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A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
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Predictors of Mitral Regurgitation and Subsequent Cardiac Geometric Changes Following Secundum Atrial Septal Defect

Chunyu Liu1, Zhibiao Zhang1, Jicheng Xi1

  • 1Shanxi Cardiovascular Hospital, Taiyuan, Shanxi, China.

The Thoracic and Cardiovascular Surgeon
|February 16, 2026
PubMed

Insights

Atrial septal defect (ASD) closure can worsen mitral regurgitation (MR). Enlarged left atrial (LA) size is a key predictor of MR worsening, suggesting prophylactic mitral annuloplasty may benefit specific patients.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Echocardiography

Background:

  • Mitral regurgitation (MR) can improve after atrial septal defect (ASD) closure, but sometimes worsens.
  • Mechanisms behind MR worsening post-ASD closure are not fully understood.

Purpose of the Study:

  • Identify predictors of MR worsening after surgical ASD closure.
  • Analyze echocardiographic changes and patient characteristics influencing MR outcomes.

Main Methods:

  • Retrospective analysis of 95 patients undergoing surgical ASD closure.
  • Preoperative and postoperative transthoracic echocardiography (TTE) at multiple time points up to 2 years.
  • Logistic regression analysis to identify MR predictors.

Main Results:

  • Left atrial (LA) size was an independent predictor and protective factor against MR worsening.
  • Significant remodeling of the right cardiac system and LA occurred within 6 months post-closure.
  • Left ventricular (LV) size increased, with differing LA changes between MR worsening and non-worsening groups.

Conclusions:

  • Prophylactic mitral annuloplasty may benefit patients with enlarged LA undergoing ASD surgery.
  • Concurrent intervention is recommended for patients with enlarged LA and additional mitral annuloplasty risk factors.

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