Predictors of Mitral Regurgitation and Subsequent Cardiac Geometric Changes Following Secundum Atrial Septal Defect...

Mitral regurgitation (MR) associated with atrial septal defect (ASD) has been observed to improve following ASD closure; however, aggravation of preexisting MR can occur postprocedure, with the underlying mechanisms of these adverse outcomes remaining poorly understood.This retrospective study evaluated 95 patients who underwent surgical secundum ASD closure, all of whom received preoperative and postoperative transthoracic echocardiography (TTE). Patient characteristics from preoperative TTE, as well as sex and age, were analyzed to identify predictors of MR. Follow-up TTE was conducted at 1 month, 3 months, 6 months, 1 year, and 2 years postprocedure, with all patients successfully completing the 2-year follow-up.The univariate logistic regression analysis indicated that age, gender, LA, RA-VD, RA-HD, RV, ASD diameter, AS diameter, PAP, and peak tricuspid regurgitation velocity may serve as predictors of MR worsening. Subsequent multiple logistic regression analysis revealed that LA size was an independent predictor of MR worsening and acted as a protective factor. Our research indicates a marked reduction in the right cardiac system after ASD closure, with significant remodeling of the LA within the first 6 months. The relative size of the LV increased notably within 2 years. The postoperative changes in LA differed between the worsening MR group and the nonworsening MR group.In conclusion, "prophylactic" mitral annuloplasty during ASD surgery may prove advantageous for patients with an enlarged LA, and the presence of additional risk factors associated with mitral annuloplasty heightens the recommendation for concurrent intervention.