title: Percutaneous device closure of atrial septal defect results in very early and sustained changes of right and left heart function.
abstract: OBJECTIVE
  To investigate the echocardiographic effects of percutaneous closure of secundum atrial septal defect (ASD) in adults and assess which pre-closure parameters predict good response to closure.
  
  
  BACKGROUND
  ASD is a common congenital heart disease often undiscovered until adulthood. ASD closure has been revolutionized by the use of percutaneous devices. The effects of these procedures on echocardiographic parameters are not well characterized.
  
  
  METHODS
  Patients undergoing percutaneous device closure of ASD between June 2007 and June 2009 had 3 sequential echocardiograms reviewed: pre-procedure, immediate post-procedure (24 hours) and 6-8 weeks post-procedure. Significant changes from baseline were investigated using paired t-test/1-way ANOVA. Pearson correlation (2-tailed) tests were used to categorize patients as 'good responders' to closure in terms of selected parameters.
  
  
  RESULTS
  129 echocardiograms in 43 consecutive patients were included. Remodeling of both ventricles occurred immediately following ASD closure and was sustained. Right ventricular (RV) diameter in diastole decreased by 13.5% and 19.3% compared to baseline at 24 hours and 6-8 weeks post-closure, respectively (p<0.05); Left ventricular (LV) diameter in diastole increased by 8.5% and 15.6%, respectively (p<0.05). Functional parameters of the RV also demonstrated early and sustained decreases (TAPSE decreased by 8.3% and 17% compared to baseline at 24 hours and 6-8 weeks post-closure, respectively (p<0.05)). Smaller RV baseline diameter appeared to predict good response to closure.
  
  
  CONCLUSIONS
  Percutaneous ASD closure has immediate, sustained benefits on multiple echocardiographic parameters. Good responders have smaller RV at baseline, suggesting early closure is preferable.
authors.affiliation: Cardiovascular Research Group, School of Biomedicine, The University of Manchester, Level 3 Core Technology Facility, Grafton Street, Manchester M13 9NT, United Kingdom. oliver.monfredi@manchester.ac.uk
authors.forename: Oliver
authors.initials: O
authors.lastname: Monfredi
authors.forename: Matthew
authors.initials: M
authors.lastname: Luckie
authors.forename: Hoda
authors.initials: H
authors.lastname: Mirjafari
authors.forename: Terence
authors.initials: T
authors.lastname: Willard
authors.forename: Helen
authors.initials: H
authors.lastname: Buckley
authors.forename: Linda
authors.initials: L
authors.lastname: Griffiths
authors.forename: Bernard
authors.initials: B
authors.lastname: Clarke
authors.forename: Vaikom S
authors.initials: VS
authors.lastname: Mahadevan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016279:Atrial Function, Left / Q000502:physiology*; D016280:Atrial Function, Right / Q000502:physiology*; D006328:Cardiac Catheterization / Q000379:methods*; D004452:Echocardiography; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult