resonance (CMR) is an accurate and reproducible imaging modality for the assessment of cardiac function and volumes. We assessed cardiac volumes pre-and post-percutaneous ASD closure using CMR.
Percutaneous closure of atrial septal defects: a decade of experience at a reference center
2010
Background: Percutaneous closure of atrial septal defects (ASDs) should potentially reduce right heart volumes by removing left-to-right shunting. Due to ventricular interdependence, this may be associated with impaired left ventricular filling and potentially function. Furthermore, atrial changes post-ASD closure have been poorly understood and may be important for understanding risk of atrial arrhythmia post-ASD closure. Cardiovascular magnetic resonance (CMR) is an accurate and reproducible imaging modality for the assessment of cardiac function and volumes. We assessed cardiac volumes pre-and post-percutaneous ASD closure using CMR.
Percutaneous closure of atrial septal defects. The role of transesophageal echocardiography
Arquivos Brasileiros De Cardiologia, 1999
Background: Percutaneous closure of atrial septal defects (ASDs) should potentially reduce right heart volumes by removing left-to-right shunting. Due to ventricular interdependence, this may be associated with impaired left ventricular filling and potentially function. Furthermore, atrial changes post-ASD closure have been poorly understood and may be important for understanding risk of atrial arrhythmia post-ASD closure. Cardiovascular magnetic resonance (CMR) is an accurate and reproducible imaging modality for the assessment of cardiac function and volumes. We assessed cardiac volumes pre-and post-percutaneous ASD closure using CMR.
Congenital Heart Disease, 2014
The objectives of this study are to assess current management algorithms for left ventricular (LV) hemodynamic and diastolic changes following atrial septal device occlusion in adult patients. Background. Percutaneous closure is now routine for atrial septal defects (ASDs). Previous studies show ventricular size normalization following percutaneous closure. Case reports have discussed the incidence of early LV dysfunction following ASD device placement with some recommending delay of closure or placement of a fenestrated device in patients with elevated LV pressures. Method. All adult patients with an isolated secundum ASD who underwent percutaneous repair were included in this study. In addition to placement of the Amplatzer septal occluder, all patients had a pre and postprocedure transthoracic echocardiography performed measuring myocardial performance index (MPI). Left ventricular end diastolic pressure (LVEDP) was measured before and after balloon occlusion. Results. Nineteen patients (17 female and two male) were included in this study. Average age was 47.2 years (± 12.7 years). All defects were of clinical significance with average Qp : Qs = 2.0 (± 0.6). Balloon occlusion led to a significant (P < .01) increase in LVEDP (pre-LVEDP mean = 7.1 mm Hg, post-LVEDP mean = 15.3 mm Hg). There was no significant change in MPI. ASD device size displayed a modest correlation relative to the change in LVEDP (R = 0.42, P = .09). Conclusions. Percutaneous ASD closure induces an increase in LVEDP. Despite this, all patients tolerated device closure without complication. It appears safe to close ASDs in these patients.
