Determinants of cardiopulmonary functional improvement after transcatheter atrial septal defect closure in asymptomatic adults

Giardini, Alessandro; Donti, Andrea; Formigari, Roberto; Specchia, Salvatore; Prandstraller, Daniela; Bronzetti, Gabriele; Bonvicini, Marco; Picchio, Fernando Maria

doi:10.1016/j.jacc.2003.10.067

Cited by 117 publications

(115 citation statements)

References 15 publications

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“…34,35 Thus, it has been demonstrated that torsional deformation is a sensitive indicator of LV function. Global LV systolic function has been shown to be impaired in ASD [8][9][10]36,37 and we also found that the LVEF in patients with ASD was lower than that of normal controls. Moreover, our results showed that a lower EF in patients with ASD was associated with reduced LV torsion values.…”

Section: Discussionsupporting

confidence: 66%

“…[1][2][3][4][5][6][7] Previous studies have demonstrated that right ventricular (RV) volume overload is associated with adverse left ventricular (LV) function in patients with ASD. [8][9][10] Recently, assessment of LV rotation has become an important approach for quantifying LV function. [11][12][13][14][15][16][17][18][19][20][21][22][23][24] However, to the best of our knowledge there are no data available to date on the impact of RV volume overload on LV twist in patients with ASD.…”

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confidence: 99%

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Left Ventricular Torsion in Patients With Secundum Atrial Septal Defect

Dong

Zhang

Shu

et al. 2009

Circ J

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he secundum atrial septal defect (ASD) is a common form of congenital heart disease accounting for approximately 10% of children and 30% of adult patients with congenital cardiac defects. [1][2][3][4][5][6][7] Previous studies have demonstrated that right ventricular (RV) volume overload is associated with adverse left ventricular (LV) function in patients with ASD. [8][9][10] Recently, assessment of LV rotation has become an important approach for quantifying LV function. [11][12][13][14][15][16][17][18][19][20][21][22][23][24] However, to the best of our knowledge there are no data available to date on the impact of RV volume overload on LV twist in patients with ASD. The recent development of 2-dimensional (D) ultrasound speckle tracking imaging (STI) has allowed LV torsional deformation to be evaluated noninvasively with validation against sonomicrometry and tagged magnetic resonance imaging (MRI). 25,26 In the present study, we sought to analyze LV twisting and untwisting using the novel STI method in adult patients with ASD. Methods Study SampleWe enrolled 45 asymptomatic adults (28±9 years, 13 males) with ASD. Inclusion criteria included age ≥18 years, isolated secundum ASD, evidence of RV volume overload and evidence of shunt on transthoracic echocardiogram. Patients were excluded if they were clinically unstable, were not in sinus rhythm at the time of echocardiographic examination, or had inadequate echocardiographic assessment. The ASD group was compared with an age-and sex-matched control group of normal subjects (n=45, 27±10 years, 13 males). The Institutional Review Board of the hospital approved the study, and all study participants provided informed consent before participation. Echocardiographic StudiesPatients were imaged in a supine position using a GE Vivid 7 ultrasound system with a M3S probe (1.7-3.4 MHz). The 2D grayscale images were acquired in the standard parasternal and apical views at a frame rate of 80-100 frames/s, and 3 cardiac cycles were recorded. Care was taken to obtain parasternal circular short-axis tomograms at basal (identified by the mitral valve) and apical (no papillary muscles noted) levels. All images were stored digitally for subsequent offline analysis. Conventional Echocardiographic AnalysisThe analysis was performed offline by a single observer without knowledge of hemodynamic data, using commercially available 2D strain software (Echopac PC, version 7.0, GE Vingmed Ultrasound, Horten, Norway). LV volumes (end-diastolic volume (EDV), end-systolic volume (ESV), and ejection fraction (EF)) were measured according to the recent guidelines of the American Society of Echocardiography. 27 Analysis of Twist MechanicsThe time interval from the R wave on the ECG to aortic

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Section: Discussionsupporting

confidence: 66%

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confidence: 99%

Left Ventricular Torsion in Patients With Secundum Atrial Septal Defect

Dong

Zhang

Shu

et al. 2009

Circ J

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“…Recent additions to the literature have shown that, in younger adults, ASD closure leads to increased left ventricle diastolic diameter and overall function by 6 months [12].…”

Section: Limitationsmentioning

confidence: 99%

Short and medium-term effects of secundum atrial septal defect percutaneous closure using the Amplatzer Septal Occluder in the elderly

Broadley¹,

Gogola²,

Roobottom³

et al. 2017

Blood Heart Circ

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Aim: to assess the effects of percutaneous secundum atrial septal defect (ASD) closure in the elderly. Methods and results:Descriptive, retrospective study in a large Regional University Teaching Hospital. Subjects were 11 patients aged over 60 (mean age 72 [range 62 to 83], 3 male) at the time they underwent percutaneous closure of a secundum ASD using an Amplatzer septal occluder (ASO). Post-closure the following parameters were significantly reduced: heart size on serial chest X-ray, from a mean (standard deviation) of 16.7 (2.1) cm to 14.8 (1.3) cm (p=0.016) after 4.5 (2.1) months; pulmonary vascularity on serial chest X-ray; right ventricular diastolic diameter on serial transthoracic echocardiogram, from 4.2 (0.8) cm to 3.0 (0.74) cm (p<0.001) after a mean of 15 (12.2) months; and right ventricular systolic pressure measured indirectly (n=4). Symptoms, particularly shortness of breath, also seemed to improve although they were not quantitatively assessed.Conclusion: percutaneous closure of ASD in the elderly using an ASO results in significant reduction in right ventricle and pulmonary artery size, improved haemodynamics and probably also symptoms. On this basis it should be considered in all cases where it is technically feasible, in preference to continuing medical therapy.

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“…[3][4][5][6][7][8] In addition, functional capacity can improve significantly after closure. [9][10][11] For this reason, the American College of Cardiology/American Heart Association 2008 Guidelines for the Management of Adults With Congenital Heart Disease recommend device closure of secundum ASDs in the presence of right heart volume load, evidence of complications such as paradoxical embolism or orthodeoxiaplatypnea, and in the absence of pulmonary hypertension. 12 Similarly, the 2010 European Society of Cardiology Guidelines recommend closure in cases of significant shunt or after paradoxical embolism.…”

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confidence: 99%