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Short and Mid-Term Outcomes of Percutaneous Ostium Secundum Atrial Septal Defect Closure in a Single-Centre Adult Population within the National Program of Percutaneous Procedures in Adults with Congenital Heart Disease

Roxana Enache
Roxana Enache
, 
Ioan M. Coman
Ioan M. Coman
, 
Ovidiu Chioncel
Ovidiu Chioncel
, 
Liana Valeanu
Liana Valeanu
, 
Anca Dragan
Anca Dragan
, 
Lucian Predescu
Lucian Predescu
, 
Adrian Bucsa
Adrian Bucsa
, 
Pavel Platon
Pavel Platon
, 
Bogdan A. Popescu
Bogdan A. Popescu
 et 
Dan Deleanu
Dan Deleanu
   | 05 mai 2022
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Article Category: Original Article
Publié en ligne: 05 mai 2022
Pages: 875 - 883
DOI: https://doi.org/10.47803/rjc.2020.31.4.875
Mots clés
© 2021 Roxana Enache et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

Effect of ASD closure on clinical, biological, and echocardiographic parameters in the patients from the study group who had at least a 1-month follow-up visit (23 from the 37 adult patients who underwent percutaneous ASD closure)

Parameter Pre-procedure Last follow-up p value
NYHA class 0/I/II/III (n) 3/3/16/1 7/2/14/0 0.005
BNP levels (pg/ml) 46.4 ± 41.3 27.7 ± 13.2 0.11
RV basal diameter (mm) 42.1 ± 5.8 32.0 ± 3.2 <0.001
RV end-diastolic area (cm2/m2) 15.7 ± 3.6 9.5 ± 2.0 0.001
RV end-systolic area (cm2/m2) 7.6 ± 1.6 4.8 ± 1.3 0.001
Fractional area change (%) 51 ± 4 50 ± 4 0.45
TAPSE (mm) 25.5 ± 4.1 23.4 ± 2.6 0.025
RV free wall S-wave (cm/s) 13.8 ± 2.4 12.6 ± 1.4 0.029
RV global longitudinal strain (%) −24.5 ± 3.4 −23 ± 4.0 0.48
RA mid-lateral diameter (mm) 45.3 ± 5.8 32.0 ± 3.2 <0.001
RA end-systolic area (cm2/m2) 21.1 ± 5.0 16.4 ± 3.8 <0.001
Tricuspid regurgitation grade mild/moderate/severe (n, %) 20/3/0 23/0/0 -
Pulmonary artery trunk (mm) 27.7 ± 5.8 24.4 ± 5.0 <0.001
Systolic PAP (mmHg) 39 ± 8 29 ± 5 <0.001
Cardiac index (l/min/m2) 2.55 ± 0.38 2.59 ± 0.48 0.79
LV end-diastolic diameter (mm) 42.8 ± 2.9 45.6 ± 2.8 <0.001
LV end-systolic diameter (mm) 27.6 ± 4.2 29.1 ± 4.0 0.066
LV ejection fraction (%) 61 ± 3 60 ± 1 0.27
Septal S wave (cm/s) 7.9 ± 1.4 7.4 ± 1.0 0.065
Lateral S wave (cm/s) 10.0 ± 2.3 8.3 ± 1.3 0.005
E wave (cm/s) 72.2 ± 20.5 78.1 ± 19.9 0.13
A wave (cm/s) 67.6 ± 18.8 62.3 ± 19.2 0.21
E/A ratio 1.1 ± 0.5 1.4 ± 0.6 0.15
EDT (ms) 185 ± 26 203 ± 36 0.019
Septal e’ (cm/s) 9.2 ± 2.2 8.9 ± 2.9 0.67
Lateral e’ (cm/s) 10.5 ± 2.7 10.3 ± 3.5 0.79
Average E/e’ 8.4 ± 3.5 10.4 ± 5.3 0.21
LA antero-posterior diameter (mm) 41.2 ± 8.5 40.4 ± 4.6 0.64
LA volume (ml/m2) 39.1 ± 14.2 40.9 ± 13.5 0.31

Differences in clinical, biological, and echocardiographic parameters in the 37 patients who underwent percutaneous ASD closure according to the patient's age at the time of the procedure

