Format

Send to

Choose Destination
Int J Cardiovasc Imaging. 2019 Jun 15. doi: 10.1007/s10554-019-01647-0. [Epub ahead of print]

Transcatheter closure of atrial septal defect in adults: time-course of atrial and ventricular remodeling and effects on exercise capacity.

Author information

1
Department of Clinical Sciences, Clinical Physiology, Lund University, Skåne University Hospital, 22241, Lund, Sweden.
2
Department of Clinical Sciences, Pediatric Cardiology, Lund University, Skåne University Hospital, Lund, Sweden.
3
Helen B Taussig Heart Center, Johns Hopkins Hospital and School of Medicine, Baltimore, MD, USA.
4
Department of Health Sciences, Physiotherapy, Lund University, Lund, Sweden.
5
Department of Clinical Sciences, Cardiology, Lund University, Skåne University Hospital, Lund, Sweden.
6
Department of Clinical Sciences, Clinical Physiology, Lund University, Skåne University Hospital, 22241, Lund, Sweden. marcus.carlsson@med.lu.se.

Abstract

Investigate ventricular and atrial remodeling following atrial septal defect (ASD) closure and examine if pulmonary-to-systemic flow ratio (QP/QS) and right ventricular (RV) volume predict improvement, determined as percentage of predicted oxygen uptake (VO2%). Long-term cardiovascular magnetic resonance (CMR) data on atrial and ventricular remodeling after ASD-closure is limited and treatment effect on exercise capacity is debated. Sixteen patients undergoing transcatheter ASD closure and 16 age and sexmatched controls were studied. CMR was performed before treatment, the day after and 3 and 12 months later. Exercise test with gas analysis was performed before and 12 months after treatment. QP/QS decreased from 2.1 ± 0.5 to 1.4 ± 0.3 at day 1 and 1.1 ± 0.1 at 3 and 12 months. Left ventricular (LV) volumes increased and normalized on day 1 whereas left atrial volumes were unchanged. RV and right atrial volumes decreased the first 3 months. LV and RV volumes had not equalized at 12 months (RV/LV ratio 1.2 ± 0.1, P < 0.01) and RV ejection fraction remained decreased compared to controls. Improvement of VO2% after ASD closure (P < 0.01) was inversely related to QP/QS at rest (r = - 0.56, P < 0.05) but unrelated to RV end-diastolic volume (P = 0.16). Following transcatheter ASD closure, LV adaptation is rapid and RV adaptation is prolonged, with decreased systolic RV function. Patients with smaller shunts had larger improvement in VO2% suggesting patients with defects of borderline hemodynamic significance might benefit from closure. This may be due to impaired LV diastolic function influencing shunt size and exercise capacity following ASD closure.

KEYWORDS:

ASD; Congenital heart disease; Exercise capacity; Heart failure; MRI

PMID:
31203534
DOI:
10.1007/s10554-019-01647-0

Supplemental Content

Full text links

Icon for Springer
Loading ...
Support Center