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Atrial septal defect closure in children at young age is beneficial for left ventricular function.

Sjöberg, Pia LU ; Clausen, Henning LU orcid ; Arheden, Håkan LU ; Liuba, Petru LU and Hedström, Erik LU orcid (2024) In European Heart Journal Imaging Methods & Practice 2(1). p.1-8
Abstract
Aims
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.

Methods and results
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... (More)
Aims
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.

Methods and results
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/m2, P = 0.0001]; however, it was still smaller than in controls [76 (70–86) vs. 82 (78–89) mL/m2, P = 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, P = 0.0076] and arterial elastance [2.1 (1.4–3.1) vs. 1.4 (1.2–2.0) mmHg/mL, P = 0.034]. After ASD closure, both contractility [2.0 (1.4–2.5) mmHg/mL, P = 0.0001] and arterial elastance [1.4 (1.3–2.0) mmHg/mL, P = 0.0002] decreased.

Conclusion
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. (Less)
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author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
European Heart Journal Imaging Methods & Practice
volume
2
issue
1
pages
1 - 8
publisher
Oxford University Press
ISSN
2755-9637
DOI
10.1093/ehjimp/qyae058
language
English
LU publication?
yes
id
7946c031-f176-4c6b-b443-af55c9992629
date added to LUP
2024-06-24 10:38:37
date last changed
2024-06-24 11:51:30
@article{7946c031-f176-4c6b-b443-af55c9992629,
  abstract     = {{Aims<br/>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.<br/><br/>Methods and results<br/>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/m2, P = 0.0001]; however, it was still smaller than in controls [76 (70–86) vs. 82 (78–89) mL/m2, P = 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, P = 0.0076] and arterial elastance [2.1 (1.4–3.1) vs. 1.4 (1.2–2.0) mmHg/mL, P = 0.034]. After ASD closure, both contractility [2.0 (1.4–2.5) mmHg/mL, P = 0.0001] and arterial elastance [1.4 (1.3–2.0) mmHg/mL, P = 0.0002] decreased.<br/><br/>Conclusion<br/>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.}},
  author       = {{Sjöberg, Pia and Clausen, Henning and Arheden, Håkan and Liuba, Petru and Hedström, Erik}},
  issn         = {{2755-9637}},
  language     = {{eng}},
  number       = {{1}},
  pages        = {{1--8}},
  publisher    = {{Oxford University Press}},
  series       = {{European Heart Journal Imaging Methods & Practice}},
  title        = {{Atrial septal defect closure in children at young age is beneficial for left ventricular function.}},
  url          = {{http://dx.doi.org/10.1093/ehjimp/qyae058}},
  doi          = {{10.1093/ehjimp/qyae058}},
  volume       = {{2}},
  year         = {{2024}},
}