Objective: To study the cardiac geometric changes after transcatheter closure of large atrial septal defects(ASDs) according to patient age at the time of the procedure. Design: Prospective echocardiographic follow-up...Objective: To study the cardiac geometric changes after transcatheter closure of large atrial septal defects(ASDs) according to patient age at the time of the procedure. Design: Prospective echocardiographic follow-up study. Setting: Tertiary referral centre. Patients and intervention: 25 asymptomatic patients younger than 16 years(median 8 years; group 1) and 21 asymptomatic adults(median 38 years; group 2) underwent percutaneous closure of large ASD with the Amplatzer septal occluder device(mean 25(SD 7) mm). Main outcome measures: Cardiac remodelling was assessed by M mode and two dimensional echocardiography one and six months after ASD closure. Results: By six months, right atrial volume decreased from 31(15) to 19(5) ml/m2(p< 0.001) and right ventricular(RV) transverse diameter decreased from 29.8(8.6) to 23.2(5.6) mm/m2(p< 0.001). Conversely, left atrial volume did not change significantly(from 18(6) to 20(6) ml/m2, NS) and left ventricular(LV) transverse diameter increased from 27.8(6.4) to 31.8(7.3) mm/m2(p< 0.05). Ventricular remodelling resulted in an RV∶LV diameter ratio decrease from 1.1(0.2) to 0.7(0.1)(p< 0.001). The magnitude and time course of cardiac remodelling did not differ significantly between the age groups. Indeed, right atrial volume decreased by 33(26)%versus 37(23)%, RV diameter decreased by 26(10)%versus 20(13)%, LV diameter increased by 17(15)%versus 15(10)%, and RV∶LV diameter ratio decreased by 36(8)%versus 27(15)%in groups 1 and 2, respectively. Conclusions: Cardiac remodelling after percutaneous ASD closure seems to be independent of the patient’s age at the time of the procedure up to early adulthood. Thus, postponing ASD closure for a few years may be a reasonable option for potentially suitable asymptomatic children.展开更多
Objective: To determine whether transcatheter device closure of a secundum atr ial septal defect (ASD) will reduce the risk of developing subsequent atrial arr hythmias. Design: The incidence and predictors of symptom...Objective: To determine whether transcatheter device closure of a secundum atr ial septal defect (ASD) will reduce the risk of developing subsequent atrial arr hythmias. Design: The incidence and predictors of symptomatic atrial tachyarrhyt hmias (AT) were examined in adults undergoing transcatheter closure of ASDs. Set ting: Toronto Congenital Cardiac Centre for Adults. Patients: 132 consecutive pa tients, mean (SD) age 44 (16) years; 74%female. Main outcome measure: Sustained or symptomatic atrial arrhythmias at early follow up (six weeks; n=115) and int ermediate follow up (last clinic visit 17(11)-months post surgery; n=121). Resu lts: 15%of the patients(20 of 132) had AT before the procedure(14 paroxysmal, s ix persistent). Patients without a history of arrhythmia had a low incidence of AT during early follow up (6%) and intermediate follow up (1 %/year), while all patients with persistent AT before closure remained in atria l fibrillation or flutter. Of patients in sinus rhythm but with a previous histo ry of AT, two thirds remained arrhythmia free at follow up, with overall incide nces of paroxysmal and persistent AT of 17%/year and 11%/year. A history of AT before closure (risk ratio (RR) 35.0, 95%con fidence interval (CI) 7.2 to 169 .0) and age ≥55 years at the time of device insertion (RR 5.6,95%CI 1.2 to 25. 0) predicted AT after closure. Conclusions: Device closure of an ASD before the onset of atrial arrhythmias may protect against the subsequent development of ar rhythmia, in particular in patients less than 55 years of age.展开更多
文摘Objective: To study the cardiac geometric changes after transcatheter closure of large atrial septal defects(ASDs) according to patient age at the time of the procedure. Design: Prospective echocardiographic follow-up study. Setting: Tertiary referral centre. Patients and intervention: 25 asymptomatic patients younger than 16 years(median 8 years; group 1) and 21 asymptomatic adults(median 38 years; group 2) underwent percutaneous closure of large ASD with the Amplatzer septal occluder device(mean 25(SD 7) mm). Main outcome measures: Cardiac remodelling was assessed by M mode and two dimensional echocardiography one and six months after ASD closure. Results: By six months, right atrial volume decreased from 31(15) to 19(5) ml/m2(p< 0.001) and right ventricular(RV) transverse diameter decreased from 29.8(8.6) to 23.2(5.6) mm/m2(p< 0.001). Conversely, left atrial volume did not change significantly(from 18(6) to 20(6) ml/m2, NS) and left ventricular(LV) transverse diameter increased from 27.8(6.4) to 31.8(7.3) mm/m2(p< 0.05). Ventricular remodelling resulted in an RV∶LV diameter ratio decrease from 1.1(0.2) to 0.7(0.1)(p< 0.001). The magnitude and time course of cardiac remodelling did not differ significantly between the age groups. Indeed, right atrial volume decreased by 33(26)%versus 37(23)%, RV diameter decreased by 26(10)%versus 20(13)%, LV diameter increased by 17(15)%versus 15(10)%, and RV∶LV diameter ratio decreased by 36(8)%versus 27(15)%in groups 1 and 2, respectively. Conclusions: Cardiac remodelling after percutaneous ASD closure seems to be independent of the patient’s age at the time of the procedure up to early adulthood. Thus, postponing ASD closure for a few years may be a reasonable option for potentially suitable asymptomatic children.
文摘Objective: To determine whether transcatheter device closure of a secundum atr ial septal defect (ASD) will reduce the risk of developing subsequent atrial arr hythmias. Design: The incidence and predictors of symptomatic atrial tachyarrhyt hmias (AT) were examined in adults undergoing transcatheter closure of ASDs. Set ting: Toronto Congenital Cardiac Centre for Adults. Patients: 132 consecutive pa tients, mean (SD) age 44 (16) years; 74%female. Main outcome measure: Sustained or symptomatic atrial arrhythmias at early follow up (six weeks; n=115) and int ermediate follow up (last clinic visit 17(11)-months post surgery; n=121). Resu lts: 15%of the patients(20 of 132) had AT before the procedure(14 paroxysmal, s ix persistent). Patients without a history of arrhythmia had a low incidence of AT during early follow up (6%) and intermediate follow up (1 %/year), while all patients with persistent AT before closure remained in atria l fibrillation or flutter. Of patients in sinus rhythm but with a previous histo ry of AT, two thirds remained arrhythmia free at follow up, with overall incide nces of paroxysmal and persistent AT of 17%/year and 11%/year. A history of AT before closure (risk ratio (RR) 35.0, 95%con fidence interval (CI) 7.2 to 169 .0) and age ≥55 years at the time of device insertion (RR 5.6,95%CI 1.2 to 25. 0) predicted AT after closure. Conclusions: Device closure of an ASD before the onset of atrial arrhythmias may protect against the subsequent development of ar rhythmia, in particular in patients less than 55 years of age.