Echocardiography, 2012
Aims: There is limited data on alterations in novel right ventricular (RV) function indices like tricuspid annular plane systolic excursion (TAPSE) and tricuspid annular systolic velocity (TASV) after transcatheter atrial septal defect (ASD) closure. We aimed to evaluate RV function by echocardiography (ECG) with these novel indices in early period in patients with secundum-type ASD that was closed percutaneously. Methods: Patients were enrolled to study if they had secundum-type ASD that was suitable for percutaneous closure. Patient population consisted of 4 men and 16 women. Echocardiography was performed before and 1 month after closure. Results: Mean age was 37 ± 16. Mean diameter of ASD and total atrial septum length measured by ECG were 19 ± 6 mm and 49 ± 7 mm, respectively. Mean diameter of defect in transesophageal echocardiography was 20 ± 6 mm. Stretched mean diameter in catheterization was 23 ± 6 mm. One month after closure, there were statistically significant decreases in RV end-diastolic diameters (43.3 ± 10.7 mm vs. 34.9 ± 5.5 mm; P < 0.001), RV/left ventricular (LV) end-diastolic diameter ratio (1.1 ± 0.3 vs. 0.87 ± 0.1; P < 0.001), TASV (16.9 ± 3.2 cm/sec vs. 14.3 ± 3.3 cm/sec; P < 0.05), early diastolic tricuspid annular velocity (15.3 ± 3.1 cm/sec vs. 13.4 ± 2.4 cm/sec P <0.05), late diastolic tricuspid annular velocity (16.2 ± 5.4 cm/sec vs. 14.3 ± 6.3 cm/sec; P < 0.05), and TAPSE (29.9 ± 6.2 mm vs. 22.4 ± 7.4 mm; P < 0.001). LV end-diastolic diameter (38.0 ± 6.9 mm and 40.0 ± 4.5 P < 0.05) was increased, whereas there was no change in LV ejection fraction. Conclusion: Closure of ASD by using Amplatzer devices led to decrease in right heart chamber size, tissue Doppler-derived tricuspid annular velocities and TAPSE in early period. (Echocardiography 2012;29:358-362)
Right Ventricle before and after Atrial Septal Defect Device Closure
Echocardiography, 2016
Background: Percutaneous atrial septal defect (ASD) device closure is a safe and effective means of reducing or eliminating interatrial shunting. The response of the right heart to device closure is incompletely understood. Aim: To evaluate the effects of transcatheter closure of secundum ASD on right ventricle size and function, that is, both systolic and diastolic by transthoracic echocardiography (TTE) over a 6-month period. Methods: Seventy-three patients had 73 device implantations. The patients were assessed with echocardiography before and at 1 and 6 months after procedure. Results: Mean age was 26 AE 17 years. Mean ASD size indexed to body surface area (BSA) was 19.1 AE 8.6 mm/m 2. The device size ranged from 12 to 42 mm. One month after closure, there were statistically significant decreases in right ventricular (RV) basal diameter (3.5 AE 0.7 cm vs. 4.2 AE 0.8 cm), RV/LV end-diastolic diameter ratio (0.9 AE 0.1 vs. 1.2 AE 0.2), left ventricular eccentricity index (LVEI) (1.0 AE 0.1 vs. 1.2 AE 0.2), right atrial (RA) major dimension (4.4 AE 0.8 cm vs. 4.8 AE 1.0 cm), RA end-systolic area (13.2 AE 4.6 cm 2 vs. 18.5 AE 6.7 cm 2), tricuspid annular plane systolic excursion (TAPSE) (2.2 AE 1.8 cm vs. 2.8 AE 0.5 cm), tricuspid annular systolic velocity (TASV or S 0) (13.1 AE 3.0 cm/sec vs. 16.0 AE 2.8 cm/sec), E/A (1.4 AE 0.3 vs. 1.7 AE 0.5), and E/e 0 (5.9 AE 5.0 vs. 7.2 AE 2.0) in comparison with baseline. Six months after closure, there were statistically significant decreases in RV major dimension (5.9 AE 1.1 cm vs. 6.3 AE 1.0 cm), RV/LV end-diastolic diameter ratio (0.8 AE 0.1 vs. 0.9 AE 0.1), RA major dimension (4.1 AE 0.8 cm vs. 4.4 AE 0.8 cm), and RA end-systolic area (11.4 AE 3.8 cm 2 vs. 13.2 AE 4.6 cm 2) in comparison with 1 month post-device closure. After 6 months, there was a statistically insignificant increase in both TASV (13.7 AE 2.8 cm/sec vs. 13.1 AE 3.0 cm/sec) and TAPSE (2.5 AE 1.6 cm/sec vs. 2.2 AE 1.8 cm/sec). There was no significant change in tissue Doppler MPI at baseline, 1 month, and 6 months after closure (0.38 AE 0.19 vs. 0.35 AE 0.15 vs. 0.38 AE 0.13). There was significant decrease in E/e 0 from baseline to 1 month and 1 month to 6 months after closure (7.2 AE 2.0 vs. 5.9 AE 5.0 vs. 4.7 AE 1.5). Conclusion: RV volumes decreased significantly in the first month after ASD device closure and continued up to 6 months. There was no change in global right ventricular systolic function but a high basal RV systolic function decreased after closure. Some patients had impaired diastolic function before closure of defect, which reversed to normal within 6 months after closure. Diastolic dysfunction in older age-group may be a cause for long duration taken by right heart chambers to regress and deserves further investigation.
