Cardiac troponin I release after transcatheter atrial septal defect closure depends on occluder size but not on
A Tárnok1, J Bocsi, P Osmancik
1Department of Paediatric Cardiology, Heart Centre, University of Leipzig, Strümpellstrasse 39, 04289 Leipzig, Germany. tarnok@medizin.uni-leipzig.de
Insights
Transcatheter closure of atrial septal defect (ASD) with the Amplatzer septal occluder causes minimal myocardial injury in both children and adults. The extent of this injury is related to occluder size, not patient age.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Interventional Cardiology
Background:
- Atrial septal defect (ASD) is a common congenital heart defect.
- Transcatheter closure is a minimally invasive treatment option for ASD.
- Concerns exist regarding potential myocardial injury in pediatric patients undergoing transcatheter procedures.
Purpose of the Study:
- To compare myocardial injury in children versus adults following transcatheter closure of secundum ASD using the Amplatzer septal occluder.
- To assess the relationship between patient age, occluder size, and myocardial injury markers.
Main Methods:
- Prospective study involving four groups: children and adults undergoing transcatheter ASD closure, children undergoing surgical ASD closure, and children undergoing diagnostic catheterization.
- Serum cardiac troponin I (cTnI) concentrations were measured pre-procedure and up to 20 months post-procedure.
- Immunoassay was used to quantify cTnI levels.
Main Results:
- Transcatheter ASD closure resulted in a significant, yet minor, increase in cTnI levels compared to baseline.
- Children exhibited higher cTnI concentrations immediately after occluder implantation than adults.
- Myocardial injury was significantly less severe than after surgical ASD closure and was dependent on occluder size, not patient age.
Conclusions:
- Transcatheter closure of ASD with the Amplatzer septal occluder induces minimal myocardial injury.
- The extent of myocardial lesion is primarily determined by the size of the occluder device.
- Current data do not suggest increased myocardial vulnerability in children compared to adults undergoing interventional ASD closure.
Objective:
To examine whether transcatheter closure of secundum atrial septal defect (ASD) with the Amplatzer septal occluder leads to more myocardial injury in children than in adults.
Design:
In a prospective study with children and adults cardiac troponin I (cTnI) serum concentrations were determined by immunoassay (AxSYM, Abbott Laboratories) before, during, and up to 20 months after surgical or transcatheter ASD closure.
Patients:
Four groups of patients were studied: transcatheter ASD closure (group 1: 22 children, age range 3.26-14.7 years; group 2: 22 adults, 18.0-67.3 years), surgical ASD closure (group 3: 18 children, 3.12-13.5 years), and diagnostic catheterisation (group 4: 12 children, 2.68-15.0 years).
Results:
cTnI concentrations were significantly increased after occluder implantation with higher serum concentrations in children than in adults (immediately after implantation: group 1, 3.2 (4.4) microg/l; group 2, 1.1 (4.2) microg/l; four hours after implantation: group 1, 4.8 (5.0) microg/l; group 2, 1.7 (2.3) microg/l; both p < 0.01, group 1 v group 2; one day after implantation: group 1, 3.0 (5.7) microg/l; group 2, 2.2 (5.2) microg/l) but were less than 20% of those after surgical ASD closure (group 3; p < 0.001) where the highest cTnI concentration was found (37.1 (26.3) microg/l). Diagnostic catheterisation (group 4) was not associated with detectable cTnI increase. From the cTnI concentrations the total amount of cTnI released after ASD closure was estimated for each patient. This was dependent on the size of the occluder (p < 0.05) but not on the patient's age or procedural duration.
Conclusion:
In regard to interventional ASD closure our data do not provide evidence that the child's myocardium is more vulnerable. Transcatheter ASD closure induces minor myocardial lesion, the extent of which depends on the size of the Amplatzer septal occluder but is irrespective of the patient's age.
