Right ventricular form and function after percutaneous atrial septal defect device closure

OBJECTIVES We sought to assess the right heart's response to percutaneous d evice closure of moderate sized atrial septal defects (ASDs) in adults over a one-year follow-up period. BACKGROUND Percutaneous ASD device closure is a safe and effective means of reducing or eliminating interatrial shunting. The response of the adult's right heart to device closure is incompletely understood. METHODS Forty consecutive patients had 40 device implantations (32 with the CardioSeal implant and 8 with the Amplatzer device). The patients were ass essed with echocardiography, chest radiography and electrocardiography befo re the procedure and at 1, 6 and 12 months. RESULTS The mean ASD size was 13 +/- 4 mm, and the device size ranged from 33 to 40 mm fur CardioSeal and 12 to 36 mm for Amplatzer. At one month, hea rt size (49%, vs. 46%), four-chamber right ventricular (RV) size (45 vs. 41 mm), paradoxical septal motion (60% vs. 5%), QRS duration (125 vs. 119 ms) , PR interval (181 vs. 155 ms) and echocardiographically determined pulmona ry artery systolic pressure decreased significantly and was maintained at 1 2-month follow-up. At six months, right atrial length decreased from 50 to 47 mm. At one year, 29% of patients had persistent RV enlargement. CONCLUSIONS Right heart morphology undergoes rapid improvement within one m onth of defect closure, with associated mechanoelectrical benefit. A small number of patients had persistent RV enlargement or pulmonary hypertension, or both, at one year. Our data support the application of transcatheter me thods in achieving excellent hemodynamic and anatomic outcomes. (J Am CoLl Cardiol 2001;37:2108-13) (C) 2001 by the American College of Cardiology.