Pediatric Cardiology, 2010
The study aimed to investigate the intermediate-term effects of transcatheter atrial septal defect (ASD) closure on cardiac remodeling in children and adult patients. Between December 2003 and February 2009, 117 patients (48 males, 50 adults) underwent transcatheter ASD closure with the Amplatzer septal occluder (ASO). The mean age of the patients was 15 years, and the mean follow-up period was 25.9 ± 12.4 months. New York Heart Association (NYHA) class, electrocardiographic parameters, and transthoracic echocardiographic (TTE) examination were evaluated before the ASD closure, then 1 day, 1 month, 6 months, 12 months, and yearly afterward. Transcatheter ASD closure was successfully performed for 112 (96%) of the 117 patients. The mean ASD diameter measured by transesophageal echocardiography (TEE) was 14.0 ± 4.2 mm, and the mean diameter stretched with a sizing balloon was 16.6 ± 4.8 mm. The mean size of the implanted device was 18.6 ± 4.9 mm. The Qp/Qs ratio was 2.2 ± 0.8. The mean systolic pulmonary artery pressure was 40 ± 10 mmHg. At the end of the mean followup period of 2 years, the indexed right ventricular (RV) end-diastolic diameter had decreased from 36 ± 5 to 30 ± 5 mm/m 2 (p = 0.005), and the indexed left ventricular (LV) end-diastolic diameter had increased from 33 ± 5 to 37 ± 6 mm/m 2 (p = 0.001), resulting in an RV/ LV ratio decreased from 1.1 ± 0.2 to 0.8 ± 0.2 (p = 0.001). The New York Heart Association (NYHA) functional capacity of the patients was improved significantly 24 months after ASD closure (1.9 ± 0.5 to 1.3 ± 0.5; p = 0.001). At the 2-year follow up electrocardiographic examination, the P maximum had decreased from 128 ± 15 to 102 ± 12 ms (p = 0.001), the P dispersion had decreased from 48 ± 11 to 36 ± 9 ms (p = 0.001), and the QT dispersion had decreased from 66 ± 11 to 54 ± 8 ms (p = 0.001). Five of six patients experienced resolution of their preclosure arrhythmias, whereas the remaining patient continued to have paroxysmal atrial fibrillation. A new arrhythmia (supraventricular tachycardia) developed in one patient and was well controlled medically. Transcatheter ASD closure leads to a significant improvement in clinical status and heart cavity dimensions in adults and children, as shown by intermediate-term follow-up evaluation. Transcatheter ASD closure can reverse electrical and mechanical changes in atrial myocardium, resulting in a subsequent reduction in P maximum and P dispersion times.
2008
Background: Percutaneous closure of atrial septal defects (ASDs) should potentially reduce right heart volumes by removing left-to-right shunting. Due to ventricular interdependence, this may be associated with impaired left ventricular filling and potentially function. Furthermore, atrial changes post-ASD closure have been poorly understood and may be important for understanding risk of atrial arrhythmia post-ASD closure. Cardiovascular magnetic resonance (CMR) is an accurate and reproducible imaging modality for the assessment of cardiac function and volumes. We assessed cardiac volumes pre-and post-percutaneous ASD closure using CMR.