Short term evaluation of right ventricular function using speckle tracking echocardiography before and after trans-catheter device closure of atrial septal defects in children

Q: What are the key findings of this study?

Transcatheter device closure of atrial septal defects significantly improved right ventricular free-wall strain from 21.60% at baseline to 29.53% at three months post-procedure (p<0.001).

Q: What is the clinical evidence from this study?

Study design: Case-Control. Population: Ostium secundum atrial septal defect (n=100). Intervention: Transcatheter device closure vs. Pre-closure baseline. Primary outcome: Right ventricular free-wall strain (RVFW strain) at 3 months post-closure (p=<0.001).

Q: What does this research mean for the field?

Transcatheter device closure of atrial septal defects in children leads to significant and progressive recovery of right ventricular systolic function and myocardial deformation. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate right ventricular systolic function and myocardial deformation in pediatric patients before and after transcatheter atrial septal defect closure using speckle tracking echocardiography.

Omar Raafat; Ahmed El-Nawawy; Aly Abdel Mohsen; Hani Mahmoud Adel

doi:10.23750/abm.v96i2.16736

April 24, 2025Acta bio-medica dell'Ateneo parmense/Acta biomedicaOpen Access

Short term evaluation of right ventricular function using speckle tracking echocardiography before and after trans-catheter device closure of atrial septal defects in children

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Key result

Transcatheter ASD closure improves RV free-wall strain by ~37% at three months.

P<0.001
n=100

Why the study?

Evaluating right ventricular function in children with atrial septal defect before and after transcatheter closure using speckle tracking echocardiography was needed to understand treatment impact.

Does transcatheter device closure improve right ventricular function assessed by speckle tracking echocardiography in children with atrial septal defects?

Key Points

To evaluate right ventricular systolic function and myocardial deformation in pediatric patients before and after transcatheter atrial septal defect closure using speckle tracking echocardiography.
Conducted a case-control study including 50 children under 18 years with ostium secundum atrial septal defect undergoing transcatheter closure and 50 age-matched healthy controls at Smouha Children's Hospital in Alexandria, Egypt.
Assessed cardiac geometry and right ventricular function pre-procedure and at 1 day, 1 month, and 3 months post-procedure using conventional echocardiography and 2D speckle tracking software.
Prior to closure, patients showed significant right ventricular impairment versus controls, including lower median right ventricular free wall strain (21.0% vs. 32.0%, P < 0.001), reduced TAPSE (1.62 ± 0.24 vs. 1.94 ± 0.12 cm, P < 0.001), and lower FAC (25.24 ± 5.03% vs. 40.28 ± 1.90%, P < 0.001).
Right ventricular systolic parameters improved progressively over follow-up, with mean TAPSE rising to 2.05 ± 0.17 cm and mean FAC reaching 44.38 ± 5.77% at 3 months post-closure (both P < 0.001 versus pre-closure).
Median right ventricular free wall strain recovered to 28.6% at 3 months post-closure, though it remained significantly lower than in healthy controls (32.0%, P < 0.001).

Study Design

Type

Case-Control (n=100)

Multicenter

No

Structured PICO

Does transcatheter device closure improve right ventricular function assessed by speckle tracking echocardiography in children with atrial septal defects?

P

Population

100 children (50 with hemodynamically significant ostium secundum ASD and 50 healthy controls) under 18 years of age, with cases evaluated before and up to 3 months after transcatheter device closure.

I

Intervention

Transcatheter device closure of ASD using Amplatzer, Occlutech, or Lifetech Cera occluders, followed by oral acetylsalicylic acid 5 mg/kg/day for six months.

C

Comparator

Age- and sex-matched healthy controls (for baseline comparison) and self-controlled longitudinal comparison (pre-closure vs. 1 day, 1 month, and 3 months post-closure).

O

Outcome

Right ventricular function assessed by right ventricular free wall strain (RVFW strain) using 2D speckle tracking echocardiography (STE) at 1 day, 1 month, and 3 months post-procedure.surrogate

Main Result

Absolute Event Rate: 29.53% vs 21.6%

p-value: p=<0.001

Transcatheter closure of ASD in children leads to significant, progressive improvement in right ventricular function and reverse remodeling within 3 months, as accurately detected by speckle tracking echocardiography.

Limitations

Focused on short-term follow-up of RV function after ASD device closure
Future studies with mid- and long-term follow-up are needed to evaluate the full extent of reverse remodeling and functional normalization
Short-term follow-up (3 months)
Lack of mid- and long-term follow-up to evaluate the full extent of reverse remodeling and functional normalization

Implication

May support speckle tracking for RV monitoring after pediatric ASD closure; hypothesis-generating and needs prospective validation before practice change.

Abstract

Background: Atrial septal defect (ASD) is a common congenital heart defect (CHD) in children. Evaluating right ventricular (RV) function is essential to understand the impact of ASD and its treatment. Speckle tracking echocardiography (STE) provides a reliable, non-invasive method for detailed RV function assessment. Aims: This study aimed to assess RV function in children with ASD before and after transcatheter device closure using STE. Methods: A case-control study was conducted in the catheterization lab at Smouha Children's Hospital, University of Alexandria, Egypt. It included 50 children under 18 years with ostium secundum ASD undergoing transcatheter device closure and 50 age-matched controls. Transthoracic echocardiography evaluated RV function through parameters such as RV fractional area change (FAC), myocardial performance index (MPI or Tei index), annular pulsed tissue Doppler imaging (TDI), and tricuspid annular plane systolic excursion (TAPSE). Right ventricular free wall strain (RVFW strain) was measured offline using 2D STE software (TomTec). Results: Significant improvement in RVFW strain was observed following ASD closure, with progressive enhancement at one and three months post-procedure. Parameters such as TAPSE, FAC, and RV MPI also showed improvement, indicating recovery of RV systolic function. Conclusions: ASD is associated with reduced RV contractility and myocardial deformation, primarily due to volume overload. Following transcatheter device closure, RV function improved significantly over time. STE is an effective tool for detecting global and regional myocardial dysfunction and monitoring functional recovery after ASD closure.

Discussion

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Cite This Study

Raafat et al. (2025) conducted a case-control in Ostium secundum atrial septal defect (n=100). Transcatheter device closure vs. Pre-closure baseline was evaluated on Right ventricular free-wall strain (RVFW strain) at 3 months post-closure (p=<0.001). Transcatheter device closure of atrial septal defects significantly improved right ventricular free-wall strain from 21.60% at baseline to 29.53% at three months post-procedure (p<0.001).

synapsesocial.com/papers/6abe3592bdd7597321d9a455 https://doi.org/10.23750/abm.v96i2.16736

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Short term evaluation of right ventricular function using speckle tracking echocardiography before and after trans-catheter device closure of atrial septal defects in children

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Short term evaluation of right ventricular function using speckle tracking echocardiography before and after trans-catheter device closure of atrial septal defects in children

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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