Right ventricular remodeling after transcatheter closure of atrial septal defect

Right ventricular (RV) volume overload is a well-known cardiac consequence of atrial septal defect (ASD) shunt, accounting for most of its long-term complications. Thus cardiac volumetric unloading is a major aim of transcatheter ASD closure. We set to study the right ventricular remodeling after transcatheter ASD closure in patients with secundum ASD.

We enrolled 46 patients who underwent successful transcatheter closure of ASD. We performed routine transthoracic echocardiographic studies, including three-dimensional echocardiography and right ventricular myocardial performance index (RVMPI), before transcatheter ASD closure, and 3 days, 1 month after transcatheter ASD closure.

We found that: (1) the right ventricular end-diastolic volume (RVEDV) and right ventricular end-systolic volume (RVESV) (respectively 106.54+/-25.97 vs 69.78+/-10.46 mL, P < 0.05; 59.73+/-17.59 vs 33.84+/-7.18 mL, P < 0.05) were enlarged in patients with ASD compared with those in control subjects, resulting in a marked decrease of the right ventricular ejection fraction (RVEF) (44.82%+/-4.51% vs 54.11%+/-5.89%, P < 0.05) from normal values; (2) the isovolumic relaxation and isovolumic contraction times (respectively [77.61+/-16.49] ms vs (64.09+/-11.82) ms, P < 0.05; [28.04+/-9.57] ms vs [20.45+/-6.53] ms, P < 0.05) were prolonged and ejection time ([250.02+/-24.21] ms vs [272.73+/-20.51] ms, P < 0.05) was shortened in patients with ASD compared with that in control subjects, resulting in a marked increase of the MPI (0.41+/-0.07 vs 0.31+/-0.05, P < 0.05) from normal values; and (3) after transcatheter closure, the RVEDV and RVESV decreased and the RVEF increased markedly and RVMPI decreased markedly.

Transcatheter closure of ASD results in rapid normalization of RV volume overload and improvement of RV function.