Percutaneous closure of atrial septal defects leads to normalisation of atrial and ventricular volumes.
BACKGROUND
Percutaneous closure of atrial septal defects (ASDs) should potentially reduce right heart volumes by removing left-to-right shunting. Due to ventricular interdependence, this may be associated with impaired left ventricular filling and potentially function. Furthermore, atrial changes post-ASD closure have been poorly understood and may be important for understanding risk of atrial arrhythmia post-ASD closure. Cardiovascular magnetic resonance (CMR) is an accurate and reproducible imaging modality for the assessment of cardiac function and volumes. We assessed cardiac volumes pre- and post-percutaneous ASD closure using CMR.


METHODS
Consecutive patients (n = 23) underwent CMR pre- and 6 months post-ASD closure. Steady state free precession cine CMR was performed using contiguous slices in both short and long axis views through the ASD. Data was collected for assessment of left and right atrial, ventricular end diastolic volumes (EDV) and end systolic volumes (ESV). Data is presented as mean +/- SD, volumes as mL, and paired t-testing performed between groups. Statistical significance was taken as p < 0.05.


RESULTS
There was a significant reduction in right ventricular volumes at 6 months post-ASD closure (RVEDV: 208.7 +/- 76.7 vs. 140.6 +/- 60.4 mL, p < 0.0001) and RVEF was significantly increased (RVEF 35.5 +/- 15.5 vs. 42.0 +/- 15.2%, p = 0.025). There was a significant increase in the left ventricular volumes (LVEDV 84.8 +/- 32.3 vs. 106.3 +/- 38.1 mL, p = 0.003 and LVESV 37.4 +/- 20.9 vs. 46.8 +/- 18.5 mL, p = 0.016). However, there was no significant difference in LVEF and LV mass post-ASD closure. There was a significant reduction in right atrial volumes at 6 months post-ASD closure (pre-closure 110.5 +/- 55.7 vs. post-closure 90.7 +/- 69.3 mL, p = 0.019). Although there was a trend to a decrease in left atrial volumes post-ASD closure, this was not statistically significant (84.5 +/- 34.8 mL to 81.8 +/- 44.2 mL, p = NS).


CONCLUSIONS
ASD closure leads to normalisation of ventricular volumes and also a reduction in right atrial volume. Further follow-up is required to assess how this predicts outcomes such as risk of atrial arrhythmias after such procedures.
Teo
Karen S L
KS
Cardiovascular Research Centre, Royal Adelaide Hospital and The University of Adelaide, Adelaide, South Australia, Australia. karen.teo@adelaide.edu.au
Dundon
Benjamin K
BK
Molaee
Payman
P
Williams
Kerry F
KF
Carbone
Angelo
A
Brown
Michael A
MA
Worthley
Matthew I
MI
Disney
Patrick J
PJ
Sanders
Prashanthan
P
Worthley
Stephen G
SG
D016275:Atrial Function; D006328:Cardiac Catheterization / Q000295:instrumentation; D002306:Cardiac Volume; D005260:Female; D006325:Heart Atria / Q000473:pathology / Q000503:physiopathology; D006344:Heart Septal Defects, Atrial / Q000150:complications / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D006352:Heart Ventricles / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D013318:Stroke Volume; D016896:Treatment Outcome