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Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
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Headache and Left Ventricular Efficiency After Transcatheter Closure of Atrial Septal Defect

Ryohei Matsuoka1, Jun Muneuchi1, Yusaku Nagatomo1,2

  • 1Department of Pediatrics, Japan Community Healthcare Organization Kyusyu Hospital, Kitakyusyu, Japan.

Headache
|October 12, 2020
PubMed

Insights

Pediatric migraine headaches after atrial septal defect closure are linked to reduced ventricular energy efficiency. This suggests impaired ventriculo-arterial coupling may contribute to headaches in these children.

Area of Science:

  • Pediatric Cardiology
  • Neurology
  • Cardiovascular Physiology

Background:

  • Atrial septal defect (ASD) closure is a common procedure in children.
  • Migraine-like headaches can occur post-ASD closure, but the underlying mechanisms are not fully understood.
  • Ventriculo-arterial coupling (VAC) describes the interaction between the left ventricle and the arterial system.

Purpose of the Study:

  • To investigate the relationship between migraine-like headaches and VAC after transcatheter ASD closure in pediatric patients.
  • To test the hypothesis that headaches are associated with abnormal hemodynamic responses, specifically increased left ventricular filling pressures.

Main Methods:

  • Retrospective cohort study of 167 children undergoing transcatheter ASD closure.
  • Echocardiography was used to calculate end-systolic elastance (Ees), effective arterial elastance (Ea), and ventricular energy efficiency before and after the procedure.
  • Comparison of hemodynamic parameters between children who developed headaches and those who did not.

Main Results:

  • 47% of subjects (28%) experienced migraine headaches post-procedure.
  • No significant differences in Ees, Ea, or energy efficiency were found before closure.
  • After closure, subjects with headaches showed significantly lower Ees and ventricular energy efficiency compared to those without headaches.
  • Migraine headache was associated with younger age at procedure and decreased ventricular energy efficiency post-closure.

Conclusions:

  • Reduced ventricular energy efficiency is common in pediatric patients with migraine-like headaches following ASD closure.
  • This suggests left ventricular functional maladaptation and impaired ventriculo-arterial coupling may play a role in headache development.
  • Impaired VAC could be a mechanism for headaches not only in this population but also in other migraine patients.
Abstract

Keywords:
autonomic nerve systemcardiac functioncongenital heart diseaseventriculoarterial coupling

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