Echocardiographic insights of right heart dynamics after transcatheter ASD closure: A prospective study

Transcatheter atrial septal defect (ASD) closure is a minimally invasive procedure, yet variability in right heart reverse remodeling post-procedure remains understudied.

To evaluate the impact of transcatheter ASD closure on right ventricular (RV) parameters and tricuspid regurgitation (TR) severity over six months, and to identify predictors of RV reverse remodeling and TR improvement.

This prospective study included 60 adult patients who underwent successful transcatheter ASD closure. Transthoracic echocardiography was performed at baseline, and at 1, 3, and 6 months post-procedure to assess RV dimensions, systolic function, and TR severity.

Significant reductions were observed in RV dimensions-including tricuspid annular diameter, RV basal diameter, RV mid-cavity diameter, and RV outflow tract diameter-at 6 months (p < 0.001). RV systolic function declined at 1 month and remained stable thereafter. TR severity improved significantly at 1 and 3 months. Predictors of RV reverse remodeling at 6 months included younger age (OR: 0.949; 95 % CI: 0.913-0.986), sinus rhythm (OR: 0.113; 95 % CI: 0.022-0.569), lower shunt ratio (OR: 0.259; 95 % CI: 0.068-0.993). Predictors of TR improvement included the same factors, in addition to smaller tricuspid annular diameter and smaller right atrial end-systolic area.

Transcatheter ASD closure leads to significant right heart reverse remodeling and TR improvement. Younger age, sinus rhythm, and smaller preprocedural chamber dimensions predict RV reverse remodeling and improvement of TR, supporting their role in patient selection and clinical decision-making.