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Atrial septal defect closure in children at young age is beneficial for left ventricular function

Pia Sjöberg1,2, Henning Clausen3,4, Håkan Arheden1,2

  • 1Clinical Physiology, Department of Clinical Sciences, Lund, Lund University, Box 188, 221 00 Lund, Sweden.

European Heart Journal. Imaging Methods and Practice
|September 3, 2024
PubMed

Insights

Atrial septal defect (ASD) closure in children improves left ventricular (LV) function and hemodynamics. However, LV volumes remain smaller than in controls post-closure, potentially impacting long-term outcomes.

Area of Science:

  • Pediatric Cardiology
  • Cardiovascular Physiology
  • Medical Imaging

Background:

  • Atrial septal defects (ASDs) cause right ventricular volume overload.
  • ASD closure doesn't always resolve symptoms or improve exercise capacity, suggesting potential left ventricular (LV) hemodynamic impacts.

Purpose of the Study:

  • To evaluate the effect of ASD closure on non-invasive LV pressure-volume (PV) loops in children.
  • To compare LV hemodynamics in children with ASD before and after closure against healthy controls.

Main Methods:

  • Cardiac magnetic resonance (CMR) imaging and brachial blood pressure were used to derive non-invasive LV PV loops.
  • Twenty-three children with ASD underwent CMR, with 17 re-examined post-closure; 12 controls were included.

Main Results:

  • After ASD closure, LV end-diastolic volume increased but remained smaller than in controls.
  • Children with ASD exhibited higher baseline contractility and arterial elastance compared to controls.
  • Post-closure, contractility and arterial elastance decreased, approaching control levels.

Conclusions:

  • The left ventricle (LV) in children with ASD remains hemodynamically efficient despite the shunt.
  • Early ASD closure is beneficial for LV function due to ventricular compliance.
  • Persistent small LV volumes post-closure may influence long-term cardiovascular risk and exercise performance.
Abstract

Keywords:
cardiac magnetic resonance (CMR) imaging • childrencongenital heart defectpaediatricpressure–volume loopsventricular function

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