Remodeling process in right and left ventricle after percutaneous atrial septal defect closure in adult patients

Abstract

Objective: The aim of this study was to evaluate acute cardiac remodeling after transcatheter closure of atrial septal defect (ASD) in adult patients. Methods: This study included 19 patients (40.0+-13.51 mean age) with secundum ASD who underwent successful transcatheter closure. All patients received routine transthoracic echocardiography, including tissue Doppler left ventricle (LV) and right ventricle (RV) myocardial performance indices (MPI), mitral annular plane systolic excursion (MAPSE) and tricuspid annular plane systolic excursion (TAPSE) before ASD closure, on first day, and at first and third months after closure. Results: Left ventricle end-diastolic diameter (LVEDD) increased (37+-4 mm to 44+-5 mm, p<0.001); RVEDD decreased markedly after closure (40+-4 mm to 32+-5 mm, p<0.001); and differences existed in LV and RV adaptation. While MAPSE (1.87+-0.22 cm to 2.01+-0.23 cm, p<0.001) and LVMPI improved soon after procedure (0.44+-0.04 to 0.36+-0.03, p<0.001), RVMPI worsened until the first month post-procedure (0.25+-0.02 to 0.31+-0.03, p<0.001), but recovered by the third month follow-up visit (0.31+-0.03 to 0.27+-0.02, p<0.001). TAPSE remained unchanged (2.49+-0.46 cm to 2.51+-0.32 cm, p=0.078). Conclusion: Closure of ASD using the Amplatzer Septal Occluder device led to a decrease in RV size and an increase in LV size. In the early period, while LV function improved, RV function deteriorated, probably due to RV functional and anatomical differences.

Keywords

• atrial septal defect
• echocardiography; left ventricle; right ventricle; ventricular remodeling