Effect of transcatheter closure on cardiac remodeling in atrial septal defect patients of different ages

AIM To evaluate the cardiac remodeling in patients with atrial septal defect in different age groups after transcatheter closure.

METHODS From January 1, 2019 to December 31, 2021, cardiac remodeling in 428 patients who were diagnosed with atrial septal defect (ASD) and had undergone concurrent catheter closure was retrospectively analyzed in the Cardiovascular Department of the First Affiliated Hospital of Air Force Medical University. The patients were divided into 4 groups according to their ages: < 7 years old group, (8~18) years old group, (19~60) years old group, and > 60 years old group. Echocardiography was used to evaluate the cardiac cavity size and pulmonary artery diameter respectively before treatment, at 1 month and at 6 months after transcatheter closure to evaluate the time and degree of postoperative cardiac remodeling.

RESULTS After ASD closure, compared with preoperative, the inner diameter of the right atrium decreased from (39 ± 5) mm to (35 ± 4) mm (P<0.01) one month after surgery, and to (33 ± 3) mm (P<0.01) six months after surgery; The right ventricular inner diameter decreased from preoperative (31 ± 6) mm to postoperative (25 ± 4) mm at 1 month (P<0.01), and then to postoperative (23 ± 3) mm at 6 months (P<0.01). Moreover, the postoperative diameter at 6 months was lower than that at 1 month (P<0.01) The right atrium and right ventricle of a 7-year-old child showed significant shrinkage at 1 and 6 months after surgery (both P<0.01), while there was no significant change at 6 months after surgery compared to 1 month after surgery; The left ventricular systolic and diastolic diameters slightly increased, but there was no statistical difference, and there was no significant change in the left atrial diameter. The right atrium and right ventricle of ASD patients aged (8~18) significantly shrank one month after surgery, and the left ventricular end diastolic volume also significantly increased in six months after surgery (both P<0.01); After ASD closure in patients aged (19~60), the pulmonary artery diameter, right atrium, and right ventricle significantly decreased one month after surgery, and the left ventricular end diastolic volume also significantly increased in six months after surgery (all P<0.01) A 60 year old patient showed no statistically significant changes in the right atrium, left atrium, and left ventricle after ASD closure, except for a significant reduction in pulmonary artery diameter and right ventricle (P<0.01). In patients with moderate/severe functional tricuspid regurgitation, the diameter of pulmonary artery and left atrium decreased (P<0.05), the diameter of right atrium and right ventricle decreased also (P<0.01) at 6 months after occlusion.

CONCLUSION In patients with atrial septal defect of different ages, the right atrium and right ventricle decrease significantly at 1 month after interventional closure and the left ventricular volume increases at 6 months after operation. The younger the age, the less the effect of ASD on cardiac structure and the earlier the recovery of atrial and ventricular structure after treatment.