Right ventricle reverse remodelling following transcatheter and surgical secundum: Atrial septal defect closure in adults by cardiac magnetic resonance imaging

Amr Mansour, Noha M. Gamal, Alaa Nady, Salwa R. Demitry, Shams-Eddin H, Khaled M. El-Maghraby

Background: Securely closed Atrial Septal Defect (ASD) leads to reduction in right cardiac dimensions and improvement of symptoms. Device has become an accepted alternative to surgical closure. CMR is an accurate imaging modality for the assessment of cardiac function and volumes.

Objective: We aimed at studying electrical and mechanical remodeling in RV preclosure and 3 months after transcatheter and surgical closure.

Results: Our prospective study included 30 consecutive adult patients with isolated secundum ASD referred to either transcatheter or surgical ASD closure. There was significant reduction in the QT dispersion among the same group as compared with the baseline values (QTc dispersion was 70.33 ± 24.04 to 60.26 ± 28.56 in device group vs. 80.73 ± 30.38 to 60.27 ± 28.57 in surgical group). There was no significant difference between two groups indicating that transcatheter and surgical closure had led to equivalent value of electrical remodelling (P-value >0.05). In CMR study we measured Right Ventricle End Diastolic Volume (RVEDV), Right Ventricle End Systolic Volume (RVESV), Right ventricle function and Right ventricle mass index. RVEDV and RVESV decreased significantly in both groups as compared to the baseline values (P-value <0.001). Transcatheter closure resulted in more significant reduction in the RVEDV and RVESV than the surgical closure (P-value=0.03 and 0.02 respectively), (Figures 1 and 2). In device closure; RV-function after closure was significantly higher in comparison to surgical closure (60.67 ± 5.12 vs. 52.73 ± 8.62 (%); P<0.001). The RV mass decreased significantly in each group as absolute value from the baseline (P-value (0.001) but it was statistically insignificant different between the two groups (P-value 0.31) while percentage of change was higher in device group (-) 20.38 ± 10.80 versus (-) 16.63 ± 14.91 in surgical group.

Conclusion: Our study showed significant changes from baseline measurements with significant RV mechanical reverse remodeling in the device group but there were no significant changes in electrical remodeling between the two groups.