Immediate and Short-Term Outcome of Percutaneous Trans-Catheter Device Closure of Atrial Septal Defects in Adults
Authors: Ewais Elsayed Eslam Sayed , Saber Hafez Mohamed , Ezz Eldin Dina Adel , ElShahed Ghada 
Published: November 2024

Abstract

Background
Atrial septal defect (ASD) is one of the most common types of congenital heart defects, occurring in about 25% of children. ASD comprises 6–10% of all congenital heart defects. Included in this group of malformations are several types of atrial communications that allow shunting of blood between the systemic and the pulmonary circulations. ASDs are the most common form of acyanotic congenital heart disease.

Objectives
The aim of the study is to evaluate the immediate and short-term outcome of transcatheter ASD closure on cardiac functions and functional capacity in adults.

Patients and Interventions
This was a prospective study which recruited all adult patients undergoing secundum ASD closure between April 2023 and December 2023. Investigations included 12 surface ECG, 2D Echocardiography and assessment of functional capacity as being assessed by 6-minute walk test. These investigations were performed preprocedural, postprocedural and at one month follow up.

Results
Fifty patients, age ranging from 18 to 62, were divided into two groups: group 1 included 25 patients, age ranging from 18 to 40 years, while group 2 included 25 patients older than 40 years old, underwent successful transcatheter closure of ASD. There was a highly significant reduction in right ventricular (RV) and right atrial (RA) volume as being assessed by RV end diastolic volume index, RV basal diameter, and RA volume index. Also, there was a significant reduction in RV systolic function as being assessed by RV fractional area change (FAC). Furthermore, there was a highly significant reduction in Right ventricular systolic pressure (RVSP) and mean pulmonary artery pressure (mPAP). Also, there was a significant improvement of functional capacity as being assessed by 6-minute walk test distance (6 MWTD). Between the 2 groups, the results of our study showed that there was a significant difference in the postprocedural percentage of reduction in mPAP between group 1 and group 2, ΔmPAP 3.45(3.03-11.11) in group 1 and ΔmPAP 11.76 (7.14 – 16.67) in group 2 with p value of 0.001 which shows more reduction in mPAP in group 2 in comparison to group 1. Also, there was a significant difference in percentage of reduction in mPAP between group 1 and group 2 at 1 month follow up, ΔmPAP 6.9(6.06-13.04) in group 1 and 14.81 (8.82 – 20.59) with p value of 0.001 which shows more reduction in mPAP in group 2 in comparison to group 1. It was observed that there was significant difference in improvement of functional capacity as being assessed by 6MWTD at one month follow up between group 1 and group 2, Δ 6MWTD was 3.52 (2 – 6.38) in group 1 and 6.67 (5.54 – 9.21) in group 2 with P value of 0.008 which shows more improvement in functional capacity in group 2 in comparison to group 1 as seen in the next table.

Conclusions
Our study indicates that transcatheter closure of ASD results in promising cardiac remodeling and early significant improvement in right ventricular dimensions and functional class in adults