35. Incomplete right ventricular remodeling after transcatheter atrial septal defect closure in pediatric age

Abstract

Published data showing the intermediate effect of transcatheter device closure of atrial septal defect (ASD) in the pediatric age group are scarce. Objective: To assess the effects of transcatheter ASD closure on right and left ventricular functions by tissue Doppler imaging (TDI). Patients &Methods: The study included 37 consecutive patients diagnosed as ASD II by TTE and TEE and referred for transcatheter closure at Cairo University Specialized Pediatric Hospital, Egypt from October 2010 to July 2013. 37 age and sex matched was selected as control group. TDI was obtained using the pulsed Doppler mode, interrogating the right cardiac border (the tricuspid annulus) and interventricular septum (lateral mitral annulus) and myocardial performance index (MPI) was calculated at 1, 6 and 12 months post device closure. Results: Transcatheter closure of ASD and echocardiographic examinations were successfully performed in all patients. There were no significant differences between two groups as regards age, gender, weight or BSA. By TDI, patients with ASD had significantly prolonged IVCT, IVRT and MPI compared to control group. Decreased tissue Doppler velocities of RV and LV began at 1 month post-closure compared to the controls. Improvement of RVMPI and LVMPI began at 1 month post-closure but still they are prolonged till 1 year. Conclusion: Reverse remodeling of right and left ventricles began 1 month after transcatheter ASD closure but didn’t completely return to normal even after 1 year follow-up by TDI.

Keywords

• Atrial septal defect (ASD)
• Myocardial performance index (MPI)
• Tissue Doppler imaging (TDI)
• Transthorathic echocardiography (TTE)
• Transeosophageal echocardiography (TEE)
• Isovolumetric contraction time (IVCT)
• Isovolumetric relaxation time (IVRT)