RESUMO
AIM: To ascertain the effects of transcatheter repair of the secondary interatrial defect (IAD) with Amplatzer occluder on heart remodeling in respect to the patient's age. MATERIAL AND METHODS: Transcatheter repair of the secondary IAD was made in 64 patients. Two groups were formed by the patients' age: group 1--age under 16 years (mean age 9 +/- 0.6 years) and group 2--age over 16 years (mean age 32 +/- 1.8 years). The control group consisted of 30 healthy subjects matched by age. Echocardiography measured size and volumes of the heart chambers, intracardiac hemodynamics before treatment of the defect and 24 hours, 1, 3, 6, 12 and 24 months after it. RESULTS: The indexed diameter of the defect in group 1 was 16.5 +/- 1.6 mm/m2, in group 2--13.7 +/- 0.7 mm/m2 (p > 0.05). The size of the occluder, in relation to the surface area, was 20 +/- 1.5 and 16 +/- 0.8 mm/m2, respectively (p < 0.05). 24 hours after the defect repair the right ventricle volume reduced by 29% in group 1 and by 21%--in group 2. The right atrium volume reduced significantly also. Mean pulmonary arterial pressure (PAP) in both groups diminished from 22 +/- 0.7 to 19 +/- 0.7 mmHg and from 24 +/- 1.0 to 20 +/- 0,8 mmHg, respectively. The left atrium decreased by 34 and 32%, respectively (p < 0.001). Remodeling reduced RV-LV in both groups by 22 and 23% (p < 0.001), respectively. 3 months after the defect repair all the indices reached control values. 12 months after the correction hemodynamics in the patients was the same with the healthy examinees. The time and degree of reduction of the right heart were similar in the groups, the volumes diminished by about 50%. 12 months after the repair in 4 of 18 patients of group 2 (22%) the right atrium and ventricle were larger than in healthy subjects though less than before the repair. CONCLUSION: Transcatheter repair of the secondary IAD with Amplatzer catheter leads to early noticeable reduction of the right heart. The type of the changes is similar in both age groups and does not depend on the size of the implanted occluder. Not all the patients over 16 years of age achieve normal sizes of the RV and RA 12 months after the defect correction.