Differences in right and left ventricular remodeling after transcatheter closure of atrial septal defect among adults.
OBJECTIVE
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.


CONCLUSIONS
"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.
Wu
En-Ting
ET
Cardiac Care Unit, Okayama University Hospital, Okayama, Japan.
Akagi
Teiji
T
Taniguchi
Manabu
M
Maruo
Takeshi
T
Sakuragi
Satoru
S
Otsuki
Shinichi
S
Okamoto
Yoshio
Y
Sano
Shunji
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization; D004452:Echocardiography; D018618:Echocardiography, Doppler, Color; D005260:Female; D005500:Follow-Up Studies; D006344:Heart Septal Defects, Atrial / Q000097:blood / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011446:Prospective Studies; D015203:Reproducibility of Results; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right; D020257:Ventricular Remodeling
D020097:Natriuretic Peptide, Brain