Parameter Age <60 years (n = 32) Age ≥60 years (n = 5) p value
NYHA class 0/I/II/III (n) 3/6/23/0 0/0/4/1 0.049
History of supraventricular arrhythmias (n) 6 3 0.081
Baseline BNP levels (pg/ml) 47.5 ± 44.6 88.8 ± 53.9 0.087
Baseline RV basal diameter (mm) 42.1 ± 5.2 44.2 ± 9.6 0.66
Baseline RV end-diastolic area (cm2/m2) 14.7 ± 2.8 15.0 ± 5.0 0.87
Baseline RV end-systolic area (cm2/m2) 7.0 ± 1.6 7.6 ± 2.3 0.61
Baseline fractional area change (%) 52 ± 5 49 ± 2 0.059
Baseline TAPSE (mm) 26.1 ± 3.6 24.8 ± 5.0 0.48
Baseline RV free wall S-wave (cm/s) 14.3 ± 2.5 12.2 ± 0.8 0.10
Baseline RV global longitudinal strain (%) −25.4 ± 2.8 −21.7 ± 2.0 0.10
Baseline RA mid-lateral diameter (mm) 46.1 ± 6.0 45.4 ± 5.7 0.80
Baseline RA end-systolic area (cm2/m2) 20.0 ± 3.9 24.6 ± 6.8 0.065
Baseline pulmonary artery trunk (mm) 27.4 ± 5.1 29.7 ± 5.1 0.47
Baseline systolic PAP (mmHg) 35.7 ± 6.6 44.4 ± 5.9 0.01
Baseline cardiac index (l/min/m2) 2.54 ± 0.38 2.37 ± 0.43 0.43
Baseline LV end-diastolic diameter (mm) 42.5 ± 3.9 43.8 ± 2.8 0.49
Baseline LV end-systolic diameter (mm) 27.5 ± 4.3 28 ± 4.7 0.82
Baseline LA antero-posterior diameter (mm) 37.9 ± 5.7 49 ± 8.5 0.001
Baseline LA volume (ml/m2) 34.0 ± 10.1 57.5 ± 8.6 <0.001
Δ RV basal diameter (mm) 9.6 ± 4.7 12.8 ± 7.6 0.28
Δ RV end-diastolic area (cm2/m2) 5.6 ± 2.9 8.0 ± 4.4 0.40
Δ RV end-systolic area (cm2/m2) 2.4 ± 1.3 4.0 ± 1.6 0.20
Δ Fractional area change (%) −3 ± 6 1 ± 6 0.51
Δ TAPSE (mm) 2.3 ± 4.4 1.5 ± 2.1 0.74
Δ RV free wall S-wave (cm/s) 1.8 ± 2.4 −0.9 ± 0.8 0.04
Δ RA mid-lateral diameter (mm) 7.5 ± 4.2 10.3 ± 3.5 0.28
Δ RA end-systolic area (cm2/m2) 4.9 ± 2.3 3.8 ± 7.1 0.79
Δ Pulmonary artery trunk (mm) 2.9 ± 2.9 6.5 ± 0.7 0.11
Δ Systolic PAP (mmHg) 7.5 ± 5.6 16.3 ± 4.3 0.01
Δ LV end-diastolic diameter (mm) 42.5 ± 3.9 43.8 ± 2.8 0.24
Δ LV end-systolic diameter (mm) 27.5 ± 4.3 28.0 ± 4.7 0.67
End-of-follow-up BNP levels (pg/ml) 23.8 ± 11.2 40.2 ± 8.9 0.045
End-of-follow-up systolic PAP (mmHg) 28.7 ± 5.9 30.0 ± 8.9 0.67

Baseline demographic, clinical and biological characteristics of the study group (37 adult patients who underwent percutaneous ASD closure

Parameter Value
Age (years) 43.5 ± 14.4
Gender F/M (n, %) 29/8 (78.4/21.6)
Body mass index (kg/m2) 26.3 ± 5.2
Body surface area (m2) 1.78 ± 0.17
Symptoms at presentation (n, %) 28 (75.7%)
Supraventricular arrythmias 9 (24.3%)
NYHA class 0/I/II/III (n, %) 3/6/27/1 (8.1/16.2/73/2.7)
Systolic blood pressure (mmHg) 117 ± 12
Diastolic blood pressure (mmHg) 74 ± 10
Heart rate (bpm) 73 ± 10
Resting O2 saturation in room air (%) 97 ± 1
BNP levels (pg/ml) 55.7 ± 48.4
Haemoglobin (g/dl) 13.7 ± 1.1

