Key result
Percutaneous atrial septal defect closure significantly increased left ventricular end diastolic pressure from a mean of 7.1 mm Hg to 15.3 mm Hg (P<0.01), without causing clinical complications.
Why the study?
Does percutaneous ASD closure alter left ventricular hemodynamics and diastolic function in adult patients?
Observational (n=19)
Does percutaneous ASD closure alter left ventricular hemodynamics and diastolic function in adult patients?
Absolute Event Rate: 15.3% vs 7.1%
p-value: p=< .01
Percutaneous ASD closure in adults safely induces an acute increase in LVEDP without significant changes in myocardial performance index or clinical complications.
Acute LVEDP rise after percutaneous ASD closure appears tolerated in this case; hypothesis-generating and requires prospective studies before practice implications.
OBJECTIVES: The objectives of this study are to assess current management algorithms for left ventricular (LV) hemodynamic and diastolic changes following atrial septal device occlusion in adult patients. BACKGROUND: Percutaneous closure is now routine for atrial septal defects (ASDs). Previous studies show ventricular size normalization following percutaneous closure. Case reports have discussed the incidence of early LV dysfunction following ASD device placement with some recommending delay of closure or placement of a fenestrated device in patients with elevated LV pressures. METHOD: All adult patients with an isolated secundum ASD who underwent percutaneous repair were included in this study. In addition to placement of the Amplatzer septal occluder, all patients had a pre and postprocedure transthoracic echocardiography performed measuring myocardial performance index (MPI). Left ventricular end diastolic pressure (LVEDP) was measured before and after balloon occlusion. RESULTS: Nineteen patients (17 female and two male) were included in this study. Average age was 47.2 years (± 12.7 years). All defects were of clinical significance with average Qp : Qs = 2.0 (± 0.6). Balloon occlusion led to a significant (P < .01) increase in LVEDP (pre-LVEDP mean = 7.1 mm Hg, post-LVEDP mean = 15.3 mm Hg). There was no significant change in MPI. ASD device size displayed a modest correlation relative to the change in LVEDP (R = 0.42, P = .09). CONCLUSIONS: Percutaneous ASD closure induces an increase in LVEDP. Despite this, all patients tolerated device closure without complication. It appears safe to close ASDs in these patients.
No takes yet. Share an insight, caveat, or question.
Ermis et al. (2014) conducted an observational in Isolated secundum atrial septal defect (n=19). Percutaneous atrial septal defect closure vs. Pre-procedure baseline was evaluated on Left ventricular end diastolic pressure (LVEDP) (p=< .01). Percutaneous atrial septal defect closure significantly increased left ventricular end diastolic pressure from a mean of 7.1 mm Hg to 15.3 mm Hg (P<0.01), without causing clinical complications.
Synapse has enriched 2 closely related papers on similar clinical questions. Consider them for comparative context: