P930Improvement of the cardiac functions and structures after transcatheter closure of secundum atrial septal defect: Short-term follow-up results


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Abstract

Objective: To determine the effects of atrial septal defect (ASD) and their closure on systolic, diastolic and global function of right and left ventricle and pulmonary venous flow.Methods: 25 patients (mean age+SD; 9.02±3.1) underwent transcatheter closure of secundum ASD with several devices (Solysafe, Amplatzer and Biostar Septal occluder). The patients were assessed with 2-D, M-mode and Doppler echocardiography and tissue doppler imaging (TDI) before the procedure and at 1 day, 1month, 3 months and 6 months. TDI was applied to record the mitral and tricuspid diastolic velocities at the septal and lateral corners. Serum Brain Natriuretic Peptid (BNP) levels measured prior to ASD closure, and 1 day, 1month, 3 months thereafter.Results: The mean ASD size was 12.24±5.25 mm. Mitral inflow E wave and E/A ratio increased significantly while isovolumetric relaxation time (IVRT) and deceleration time (DT) did not change during follow-up. There was no significant change was observed on mitral lateral annulus velocities before and after the procedure. Also the ratio of E/E' was increased significantly during follow up. The E' wave measured from tricuspid lateral anulus was increased significantly at 6 month. After ASD closure, right ventricular size and right atrial volume reduced, left ventricular size increased significantly while left atrial volume did not change. Right ventricular infundibuler (RVEDd) and inlet diameters had a different time-course of changes. There was a statistically significant improvement in LV Tei index and RV Tei index measured by both PW doppler and TDI after closure of ASD. Pulmonary vein S wave and S/D ratio decreased, but atrial reversal (AR) wave velocity and duration increaed immediately after procedure and maintained during follow-up. Concentrations of BNP increased during the first day after procedure and normalized at 1 month of follow-up.Conclusions: Device closure of ASD results to an acute increase of LV filling pressure and decrease in RV preload. The transmitral E wave change may represent a response to increased LV preload. The ratio of E/E' increased at the follow-up. Other LV diastolic function indices derived PW (IVRT, DT) did not change at the follow-up. These changes would not be due to LV diastolic dysfunction, but probably related to the increase in LV diastolic filling. Early diastolic velocities of tricuspid annulus increased late after the closure and RV Tei index derived both PW and TDI were decreased during follow-up. These findings suggested that transcatheter closure of atrial septal defect preserves right ventricular function.

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