Eun Lucy Youngmin, Park Han Ki, Choi Jae Young
Division of Pediatric Cardiology, Department of Pediatrics, Yonsei University College of Medicine, Seoul 03722, Korea.
Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul 03722, Korea.
J Clin Med. 2020 Nov 12;9(11):3637. doi: 10.3390/jcm9113637.
Transcatheter device closure of a secundum atrial septal defect (ASD) is followed by a noticeable change in the left atrium (LA) and left ventricle (LV) over a long-term follow-up. This study aimed to assess the remodeling of the atrial and ventricular myocardium with respect to diastolic function in adult ASD patients. Around 38 asymptomatic patients (age: 48.6 ± 17.1 years, range: 23-69 years) diagnosed with ASD during routine health check-up and who underwent ASD device closure with the Amplatzer septal occluder were included in this retrospective study, and their medical records (containing echocardiographic data) were reviewed. The defect size was 21.77 + 6.79 mm, while the balloon measurement of the defect was 24.29 ± 6.64 mm. The patients were divided into two groups, namely, Group I (with 18 patients aged <50 years [mean: 33.06 ± 9.43 years] and Group II (with 20 patients aged ≥50 years [mean: 62.55 ± 7.54 years]). Comparison of echocardiographic data collected before closure and at a follow-up 2 years later revealed significant differences between pre-closure and post-closure states in the left ventricular end-diastolic dimension (40.76 ± 3.28 vs. 43.39 ± 3.52), left ventricular mass (99.64 ± 28.81 vs. 116.57 ± 32.03), and right ventricular pressure (36.88 ± 12.20 vs. 31.81 ± 11.11). Tissue Doppler measurements were significantly decreased 2 years after closure, while the post-closure E/E' was higher than the pre-closure E/E' (11.58 ± 4.80 vs. 8.79 + 3.19, < 0.005). In both groups, mitral A and tissue Doppler E', A', and S' values decreased post-closure, while the E/E' was higher in Group II than in Group I at both pre-closure and long-term follow-up measurements (pre-closure: 9.60 ± 5.15 vs. 7.41 ± 1.42, < 0.003; post-closure: 13.03 + 4.05 vs. 10.49 ± 3.95, < 0.02). The LA size and LV function exhibited recognizable remodeling after transcatheter ASD closure. Because the LV preload elevation (i.e., E/E') after ASD closure can be pronounced in older patients, caution should be provided more in older patients than in younger patients. Hence, it may be beneficial to close the ASD at an earlier age in adults even after a late diagnosis; a relatively younger age may be more suited for adaptation to the remodeling process to protect the myocardial function. Careful consideration should be given to the previous underloaded left heart after long-term closure.
继发孔型房间隔缺损（ASD）经导管装置封堵术后，在长期随访中左心房（LA）和左心室（LV）会出现明显变化。本研究旨在评估成年ASD患者心房和心室心肌舒张功能的重塑情况。本项回顾性研究纳入了约38例在常规健康检查中被诊断为ASD且使用Amplatzer房间隔封堵器进行ASD装置封堵的无症状患者（年龄：48.6±17.1岁，范围：23 - 69岁），并对其病历（包含超声心动图数据）进行了回顾。缺损大小为21.77 + 6.79 mm，而缺损的球囊测量值为24.29±6.64 mm。患者被分为两组，即I组（18例年龄<50岁的患者[平均：33.06±9.43岁]）和II组（20例年龄≥50岁的患者[平均：62.55±7.54岁]）。对封堵术前和术后2年随访时收集的超声心动图数据进行比较，结果显示封堵术前和术后状态在左心室舒张末期内径（40.76±3.28 vs. 43.39±3.52）、左心室质量（99.64±28.81 vs. 116.57±32.03）和右心室压力（36.88±12.20 vs. 31.81±11.11）方面存在显著差异。封堵术后2年组织多普勒测量值显著降低，而术后E/E'高于术前E/E'（11.58±4.80 vs. 8.79 + 3.19，P<0.005）。在两组中，二尖瓣A以及组织多普勒E'、A'和S'值在封堵术后均降低，而在术前和长期随访测量中，II组的E/E'均高于I组（术前：9.60±5.15 vs. 7.41±1.42，P<0.003；术后：13.03 + 4.05 vs. 10.49±3.95，P<0.02）。经导管ASD封堵术后，LA大小和LV功能呈现出可识别的重塑。由于ASD封堵术后LV前负荷升高（即E/E'）在老年患者中可能更为明显，因此与年轻患者相比，应给予老年患者更多关注。因此，即使在成年后诊断较晚，尽早封堵ASD可能是有益的；相对年轻的年龄可能更适合适应重塑过程以保护心肌功能。对于长期封堵后先前负荷不足的左心应给予仔细考虑。
