1
|
Tanaka S, Imamura T, Fukuda N, Ueno H, Kinugawa K. Left Atrial Stiffness Increases after Trans-Catheter Atrial Septal Closure. J Clin Med 2024; 13:327. [PMID: 38256461 PMCID: PMC10816685 DOI: 10.3390/jcm13020327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 12/29/2023] [Accepted: 01/05/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND 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. METHOD 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. RESULTS 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. CONCLUSIONS 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.
Collapse
Affiliation(s)
| | - Teruhiko Imamura
- Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan; (S.T.); (N.F.); (H.U.); (K.K.)
| | | | | | | |
Collapse
|
2
|
Zi-Yang Y, Hezhi L, Nanshan X, Yin Z, Dongling L, Hongwen F, Caojin Z. Model for screening adult congenital heart disease surgery eligibility with echocardiography parameters. J Heart Lung Transplant 2022; 41:1831-1838. [PMID: 36150995 DOI: 10.1016/j.healun.2022.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 07/30/2022] [Accepted: 08/22/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES This study aimed to screen for the eligibility of correction in cases of adult congenital heart disease (CHD). Pulmonary to systemic flow ratios (Qp/Qs) > 1.5 and pulmonary to systemic vascular resistance ratios (Rp/Rs) < 1/3, acquired by right heart catheterization (RHC), are two essential parameters. Nonetheless, performing RHC at every follow-up is impractical and even harmful. Thus, it is important to establish a model to predict Qp/Qs and Rp/Rs status before a RHC confirmation, using echocardiography parameters. METHODS A total of 1,785 patients with adult CHD were enrolled and randomly assigned to the derivation or validation groups. Echocardiogram parameters of the 974 patients in the derivation group were considered candidate predictors for surgery eligibility (Qp/Qs > 1.5 and Rp/Rs < 1/3). Binary logistic regression analyses were performed to identify the independent predictors and establish a scoring system. The scoring system was further examined in the validation group using a receiver operating characteristic (ROC) analysis. RESULTS Estimated pulmonary artery systolic pressure, velocity through the pulmonary valve, and diameters of the left and right atria were identified as independent predictors. The area under the ROC curve of the predictive value in the validation group and its pre- and post-tricuspid valve malformation subgroups were 0.87 (95% confidence interval [CI]: 0.84-0.90, p < 0.01), 0.86 (95% CI: 0.82-0.91, p < 0.01), and 0.85 (95% CI: 0.79-0.90, p < 0.01), respectively. CONCLUSIONS This scoring system could augment flexibility and convenience for pre-screening CHD patients' eligibility for surgery, before RHC.
Collapse
Affiliation(s)
- Yang Zi-Yang
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China; Southern Medical University, The Second School of Clinical Medicine, Guangzhou, Guangdong, China; Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, Guangdong, China
| | - Li Hezhi
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Xie Nanshan
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China; Southern Medical University, The Second School of Clinical Medicine, Guangzhou, Guangdong, China; Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, Guangdong, China
| | - Zhou Yin
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China; Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, Guangdong, China
| | - Luo Dongling
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Fei Hongwen
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China; Southern Medical University, The Second School of Clinical Medicine, Guangzhou, Guangdong, China.
| | - Zhang Caojin
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China; Southern Medical University, The Second School of Clinical Medicine, Guangzhou, Guangdong, China; Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, Guangdong, China.
| |
Collapse
|
3
|
Albalawi M, Ahmad S, Nasef MA, Alotay A, Rajaa NA, Alsahari A, Saleem I, Abudlhamed JM. Mid-Term Outcome of Left Ventricle Reverse Remodeling After Atrial Septal Defect Closure: A Comparison Between Surgical and Device Groups. Pediatr Cardiol 2022; 43:1530-1538. [PMID: 35325281 DOI: 10.1007/s00246-022-02879-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/15/2022] [Indexed: 10/18/2022]
Abstract
Right ventricular (RV) volume overload occurs in patients with significant atrial septal defect (ASD II) shunts, which can impair left ventricle (LV) filling, thus decreasing LV indices. However, after ASD II closure, the left ventricle regains near normal dimensions. The purpose of this study was to compare the long-term outcomes of LV reverse remodeling between device and surgical closure. We retrospectively reviewed the echocardiographic data of 222 patients with isolated ASD II who underwent surgical (95 patients) or device closure (127 patients) between January 2012 and December 2017. The ASD II was significantly larger in the surgical closure group (p < 0.001.) leading to a higher degree of paradoxical interventricular septal (IVS) movement. In contrast, the LV volume was larger in the device closure group (p < 0.001). After a median follow-up period of 19.5 months, the maximum LV systolic and diastolic volumes were reached at 1 year in the device closure group and 2 years in the surgical closure group. IVS motion normalized in 91% of the device closure group compared to 57% of the surgical closure group (p = < 0.001). There was significant improvement in left ventricular indices and IVS motion after ASD II closure in both groups but more favorable in patients after device closure.
Collapse
Affiliation(s)
- Muflih Albalawi
- Division of Pediatrics, Department of Cardiology, King Salman Armed Forces Hospital, Tabuk, Saudi Arabia.
| | - Salim Ahmad
- Department of Pediatric Cardiology, Prince Sultan Cardiac Center (PSCC), Riyadh, Saudi Arabia
| | - Mohamed Al Nasef
- Department of Pediatric Cardiology, Prince Sultan Cardiac Center (PSCC), Riyadh, Saudi Arabia
| | - Abdulmajeed Alotay
- Department of Pediatric Cardiology, Prince Sultan Cardiac Center (PSCC), Riyadh, Saudi Arabia
| | - Najlaa Al Rajaa
- Department of Pediatric Cardiology, Prince Sultan Cardiac Center (PSCC), Riyadh, Saudi Arabia
| | - Atif Alsahari
- Department of Pediatric Cardiology, Prince Sultan Cardiac Center (PSCC), Riyadh, Saudi Arabia
| | - Irfan Saleem
- Department of Pediatric Cardiology, Prince Sultan Cardiac Center (PSCC), Riyadh, Saudi Arabia
| | - Jassim Mohamed Abudlhamed
- The King Abdul-Aziz Cardiac Center (KACC), King Abdul-Aziz Medical City (KAMC), Riyadh, Saudi Arabia
| |
Collapse
|
4
|
Goh E, Mohammed H, Salmasi MY, Ho S, Benedetto U, Caputo M, Angelini G, Vohra HA. Minimally invasive versus transcatheter closure of secundum atrial septal defects: a systematic review and meta-analysis. Perfusion 2022; 37:700-710. [PMID: 34109866 PMCID: PMC9500175 DOI: 10.1177/02676591211021935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Limited data exists demonstrating the efficacy of minimally invasive surgery (MIS) compared to transcatheter (TC) closure of atrial septal defects (ASD). This systematic review and meta-analysis aims to compare post-operative outcomes of MIS versus TC repair in ASD closure. METHODS PubMed, Medline and EMBASE were searched from inception until June 2018 for randomised and observational studies comparing post-operative outcomes for MIS and TC repair. The studies were reviewed for bias using the ROBINS-I Score and pooled in a meta-analysis using STATA (version 15). RESULTS Six observational studies, involving 1524 patients assessing three primary and five secondary outcomes were included. Evidence suggests TC repair yielded shorter hospital stay (MD = 3.32, 95% CI 1.04-5.60) and lower rates of transient atrial fibrillation (AF) (RR = 0.48, 95% CI 0.20-1.15). TC repair patients also had fewer pericardial effusions (RR = 0.27, 95% CI 0.05-1.54, I2 = 0.0%) and pneumothoraxes (RR = 0.18, 95% CI 0.04-0.80, I2 = 0.0%). However, TC repair results in more minor residual shunts (RR = 6.04, 95% CI 1.69-21.63 in favour of MIS, I2 = 39.0%). No differences were found for incidences of strokes (RR = 1.58, 95% CI 0.23-10.91, I2 = 19.3%), unexpected bleeding (RR = 0.44, 95% CI 0.19-1.04, I2 = 0.0%) and blood transfusion (RR = 0.39, 95% CI 0.09-1.59, I2 = 0.0%). CONCLUSIONS MIS closure for ASD has similar outcomes compared to TC repair. However, the lack of randomised literature related to MIS versus TC repair for ASD closure warrants further evidence in the form of RCTs to further support these findings.
