The Turkish Journal of Pediatrics
2013 , Vol 55 , Num 4
Improvement in Cardiac Structure and Functions Early After Transcatheter Closure of Secundum Atrial Septal Defect in Children and Adolescents
Divisions of Pediatric Cardiology, Department of Pediatrics, 1Dicle University Faculty of Medicine, Diyarbakır, and 4Şifa
University Faculty of Medicine, and 2Division of Pediatric Cardiology, İzmir Dr. Behçet Uz Children’s Hospital, and
3Department of Statistics, Dokuz Eylül University Faculty of Sciences, İzmir, Turkey. E-mail: drmuratmuhtar@hotmail.com
We sought to assess the effects of transcatheter closure of atrial septal
defect (ASD) on right and left ventricular form and functions, as well as
atrial volumes and pulmonary venous flows. We enrolled 25 patients (mean
age: 9.02) prospectively who underwent successful transcatheter closure of
secundum ASD. We performed transthoracic echocardiography, including
two-dimensional, pulsed wave Doppler, M-mode echocardiography, and tissue
Doppler imaging before the procedure and 1 day, 1 month, 3 months and
6 months after the procedure. Serum brain natriuretic peptide (BNP) levels
were measured prior to the procedure, and 1 day, 1 month, and 3 months
thereafter. Mitral inflow early diastolic wave increased significantly, while
isovolumetric relaxation time and deceleration time did not change during
the follow-up. The E/E’was also increased significantly during follow-up. After
the closure, right ventricular size and right atrial volume reduced, while left
ventricular size increased significantly. There was a statistically significant
improvement in left and right ventricular Tei indices. Pulmonary vein systolic
velocity and the ratio of systolic to diastolic wave decreased, while atrial
reversal wave (ARW) velocity increased immediately after the procedure.
Although the concentration of BNP was increased on the first day after the
procedure, its levels reduced and had reached the pre-procedure values at 1
month of follow-up. In the study, a significant improvement in the right and
left ventricular functions was detected after transcatheter closure of secundum
ASD in the short-term follow-up. In addition, we found a significant reduction
in right heart sizes with corresponding global functional improvement in the
right ventricle after the procedure.
Keywords :
diastolic functions, Tei index, filling pressure, cardiac chambers, pulmonary
venous flow.