title: Long-term effects of transcatheter closure of atrial septal defect on cardiac remodeling and exercise capacity in patients older than 40 years with a reduction in cardiopulmonary function.
abstract: BACKGROUND
  Although it has been demonstrated that cardiac remodeling and exercise capacity improve after transcatheter closure of atrial septal defect (ASD), little is known about long-term benefits in middle-aged and elderly patients with a reduction in cardiopulmonary function.
  
  
  OBJECTIVE
  To evaluate long-term extent and time course of improvements in cardiac remodeling and exercise capacity in those patients.
  
  
  METHODS
  Twenty ASD patients ≥ 40 years of age with a reduction in cardiopulmonary function (predicted peak oxygen uptake [VO(2)] < 65%) were enrolled. Transthoracic echocardiography and cardiopulmonary exercise testing were performed at baseline and at 1 month, 3 months, 6 months, and >12 months after the procedure.
  
  
  RESULTS
  At 1 month after the procedure, significant decreases in right ventricular (RV) end-diastolic diameter (38.2 ± 4.4 to 31.9 ± 4.4 mm; P < 0.001) and RV/left ventricular end-diastolic diameter ratio (0.95 ± 0.17 to 0.71 ± 0.13; P < 0.001) occurred, and they were maintained during the follow-up period. Normal RV size was achieved in 11 of 18 patients with RV enlargement. Predicted peak VO(2) did not change at 1 month and 3 months, but it improved significantly after 6 months (53.6 ± 6.5 to 62.1 ± 12.6%; P < 0.01). Sixteen of the 20 patients showed improved predicted peak VO(2).
  
  
  CONCLUSIONS
  Cardiac remodeling and exercise capacity could be improved over the long-term period after transcatheter closure of ASD in middle-aged and elderly patients with a reduction in cardiopulmonary function. There were differences in the time course of improvement between cardiac remodeling and exercise capacity in those patients.
authors.affiliation: Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Takaya
authors.forename: Manabu
authors.initials: M
authors.lastname: Taniguchi
authors.forename: Teiji
authors.initials: T
authors.lastname: Akagi
authors.forename: Saori
authors.initials: S
authors.lastname: Nobusada
authors.forename: Kengo
authors.initials: K
authors.lastname: Kusano
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ito
authors.forename: Shunji
authors.initials: S
authors.lastname: Sano
mesh_terms: D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization / Q000379:methods*; D004452:Echocardiography / Q000379:methods*; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013995:Time; D016896:Treatment Outcome; D020257:Ventricular Remodeling / Q000502:physiology*