Right ventricular remodeling after transcatheter closure of atrial septal defect.
BACKGROUND
Right ventricular (RV) volume overload is a well-known cardiac consequence of atrial septal defect (ASD) shunt, accounting for most of its long-term complications. Thus cardiac volumetric unloading is a major aim of transcatheter ASD closure. We set to study the right ventricular remodeling after transcatheter ASD closure in patients with secundum ASD.


METHODS
We enrolled 46 patients who underwent successful transcatheter closure of ASD. We performed routine transthoracic echocardiographic studies, including three-dimensional echocardiography and right ventricular myocardial performance index (RVMPI), before transcatheter ASD closure, and 3 days, 1 month after transcatheter ASD closure.


RESULTS
We found that: (1) the right ventricular end-diastolic volume (RVEDV) and right ventricular end-systolic volume (RVESV) (respectively 106.54+/-25.97 vs 69.78+/-10.46 mL, P < 0.05; 59.73+/-17.59 vs 33.84+/-7.18 mL, P < 0.05) were enlarged in patients with ASD compared with those in control subjects, resulting in a marked decrease of the right ventricular ejection fraction (RVEF) (44.82%+/-4.51% vs 54.11%+/-5.89%, P < 0.05) from normal values; (2) the isovolumic relaxation and isovolumic contraction times (respectively [77.61+/-16.49] ms vs (64.09+/-11.82) ms, P < 0.05; [28.04+/-9.57] ms vs [20.45+/-6.53] ms, P < 0.05) were prolonged and ejection time ([250.02+/-24.21] ms vs [272.73+/-20.51] ms, P < 0.05) was shortened in patients with ASD compared with that in control subjects, resulting in a marked increase of the MPI (0.41+/-0.07 vs 0.31+/-0.05, P < 0.05) from normal values; and (3) after transcatheter closure, the RVEDV and RVESV decreased and the RVEF increased markedly and RVMPI decreased markedly.


CONCLUSIONS
Transcatheter closure of ASD results in rapid normalization of RV volume overload and improvement of RV function.
Ding
Jiandong
J
Department of Cardiology, Zhongda Hospital and School of Clinical Medicine, Southeast University, Nanjing, China. dingjiandong@163.com
Ma
Genshan
G
Huang
Yaoyao
Y
Wang
Chen
C
Zhang
Xiaoli
X
Zhu
Jian
J
Lu
Fengxiang
F
D000293:Adolescent; D000328:Adult; D006328:Cardiac Catheterization; D002648:Child; D019560:Echocardiography, Three-Dimensional; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013812:Therapeutics; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D020257:Ventricular Remodeling; D055815:Young Adult