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Updated: Jan 12, 2026
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Echocardiographic Evaluation of Right Heart and Hemodynamic Changes After Transcatheter Secundum Atrial Septal Defect
Jamilah S AlRahimi1,2,3,4, Almas S AlSolami2,4, Renad S Alghamdi2,4
1Department of Cardiology, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia.
Insights
Transcatheter closure of atrial septal defects (ASDs) rapidly improves heart structure and function in adults. Echocardiography confirms sustained benefits in right heart remodeling and pulmonary pressures post-procedure.
Area of Science:
- Cardiology
- Cardiac Surgery
- Medical Imaging
Background:
- Transcatheter closure of secundum atrial septal defects (ASDs) is standard for adults with left-to-right shunting.
- The long-term effects of ASD closure on cardiac remodeling and function require further definition.
Purpose of the Study:
- To evaluate serial echocardiographic changes in right heart structure and hemodynamics after transcatheter ASD closure.
- To assess the time course and magnitude of cardiac remodeling and functional improvement.
Main Methods:
- Retrospective cohort study of adults undergoing transcatheter secundum ASD closure.
- Serial echocardiography at baseline, immediately post-procedure, 3-6 months, and 1 year.
- Key parameters included right atrial/ventricular dimensions, pulmonary pressures, and tricuspid regurgitation severity.
Main Results:
- Significant early reductions in tricuspid regurgitation, pulmonary valve velocities, right atrial size, and pulmonary artery pressures were observed.
- Right atrial volume index, right ventricular systolic pressure, and shunt fraction (QP:QS) also decreased significantly post-closure.
- These improvements were sustained at 1-year follow-up.
Conclusions:
- Transcatheter ASD closure leads to prompt and lasting improvements in right heart remodeling, pulmonary pressures, and tricuspid regurgitation.
- Echocardiography is crucial for monitoring patients post-ASD closure.
- Timely intervention is recommended for patients with significant shunting.
Background:
Transcatheter closure of secundum atrial septal defects (ASDs) is a widely accepted intervention in adults with left-to-right shunting and right heart volume overload. However, the time course and magnitude of cardiac remodeling and functional improvement after closure remain incompletely defined. This study evaluated serial echocardiographic changes in right heart structure and hemodynamics following ASD closure.
Methods:
In this single-center retrospective cohort, adults who underwent transcatheter secundum ASD closure between January 2020 and December 2023 were included. Echocardiography was performed at baseline, immediately post-procedure, at 3 to 6 months, and at 1 year. Parameters included right atrial (RA) area and volume index (RAVI), right ventricular (RV) dimensions, pulmonary valve velocities, RV systolic pressure (RVSP), mean pulmonary artery pressure (mPAP), tricuspid annular plane systolic excursion (TAPSE), and tricuspid regurgitation (TR) severity. Analyses used Wilcoxon signed-rank tests, Chi-square tests, repeated-measures analysis of variance (ANOVA)/multivariate ANOVA (MANOVA), and mixed-effects models.
Results:
Eighty patients were included (mean age: 42.3 ± 15.0 years; 72.5% female). Immediately after closure, significant reductions were observed in TR Vmax (-20.8 cm/s, P = 0.0005), pulmonary valve Vmax (-32.1 cm/s, P < 0.0001), Vmean (-18.6 cm/s, P < 0.0001), velocity time integral (VTI) (-6.9 cm, P < 0.0001), RA area (-2.6 cm2, P < 0.0001), RAVI (-7.0 mL/m2, P < 0.0001), RVSP (-7.7 mm Hg, P < 0.0001), QP:QS (-0.8, P ≤ 0.0001), and mPAP (-10.0 mm Hg, P = 0.0007). Improvements were sustained at 3 - 6 months (n = 54) and at 1 year (n = 19).
Conclusions:
Transcatheter ASD closure in adults results in early and sustained improvements in RA and ventricular remodeling, pulmonary pressures, and TR severity. These findings underscore the role of echocardiography in longitudinal surveillance and support timely intervention in patients with significant shunting (QP:QS > 1.5). Larger multicenter studies with extended follow-up and correlation to clinical outcomes are warranted.
