Key result
Surgical closure of atrial septal defect after age 25 was associated with significantly lower peak systolic tricuspid annular velocity compared to closure before age 25 (8.0 vs 10.8 cm/s, p<0.01).
Why the study?
Controversy exists about the influence of patient age on the benefit of surgical closure in atrial septal defect (ASD).
Does patient age at surgical intervention for atrial septal defect affect long-term right ventricular performance?
Observational (n=81)
No
Does patient age at surgical intervention for atrial septal defect affect long-term right ventricular performance?
Delayed surgical closure of atrial septal defect (after 25 years of age) is less effective at restoring secondary right ventricular dysfunction compared to earlier intervention.
Controversy exists about the influence of patient age on the benefit of surgery in atrial septal defect (ASD). Tissue Doppler echocardiography (TDE) when applied to atrioventricular annuli provides variables reliably reflecting the performance of the corresponding ventricle. We sought to investigate the effect of timing of surgery on biventricular functions by comparing the conventional echocardiography variables and TDE profiles of right and left atrioventricular annuli in patients treated at various ages. Conventional echocardiography and TDE analysis of mitral and tricuspid annuli were performed in 20 controls and 61 patients who underwent surgical ASD closure 2.8 +/- 2.5 years before the study. Standard parameters included were right and left-sided dimensions, estimated pulmonary artery pressure, ejection fraction, and tricuspid annular motion amplitude. TDE variables were systolic, early and late diastolic peak velocities at tricuspid lateral-and mitral-annulus at lateral and septal corners. Two subsets of patients who underwent surgery before (group 1, n = 20) and after 25 years (group 2, n = 41) formed our subgroups. Peak systolic TDE velocity and tricuspid annular motion amplitude had the lowest value in group 2 (P < 0.01 and <0.02, respectively). Late diastolic TDE velocity was significantly lower in group 2 compared to group 1 (P < 0.05). Increased right ventricular and atrial dimensions (P < 0.001 for both) and the estimated pulmonary artery pressure (P < 0.03) were the conventional measurements discriminating group 2 from group 1. The TDE profile of the mitral annulus was similar between the groups. These results suggest that delayed ASD closure is a relatively less effective procedure to restore secondary right ventricular dysfunction, as demonstrated by significantly different TDE measurements reflecting right ventricular longitudinal contraction and relaxation.
No takes yet. Share an insight, caveat, or question.
Celik et al. (2004) conducted an observational in Atrial septal defect (n=81). Surgical ASD closure after age 25 vs. Surgical ASD closure before age 25 was evaluated on Peak systolic tissue Doppler velocity of tricuspid annulus (TAn S) (p=<0.01). Surgical closure of atrial septal defect after age 25 was associated with significantly lower peak systolic tricuspid annular velocity compared to closure before age 25 (8.0 vs 10.8 cm/s, p<0.01).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: