Late Electrical and Mechanical Remodeling After Atrial Septal Defect Closure in Children: Surgical Versus Percutaneous Approach.

ABSTRACT

BACKGROUND: Conflicting data were reported about normalization of sizes of right chambers, systolic and diastolic function and prevalence of arrhythmias after ostium secundum atrial septal defect closure. We sought to compare surgical and percutaneous approaches in terms of arrhythmias, right chamber volumes, and function at long-term follow-up. METHODS: In all, 107 patients were enrolled, all corrected at pediatric age. Forty-four of them were treated surgically with a right thoracotomy approach and 63 were treated percutaneously. All patients underwent a standard echocardiogram and electrocardiographic Holter examinations. RESULTS: No difference was detected between the two groups regarding right atrial or ventricular volumes. The global right ventricular function assessed by fractional area change was similar between the two groups. However, the longitudinal function and the diastolic function were significantly impaired in the surgical group (tricuspid annulus peak systolic excursion 23.7 ± 4.5 mm versus 18.7 ± 3.5 mm, p < 0.001; S' wave 13.7 ± 3.1 cm/s versus 9.8 ± 2.4 cm/s, p < 0.001; E/E' 4.7 ± 1.7 versus 7.1 ± 2.9, p < 0.001). There was a low incidence of supraventricular couples or runs, but slightly higher in the surgical group (6.8% versus 1.6%), although not statistically significant. No echocardiographic variable related to ventricular or supraventricular arrhythmic events. CONCLUSIONS: Either surgical or percutaneous closure of atrial septal defect have a similar efficacy on the volume normalization of the right chamber. Modern surgical techniques have a limited impact on the systolic and diastolic function as well as on the arrhythmic risk; however, the right ventricular longitudinal and diastolic function seems to be better preserved in the percutaneous group.