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Venous flow patterns after percutaneous atrial septal defect closure: Does the mechanical device decrease right
Amitabh Poonia1, Priya Giridhara1, Sivasankaran Sivasubramonian1
1Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India.
Insights
Percutaneous closure of atrial septal defects (ASDs) improves systemic venous flow, especially in larger defects. Follow-up reveals progressive enhancement of diastolic flow over six months.
Area of Science:
- Cardiology
- Medical Devices
- Vascular Physiology
Background:
- Surgical closure of ostium secundum atrial septal defects (ASDs) can lead to abnormal systemic venous flow.
- Systemic venous flow changes after percutaneous ASD closure are not well-studied.
Purpose of the Study:
- To investigate systemic venous Doppler flow patterns after percutaneous closure of ASD.
- To correlate these changes with defect and device size.
Main Methods:
- Prospective documentation of systemic venous Doppler flow patterns in 50 subjects.
- Measurements taken before, immediately after, and at 6-month follow-up.
- Correlation with defect and device size.
Main Results:
- Increased forward flow velocity (systolic and diastolic) in hepatic veins and superior vena cava post-closure.
- Significant increase in the diastolic/systolic (D/S) flow ratio, indicating improved atrial filling.
- Changes were more pronounced and statistically significant in patients with larger defect sizes (≥15 mm/sq.m).
Conclusions:
- Percutaneous ASD closure positively impacts systemic venous flow dynamics.
- Larger defects and devices are associated with more significant flow changes.
- Persistent abnormalities warrant follow-up for potential atrial remodeling and arrhythmias.
Introduction:
Systemic venous flow patterns become abnormal and restrictive after surgical closure of ostium secundum atrial septal defect (ASD) but rarely studied after percutaneous device closure.
Methods:
From January 2017 to January 2018, systemic venous Doppler flow patterns were documented prospectively in 50 subjects who underwent percutaneous closure of ASD, prior to, after procedure, and at 6-month follow-up and correlated with defect size and device size.
Results:
In hepatic veins and superior venacava post device-closure closure, the velocity time integral (VTI) of forward flow in both systole (S) and diastole (D) increased. Overall S was higher than D, and D/S ratio was <1. The D/S ratio increased after device closure significantly reflecting that the improvement in atrial filling increase in diastolic flow more than the increase in systolic flow. Increase in flow velocities was more prominent at 6 months with further increase in D/S VTI ratios. When correlated with the defect size, in those with defect size less than 15 mm/sq.m (mean device size 13.05 ± 3.21 mm), the changes in S- or D-wave, D/S ratio were less prominent and statistically not significant, while in subjects with defect size ≥ 15 mm/sq.m (mean device size 23.02 (±4.77 mm), these changes were greater and statistical significant.
Conclusion:
Residual filling defects with restriction of systolic venous flow were observed in subjects after device closure, correlating with larger device sizes, implying the compliance abnormality conferred by them which progresses at 6 months. Subjects with persistent abnormalities would need careful follow up for incomplete remodeling and increase in atrial size related arrhythmias.