Collapse
Affiliation(s)
- Esther Goh
- Department of Cardiovascular Sciences Surgery, Bristol Hearth Institute, Bristol, UK
| | - Haya Mohammed
- Department of Cardiovascular Sciences Surgery, Bristol Hearth Institute, Bristol, UK
| | | | - Samantha Ho
- Department of Cardiovascular Sciences Surgery, Bristol Hearth Institute, Bristol, UK
| | - Umberto Benedetto
- Department of Cardiovascular Sciences Surgery, Bristol Hearth Institute, Bristol, UK
| | - Massimo Caputo
- Department of Cardiovascular Sciences Surgery, Bristol Hearth Institute, Bristol, UK
| | - Gianni Angelini
- Department of Cardiovascular Sciences Surgery, Bristol Hearth Institute, Bristol, UK
| | - Hunaid A Vohra
- Department of Cardiovascular Sciences Surgery, Bristol Hearth Institute, Bristol, UK
| |
Collapse
|
5
|
Bach Y, Abrahamyan L, Lee DS, Dharma C, Day J, Parker JD, Benson L, Osten M, Horlick E. Long-Term Outcomes of Adults with Tricuspid Regurgitation Following Transcatheter Atrial Septal Defect Closure. Can J Cardiol 2021; 38:330-337. [PMID: 34974138 DOI: 10.1016/j.cjca.2021.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/22/2021] [Accepted: 12/23/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Functional tricuspid regurgitation (TR) is a common pathophysiological condition in adults with secundum atrial septal defect (ASD). The aim of this study was to evaluate long-term outcomes following transcatheter ASD closure, which have not been well studied among patients with significant TR. METHODS We reviewed consecutive adult patients who underwent transcatheter ASD closure at Toronto General Hospital, Ontario, Canada, between 1998 and 2016. We linked our hospital registry with Ontario population-based health administrative databases to collect longitudinal data on inpatient and outpatient healthcare utilization and vital status. RESULTS In this cohort study of 949 patients, 199 (22%) patients had moderate to severe TR prior to transcatheter ASD closure. A significant proportion of patients (61%) showed improvement in TR severity to at least mild TR following ASD intervention. At a median follow-up of 10.9 years, patients with baseline mild or no TR, compared to those with greater than moderate TR, had significantly lower rates of all-cause mortality (6.8 vs 22.5 per 1000 person years (PY), p=<0.001), composite hospitalization for atrial fibrillation (AF) or heart failure (HF) (22.3 vs 49.1 per 1000 PY, p<0.001), and new onset of AF (10.4 vs 20.2 per 1000 PY, p=0.002), and HF (5.0 vs 9.2 per 1000 PY, p=0.039). Pre-procedural TR was independently associated with higher all-cause mortality (adjusted hazards ratio; HR=1.69, 95% confidence interval: 1.08-2.62). CONCLUSIONS TR severity was independently associated with a higher risk of mortality and morbidity. Further investigation of earlier device closure or concomitant tricuspid valve intervention may be of interest.
Collapse
Affiliation(s)
- Yvonne Bach
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada; Institute of Medical Science, Cardiovascular Sciences Collaborative Program University of Toronto, Toronto, ON, Canada.
| | - Lusine Abrahamyan
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Douglas S Lee
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Toronto General Hospital, University Health Network, Toronto, ON, Canada; ICES, Toronto, ON, Canada
| | | | - Jennifer Day
- Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - John D Parker
- Toronto General Hospital, University Health Network, Toronto, ON, Canada; Mount Sinai Hospital, Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada
| | - Lee Benson
- The Labatt Family Heart Centre, The Hospital for Sick Children, Division of Cardiology, The University of Toronto School of Medicine, Toronto, ON, Canada
| | - Mark Osten
- Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Eric Horlick
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada; Toronto General Hospital, University Health Network, Toronto, ON, Canada; Institute of Medical Science, Cardiovascular Sciences Collaborative Program University of Toronto, Toronto, ON, Canada
| |
Collapse
|
6
|
Velocity Vector Imaging Assessment of Functional Change in the Right Ventricle during Transcatheter Closure of Atrial Septal Defect by Intracardiac Echocardiography. J Clin Med 2020; 9:jcm9041132. [PMID: 32326588 PMCID: PMC7230484 DOI: 10.3390/jcm9041132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/09/2020] [Accepted: 04/13/2020] [Indexed: 11/17/2022] Open
Abstract
The functional change of the right ventricle (RV) after atrial septal defect (ASD) via transcatheter closure is well known. We assessed the immediate RV functional change using velocity vector imaging (VVI) with intracardiac echocardiography (ICE). Seventy-four patients who underwent transcatheter closure of an ASD were enrolled. VVI in the “home view” of ICE showing the RV was obtained before and after the procedure. Velocity, strain, strain rate (SR), and longitudinal displacement were analyzed from VVI data, and the changes of these parameters before and after the procedure were compared. The velocity of the RV decreased after ASD transcatheter closure (3.97 ± 1.48 to 3.56 ± 1.4, p = 0.024), especially in the RV inlet and outlet. The average strain decreased (−19.21 ± 5.79 to −16.87 ± 5.03, p = 0.002), as did the average SR (−2.28 ± 0.64 to −2.03 ± 0.61, p = 0.006). The average longitudinal displacement did not differ. With the VVI technique, we could clearly observe RV functional change immediately after transcatheter closure of the ASD. RV functional change with regional difference may reflect the heterogeneity of volume reduction and suggest subclinical RV dysfunction. These findings can enhance our understanding of the physiologic changes in the RV during reverse remodeling.
Collapse
|
7
|
El-Sisi A, Dabour S, Fattouh AM, Assar E, Naguib R, AbdelMassih AF. Biventricular reverse remodeling and relationship with mitral valve prolapse after transcatheter closure of ASD secundum, a 3D echocardiographic study. J Cardiovasc Thorac Res 2020; 12:15-19. [PMID: 32211133 PMCID: PMC7080331 DOI: 10.34172/jcvtr.2020.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 12/04/2019] [Indexed: 12/02/2022] Open
Abstract
Introduction: Mitral valve prolapse (MVP) is the most common anomaly of the mitral valve. Several studies have shown prevalence of MVP in atrial septal defect (ASD) especially secundum types (II). The aims of this study is to show the potential role of 3D echocardiography in improving the diagnosis of MVP and to depict the relationship between reverse remodeling of the right and left ventricles (RV, LV) and MVP after transcatheter closure of ASD II. Methods: Sixty patients underwent transcatheter closure of ASD II and completed follow up by 2D and 3D echocardiography in Cairo University Children Hospital before the procedure and at 24 hours, 1 and 6 months after the procedure. Results: 3D echocardiography was more accurate than 2D echocardiography in detecting MVP frequency in ASD II patients (75% vs. 50%). Maximum statistically significant remodeling was detected by 3D echocardiography 1 month after the procedure (RV: LV ratio by 3D echocardiography 1.9±0.03 24 hours after the procedure vs. 1.6±0.03 1 months after the procedure, P <0.01) while 2D echocardiography was delayed in detecting biventricular reverse remodeling. 3D derived RV: LV ratio was accurate in detecting MVP status with a sensitivity of 88%. Conclusion: MVP in ASD II may be related to Biventricular remodeling; 3D echocardiography is accurate in the detection of reverse remodeling as well as MVP in ASD II patients before and after device closure.
Collapse
Affiliation(s)
- Amal El-Sisi
- Pediatric Cardiology Unit, Pediatrics' Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Shaheen Dabour
- Pediatric Cardiology Unit, Pediatrics' Department, Faculty of Medicine, Benha University, Benha, Egypt
| | - Aya M Fattouh
- Pediatric Cardiology Unit, Pediatrics' Department, Faculty of Medicine, Benha University, Benha, Egypt
| | - Effat Assar
- Pediatric Cardiology Unit, Pediatrics' Department, Faculty of Medicine, Benha University, Benha, Egypt
| | - Rasha Naguib
- Pediatric Cardiology Unit, Pediatrics' Department, Faculty of Medicine, Benha University, Benha, Egypt
| | - Antoine Fakhry AbdelMassih
- Pediatric Cardiology Unit, Pediatrics' Department, Faculty of Medicine, Cairo University, Cairo, Egypt.,Pediatric Cardio-Oncology Department, Children's Cancer Hospital Egypt (CCHE 57357), Cairo, Egypt
| |
Collapse
|
8
|
P wave dispersion in assessment of dysrhythmia risk in patients with secundum type atrial septal defect and the effect of transcatheter or surgical closure. Cardiol Young 2020; 30:263-270. [PMID: 31854289 DOI: 10.1017/s1047951119002828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Atrial dysrhythmia is an important cause of mortality and morbidity in patients with atrial septal defect. Increased P wave duration can predict the risk of atrial dysrhythmia. The aim of this study is to evaluate the risk of atrial dysrhythmia by measuring P wave dispersion, and to observe the effect of surgical and transcatheter closure. Sixty-one patients and 30 controls were investigated. In patient group, before and after closure and in control group at the time of presentation, 12-lead electrocardiography records were evaluated. P wave duration and amplitude, P wave axis, PR interval, P wave dispersion, QRS axis, corrected QT interval, and QT dispersion were calculated. The measurements in patient and control groups, measurements before and after closure, and measurements of surgical and transcatheter group were compared. There were 27 patients in surgical group and 34 patients in transcatheter group. In patient group, signs of right heart volume overload were apparent but there was no significant difference in terms of P wave dispersion between two groups. We compared patient group in itself and found that while the use of medication, cardiothoracic index, ratio of right ventricular dilation, and paradoxical movement in interventricular septum were increased, mean age of closure was younger in surgical group. While P wave dispersion decreased in transcatheter group after closure, it increased in surgical group (p = 0.021). In conclusion, atrial septal defects may cause atrial repolarisation abnormalities and this effect persists even after surgical closure. Transcatheter closure in childhood may decrease dysrhythmia risk in long-term follow-up.
