Intergenerational differences in the effects of transcatheter closure of atrial septal defects on cardiac function

Little is known regarding intergenerational differences in the effects of atrial sepal defect (ASD) closure on the left heart. We therefore analyzed age-related serial changes in the left heart following ASD closure.

We studied 50 patients with an isolated ASD who underwent successful transcatheter closure using Amplatzer septal occluders (St. Jude Medical, Little Canada, MN, USA) between June 2007 and June 2013. Patients were divided into three age groups: young patients aged ≤17 years; middle-aged patients aged 18-50 years; and older patients aged >50 years. Multi-modal echocardiographic studies with different views were performed before and at 1 day, 1-3 months, and 6-12 months after ASD closure. Echocardiographic variables were compared among the groups at different time points after closure.

Left ventricular end-diastolic and end-systolic volume indices (EDVI and ESVI) in the older group were significantly smaller than those in the other groups before closure. EDVI and ESVI increased with time after closure in all groups with stable ejection fractions. However, EDVI and ESVI remained significantly smaller in the older group compared with the other groups. There was a significant interaction among the age groups only in terms of left atrial volume index (LAVI). LAVI increased significantly with time in the older group, but did not change in the other groups.

Although the left ventricle enlarged with time after ASD closure in all age groups, left ventricular size in older patients never reached that in younger patients. In addition to this inadequate enlargement of the left ventricle, diastolic dysfunction might also result in late left atrial enlargement in older patients following ASD closure.