Incomplete RV Remodeling After Transcatheter ASD Closure in Pediatric Age

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.

Left and right ventricular speckle tracking study before and after percutaneous atrial septal defect closure in children

“…This study demonstrated reverse of remodeling both RV and LV using STE after transcatheter ASD closure in children. The assessment of ventricular function following percutaneous ASD closure is complicated by the alteration to loading conditions caused by the elimination of intracardiac shunting [ 8 ]. Adverse ventricular interdependence associated with RV volume overload was previously described as “Bernheim effect”, in which the interventricular septum bulges into the LV cavity and leads to impairment of LV filling [ 9 ].…”

“…In our cohort, by TDI, LVMPI significantly improved as well as the peak systolic velocity of LV lateral wall increased after device closure. This finding might be explained by the restoration of LV compression and the increase in LV filling [ 8 ]. Furthermore, Raymond et al [ 27 ] concluded that the LV geometry is altered with mild impairment of LV filling and decrease in LV dimensions.…”

Evaluation of right ventricular myocardial strains by speckle tracking echocardiography after percutaneous device closure of atrial septal defects in children

“…Moreover, both studies demonstrated preservation of right ventricular function. However, the RV contraction takes time to recover completely after eliminating a left‐to‐right shunt . Additionally, the permanent implantation of an occluder in the atrial septum may acutely influence the RV contraction postprocedure, particularly in younger children …”

The immediate haemodynamic response and right and left cardiac remodelling after percutaneous transcatheter closure of secundum atrial septal defect in children: a longitudinal cohort study

“…17 The time course of cardiac remodelling in the literature has a broad range from 3 months 29 to 2 years. 30 In one study on children weighing less than 10 kg, the RV dimensions and the RV/LV proportion gradually decreased and normalised in the first year after the PTC. 28 On the other hand, in a recent study on the evaluation of RV myocardial strains after PTC of secundum ASD in children, the researchers showed that the intervention improved the RV strain indices and RV function normalised in 3 months.…”