CLINICAL STUDY: CONGENITAL HEART DISEASE
Right ventricular form and function after percutaneous atrial septal defect device closure
Gruschen R. Veldtman, MB, ChB*,1,
Vanessa Razack*,
Samuel Siu, MD, FACC*,
Hassan El-Hajj, MB, ChB*,
Fiona Walker, MB, ChB*,
Gary D. Webb, MD, FACC*,
Leland N. Benson, MD, FACC and
Peter R. McLaughlin, MD, FACC*
* Congenital Cardiac Centre for Adults, University of Toronto and Toronto General Hospital, Toronto, Ontario, Canada
Division of Cardiology, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
Manuscript received October 10, 2000;
revised manuscript received February 27, 2001,
accepted March 22, 2001.
Reprint requests and correspondence: Dr. Peter R. McLaughlin, Congenital Cardiac Centre for Adults, University of Toronto, Toronto General Hospital, 200 Elizabeth Street, 12 EN, Room 224, Toronto, Ontario M5G 2C4, Canada
peter.mclaughlin{at}uhn.on.ca
OBJECTIVES
We sought to assess the right heart’s response to percutaneous device closure of moderate sized atrial septal defects (ASDs) in adults over a one-year follow-up period.
BACKGROUND
Percutaneous ASD device closure is a safe and effective means of reducing or eliminating interatrial shunting. The response of the adult’s right heart to device closure is incompletely understood.
METHODS
Forty consecutive patients had 40 device implantations (32 with the CardioSeal implant and 8 with the Amplatzer device). The patients were assessed with echocardiography, chest radiography and electrocardiography before the procedure and at 1, 6 and 12 months.
RESULTS
The mean ASD size was 13 ± 4 mm, and the device size ranged from 33 to 40 mm for CardioSeal and 12 to 36 mm for Amplatzer. At one month, heart size (49% vs. 46%), four-chamber right ventricular (RV) size (45 vs. 41 mm), paradoxical septal motion (60% vs. 5%), QRS duration (125 vs. 119 ms), PR interval (181 vs. 155 ms) and echocardiographically determined pulmonary artery systolic pressure decreased significantly and was maintained at 12-month follow-up. At six months, right atrial length decreased from 50 to 47 mm. At one year, 29% of patients had persistent RV enlargement.
CONCLUSIONS
Right heart morphology undergoes rapid improvement within one month of defect closure, with associated mechanoelectrical benefit. A small number of patients had persistent RV enlargement or pulmonary hypertension, or both, at one year. Our data support the application of transcatheter methods in achieving excellent hemodynamic and anatomic outcomes.
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Abbreviations and Acronyms
| | ASD | = atrial septal defect | | ECG | = electrocardiogram or electrocardiographic | | PA | = pulmonary artery | | PSM | = paradoxical septal motion | | RA | = right atrium or atrial | | RV | = right ventricle or ventricular | | RVOTD | = right ventricular outflow tract diameter |
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