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A Comparison of Long-Term Right Ventricular Functions in Children with Transcatheter and Surgically Closed Secundum
Serra Karaca1, Doruk Özbingöl1, Pelin Karaca Özer2
1Pediatric Cardiology Department, Istanbul Faculty of Medicine, Istanbul 34093, Turkey.
Insights
Surgical closure of large atrial septal defects (ASDs) in children may negatively impact long-term right ventricular function, indicated by lower strain values and longer QRS duration on ECG compared to transcatheter closure.
Area of Science:
- Cardiology
- Pediatric Congenital Heart Disease
- Echocardiography and Electrocardiography
Background:
- Secundum-type atrial septal defect (ASD) is a common congenital heart defect.
- Evaluating long-term outcomes of ASD closure methods is crucial for pediatric cardiac care.
- Right ventricular function assessment is key in managing ASD patients.
Purpose of the Study:
- To compare long-term follow-up results of percutaneous versus surgical ASD closure in children.
- To evaluate right ventricular function using strain echocardiography and electrocardiography (ECG).
- To correlate ECG parameters like QRS duration with echocardiographic strain measurements.
Main Methods:
- Prospective comparison of 30 children with transcatheter ASD closure, 30 with surgical closure, and 50 healthy controls.
- Echocardiography assessed Tricuspid annular plane systolic excursion (TAPSE), right ventricle (RV) and right atrium (RA) dimensions, and RV longitudinal strain (segmental and global).
- ECG evaluated QRS duration and its correlation with strain echo findings.
Main Results:
- Surgical group had significantly larger ASDs (20 mm) than the transcatheter group (14.87 mm).
- Surgical closure was associated with increased RA and RV diameters, and decreased RV longitudinal strain (p < 0.001).
- Patients undergoing surgical closure showed significantly longer QRS durations on ECG compared to transcatheter and control groups (p < 0.001).
Conclusions:
- Surgical ASD closure in children is linked to reduced long-term right ventricular function and longer QRS duration.
- Large ASD diameter negatively affects long-term RV function, as indicated by strain values and ECG.
- Early surgical closure may be appropriate for large ASDs in children unsuitable for transcatheter treatment.
Abstract:
Background/Objectives: Secundum-type atrial septal defect (ASD) is one of the most common congenital heart defects, with an incidence of 5.64 per 10,000 live births worldwide. In our study, long-term follow-up results of children who underwent percutaneous ASD closure and patients who underwent surgical treatment were evaluated using right ventricular strain echocardiography and electrocardiography. Methods: 30 patients who underwent transcatheter ASD closure and 30 patients provided with surgical ASD closure were prospectively compared with 50 healthy children with similar demographic characteristics. ECG and transthoracic echocardiography were performed for all patients. The evaluated echocardiography variables are Tricuspid annular plane systolic excursion (TAPSE), 2D right ventricle (RV) and right atrium (RA) dimensions, right ventricular segmental longitudinal strain, and global longitudinal strain. ECG evaluation was performed especially in terms of QRS duration and its correlation with strain echo measurements. Results: The surgical treatment group has statistically significant ASD size compared to patients who underwent transcatheter closure (20 ± 3.6 and 14.87 ± 3.7 mm, p < 0.001). Patients who had surgical treatment have increased RA and RV diameters, and a statistically significant decrease was observed in right ventricular free-wall longitudinal strain and right ventricular four-chamber longitudinal strain compared to patients in transcatheter and the control group (p < 0.001). QRS durations were similarly normal in electrocardiography in the transcatheter and the control groups, and the QRS duration was observed as statistically significantly increased in the patients in the surgical treatment group (p < 0.001). Conclusions: Strain values of the patients who underwent surgical closure were lower, and the QRS values on the ECG were longer, compared to the transcatheter group, which is an indicator that a large ASD diameter has a negative effect on long-term right ventricular function. With this in mind, we argue that early surgical closure is an appropriate treatment option for children whose ASD is large for their age and who are not suitable candidates for transcatheter treatment.
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