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Left Ventricular Diastolic Function in Children with Atrial Septal Defects Improves After Closure by Means of

Pia Sjöberg1,2, Henning Clausen3,4, Håkan Arheden5,6

  • 1Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden. pia.sjoberg@med.lu.se.

Pediatric Cardiology
|June 11, 2024
PubMed

Insights

Children with atrial septal defect (ASD) show altered hydraulic force affecting left ventricular diastolic filling. ASD closure improves this force, but it remains lower than in healthy children, suggesting persistent diastolic abnormalities.

Area of Science:

  • Cardiovascular Physiology
  • Pediatric Cardiology
  • Medical Imaging

Background:

  • Hydraulic force, determined by atrioventricular area difference (AVAD), aids left ventricular (LV) diastolic filling.
  • Atrial septal defect (ASD) can reduce LV filling due to a left-to-right shunt, potentially altering hydraulic force.

Purpose of the Study:

  • To assess if AVAD and hydraulic force differ in children with ASD compared to controls.
  • To evaluate if ASD closure improves AVAD and hydraulic force in pediatric patients.

Main Methods:

  • Cardiac magnetic resonance imaging (CMR) was used to delineate left atrial and ventricular areas in short-axis views.
  • Atrioventricular area difference (AVAD) was calculated and normalized to body height (AVADi).
  • Comparisons were made between children with ASD (before and after closure) and healthy controls.

Main Results:

  • Children with ASD had significantly lower normalized AVADi compared to controls, both before and after ASD closure.
  • AVADi improved after ASD closure, indicating enhanced hydraulic force and LV diastolic function.
  • Despite improvement, AVADi remained lower in post-closure ASD patients than in controls, suggesting residual diastolic abnormalities.

Conclusions:

  • Left ventricular diastolic function improves in children after ASD closure, mediated by enhanced hydraulic force (AVAD).
  • Persistent lower AVADi post-closure highlights ongoing diastolic abnormalities, even after successful ASD repair.
  • Consideration of ASD closure for patients with smaller shunts, particularly younger children, may be warranted to prevent diastolic dysfunction and improve long-term outcomes.

Keywords:
ASD closureCardiac magnetic resonance imaging (CMR)Congenital heart defect (CHD)Physiology

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