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Updated: Sep 2, 2025
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Functional Echocardiographic and Serum Biomarker Changes Following Surgical and Percutaneous Atrial Septal Defect
Jelle P G van der Ven1,2,3, Eva van den Bosch1,3, Vivian P Kamphuis3,4
1Department of Pediatrics Division of Pediatric Cardiology Erasmus MC Sophia Children's Hospital Rotterdam The Netherlands.
Insights
Surgical atrial septal defect closure temporarily reduces biventricular performance, especially in the right ventricle, which may not fully recover. Biomarkers like NT-proBNP may offer insights into these changes.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Cardiac Surgery
Background:
- Atrial septal defect (ASD) closure can temporarily impair ventricular function.
- The impact of cardiopulmonary bypass and altered loading conditions on biventricular performance post-ASD closure is not fully understood.
Purpose of the Study:
- To characterize biventricular performance after surgical and percutaneous ASD closure.
- To identify correlations between biomarkers and ventricular performance post-intervention.
Main Methods:
- Multicenter prospective study including children undergoing ASD closure (surgical or percutaneous).
- Echocardiography and biomarker analysis at baseline, 2 weeks, and 1 year post-intervention.
- Assessment of biventricular global longitudinal strain and NT-proBNP levels.
Main Results:
- Surgical ASD closure led to decreased right and left ventricular global longitudinal strain at 2 weeks, unlike percutaneous closure.
- Left ventricular function normalized by 1 year, while right ventricular function remained below baseline.
- NT-proBNP levels correlated with less favorable left ventricular strain at 2 weeks.
Conclusions:
- Surgical ASD closure causes early biventricular dysfunction, with persistent right ventricular impairment.
- Biomarkers, including NT-proBNP, may reflect underlying processes affecting ventricular function post-ASD closure.
Abstract:
Background Ventricular performance is temporarily reduced following surgical atrial septal defect closure. Cardiopulmonary bypass and changes in loading conditions are considered important factors, but this phenomenon is incompletely understood. We aim to characterize biventricular performance following surgical and percutaneous atrial septal defect closure and to relate biomarkers to ventricular performance following intervention. Methods and Results In this multicenter prospective study, children scheduled for surgical or percutaneous atrial septal defect closure were included. Subjects were assessed preoperatively, in the second week postintervention (at 2-weeks follow-up), and 1-year postintervention (1-year follow-up). At each time point, an echocardiographic study and a panel of biomarkers were obtained. Sixty-three patients (median age, 4.1 [interquartile range, 3.1-6.1] years) were included. Forty-three patients underwent surgery. At 2-weeks follow-up, right ventricular global longitudinal strain was decreased for the surgical, but not the percutaneous, group (-17.6±4.1 versus -27.1±3.4; P<0.001). A smaller decrease was noted for left ventricular global longitudinal strain at 2-weeks follow-up for the surgical group (surgical versus percutaneous, -18.6±3.2 versus -20.2±2.4; P=0.040). At 1-year follow-up, left ventricular performance returned to baseline, whereas right ventricular performance improved, but did not reach preintervention levels. Eight biomarkers relating to cardiovascular and immunological processes differed across study time points. Of these biomarkers, only NT-proBNP (N-terminal pro-B-type natriuretic peptide) correlated with less favorable left ventricular global longitudinal strain at 2-weeks follow-up. Conclusions Right, and to a lesser degree left, ventricular performance was reduced early after surgical atrial septal defect closure. Right ventricular performance at 1-year follow-up remained below baseline levels. Several biomarkers showed a pattern over time similar to ventricular performance. These biomarkers may provide insight into the processes that affect ventricular function. Registration URL: https://www.trialregister.nl/; Unique identifier: NL5129.
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