Sjöberg Pia, Clausen Henning, Arheden Håkan, Liuba Petru, Hedström Erik
Clinical Physiology, Department of Clinical Sciences, Lund, Lund University, Box 188, 221 00 Lund, Sweden.
Department of Clinical Physiology, Skåne University Hospital, Entrégatan 7, 221 85 Lund, Sweden.
Eur Heart J Imaging Methods Pract. 2024 Jun 8;2(1):qyae058. doi: 10.1093/ehjimp/qyae058. eCollection 2024 Jan.
Atrial septal defects (ASDs) lead to volume-loaded right ventricles (RVs). ASD closure does not always alleviate symptoms or improve exercise capacity, which is possibly explained by impaired left ventricular (LV) haemodynamics. This study evaluated the effect of ASD closure in children using non-invasive LV pressure-volume (PV) loops derived from cardiac magnetic resonance (CMR) imaging and brachial blood pressure, compared with controls.
Twenty-three children with ASD underwent CMR, and 17 of them were re-examined 7 (6-9) months after ASD closure. Twelve controls were included. Haemodynamic variables were derived from PV loops by time-resolved LV volumes and brachial blood pressure. After ASD closure, LV volume increased [76 (70-86) vs. 63 (57-70) mL/m, = 0.0001]; however, it was still smaller than in controls [76 (70-86) vs. 82 (78-89) mL/m, = 0.048]. Compared with controls, children with ASD had higher contractility [2.6 (2.1-3.3) vs. 1.7 (1.5-2.2) mmHg/mL, = 0.0076] and arterial elastance [2.1 (1.4-3.1) vs. 1.4 (1.2-2.0) mmHg/mL, = 0.034]. After ASD closure, both contractility [2.0 (1.4-2.5) mmHg/mL, = 0.0001] and arterial elastance [1.4 (1.3-2.0) mmHg/mL, = 0.0002] decreased.
Despite the left-to-right atrial shunt that leads to low LV filling and RV enlargement, the LV remains efficient and there is no evidence of impaired LV haemodynamics in children. Closure of ASD at young age while the ventricle is compliant is thus beneficial for LV function. LV volumes, however, remain small after ASD closure, which may impact long-term cardiovascular risk and exercise performance.
房间隔缺损（ASD）导致右心室容量负荷增加。ASD封堵并不总能缓解症状或提高运动能力，这可能是由于左心室（LV）血流动力学受损所致。本研究使用源自心脏磁共振（CMR）成像和肱动脉血压的无创左心室压力-容积（PV）环，评估ASD封堵对儿童的影响，并与对照组进行比较。
23例ASD患儿接受了CMR检查，其中17例在ASD封堵术后7（6 - 9）个月进行了复查。纳入12名对照组。通过时间分辨的左心室容积和肱动脉血压从PV环中获取血流动力学变量。ASD封堵术后，左心室容积增加[76（70 - 86）对63（57 - 70）mL/m，P = 0.0001]；然而，仍小于对照组[76（70 - 86）对82（78 - 89）mL/m，P = 0.048]。与对照组相比，ASD患儿具有更高的收缩性[2.6（2.1 - 3.3）对1.7（1.5 - 2.2）mmHg/mL，P = 0.0076]和动脉弹性[2.1（1.4 - 3.1）对1.4（1.2 - 2.0）mmHg/mL，P = 0.034]。ASD封堵术后，收缩性[2.0（1.4 - 2.5）mmHg/mL，P = 0.0001]和动脉弹性[1.4（1.3 - 2.0）mmHg/mL，P = 0.0002]均降低。
尽管房水平左向右分流导致左心室低充盈和右心室扩大，但左心室仍保持高效，且没有证据表明儿童左心室血流动力学受损。因此，在心室顺应性良好的幼年时期封堵ASD对左心室功能有益。然而，ASD封堵术后左心室容积仍较小，这可能会影响长期心血管风险和运动表现。
