Key result
Following percutaneous device closure of ASD, 27% of patients exhibited paradoxically increased tricuspid regurgitant velocity at one day, which decreased below baseline levels at one year.
Why the study?
With the increasing age of candidates for device closure of ASD, concerns exist regarding dyspnea aggravation or atrial fibrillation development due to LV and LA preload augmentation.
Does percutaneous device closure of ASD affect serial pulmonary arterial pressure and left ventricular filling pressure over one year?
Cohort (n=78)
Does percutaneous device closure of ASD affect serial pulmonary arterial pressure and left ventricular filling pressure over one year?
Device closure of ASD may cause transient immediate increases in pulmonary arterial and left ventricular filling pressures, but these parameters improve below baseline levels at one year, suggesting peri-interventional preload reduction may be beneficial for high-risk patients.
Transient TR velocity rise after ASD closure warrants monitoring; hypothesis-generating for peri-interventional preload reduction in high-risk patients.
BACKGROUND: The age of candidates for device closure of atrial septal defect (ASD) has been increasing. Thus, concerns exist about dyspnea aggravation or atrial fibrillation development after device closure due to augmentation of left ventricular (LV) and left atrial (LA) preload. This study aimed to examine patterns and determinants of serial pulmonary arterial pressure and left ventricular filling pressure changes after device closure of ASD. METHODS: Among the 86 consecutive patients who underwent percutaneous device closure of ASD, those with end-stage renal disease or those without pre- or postprocedural Doppler data were excluded. The clinical, transesophageal, and transthoracic echocardiographic findings of 78 patients were collected at baseline, one-day postprocedure, and one-year follow-up. RESULTS: = 21; 27%) exhibited paradoxically increased tricuspid regurgitant velocity (TRV) one-day postprocedure; they also were older with lower e', glomerular filtration rate, and LV ejection fraction and a higher LA volume index. However, even in these patients, TRV deceased below baseline levels one-year later. Both E/e' and LA volume index significantly increased immediately after device closure, but all decreased one-year later. Larger defect size and higher TRV were significantly correlated with immediate E/e' elevation. CONCLUSION: In older, renal, diastolic, and systolic dysfunctional patients with larger LA and scheduled for larger device implantation, peri-interventional preload reduction therapy would be beneficial.
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Shin et al. (2021) conducted a cohort in Atrial septal defect (n=78). Percutaneous device closure of atrial septal defect vs. Baseline was evaluated on Serial pulmonary arterial pressure and left ventricular filling pressure changes. Following percutaneous device closure of ASD, 27% of patients exhibited paradoxically increased tricuspid regurgitant velocity at one day, which decreased below baseline levels at one year.
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