Open Access

ARTICLE

The Effect of Atrial Septal Defect Closure on Cardiac Volumetric Changes in Adults, Transcatheter Versus Surgical Closure, a Pilot Cardiac Magnetic Resonance Study

by Amr Mansour¹, Noha M. Gamal^2,*, Alaa M. Nady³, Amr Ibraheem³, Dalia M. Salah⁴, Khaled M. El-Maghraby²

1 Cardiology Department, Congenital and Structural Heart Disease Unit, Ain Shams University Hospitals, Faculty of Medicine, Ain Shams University, Cairo, Egypt
2 Cardiology Department, Faculty of Medicine, Assuit University, Assuit, Egypt
3 Cardiothoracic Surgery Department, Faculty of Medicine, Assuit University, Assuit, Egypt
4 Anesthesia Department, Faculty of Medicine, Assuit University, Assuit, Egypt

* Corresponding Author: Noha M. Gamal. Email:

Congenital Heart Disease 2023, 18(6), 679-691. https://doi.org/10.32604/chd.2023.020028

Received 30 October 2021; Accepted 25 May 2022; Issue published 19 January 2024

Abstract

Background: Closure of an atrial septal defect (ASD) reduces right-side heart volumes by abolishing shunting with simultaneous improvement of the left ventricle (LV) filling and functions due to ventricular interdependence, thereby improving symptoms. Furthermore, studies conducted on atrial volume changes after ASD closure are limited. Cardiac magnetic resonance (CMR) is considered as the gold standard method for measuring cardiac volume and mass. Objective: We aimed to study the effect of transcatheter and surgical closure of secundum ASD on cardiac volumes and systolic functions as well as the fate of tricuspid regurgitation (TR), using CMR analysis. Methods: We prospectively enrolled 30 adult patients with isolated secundum ASD who were referred to ASD closure. CMR evaluation of cardiac chambers indexed volumes, systolic function, myocardial mass index, and tricuspid regurgitant fraction were done at before and 6 months after closure. Results: RV volumes decreased in both groups when compared to baseline (p-value 0.001), the device group had more reduction in volumes and more improvement in RV function after closure (p-value 0.001) when compared to the surgical arm. The changes in the RV mass index were insignificant between both groups (p-value 0.31). Functional TR improved to the same extent in both groups. Left ventricular end diastolic volume index (LVEDVI) and LV mass index increased significantly in both groups when compared to baseline in both groups but with no difference between groups p-value 0.01), left ventricular end systolic volume index (LVESVI) changes were insignificant. LV systolic function improved in patients who underwent device closure only (63.53 ± 3.85 vs. 67.13 ± 4.34, p-value 0.01). There was a significant reduction in right atrial (RA) volumes and an insignificant decrease in left atrial (LA) volumes, with no difference between groups. Conclusion: Transcatheter and surgical secundum ASD closure resulted in volumetric changes in some cardiac chambers with better improvement in bi-ventricular systolic function in the transcatheter arm and no difference in the TR reduction between the two groups at 6 months follow-up by CMR.

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Keywords

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