Transcatheter closure of atrial septal defect in adults

time-course of atrial and ventricular remodeling and effects on exercise capacity

Sigurdur S. Stephensen, Ellen Ostenfeld, Shelby Kutty, Katarina Steding-Ehrenborg, Hakan Arheden, Ulf Thilén, Marcus Carlsson

Research output: Contribution to journalArticle

Abstract

Investigate ventricular and atrial remodeling following atrial septal defect (ASD) closure and examine if pulmonary-to-systemic flow ratio (QP/QS) and right ventricular (RV) volume predict improvement, determined as percentage of predicted oxygen uptake (VO2%). Long-term cardiovascular magnetic resonance (CMR) data on atrial and ventricular remodeling after ASD-closure is limited and treatment effect on exercise capacity is debated. Sixteen patients undergoing transcatheter ASD closure and 16 age and sexmatched controls were studied. CMR was performed before treatment, the day after and 3 and 12 months later. Exercise test with gas analysis was performed before and 12 months after treatment. QP/QS decreased from 2.1 ± 0.5 to 1.4 ± 0.3 at day 1 and 1.1 ± 0.1 at 3 and 12 months. Left ventricular (LV) volumes increased and normalized on day 1 whereas left atrial volumes were unchanged. RV and right atrial volumes decreased the first 3 months. LV and RV volumes had not equalized at 12 months (RV/LV ratio 1.2 ± 0.1, P < 0.01) and RV ejection fraction remained decreased compared to controls. Improvement of VO2% after ASD closure (P < 0.01) was inversely related to QP/QS at rest (r = − 0.56, P < 0.05) but unrelated to RV end-diastolic volume (P = 0.16). Following transcatheter ASD closure, LV adaptation is rapid and RV adaptation is prolonged, with decreased systolic RV function. Patients with smaller shunts had larger improvement in VO2% suggesting patients with defects of borderline hemodynamic significance might benefit from closure. This may be due to impaired LV diastolic function influencing shunt size and exercise capacity following ASD closure.

Original languageEnglish (US)
JournalInternational Journal of Cardiovascular Imaging
DOIs
StatePublished - Jan 1 2019

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Atrial Remodeling
Ventricular Remodeling
Atrial Heart Septal Defects
Exercise
Stroke Volume
Magnetic Resonance Spectroscopy
Right Ventricular Function
Exercise Test
Left Ventricular Function
Therapeutics
Gases
Hemodynamics
Oxygen
Lung

Keywords

  • ASD
  • Congenital heart disease
  • Exercise capacity
  • Heart failure
  • MRI

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Transcatheter closure of atrial septal defect in adults : time-course of atrial and ventricular remodeling and effects on exercise capacity. / Stephensen, Sigurdur S.; Ostenfeld, Ellen; Kutty, Shelby; Steding-Ehrenborg, Katarina; Arheden, Hakan; Thilén, Ulf; Carlsson, Marcus.

In: International Journal of Cardiovascular Imaging, 01.01.2019.

Research output: Contribution to journalArticle

Stephensen, Sigurdur S. ; Ostenfeld, Ellen ; Kutty, Shelby ; Steding-Ehrenborg, Katarina ; Arheden, Hakan ; Thilén, Ulf ; Carlsson, Marcus. / Transcatheter closure of atrial septal defect in adults : time-course of atrial and ventricular remodeling and effects on exercise capacity. In: International Journal of Cardiovascular Imaging. 2019.
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