Key result
Transcatheter closure of atrial septal defect secundum in children significantly improved the right ventricular myocardial performance index (0.46 vs 0.38, p<0.0001) at 6 months.
Why the study?
To analyze acute and short-term deformation changes of the RV and LV walls before and after transcatheter ASD secundum closure in children, and evaluate the feasibility of myocardial deformation imaging.
Does percutaneous transcatheter closure of atrial septal defect improve right and left ventricular myocardial deformation in children?
Cohort (n=32)
No
Does percutaneous transcatheter closure of atrial septal defect improve right and left ventricular myocardial deformation in children?
Absolute Event Rate: 0.38% vs 0.46%
p-value: p=<0.0001
Transcatheter closure of ASD secundum in children leads to significant short-term improvements in both right and left ventricular myocardial deformation and volumes as assessed by speckle tracking echocardiography.
Supports short-term RV functional gains after pediatric ASD closure; leaves open long-term benefits and need for randomized trials.
Objectives: To analyze the acute and short-term deformation changes of both right (RV) and left (LV) ventricular wall before and after transcatheter closure of atrial septal defect (ASD) secundum in children. Outcome measures: To determine the feasibility of tissue Doppler and myocardial deformation imaging for evaluating RV and LV functions in children undergoing transcatheter ASD closure. Patients and methods: A prospective study was performed for 32 children with hemodynamic significant ASD secundum before and 6 months after percutaneous ASD closure in the Pediatric Cardiology Division of Specialized Pediatric Hospital, Cairo University. Speckle tracking echocardiography (STE) of LV and RV global analysis (longitudinal and circumferential strain) before and after ASD transcatheter closure was performed. Results: The mean age of the patients was 6.01 ± 3.19 (range: 3e9) years with a female to male ratio of 1.3:1. There was an improvement in the RV and LV myocardial performance index (MPI) 6 months post-ASD closure (RVMPI ¼ 0.46 ± 0.069 vs. 0.38 ± 0.05, p < 0.0001; LVMPI ¼ 0.49 ± 0.12 vs. 0.38 ± 0.08, p < 0.0001, respectively). By 2D STE, there was a significant improvement in the RV global longitudinal strain (GLS) 6 months post-ASD closure (¡20.17 ± 3.14% vs. ¡25.86 ± 5.02%, p < 0.0001). There was a significant increase in the LV end-diastolic volume (EDV) and LV end-systolic volume (ESV) using 4D STE after device closure (LVEDV ¼ 32.96 ± 10.99 mL vs. 44.024 ± 14.9017 mL, p < 0.0001; LVESV ¼ 15.16 ± 6.08 mL vs. 21.76 ± 8.34 mL, p < 0.0001, respectively). Additionally, there was a significant improvement in the LV GLS after device occlusion (¡19.17 ± 3.67% vs. ¡22.36 ± 4.72%, p ¼ 0.009) using 4D TomTec software. There was a significant decrease in the RVEDV (54.65 ± 10.05 mL vs. 15.73 ± 8.67 mL) and RV stroke volume (25.15 ± 6.36 vs. 20.06 ± 7.2) after device occlusion using 4D TomTec software. Conclusion: By using 4D STE, the LV GLS was significantly improved; in contrast, by 2D STE, the RV volume overload decreased and the RV GLS was improved on short term after transcatheter ASD secundum closure in children.
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Agha et al. (2020) conducted a cohort in Hemodynamically significant atrial septal defect (ASD) secundum (n=32). Transcatheter closure of atrial septal defect secundum vs. Baseline (pre-closure) was evaluated on Right ventricular myocardial performance index (RVMPI) (p=<0.0001). Transcatheter closure of atrial septal defect secundum in children significantly improved the right ventricular myocardial performance index (0.46 vs 0.38, p<0.0001) at 6 months.
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