Collapse
|
9
|
Jung SY, Kim AY, Jung JW, Choi JY. Procedural, Early and Long-term Outcomes after Percutaneous Closure of Atrial Septal Defect: Comparison between Large and Very Large Atrial Septal Defect Groups. Korean Circ J 2019; 49:975-986. [PMID: 31165594 PMCID: PMC6753025 DOI: 10.4070/kcj.2018.0391] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 03/13/2019] [Accepted: 04/10/2019] [Indexed: 12/03/2022] Open
Abstract
Background This study aimed to compare procedural, early and long-term outcome of device closure of atrial septal defect (ASD) between large ASD patients and very large ASD patients. Methods We carried a retrospective study of adult large ASD (defined as ≥25 mm) treated by percutaneous closure using Amplatzer septal occluder during 12-year period (May 2003–February 2015) at a single tertiary center. A total of 269 patients were divided into 2 groups, according to the pre-procedural maximal ASD diameter; 25 mm≤ASD<35mm, group 1 (n=216) and 35 mm≤ASD, group 2 (n=53). We compared procedural parameters, early complications and long-term follow-up results between 2 groups. Results The need of modified implantation techniques (MITs) was higher group 2 (23.6% vs. 37.7%, p=0.034). Procedural success rate was considerably high in both groups (99.1% in group 1 vs. 100% in group 2, p=0.620). Major complications were occurred in 4 (1.5%) patients (1.4% vs. 1.9%, p=0.804). Minor complication rate was not different between 2 groups. During long-term follow-up (47.2±32.0 months, range, 6.0–135.5), there was one major complication (0.4%) of stroke. Most common long-term minor event was migraine headache (3.9%) followed by arrhythmias (1.9%) without statistical difference between 2 groups. Conclusions Although MIT was more frequently required in very large ASD groups, the procedural, early and long-term outcomes after percutaneous ASD closure were similar in both groups. This suggested that percutaneous ASD closure for very large ASD could be considered a good treatment option.
Collapse
Affiliation(s)
- Se Yong Jung
- Division of Pediatric Cardiology, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Ah Young Kim
- Division of Pediatric Cardiology, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Jo Won Jung
- Division of Pediatric Cardiology, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Young Choi
- Division of Pediatric Cardiology, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.
| |
Collapse
|
10
|
Razak A, Said Mohd M, Hajri A, Shetty KR, Nayak K. Left Ventricular Torsion Deformation in Atrial Septal Defect Patients Undergoing Transcatheter Device Closure. INTERNATIONAL JOURNAL OF CARDIOVASCULAR PRACTICE 2018. [DOI: 10.21859/ijcp-03033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
11
|
Prochownik P, Przewłocki T, Podolec P, Wilkołek P, Sobień B, Gancarczyk U, Podolec N, Komar M. Improvement of physical capacity in patients undergoing transcatheter closure of atrial septal defects. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2018; 14:90-94. [PMID: 29743909 PMCID: PMC5939550 DOI: 10.5114/aic.2018.74360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 08/29/2017] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Atrial septal defect (ASD) is the most common congenital cardiac anomaly diagnosed in adults. It often remains asymptomatic until the fourth or fifth decade of life. Significant left-to-right interatrial shunting is associated with the risk of heart failure, pulmonary hypertension and atrial fibrillation. Percutaneous ASD closure is a recognized method of treatment. AIM To evaluate the clinical outcomes and physical capacity in patients undergoing transcatheter closure of ostium secundum ASD. MATERIAL AND METHODS One hundred and twenty adult patients (75 females and 45 males) with a mean age of 43.1 ±13.3 (17-78) years who underwent transcatheter device closure of ostium secundum ASD were analyzed. Clinical evaluation and transthoracic color Doppler echocardiographic study were repeated in all patients before as well as 1 and 24 months after the procedure. To assess the physical capacity symptom-limited treadmill exercise tests with respiratory gas-exchange analysis were performed in all patients before the procedure and after 24 months of follow-up. RESULTS The devices were successfully implanted in all patients. During 24 months of follow-up all patients showed significant clinical and spiroergometric improvement of exercise capacity, and a significant decrease of right heart chamber overload features on echocardiography. CONCLUSIONS Transcatheter closure of ASD in patients with significant shunt resulted in significant clinical and hemodynamic improvement regardless of the baseline functional class.
Collapse
Affiliation(s)
- Paweł Prochownik
- Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland
| | - Tadeusz Przewłocki
- Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland
| | - Piotr Podolec
- Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland
| | - Piotr Wilkołek
- Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland
| | - Bartosz Sobień
- Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland
| | - Urszula Gancarczyk
- Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland
| | - Natalia Podolec
- Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Monika Komar
- Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland
| |
Collapse
|
12
|
Yoo BW, Kim JO, Eun LY, Choi JY, Kim DS. Time course of the changes in right and left ventricle function and associated factors after transcatheter closure of atrial septal defects. CONGENIT HEART DIS 2017; 13:131-139. [DOI: 10.1111/chd.12541] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 09/06/2017] [Accepted: 09/10/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Byung W. Yoo
- Department of Clinical Pharmacology, Clinical Trial Center, Severance Hospital; Yonsei University College of Medicine; Seoul Korea
| | - Jung O. Kim
- Division of Pediatric Cardiology, Department of Pediatrics; Yonsei University College of Medicine; Seoul Korea
| | - Lucy Y. Eun
- Division of Pediatric Cardiology, Department of Pediatrics; Yonsei University College of Medicine; Seoul Korea
| | - Jae Y. Choi
- Division of Pediatric Cardiology, Department of Pediatrics; Yonsei University College of Medicine; Seoul Korea
| | - Dong S. Kim
- Department of Pediatrics, Severance Children's Hospital; Yonsei University College of Medicine; Seoul Korea
| |
Collapse
|
13
|
Wang J, Patel M, Xiao M, Xu Z, Jiang S, Sun X, Xu L, Wang H. Incidence and predictors of asymptomatic pericardial effusion after transcatheter closure of atrial septal defect. EUROINTERVENTION 2017; 12:e250-6. [PMID: 27290684 DOI: 10.4244/eijv12i2a39] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
AIMS Pericardial effusion (PE) without obvious periprocedural complications (e.g., cardiac perforation, device erosion) may occur after transcatheter closure of secundum atrial septal defects (ASD). The aim of the study was to investigate the incidence and predictors of PE unrelated to procedural complications. METHODS AND RESULTS We included all patients who had undergone successful percutaneous ASD closure from June 2009 to April 2014 (n=2,652) with no pre-existing PE or cardiac perforation or erosion. Transthoracic echocardiography (TTE) was performed during the procedure and one, three, and six months postoperatively. After device implantation, fifty patients (1.9%) developed new-onset PE (37 immediately, 13 during follow-up). These patients were asymptomatic, stable haemodynamically, and had no new arrhythmias. PE appeared mild (5.1±1.9 mm) and homogeneously echolucent by TTE. PE diminished spontaneously. Compared with 2,602 patients without PE, factors independently predicting asymptomatic PE were the device touching the atrial free wall, device size, patient age, and total defect size. Areas under the receiver operating characteristic curves were 0.78 (p<0.001), 0.66 (p<0.001) and 0.77 (p<0.001) for device size, patient age, and total defect size, respectively. CONCLUSIONS This is the first systematic report of a new type of PE. Our data provide new insights into new-onset PE after percutaneous ASD closure.
Collapse
Affiliation(s)
- Jingjin Wang
- Department of Echocardiography, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | | | | | | | | | | | | | | |
Collapse
|
14
|
Agha HM, El-Saiedi SA, Shaltout MF, Hamza HS, Nassar HH, Abdel-Aziz DM, Tantawy AEE. Incomplete RV Remodeling After Transcatheter ASD Closure in Pediatric Age. Pediatr Cardiol 2015; 36:1523-31. [PMID: 25981566 DOI: 10.1007/s00246-015-1196-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 05/06/2015] [Indexed: 10/23/2022]
Abstract
Published data showing the intermediate effect of transcatheter device closure of atrial septal defect (ASD) in the pediatric age-group are scarce. The objective of the study was to assess the effects of transcatheter ASD closure on right and left ventricular functions by tissue Doppler imaging (TDI). The study included 37 consecutive patients diagnosed as ASD secundum by transthoracic echocardiography and TEE and referred for transcatheter closure at Cairo University Specialized Pediatric Hospital, Egypt, from October 2010 to July 2013. Thirty-seven age- and sex-matched controls were selected. TDI was obtained using the pulsed Doppler mode, interrogating the right cardiac border (the tricuspid annulus) and lateral mitral annulus, and myocardial performance index (MPI) was calculated at 1-, 3-, 6- and 12-month post-device closure. Transcatheter closure of ASD and echocardiographic examinations were successfully performed in all patients. There were no significant differences between two groups as regards the age, gender, weight or BSA. TDI showed that patients with ASD had significantly prolonged isovolumetric contraction, relaxation time and MPI compared with control group. Decreased tissue Doppler velocities of RV and LV began at one-month post-closure compared with the controls. Improvement in RVMPI and LVMPI began at 1-month post-closure, but they are still prolonged till 1 year. Reverse remodeling of right and left ventricles began 1 month after transcatheter ASD closure, but did not completely normalize even after 1 year of follow-up by tissue Doppler imaging.
Collapse
Affiliation(s)
- Hala M Agha
- Pediatric Cardiology Division, Pediatric Department, Faculty of Medicine, Specialized Pediatric Hospital, Cairo University, Kasr Al Aini street, Cairo, 11562, Egypt.
| | - Sonia A El-Saiedi
- Pediatric Cardiology Division, Pediatric Department, Faculty of Medicine, Specialized Pediatric Hospital, Cairo University, Kasr Al Aini street, Cairo, 11562, Egypt.
| | - Mohamed F Shaltout
- Pediatric Cardiology Division, Pediatric Department, Faculty of Medicine, Specialized Pediatric Hospital, Cairo University, Kasr Al Aini street, Cairo, 11562, Egypt.
| | - Hala S Hamza
- Pediatric Cardiology Division, Pediatric Department, Faculty of Medicine, Specialized Pediatric Hospital, Cairo University, Kasr Al Aini street, Cairo, 11562, Egypt.
| | - Hayat H Nassar
- Pediatric Cardiology Division, Pediatric Department, Faculty of Medicine, Specialized Pediatric Hospital, Cairo University, Kasr Al Aini street, Cairo, 11562, Egypt.
| | - Doaa M Abdel-Aziz
- Pediatric Cardiology Division, Pediatric Department, Faculty of Medicine, Specialized Pediatric Hospital, Cairo University, Kasr Al Aini street, Cairo, 11562, Egypt.
| | - Amira Esmat El Tantawy
- Pediatric Cardiology Division, Pediatric Department, Faculty of Medicine, Specialized Pediatric Hospital, Cairo University, Kasr Al Aini street, Cairo, 11562, Egypt.
| |
Collapse
|
15
|
Ermis P, Franklin W, Mulukutla V, Parekh D, Ing F. Left Ventricular Hemodynamic Changes and Clinical Outcomes after Transcatheter Atrial Septal Defect Closure in Adults. CONGENIT HEART DIS 2014; 10:E48-53. [DOI: 10.1111/chd.12204] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/09/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Peter Ermis
- Department of Pediatric Cardiology; Texas Children's Hospital; Baylor College of Medicine; Houston Tex USA
| | - Wayne Franklin
- Department of Pediatric Cardiology; Texas Children's Hospital; Baylor College of Medicine; Houston Tex USA
| | - Venkatachalam Mulukutla
- Department of Pediatric Cardiology; Texas Children's Hospital; Baylor College of Medicine; Houston Tex USA
| | - Dhaval Parekh
- Department of Pediatric Cardiology; Texas Children's Hospital; Baylor College of Medicine; Houston Tex USA
| | - Frank Ing
- Department of Pediatric Cardiology; Children's Hospital of Los Angeles; Los Angeles Calif USA
| |
Collapse
|
16
|
Abstract
Atrial septal defects are the third most common type of congenital heart disease. Included in this group of malformations are several types of atrial communications that allow shunting of blood between the systemic and the pulmonary circulations. Most children with isolated atrial septal defects are free of symptoms, but the rates of exercise intolerance, atrial tachyarrhythmias, right ventricular dysfunction, and pulmonary hypertension increase with advancing age and life expectancy is reduced in adults with untreated defects. The risk of development of pulmonary vascular disease, a potentially lethal complication, is higher in female patients and in older adults with untreated defects. Surgical closure is safe and effective and when done before age 25 years is associated with normal life expectancy. Transcatheter closure offers a less invasive alternative for patients with a secundum defect who fulfil anatomical and size criteria. In this Seminar we review the causes, anatomy, pathophysiology, treatment, and outcomes of atrial septal defects in children and adult patients in whom this defect is the primary cardiac anomaly.
Collapse
Affiliation(s)
- Tal Geva
- Department of Cardiology, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
| | - Jose D Martins
- Department of Pediatric Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Rachel M Wald
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
17
|
Impact of ostium secundum atrial septal defect closure on the resolution of falsely positive electrocardiographic criteria for myocardial scarring. J Electrocardiol 2014; 47:197-201. [DOI: 10.1016/j.jelectrocard.2013.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Indexed: 11/21/2022]
|
18
|
Monfredi O, Luckie M, Mirjafari H, Willard T, Buckley H, Griffiths L, Clarke B, Mahadevan VS. Percutaneous device closure of atrial septal defect results in very early and sustained changes of right and left heart function. Int J Cardiol 2013; 167:1578-84. [PMID: 22608895 DOI: 10.1016/j.ijcard.2012.04.081] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Accepted: 04/14/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Oliver Monfredi
- Cardiovascular Research Group, School of Biomedicine, The University of Manchester, Level 3 Core Technology Facility, Grafton Street, Manchester M13 9NT, United Kingdom.
| | | | | | | | | | | | | | | |
Collapse
|
19
|
Shimpo H, Hojo R, Ryo M, Konuma T, Tempaku H. Transcatheter closure of secundum atrial septal defect. Gen Thorac Cardiovasc Surg 2013; 61:614-8. [DOI: 10.1007/s11748-013-0268-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Indexed: 10/26/2022]
|
20
|
Walters D, Boga T, Burstow D, Scalia G, Hourigan L, Aroney C. Percutaneous ASD Closure in a Large Australian Series: Short- and Long-Term Outcomes. Heart Lung Circ 2012; 21:572-5. [DOI: 10.1016/j.hlc.2012.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2011] [Revised: 04/28/2012] [Accepted: 05/02/2012] [Indexed: 10/28/2022]
|
21
|
VIJARNSORN CHODCHANOK, DURONGPISITKUL KRITVIKROM, CHANTHONG PRAKUL, CHUNGSOMPRASONG PAWEENA, SOONGSWANG JARUPIM, LOAHAPRASITIPORN DUANGMANEE, NANA APICHART, KURASIRIKUL SURUTHAI, NIMDET KACHAPORN. Beneficial Effects of Transcatheter Closure of Atrial Septal Defects Not Only in Young Adults. J Interv Cardiol 2012; 25:382-90. [DOI: 10.1111/j.1540-8183.2012.00723.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
22
|
Assessment of right ventricular function by three-dimensional echocardiography and myocardial strain imaging in adult atrial septal defect before and after percutaneous closure. Int J Cardiovasc Imaging 2012; 28:1905-16. [PMID: 22310981 DOI: 10.1007/s10554-012-0022-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Accepted: 01/19/2012] [Indexed: 10/14/2022]
|
23
|
Park JJ, Lee SC, Kim JB, Seo DJ, Song JM, Yun SC, Yun TJ. Deterioration of Mitral Valve Competence After the Repair of Atrial Septal Defect in Adults. Ann Thorac Surg 2011; 92:1629-33. [DOI: 10.1016/j.athoracsur.2011.05.118] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2011] [Revised: 05/11/2011] [Accepted: 05/16/2011] [Indexed: 10/17/2022]
|
24
|
Fang F, Yu CM, Sanderson JE, Luo XX, Jiang X, Yip GWK, Lam YY. Prevalence and determinants of incomplete right atrial reverse remodeling after device closure of atrial septal defects. Am J Cardiol 2011; 108:114-9. [PMID: 21529749 DOI: 10.1016/j.amjcard.2011.03.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Revised: 02/28/2011] [Accepted: 03/03/2011] [Indexed: 10/18/2022]
Abstract
Whether the relief of chronic right atrial (RA) volume load by device closure of an atrial septal defect (ASD) normalizes RA size is unknown. The present study evaluated the prevalence and determinants of incomplete RA reverse remodeling (RAR) after ASD closure in adults. Transthoracic echocardiography was performed in 44 consecutive patients with secundum ASD (age 43 ± 17 years, 10 men) without a history of atrial arrhythmia shortly before and at 3 months after device closure of ASD. The pulmonary/systemic flow ratio was derived using invasive oximetry. The RA size had significantly decreased at 3 months of follow-up (RA volume index [RAVI] 52 ± 29 to 27 ± 17 ml/m(2), p <0.001). Incomplete RAR (defined as a RAVI of ≥21 ml/m(2)) was detected in 25 patients (57%) after closure. They were older, had a larger pulmonary/systemic flow ratio, a higher pulmonary arterial systolic pressure, more tricuspid regurgitation, and larger RA, left atrial, and right ventricular sizes before closure than those with a normalized right atrium. Before closure, RAVI was the only independent determinant for incomplete RAR (odds ratio 1.115, 95% confidence interval 1.019 to 1.220; p = 0.018). A cutoff value of RAVI of ≥40 ml/m(2) has a sensitivity of 84% and specificity of 72% in the receiver operating characteristic curve. The preclosure RAVI correlated moderately with the shunt-duration index, calculated by multiplying the age to pulmonary/systemic flow ratio (r = 0.64, p <0.01). In conclusion, incomplete RAR occurred in >1/2 of the adult patients at 3 months after ASD device closure and was related to excessive preclosure RA dilation.
Collapse
|
25
|
Samiei N, Bayat F, Moradi M, Parsaei M, Haghighi SZO, Mohebbi A, Hamzepour N, Noohi F. Comparison of the response of the right ventricle with endovascular occlusion and surgical closure in adults with atrial septal defect one year after intervention. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2010; 4:143-7. [PMID: 21234294 PMCID: PMC3018896 DOI: 10.4137/cmc.s6493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Use of the Amplatzer septal occluder (ASO) for the closure of secundum atrial septal defect (ASD) has recently become the procedure of choice, while earlier the only treatment for ASD was surgical closure. This study compares the right ventricular indices of the ASO group with the surgical closure group one year after intervention in adults. METHODS From January 2008 to February 2010, 38 patients with isolated atrial septal defect of the secundum type one year after surgical (n = 20, age = 27 ± 4 years, 13 females, 7 males) or Amplatzer septal occluder closure (n = 18, age = 25 ± 4 years, 12 females, 6 males) were studied. At the same time, thirty-one age-matched normal subjects (age = 26 ± 6 years, 23 females, 9 males) were included as the control group. Strain and strain rate of the right ventricle were measured. RESULTS The mean values of strain of the midportion were -26% ± 11.7%, -8.9% ± 4.2%, and 24.5% ± 7.4% (P < 0.001). Strain rates of the midportion were -2.19 ± 0.6 s(-1), -1.2 ± 0.4 s(-1), -1.9 ± 0.6 s(-1) (P < 0.001) in ASO, surgery, and control groups, respectively. CONCLUSION This study showed that the right ventricle might show better performance in the ASO than the surgery group in adults with ASD in midterm follow-up.
Collapse
|
26
|
Gao CH, Zhang H, Chen XJ. The impacts of transcatheter occlusion for congenital atrial septal defect on left ventricular systolic synchronicity: a three-dimensional echocardiography study. Echocardiography 2010; 27:324-8. [PMID: 20486961 DOI: 10.1111/j.1540-8175.2009.01054.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES To investigate the impacts of transcatheter occlusion for congenital atrial septal defect (ASD) on left ventricular (LV) systolic synchronicity using a real time three-dimensional echocardiography (RT3DE). METHODS Thirty patients with ASD closure were recruited for the study. Realtime three-dimensional echocardiographic data sets were acquired for the measurement of LV volumes LV ejection fractions and LV three-dimensional systolic synchronicity before and at 6 months after transcatheter occlusion for ASD. M-mode echocardiography and RT3DE were performed to characterize interventricular septal (IVS) motion. RESULTS There were no differences in LV systolic synchronicity between before and after transcatheter closure of ASD (Tmsv-16SD%: 5.6%+/- 1.4% vs 5.8%+/- 1.8%, P > 0.05; Tmsv-12SD%: 5.2 +/- 1.1% vs 5.4 +/- 1.2%, P > 0.05). But the abnormal IVS motion was found before device closure and normalized after transcatheter occlusion for ASD using M-mode echocardiography and the excursion-time figure (bull's-eye derived from RT3DE); At the same time, LV ejection fraction (59.8 +/- 2.6 vs 66.7 +/- 5.9, P < 0.05) stroke volume (49 +/- 14 vs 63 +/- 11, P < 0.05) was improved significantly as well as normalization of IVS motion after transcatheter occlusion for ASD. The correlation between ASD diameter and change of LVEF is significant (r = 0.85, P < 0.001). CONCLUSION Although transcatheter occlusion did not significantly impact on intrinsic LV systolic synchronicity in patients with ASD, LV systolic function can be improved through normalization of IVS abnormal motion after transcatheter ASD occlusion.
Collapse
Affiliation(s)
- Chun-Heng Gao
- Department of Ultrasonography, Jiangyin People's Hospital, South-East University, Jiangyin, Jiangsu, People's Republic of China.
| | | | | |
Collapse
|
27
|
Kaya MG, Baykan A, Dogan A, Inanc T, Gunebakmaz O, Dogdu O, Uzum K, Eryol NK, Narin N. Intermediate-term effects of transcatheter secundum atrial septal defect closure on cardiac remodeling in children and adults. Pediatr Cardiol 2010; 31:474-82. [PMID: 20084376 DOI: 10.1007/s00246-009-9623-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Accepted: 12/14/2009] [Indexed: 11/25/2022]
Abstract
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 follow-up 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.
Collapse
Affiliation(s)
- Mehmet G Kaya
- Department of Cardiology, Erciyes University School of Medicine, 38039 Kayseri, Turkey.
| | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Serum Levels of Natriuretic Peptides in Children before and after Treatment for an Atrial Septal Defect, a Patent Ductus Arteriosus, and a Coarctation of the Aorta-A Prospective Study. Int J Pediatr 2010; 2010:674575. [PMID: 20445736 PMCID: PMC2859410 DOI: 10.1155/2010/674575] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2009] [Revised: 12/13/2009] [Accepted: 02/08/2010] [Indexed: 11/18/2022] Open
Abstract
Background and Objectives. We evaluated and compared the influence of treatment for atrial septal defect (ASD), patent ductus arteriosus (PDA), and coarctation of the aorta (CoA) on serum levels of N-terminal proatriopeptide and N-terminal probrain natriuretic peptide. Correlations between peptide levels and echocardiographic measurements were calculated. Patients and Methods. Peptide levels were measured and echocardiography performed before and 6-12 months after treatment in 21 children with ASD, 25 with PDA, 15 with CoA, and 76 control children. Results. ANPN levels were higher than in controls at baseline in all patient groups, and NT-proBNP in patients with ASD and PDA. Both peptide levels were elevated 6 months after treatment and decreased thereafter. Peptide levels were higher in patients with volume than pressure overload. They correlated with echocardiographic measurements. At the 6-month follow-up, dimensions of the originally overloaded ventricle had normalized only in patients with PDA. Conclusions. After intervention, peptide levels decrease but normalization takes over 6 months. The type of correlation between peptide levels and echocardiography varies according to the loading condition. Measurement of peptide levels can be used for monitoring the course of a patient's heart disease.
Collapse
|
29
|
Rao PS, Lorch S. Left Ventricular Function after Percutaneous Occlusion of Atrial Septal Defects. Echocardiography 2010; 27:351-3. [PMID: 20486968 DOI: 10.1111/j.1540-8175.2009.01100.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
30
|
The Relative Atrial Index (RAI)—A Novel, Simple, Reliable, and Robust Transthoracic Echocardiographic Indicator of Atrial Defects. J Am Soc Echocardiogr 2010; 23:275-81. [DOI: 10.1016/j.echo.2009.11.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Indexed: 11/21/2022]
|
31
|
Mainzer G, Braver Y, Khoury A, Schwartz Y, Galenter-Yaniv L, Yalonetsky S, Lorber A. Morphologic, Mechanical, Conductive, and Hemodynamic Changes Following Transcatheter Closure of Atrial Septal Defect. CONGENIT HEART DIS 2010; 5:25-31. [DOI: 10.1111/j.1747-0803.2009.00371.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
32
|
Ding J, Ma G, Huang Y, Wang C, Zhang X, Zhu J, Lu F. Right Ventricular Remodeling after Transcatheter Closure of Atrial Septal Defect. Echocardiography 2009; 26:1146-52. [DOI: 10.1111/j.1540-8175.2009.00941.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
33
|
Taniguchi M, Akagi T, Ohtsuki S, Okamoto Y, Tanabe Y, Watanabe N, Nakagawa K, Toh N, Kusano K, Sano S. Transcatheter closure of atrial septal defect in elderly patients with permanent atrial fibrillation. Catheter Cardiovasc Interv 2009; 73:682-6. [DOI: 10.1002/ccd.21870] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
34
|
Lin WW, Fu YC, Jan SL, Wang KY, Ho HC, Lin FY, Ting CT, Chen YT. Immediate Change in Pulmonary Venous Flow Pattern after Deployment of Occluder Device for Atrial Septal Defect. Echocardiography 2009; 26:452-8. [DOI: 10.1111/j.1540-8175.2008.00835.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
35
|
Spies C, Hijazi ZM. Transcatheter Closure of Secundum Atrial Septal Defects in the Elderly. Korean Circ J 2009. [DOI: 10.4070/kcj.2009.39.2.47] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Christian Spies
- The Queen's Medical Center and Department of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Ziyad M. Hijazi
- Rush Center for Congenital and Structural Heart Disease, Rush University Medical Center, Chicago, IL, USA
| |
Collapse
|
36
|
Teo KSL, Dundon BK, Molaee P, Williams KF, Carbone A, Brown MA, Worthley MI, Disney PJ, Sanders P, Worthley SG. Percutaneous closure of atrial septal defects leads to normalisation of atrial and ventricular volumes. J Cardiovasc Magn Reson 2008; 10:55. [PMID: 19040763 PMCID: PMC2633333 DOI: 10.1186/1532-429x-10-55] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2008] [Accepted: 12/01/2008] [Indexed: 01/25/2023] Open
Abstract
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. METHODS Consecutive patients (n = 23) underwent CMR pre- and 6 months post-ASD closure. Steady state free precession cine CMR was performed using contiguous slices in both short and long axis views through the ASD. Data was collected for assessment of left and right atrial, ventricular end diastolic volumes (EDV) and end systolic volumes (ESV). Data is presented as mean +/- SD, volumes as mL, and paired t-testing performed between groups. Statistical significance was taken as p < 0.05. RESULTS There was a significant reduction in right ventricular volumes at 6 months post-ASD closure (RVEDV: 208.7 +/- 76.7 vs. 140.6 +/- 60.4 mL, p < 0.0001) and RVEF was significantly increased (RVEF 35.5 +/- 15.5 vs. 42.0 +/- 15.2%, p = 0.025). There was a significant increase in the left ventricular volumes (LVEDV 84.8 +/- 32.3 vs. 106.3 +/- 38.1 mL, p = 0.003 and LVESV 37.4 +/- 20.9 vs. 46.8 +/- 18.5 mL, p = 0.016). However, there was no significant difference in LVEF and LV mass post-ASD closure. There was a significant reduction in right atrial volumes at 6 months post-ASD closure (pre-closure 110.5 +/- 55.7 vs. post-closure 90.7 +/- 69.3 mL, p = 0.019). Although there was a trend to a decrease in left atrial volumes post-ASD closure, this was not statistically significant (84.5 +/- 34.8 mL to 81.8 +/- 44.2 mL, p = NS). CONCLUSION ASD closure leads to normalisation of ventricular volumes and also a reduction in right atrial volume. Further follow-up is required to assess how this predicts outcomes such as risk of atrial arrhythmias after such procedures.
