Changes of the left ventricular function after transcatheter closure for atrial septal defect associated with pulmonary arterial hypertension in adult patients

Objective: To discuss the changes of the left ventricular function occurring after transcatheter closure for atrial septal defect (ASD) associated with pulmonary arterial hypertension (PAH) in adult patients. Methods: During the period from June 2009 to Aug. 2011, a total of 75 ASD patients (15 males and 60 females, aged ≥ 40 years) were admitted to authors' hospital. The patients were divided into PAH group (n = 36) and non-PAH group (n = 39). ASD diameters were determined by transthoracic echocardiogram (TTE) in all patients. The left ventricular functions, including left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left ventricular stroke volume (LVSV) and left ventricular ejection fraction (LVEF) were measured before operation as well as one day, one and three months after the operation. The pulmonary artery pressure and shunted blood were determined by cardiac catheterization. All patients were followed up for three months. The results were analyzed and compared between the two groups. Results: Successful placement of the ASD occluder was obtained in all patients. The mean age of PAH group and non-PAH group was (51.7 ± 9.3) years and (49.3 ± 6.0) years respectively. The mean ASD diameters of PAH group and non-PAH group were (22.9 ± 8.1) mm and (20.6 ± 6.8) mm respectively. The size of the ASD occluder used in PAH group and non-PAH group was (18-42) mm with a mean of (30.8 ± 9.1) mm and (9-40) mm with a mean of (27.5 ± 7.4) mm respectively. Cardiac catheterization showed that the systolic pulmonary artery pressure (sPAP) and the mean pulmonary artery pressure (mPAP) in PAH group were (57.8 ± 16.0) mmHg and (37.1 ±7.7) mmHg respectively, while those in non-PAH group were (28.9 ± 3.9) mmHg and (15.9 ± 2.8) mmHg respectively. Fenestrated device was employed in 3 patients of PAH group as the associated PAH was severe. The LVEDD, LVEDV, LVSV and LVEF of PAH group were significantly lower than those of non-PAH group (P < 0.05). After transcatheter closure of ASD the pulmonary arterial pressure in PAH group was significantly decreased (P < 0.01). Follow-up checkups showed that postoperative LVEDD, LVEDV, LVSV and LVEF were significantly increased (P < 0.05). Conclusion: The left ventricular dysfunction is more severe in ASD patients with PAH than in ASD patients with no PAH. The left ventricular function can be markedly improved by transcatheter closure, thus the left ventricular function can be prevented from further deterioration. (authors)