title: Impact of Right Ventricular Geometry on Mitral Regurgitation After Transcatheter Closure of Atrial Septal Defect.
abstract: Worsening of mitral regurgitation (MR) is sometimes observed after closure of an atrial septal defect (ASD). However, since the mechanism of this deterioration remains unclear, the aim of our study was to investigate the effect of left (LV) and right ventricular (RV) geometry on MR after transcatheter closure of ASD.We studied 27 patients with ASD who underwent transcatheter closure. Echocardiography was performed before and 6 ± 2 months after the procedure. In addition to conventional echocardiographic parameters, full volume data of the whole LV and RV heart was obtained with 3-dimensional echocardiography. MR was quantified by measuring the width of the vena contracta, and was graded as mild (< 3.0 mm), moderate (3.0 to 6.9 mm), or severe (≥ 7.0 mm).Ten patients (37%) were classified as having worsening MR and the remaining 17 (63%) as not having worsening MR. The two groups showed similar baseline characteristics, except for patients with worsening MR being more likely to be older (P = 0.009) and having a larger left-to-right shunt of pulmonary and systemic blood flow ratio (P = 0.02). It is noteworthy that the horizontal-to-vertical ratio of basal-RV at end-systole for patients with worsening MR was significantly smaller than that for patients without worsening MR (1.0 ± 0.2 versus 1.4 ± 0.2, P < 0.0001). Furthermore, multivariate analysis showed that the horizontal-to-vertical ratio of basal-RV at end-systole was the independent predictor of worsening MR during follow-up (P < 0.001).RV geometry may affect MR after closure of ASD. The pre-operative horizontal-to-vertical ratio of basal-RV is considered useful for predicting worsening of MR after closure of ASD.
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine.
authors.forename: Mana
authors.initials: M
authors.lastname: Hiraishi
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Tanaka
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Motoji
authors.forename: Takuma
authors.initials: T
authors.lastname: Sawa
authors.forename: Takayuki
authors.initials: T
authors.lastname: Tsuji
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Miyoshi
authors.forename: Junichi
authors.initials: J
authors.lastname: Imanishi
authors.forename: Akihiro
authors.initials: A
authors.lastname: Kaneko
authors.forename: Kensuke
authors.initials: K
authors.lastname: Matsumoto
authors.forename: Toshiro
authors.initials: T
authors.lastname: Shinke
authors.forename: Ken-ichi
authors.initials: K
authors.lastname: Hirata
mesh_terms: D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000379:methods; D018450:Disease Progression; D004452:Echocardiography / Q000379:methods; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D055989:Septal Occluder Device