Collapse
Affiliation(s)
- Karen SL Teo
- Cardiovascular Research Centre, Royal Adelaide Hospital and The University of Adelaide, Adelaide, South Australia, Australia
- The University of Adelaide, Adelaide, South Australia, Australia
| | - Benjamin K Dundon
- Cardiovascular Research Centre, Royal Adelaide Hospital and The University of Adelaide, Adelaide, South Australia, Australia
- The University of Adelaide, Adelaide, South Australia, Australia
| | - Payman Molaee
- Cardiovascular Research Centre, Royal Adelaide Hospital and The University of Adelaide, Adelaide, South Australia, Australia
- The University of Adelaide, Adelaide, South Australia, Australia
| | - Kerry F Williams
- Cardiovascular Research Centre, Royal Adelaide Hospital and The University of Adelaide, Adelaide, South Australia, Australia
| | - Angelo Carbone
- Cardiovascular Research Centre, Royal Adelaide Hospital and The University of Adelaide, Adelaide, South Australia, Australia
| | - Michael A Brown
- Cardiovascular Research Centre, Royal Adelaide Hospital and The University of Adelaide, Adelaide, South Australia, Australia
| | - Matthew I Worthley
- Cardiovascular Research Centre, Royal Adelaide Hospital and The University of Adelaide, Adelaide, South Australia, Australia
- The University of Adelaide, Adelaide, South Australia, Australia
| | - Patrick J Disney
- Cardiovascular Research Centre, Royal Adelaide Hospital and The University of Adelaide, Adelaide, South Australia, Australia
| | - Prashanthan Sanders
- Cardiovascular Research Centre, Royal Adelaide Hospital and The University of Adelaide, Adelaide, South Australia, Australia
- The University of Adelaide, Adelaide, South Australia, Australia
| | - Stephen G Worthley
- Cardiovascular Research Centre, Royal Adelaide Hospital and The University of Adelaide, Adelaide, South Australia, Australia
- The University of Adelaide, Adelaide, South Australia, Australia
| |
Collapse
|
37
|
Blake GE, Lakkireddy D. Atrial Septal Defect and Atrial Fibrillation: The Known and Unknown. J Atr Fibrillation 2008; 1:45. [PMID: 28496588 DOI: 10.4022/jafib.45] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2008] [Revised: 05/19/2008] [Accepted: 08/25/2008] [Indexed: 11/10/2022]
Abstract
Atrial fibrillation (AF) is a common complication in patients with atrial septal defects (ASDs). The link between AF and ASD is fairly complex and entails modifications in electrophysiologic, contractile and structural properties, at the cellular and tissue level, of both atria, mainly due to chronic atrial stretch and dilation. Surgical repair or percutaneous closure of ASDs are equally effective in reducing mortality and symptoms but limited in preventing or curbing AF, unless combined with an arrhythmia-specific procedure. Transesophageal echocardiography (TEE) and intracardiac echocardiography (ICE) have improved the safety and success of the above procedures. Finally, clearer understanding of the pathophysiology of AF in patients with ASD (and CHF, in general) has led to target-specific advances in medical management.
Collapse
Affiliation(s)
- George E Blake
- Mid America Cardiology @ University of Kansas Hospital, Kansas City, KS
| | | |
Collapse
|
38
|
Ding J, Ma G, Huang Y, Zhang X, Liu B, Lu F. Atrial natriuretic peptide and three-dimensional echocardiography after transcatheter closure of atrial septal defect. Cardiovasc Ultrasound 2008; 6:35. [PMID: 18605990 PMCID: PMC2467405 DOI: 10.1186/1476-7120-6-35] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2008] [Accepted: 07/07/2008] [Indexed: 11/23/2022] Open
Abstract
Background Atrial septal defect (ASD) accounts for 10% of all congenital heart lesions and represent the third most congenital cardiac defect seen in adults. Atrial natriuretic peptide (ANP) is an important regulator of the sodium and volume homeostasis. This study was designed to investigate the changes in plasma ANP concentrations and three-dimensional echocardiography (3DE) measurements of cardiac volume in patients with ASD during transcatheter closure of defect. Methods Plasma ANP concentrations and transthoracic 3DE measurements of right ventricular volume were performed in 46 patients with ASD before closure, and at 3 days after closure. 22 healthy subjects matched for age, sex served as control subjects. Results The 46 patients (20 men, 26 women; mean age 26.32 ± 13.28, range 6 to 63 years) were diagnosed to secundum ASD (the stretched diameters of ASD were from 9~36(25.34 ± 7.80 mm), and had been successfully placed Amplatzer septal occluder (the sizes of occluder were from 11 to 40 mm). The results showed that compared with control subjects, plasma ANP concentrations were elevated in patients with ASD. Plasma ANP concentrations positively correlated significantly with pulmonary artery pressure (PAP) (r = 0.74, p < 0.05) and 3DE measurements of cardiac volumes (right ventricular end-diastolic (r = 0.50, p < 0.05) and end-systolic volume (r = 0.50, p < 0.05) and negatively correlated with RVEF (r = -0.38, p < 0.05). Transthoracic 3DE measurements of right ventricular volume and plasma ANP concentrations decreased significantly at 3 days after closure (p < 0.05) compared with it before closure. Conclusion Plasma ANP concentrations were markedly elevated in patients with pulmonary arterial hypertension and right ventricular volume overload and decreased significantly after closure of ASD. This study suggested that ANP may help to identify patients with ASD complicated by pulmonary arterial hypertension and right ventricular volume overload that demanded early intervention and may become effective marker for evaluating changes in cardiac load after transcatheter ASD closure.
Collapse
Affiliation(s)
- Jingdong Ding
- Department of Cardiology, Zhongda hospital & School of Clinical Medicine Southeast University, Nanjing, PR China.
| | | | | | | | | | | |
Collapse
|
39
|
Eerola A, Pihkala JI, Boldt T, Mattila IP, Poutanen T, Jokinen E. Hemodynamic improvement is faster after percutaneous ASD closure than after surgery. Catheter Cardiovasc Interv 2007; 69:432-41; discussion 442. [PMID: 17195197 DOI: 10.1002/ccd.20962] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Hemodynamic effects of surgical and percutaneous closure of atrial septal defect (ASD) were evaluated. BACKGROUND ASD causes volume overload of right ventricle (RV) and is associated with distortion and dysfunction of left ventricle (LV). The amount and timing of hemodynamic changes after ASD closure are not well known. METHODS The study group consisted of 7 children treated surgically and 17 treated in the catheterization laboratory. In the control group, there were 51 healthy children. RV size and LV end-diastolic and systolic dimensions, volumes, and function were examined by two- and three- dimensional echocardiography and serum concentrations of natriuretic peptides measured prior to ASD closure, and 1, 6, and 12 months thereafter. RESULTS In all children with ASD, during the 1-year follow-up, the z score of RV end-diastolic diameter decreased from a median 5.00 SD to 2.25 SD (P < 0.001). Dilatation of RV did not resolve entirely during 1-year follow-up in either treatment group. End-diastolic LV diameter increased from -1.50 to -0.50 SD (P < 0.001). LV size increased slower in the surgical subgroup but reached control levels in both groups. Concentrations of natriuretic peptides increased during the first month after ASD closure and normalized thereafter in patients treated percutaneously but remained higher than in controls in patients treated surgically. CONCLUSIONS During 1-year follow-up after ASD closure, RV size decreases but does not normalize in all patients. The size of the LV normalizes after ASD closure but the increase in LV size is slower in patients treated surgically. Serum levels of ANPN and proBNP are elevated prior to ASD closure but decrease thereafter to control levels in patients treated with the percutaneous technique but not in those treated surgically.
