Effect of Atrial Septal Defect Closure on Right Atrial Function in Adults; A Prospective Comparative Controlled Study
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Keywords
ASD, Congenital Heart Defects, Closure, Trans-catheter, Atrium, Speckle Tracking
Abstract
Atrial septal defects (ASDs) account for approximately 10% of all congenital heart defects. The closure of ASD with significant left-to-right shunt results in improved functional capacity and improves arrhythmias. ASD closure in adult patients has certain risks, it may result in pulmonary edema and heart failure.
Objectives: The study aimed to assess right atrial (RA) function by speckle-tracking echocardiography (STE) in adult patients with ostium secundum ASD, before and 3 months after transcatheter or surgical closure.
Material and methods: A prospective comparative controlled study involved 40 ASD adult patients and 20 healthy age-matched individuals, to study and compare the RA function in patients diagnosed with ostium secundum ASD, before and 3 months after closure.
Results: There was a significant difference between the mean RA volume index (RAVI) in the case group which was significantly higher than the mean RAVI in the control group (p-value <0.001). The mean tricuspid E/e' ratio in the case group was significantly lower than the mean tricuspid E/e' ratio in the control group (p-value 0.003). The mean RAS-r was statistically significantly lower in the ASD group than the mean RAS-r in the control group (p-value 0.001). The mean RAS-ct was significantly lower in the ASD group than the mean RAS-ct in the control group (p-value <0.001). RAS-ct increased significantly after ASD closure (p-value <0.05). RAS-r increased significantly in the catheter group than in the surgical group after closure (P-value <0.001).
Conclusions: Reduced right atrial (RA) mechanical function assessed by speckle tracking echocardiography due to long-standing ASD in adults. Improved RA contractile function after ASD closure. Also, the RA geometrical reverse remodeling was evident at 3 months following ASD closure. Finally, In the catheter-treated patients, RA function improvement was greater than in the surgically treated patients.
Keywords: ASD, Congenital Heart Defects, Closure, Trans-catheter, Atrium, Speckle Tracking.
Abbreviations: ASD: atrial septal defect, EF: ejection fraction, LV: left ventricle, RA: right atrium, RAScd: right atrial conduit strain; RASct: right atrial contractile strain. RASr: right atrial reservoir strain, RAVI: right atrial volume index, RV: right ventricle, TAPSE: tricuspid annular plane systolic excursion.
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