PEDIATRIC CARDIOLOGY
Resolution of right heart enlargement after closure of secundum atrial septal defect with transcatheter technique1
Henry W. Kort, MDa,
David T. Balzer, MDa and
Mark C. Johnson, MD*,a
a Division of Cardiology, Department of Pediatrics, Washington University School of Medicine, St. Louis Children’s Hospital, St. Louis, Missouri, USA
Manuscript received February 13, 2001;
revised manuscript received July 10, 2001,
accepted July 26, 2001.
* Reprint requests and correspondence: Dr. Mark C. Johnson, Division of Cardiology, St. Louis Children’s Hospital, One Children’s Place, St. Louis, Missouri 63110 USA.
johnson_m{at}kids.wustl.edu
OBJECTIVES
The purpose of this study was to prospectively characterize the reduction in right atrial (RA) area and right ventricular (RV) volume after transcatheter closure of atrial septal defect (ASD) and to investigate factors that may predict magnitude of resolution in right heart enlargement.
BACKGROUND
Secundum ASD can cause volume overload of the right side of the heart with the potential for development of late complications. Little is known about reduction in right heart size after closure of ASD.
METHODS
Transthoracic echocardiography was performed in 38 patients undergoing transcatheter closure of ASD. The RA area and RV volume were measured prior (n = 38), within 24 hours (n = 37), at 3 to 6 months (n = 24), at 12 months (n = 20) and at 24 months (n = 10) after closure of ASD. Change over time within the study group was assessed and the study group was compared to a control group of 19 patients with structurally normal hearts.
RESULTS
Indexed RA area decreased from baseline to 3- to 6-month follow-up (p = 0.004) as did indexed RV volume (p < 0.0001). Indexed RV volume was similar to that in the control group at 24 months (p = 0.3); however, indexed RA area remained greater than in the control group (p = 0.006). Decrease in indexed RA area over the first 12 months of follow-up was related to young age at time of closure by regression analysis (r = 0.55, p = 0.013).
CONCLUSION
Closure of secundum ASD results in decreased indexed RV volume comparable to that in control subjects at 24 months following closure. Indexed RA area remains increased compared to that in control subjects but does decrease over time. Decrease in RA area is inversely proportional to age at time of ASD closure. Long-term follow-up is required to evaluate the clinical impact of persistently increased RA size.
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Abbreviations and Acronyms
| | ANCOVA | = analysis of covariance | | ANOVA | = analysis of variance | | ASD | = atrial septal defect | | MRI | = magnetic resonance imaging | | PFO | = patent foramen ovale | | Qp | = pulmonary blood flow | | Qs | = systemic blood flow | | RA | = right atrium | | RV | = right ventricle | | RVEDD | = right ventricular end-diastolic dimension |
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