Collapse
MESH Headings
- Adolescent
- Atrial Natriuretic Factor/blood
- Biomarkers/blood
- Cardiac Catheterization
- Cardiac Surgical Procedures
- Cardiopulmonary Bypass
- Case-Control Studies
- Child
- Child, Preschool
- Echocardiography/methods
- Female
- Follow-Up Studies
- Heart Septal Defects, Atrial/complications
- Heart Septal Defects, Atrial/diagnostic imaging
- Heart Septal Defects, Atrial/physiopathology
- Heart Septal Defects, Atrial/surgery
- Heart Ventricles/physiopathology
- Humans
- Male
- Natriuretic Peptide, Brain/blood
- Peptide Fragments/blood
- Protein Precursors/blood
- Stroke Volume
- Time Factors
- Treatment Outcome
- Ventricular Dysfunction, Left/etiology
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Dysfunction, Right/etiology
- Ventricular Dysfunction, Right/physiopathology
- Ventricular Function, Left
- Ventricular Function, Right
Collapse
Affiliation(s)
- Anneli Eerola
- Department of Pediatrics, University Hospital of Kuopio, Kuopio, Finland.
| | | | | | | | | | | |
Collapse
|
40
|
Rosas M, Zabal C, Garcia-Montes J, Buendia A, Webb G, Attie F. Transcatheter versus surgical closure of secundum atrial septal defect in adults: impact of age at intervention. A concurrent matched comparative study. CONGENIT HEART DIS 2007; 2:148-55. [PMID: 18377458 DOI: 10.1111/j.1747-0803.2007.00091.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To compare the short- and mid-term outcomes of surgical (SUR) vs. transcatheter closure of secundum atrial septal defect (ASD) using Amplatzer septal occluder (ASO) in adults with a very similar spectrum of the disease; and to identify predictors for the primary end point. DESIGN Single-center, concurrent comparative study. Surgically treated patients were randomly matched (2:1) by age, sex, date of procedure, ASD size, and hemodynamic profile. SETTING Tertiary referral center. PATIENTS One hundred sixty-two concurrent patients with ASD submitted to ASO (n = 54) or SUR closure (n = 108) according with their preferences. MAIN OUTCOME MEASURES Primary end point was a composite index of major events including failure of the procedure, important bleeding, critical arrhythmias, serious infections, embolism, or any major cardiovascular intervention-related complication. Predictors of these major events were investigated. RESULTS Atrial septal defects were successfully closed in all patients, and there was no mortality. The primary event rate was 13.2% in ASO vs. 25.0% in SUR (P = .001). Multivariate analysis showed that higher rate of events was significantly associated with age >40 years; systemic/pulmonary output ratio <2.1; and systolic pulmonary arterial pressure >50 mm Hg; while in the ASO group the event rate was only associated with the ASD size (>15 cm(2)/m(2); relative risk = 1.75, 95% confidence interval 1.01-8.8). There were no differences in the event-free survival curves in adults with ages <40 years. CONCLUSIONS The efficacy for closure ASD was similar in both groups. The higher morbidity observed in SUR group was observed only in the patients submitted to the procedure with age >40 years. The length of hospital stay was shorter in the ASO group. Surgical closure is a safe and effective treatment, especially in young adults. There is certainly nothing wrong with continuing to do surgery in countries where the resources are limited.
Collapse
Affiliation(s)
- Martin Rosas
- Instituto Nacional de Cardiologia-Adult Cardiology, Mexico City, Mexico.
| | | | | | | | | | | |
Collapse
|
41
|
Marie Valente A, Rhodes JF. Current indications and contraindications for transcatheter atrial septal defect and patent foramen ovale device closure. Am Heart J 2007; 153:81-4. [PMID: 17394907 DOI: 10.1016/j.ahj.2007.01.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
42
|
Giardini A, Donti A, Specchia S, Formigari R, Oppido G, Picchio FM. Long-term impact of transcatheter atrial septal defect closure in adults on cardiac function and exercise capacity. Int J Cardiol 2007; 124:179-82. [PMID: 17399817 DOI: 10.1016/j.ijcard.2006.12.031] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2006] [Revised: 11/21/2006] [Accepted: 12/30/2006] [Indexed: 11/21/2022]
Abstract
BACKGROUND The long-term impact of transcatheter atrial septal defect (ASD) closure on right ventricular (RV) remodeling and exercise capacity is unknown. METHODS We studied with cardiopulmonary exercise testing and transthoracic echocardiography 29 adults (age 42.3+/-16.4 years) with hemodynamically significant ASD just before transcatheter defect closure and after 6 and >36 months from closure. RESULTS Compared to 6 months after closure, a further improvement of peak oxygen uptake (p<0.001) and of the slope of ventilation/carbon dioxide production (p<0.001) was observed 3 years after the procedure, so that peak oxygen uptake appeared to be within the normal range in 23/29 patients (79%). Right ventricular short-axis (p<0.05) and long-axis (p<0.05) diameters further decreased beyond the 6-month period. The long-term improvement in exercise capacity correlated with pulmonary-to-systemic flow ratio (R=0.55, p=0.003) and with percentage decrease in RV short-axis diameter (R=0.59, p=0.002), but it did not correlate with age at closure (R=0.25, p=0.46). All patients who did not achieve a normal exercise capacity after 3 years from closure had a severely depressed pre-closure peak oxygen uptake (<50% of predicted). CONCLUSIONS Adults who undergo transcatheter ASD closure may experience a further improvement in exercise capacity in the long term. The long-term improvement in exercise capacity is associated to an improvement in cardiac form and function and is not influenced by age at closure. Even if the majority of patients may reach a normal exercise capacity after ASD closure, an abnormal exercise capacity may persist in those patients that had a peak oxygen uptake below 50% of predicted value before the procedure.
Collapse
Affiliation(s)
- Alessandro Giardini
- Pediatric Cardiology and Adult Congenital Unit, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy.
| | | | | | | | | | | |
Collapse
|
43
|
Wu ET, Akagi T, Taniguchi M, Maruo T, Sakuragi S, Otsuki S, Okamoto Y, Sano S. Differences in right and left ventricular remodeling after transcatheter closure of atrial septal defect among adults. Catheter Cardiovasc Interv 2007; 69:866-71. [PMID: 17390329 DOI: 10.1002/ccd.21075] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To evaluate acute cardiac remodeling after transcatheter closure of atrial septal defect (ASD) in adult patients. BACKGROUND In adult patients with ASD, longer periods of cardiac adaptation should be expected after the procedure due to long-standing RV volume overload and subsequent changes in the pulmonary vasculature. There are limited reports about this remodeling in adult patients. METHODS We prospectively enrolled 17 adults (mean age 58.4 +/- 17.3 years) who underwent successful transcatheter closure of their ASDs from August 2005 to July 2006. We performed routine transthoracic echocardiographic studies, including LV and RV myocardial performance indices, or Tei indices, and plasma brain natriuretic peptide (BNP) sampling before closure of the ASD, and 1 day, 1 month, and 3 months after closure. RESULTS We found (1) LV end diastolic diameter increased, and RVEDD decreased markedly after the closure; (2) differences existed in LV and RV adaptation. While LV Tei index improved soon after the procedure, RV Tei index worsened until 1 month after the procedure, then recovered by the 3 month follow-up visit; and (3) BNP elevated 1 day after closure of the ASD and declined by the 1-month follow-up visit. CONCLUSION "Shrinkage" of the RV and "expansion" of the LV occurred soon after the procedure, even in elderly patients. Device closure of ASDs caused rapid improvement of LV function, but RV function underwent transient deterioration, probably due to delayed changes in RV ventricular mass in the face of acute volume reduction in this aged cohort.
Collapse
MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Cardiac Catheterization
- Echocardiography
- Echocardiography, Doppler, Color
- Female
- Follow-Up Studies
- Heart Septal Defects, Atrial/blood
- Heart Septal Defects, Atrial/diagnostic imaging
- Heart Septal Defects, Atrial/physiopathology
- Heart Septal Defects, Atrial/therapy
- Heart Ventricles/diagnostic imaging
- Humans
- Male
- Middle Aged
- Natriuretic Peptide, Brain/blood
- Prospective Studies
- Reproducibility of Results
- Time Factors
- Treatment Outcome
- Ventricular Function, Left
- Ventricular Function, Right
- Ventricular Remodeling
Collapse
Affiliation(s)
- En-Ting Wu
- Cardiac Care Unit, Okayama University Hospital, Okayama, Japan
| | | | | | | | | | | | | | | |
Collapse
|
44
|
Lam YY, Yu CM. Improvement of biventricular function after transcatheter closure of atrial septal defect: a case report. Catheter Cardiovasc Interv 2006; 68:775-7. [PMID: 17039533 DOI: 10.1002/ccd.20614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We report a 17-year-old man presented with palpitation. Echocardiography demonstrated secundum atrial septal defect (ASD) with marked right sided dilatation, indicating significant left to right intracardiac shunting. Cardiac magnetic resonance imaging performed 3 months after transcatheter ASD closure demonstrated marked improvement in biventricular systolic function.
Collapse
Affiliation(s)
- Yat-Yin Lam
- Department of Medicine and Therapeutics, Division of Cardiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
| | | |
Collapse
|
45
|
Eyskens B, Ganame J, Claus P, Boshoff D, Gewillig M, Mertens L. Ultrasonic strain rate and strain imaging of the right ventricle in children before and after percutaneous closure of an atrial septal defect. J Am Soc Echocardiogr 2006; 19:994-1000. [PMID: 16880094 DOI: 10.1016/j.echo.2006.02.001] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2005] [Indexed: 11/16/2022]
Abstract
This study examined the influence of preload alterations on systolic right ventricular (RV) velocities and deformation indices in patients with atrial septal defect (ASD). A total of 21 patients with ASD underwent 2-dimensional echocardiography and color Doppler myocardial imaging scan before and 24 hours after transcatheter ASD closure. The data were compared with those obtained from 30 healthy age-matched children. Longitudinal peak systolic velocities, peak systolic strain rate (SR), and end-systolic strain (epsilon) were calculated in the midsegment of the RV free wall and the septum. In patients with ASD, higher RV peak systolic velocities were recorded, which returned to normal values after closure of the defect. In contrast, RV deformation indices in the patients with ASD were not different from normal values. These RV indices did not change significantly after ASD closure. We found a significantly decreased septal function after percutaneous ASD closure. This may be attributed to the device within the atrial septum, affecting deformation of the interventricular septum. In conclusion, RV longitudinal systolic deformation indices were not significantly influenced by chronic ventricular volume overload and sudden abolishment of this volume overload. These findings suggest that SR/epsilon are relatively load-stable measures of contractile function in the clinical setting. In contrast, myocardial velocities are clearly load dependent.