Baseline echocardiographic parameters of the study group (37 adult patients who underwent percutaneous ASD closure) compared to a control group of 33 healthy volunteers

Parameter ASD patients (n = 37) Healthy controls (n = 33) p value
Age (years) 43.5 ± 14.4 39.9 ± 11.1 0.25
Gender F/M (n, %) 29/8 21/12 0.14
RV basal diameter (mm) 42.4 ± 5.8 30.4 ± 2.8 <0.001
RV end-diastolic area (cm2/m2) 14.7 ± 3.0 8.6 ± 1.3 <0.001
RV end-systolic area (cm2/m2) 7.1 ± 1.6 4.5 ± 0.9 <0.001
Fractional area change (%) 51 ± 5 47 ± 6 0.009
TAPSE (mm) 25.9 ± 3.8 24.0 ± 2.8 0.023
RV free wall S-wave (cm/s) 14.0 ± 2.4 13.5 ± 1.9 0.41
RV global longitudinal strain (%) −24.9 ± 2.9 −23.3 ± 2.7 0.057
RA mid-lateral diameter (mm) 46.0 ± 5.9 34.9 ± 3.3 <0.001
RA end-systolic area (cm2/m2) 20.7 ± 4.6 13.4 ± 2.3 <0.001
Tricuspid regurgitation grade mild/moderate/severe (n, %) 28/9/0 (75.7/24.3/0) 33/0/0 (100/0/0) 0.004
Pulmonary artery trunk (mm) 27.6 ± 5.1 18.6 ± 2.7 <0.001
Systolic PAP (mmHg) 37 ± 7 23 ± 4 <0.001
Mean PAP (mmHg) 23 ± 7 16 ± 2 0.007
Cardiac index (l/min/m2) 2.51 ± 0.38 2.48 ± 0.66 0.77
LV end-diastolic diameter (mm) 42.7 ± 3.7 46.7 ± 4.5 <0.001
LV end-systolic diameter (mm) 27.6 ± 4.3 28.9 ± 3.6 0.17
LV ejection fraction (%) 60 ± 4 61 ± 4 0.42
Septal S wave (cm/s) 7.8 ± 1.4 8.2 ± 1.2 0.32
Lateral S wave (cm/s) 10.2 ± 2.3 9.4 ± 1.5 0.13
E wave (cm/s) 71.1 ± 17.8 76.6 ± 15.4 0.20
A wave (cm/s) 62.9 ± 18.8 58.8 ± 13.9 0.33
E/A ratio 1.2 ± 0.4 1.4 ± 0.5 0.16
EDT (ms) 182 ± 30 180 ± 22 0.83
Septal e’ (cm/s) 9.4 ± 2.1 11.3 ± 2.3 0.005
Lateral e’ (cm/s) 11.2 ± 2.6 14.6 ± 2.6 <0.001
Average E/e’ 7.8 ± 3.2 6.0 ± 1.4 0.021
LA antero-posterior diameter (mm) 39.5 ± 7.2 32.2 ± 3.5 <0.001
LA volume (ml/m2) 37.8 ± 13.1 26.9 ± 6.2 0.001
ASD maximum diameter (mm) 19.2 ± 4.6 - -
Device size (mm) 24.3 ± 4.8 - -

Correlations of ASD size in the ASD population

Parameter r p
BNP levels (pg/ml) 0.19 0.37
RV basal diameter (mm) 0.38 0.019
RV end-diastolic area (cm2/m2) 0.59 0.003
RV end-systolic area (cm2/m2) 0.57 0.005
Fractional area change (%) −0.05 0.82
TAPSE (mm) 0.17 0.33
RV free wall S-wave (cm/s) 0.08 0.66
RV global longitudinal strain (%) −0.13 0.60
RA mid-lateral diameter (mm) 0.35 0.040
RA end-systolic area (cm2/m2) 0.45 0.021
Pulmonary artery trunk (mm) 0.42 0.031
Systolic PAP (mmHg) 0.29 0.10
Cardiac index (l/min/m2) 0.25 0.18
LV end-diastolic diameter (mm) −0.22 0.18
LV end-systolic diameter (mm) −0.14 0.42
LA antero-posterior diameter (mm) 0.28 0.11
LA volume (ml/m2) 0.20 0.34
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Medicine, Clinical Medicine, Internal Medicine, Cardiology, Pediatrics and Juvenile Medicine, Paediatric Cardiology, Surgery, Cardiac Surgery
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