Similar cardiac remodelling after transcatheter atrial septal defect closure in children and young adults

Abstract

Objective: To study the cardiac geometric changes after transcatheter closure of large atrial septal defects (ASDs) according to patient age at the time of the procedure. Design: Prospective echocardiographic follow-up study. Setting: Tertiary referral centre. Patients and intervention: 25 asymptomatic patients younger than 16 years (median 8 years; group 1) and 21 asymptomatic adults (median 38 years; group 2) underwent percutaneous closure of large ASD with the Amplatzer septal occluder device (mean 25 (SD 7) mm). Main outcome measures: Cardiac remodelling was assessed by M mode and two dimensional echocardiography one and six months after ASD closure. Results: By six months, right atrial volume decreased from 31 (15) to 19 (5) ml/m 2 (p , 0.001) and right ventricular (RV) transverse diameter decreased from 29.8 (8.6) to 23.2 (5.6) mm/m 2 (p , 0.001). Conversely, left atrial volume did not change significantly (from 18 (6) to 20 (6) ml/m 2 , NS) and left ventricular (LV) transverse diameter increased from 27.8 (6.4) to 31.8 (7.3) mm/m 2 (p , 0.05). Ventricular remodelling resulted in an RV:LV diameter ratio decrease from 1.1 (0.2) to 0.7 (0.1) (p , 0.001). The magnitude and time course of cardiac remodelling did not differ significantly between the age groups. Indeed, right atrial volume decreased by 33 (26)% versus 37 (23)%, RV diameter decreased by 26 (10)% versus 20 (13)%, LV diameter increased by 17 (15)% versus 15 (10)%, and RV:LV diameter ratio decreased by 36 (8)% versus 27 (15)% in groups 1 and 2, respectively. Conclusions: Cardiac remodelling after percutaneous ASD closure seems to be independent of the patient's age at the time of the procedure up to early adulthood. Thus, postponing ASD closure for a few years may be a reasonable option for potentially suitable asymptomatic children.

Incomplete RV Remodeling After Transcatheter ASD Closure in Pediatric Age

“…Our data partially contradict previous studies showing a significant cardiac remodeling early after percutaneous ASD closure [8,16,22]. Berger et al [2] reported an early decrease in RV end-diastolic volume after closure of the ASD with a device or by surgery.…”

Transcatheter closure of secundum atrial defect in small children

“…The possibility of spontaneous closure should also be considered before making any decision about treatment [27]. Delaying closure in asymptomatic young children is reinforced by the observation of similar magnitude and time-course of cardiac remodelling after percutaneous ASD closure, as assessed by m-mode and two-dimensional echocardiography, in children and in young adults [28]. Our choice was to analyze \small" patients based on weight rather than age as technical issues in percutaneous interventions in children are usually more related to weight.…”

The Impact of Transcatheter Atrial Septal Defect Closure in the Older Population

“…Pascotto et al (10,34) has shown that cardiac remodeling starts very shortly after transcatheter ASD closure in relatively young populations (mean age 22 Ϯ 18 years) and that most of the cardiac remodeling appeared within a few weeks of closure. Pascotto et al (10,34) has shown that cardiac remodeling starts very shortly after transcatheter ASD closure in relatively young populations (mean age 22 Ϯ 18 years) and that most of the cardiac remodeling appeared within a few weeks of closure.…”