Collapse
Affiliation(s)
- Benedicte Eyskens
- Department of Pediatric Cardiology, University Hospital Leuven, Leuven, Belgium
| | | | | | | | | | | |
Collapse
|
46
|
Thilén U, Persson S. Closure of atrial septal defect in the adult. Cardiac remodeling is an early event. Int J Cardiol 2006; 108:370-5. [PMID: 15982760 DOI: 10.1016/j.ijcard.2005.05.042] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2005] [Revised: 04/29/2005] [Accepted: 05/13/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Study aimed to describe the extent and the temporal profile of cardiac remodeling after atrial septal defect closure in the adult. METHODS Prospective and longitudinal echocardiographic assessment of right and left heart size before and after (1 day-1 week/1/4/12 months) surgical or catheter-based atrial septal closure in 39 adults (age 54+/-15 years). RESULTS Right ventricular and atrial sizes were markedly reduced, left ventricular size increased and left atrial size remained unchanged after closure. Older age and a history of atrial fibrillation reduced the potential to normalize right and left atrial size after closure. The greater part of the changes occurred very early, in the 1st day/1st week. From then on the speed of change gradually diminished and after 4 months no important changes were observed. The mode of closure did not influence the degree or the pace of the remodeling. CONCLUSION Cardiac remodeling after atrial septal closure in the adult is a common and early event that seems by and large completed within the first half year after closure. The ventricles seem to have a higher capacity of remodeling than the atria in this setting. The mode of closure does not seem to significantly impact remodeling.
Collapse
Affiliation(s)
- U Thilén
- Department of Cardiology, Lund University, Lund University Hospital, SE-221 85 LUND, Sweden.
| | | |
Collapse
|
47
|
Santoro G, Pascotto M, Caputo S, Cerrato F, Cappelli Bigazzi M, Palladino MT, Iacono C, Carrozza M, Russo MG, Calabrò R. Similar cardiac remodelling after transcatheter atrial septal defect closure in children and young adults. Heart 2005; 92:958-62. [PMID: 16339812 PMCID: PMC1860715 DOI: 10.1136/hrt.2005.070169] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To study the cardiac geometric changes after transcatheter closure of large atrial septal defects (ASDs) according to patient age at the time of the procedure. DESIGN Prospective echocardiographic follow-up study. SETTING Tertiary referral centre. PATIENTS AND INTERVENTION 25 asymptomatic patients younger than 16 years (median 8 years; group 1) and 21 asymptomatic adults (median 38 years; group 2) underwent percutaneous closure of large ASD with the Amplatzer septal occluder device (mean 25 (SD 7) mm). MAIN OUTCOME MEASURES Cardiac remodelling was assessed by M mode and two dimensional echocardiography one and six months after ASD closure. RESULTS By six months, right atrial volume decreased from 31 (15) to 19 (5) ml/m(2) (p < 0.001) and right ventricular (RV) transverse diameter decreased from 29.8 (8.6) to 23.2 (5.6) mm/m(2) (p < 0.001). Conversely, left atrial volume did not change significantly (from 18 (6) to 20 (6) ml/m(2), NS) and left ventricular (LV) transverse diameter increased from 27.8 (6.4) to 31.8 (7.3) mm/m(2) (p < 0.05). Ventricular remodelling resulted in an RV:LV diameter ratio decrease from 1.1 (0.2) to 0.7 (0.1) (p < 0.001). The magnitude and time course of cardiac remodelling did not differ significantly between the age groups. Indeed, right atrial volume decreased by 33 (26)% versus 37 (23)%, RV diameter decreased by 26 (10)% versus 20 (13)%, LV diameter increased by 17 (15)% versus 15 (10)%, and RV:LV diameter ratio decreased by 36 (8)% versus 27 (15)% in groups 1 and 2, respectively. CONCLUSIONS Cardiac remodelling after percutaneous ASD closure seems to be independent of the patient's age at the time of the procedure up to early adulthood. Thus, postponing ASD closure for a few years may be a reasonable option for potentially suitable asymptomatic children.
Collapse
Affiliation(s)
- G Santoro
- Division of Cardiology, A O Monaldi, 2nd University of Naples, Naples, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Pascotto M, Santoro G, Cerrato F, Caputo S, Bigazzi MC, Iacono C, Carrozza M, Russo MG, Caianiello G, Calabrò R. Time-course of cardiac remodeling following transcatheter closure of atrial septal defect. Int J Cardiol 2005; 112:348-52. [PMID: 16303193 DOI: 10.1016/j.ijcard.2005.10.008] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2005] [Revised: 09/27/2005] [Accepted: 10/02/2005] [Indexed: 11/29/2022]
Abstract
BACKGROUND Right chamber dilatation and right-to-left volumetric unbalance are well-known cardiac consequences of atrial septal defect (ASD) shunt, accounting for most of its long-term complications. Thus, cardiac volumetric unloading is a major aim of ASD closure. Different from surgery, transcatheter option might be considered as an "unbiased" tool to evaluate the cardiac geometric remodeling following ASD closure. METHODS Extent and time-course of cardiac geometric changes were assessed by echocardiography 24 h, 1 and 6 months after percutaneous closure of large ASD (mean diameter 17+/-6 mm, QP/QS 2.2+/-0.9) in 42 asymptomatic patients (age 22+/-18 years). RESULTS Transcatheter closure was accomplished using the Amplatzer Septal Occluder device (mean 23+/-7 mm, median 24 mm), achieving a complete occlusion in all patients at the 6-month follow-up control. After ASD closure, right atrial (RA) volume reduced from 45+/-24 to 28+/-12 ml (-37.8%, p<0.001), while left atrial (LA) volume did not significantly change. Inlet and infundibulum right ventricular (RV) end-diastolic diameters reduced by 23+/-2% and 23+/-3%, respectively (p<0.001 for both measurements), although with a different time-course of changes. Finally, transverse left ventricular (LV) end-diastolic diameter increased from 39+/-7 to 44+/-5 mm (+11.4%, p<0.01). These geometric changes resulted in an RV/LV diameter ratio decrease by 34+/-3% (p<0.001). Nearly 90% of cardiac remodeling ensued within 1 month from shunt disappearance (50% within 24 h). CONCLUSIONS Percutaneous ASD closure results in early and striking cardiac geometric changes that almost completely revert the right-to-left volumetric unbalance. Most of this geometric remodeling ensues within a few weeks from ASD closure.
Collapse
Affiliation(s)
- Marco Pascotto
- Division of Cardiology, A.O. Monaldi, 2nd University of Naples, Naples, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Pascotto M, Santoro G, Caso P, Cerrato F, Caso I, Caputo S, Bigazzi MC, D'Andrea A, Russo MG, Calabrò R. Global and regional left ventricular function in patients undergoing transcatheter closure of secundum atrial septal defect. Am J Cardiol 2005; 96:439-42. [PMID: 16054478 DOI: 10.1016/j.amjcard.2005.03.096] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2004] [Revised: 03/25/2005] [Accepted: 03/25/2005] [Indexed: 11/18/2022]
Abstract
This study sought to evaluate global and regional left ventricular (LV) function before and early after device closure of atrial septal defects (ASDs) in patients with normal pulmonary pressure. Global LV diastolic function was unaffected by ASD closure. An improvement in global LV systolic function at rest resulted in an increase in stroke volume at rest. Nevertheless, total cardiac output did not change after the procedure, because of a decrease in heart rate at rest counterbalancing the increase in stroke volume. Thus, lateral and inferior LV regional systolic function were preserved after device implantation. Moreover, no changes in regional LV diastolic function were highlighted during the study.
Collapse
Affiliation(s)
- Marco Pascotto
- Pediatric Cardiology, Second University of Naples, Naples, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Yew G, Wilson NJ. Transcatheter atrial septal defect closure with the Amplatzer septal occluder: five-year follow-up. Catheter Cardiovasc Interv 2005; 64:193-6. [PMID: 15678447 DOI: 10.1002/ccd.20268] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We report 5-year follow-up data of patients following atrial septal defect (ASD) closure with the Amplatzer septal occluder (ASO). Patients completed a questionnaire related to symptoms pre- and post-ASO implantation. Complete transthoracic echocardiography was used to assess residual atrial septal defect, right ventricular volume overload, and degree of mitral regurgitation. Mean follow-up duration was 4.8 +/- 0.6 years (range, 5.7-3.0 years). Complete closure was observed in all patients. Right ventricular volume overload, present in all patients prior to ASD closure, had resolved in 82% of patients. No mitral valve sequelae were found; 75% of patients were asymptomatic or felt much improved compared to their preclosure symptoms. New onset of migraine-type headaches was encountered in two patients, one for 12 months and one patient persisted with intermittent migrainous episode. In conclusion, we report 100% closure rate of ASD with ASO device, with return of right ventricular size to normal in the majority of patients. New onset of migraine headaches after ASO implantation can persist more than a few months.
Collapse
Affiliation(s)
- Guan Yew
- Paediatric Cardiology Department, Green Lane and Starship Children's Hospitals, Auckland, New Zealand
| | | |
Collapse
|