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Effect of Renal and Left Ventricular Function on Serial Pulmonary Arterial Pressure Changes after Device Closure of Atrial Septal Defect. | LitMetric

AI Article Synopsis

  • The study investigates the effects of device closure for atrial septal defect (ASD) on pulmonary arterial pressure and left ventricular filling pressure, focusing on changes that occur post-procedure, especially in older patients.
  • In a sample of 78 patients (excluding those with specific health conditions), findings showed that some patients experienced increased tricuspid regurgitant velocity immediately after surgery, but this normalized over time.
  • The research suggests that older patients with renal issues and larger left atrial size may benefit from preload reduction therapy during the device closure process to mitigate risks of complications like atrial fibrillation.

Article Abstract

Background: The age of candidates for device closure of atrial septal defect (ASD) has been increasing. Thus, concerns exist about dyspnea aggravation or atrial fibrillation development after device closure due to augmentation of left ventricular (LV) and left atrial (LA) preload. This study aimed to examine patterns and determinants of serial pulmonary arterial pressure and left ventricular filling pressure changes after device closure of ASD.

Methods: Among the 86 consecutive patients who underwent percutaneous device closure of ASD, those with end-stage renal disease or those without pre- or postprocedural Doppler data were excluded. The clinical, transesophageal, and transthoracic echocardiographic findings of 78 patients were collected at baseline, one-day postprocedure, and one-year follow-up.

Results: The mean age of study patients was 49.8 ± 15.0 years, and the average maximal defect diameter and device size were 20.2 ± 6.0 mm and 23.8 ± 6.4 mm. Four patients (5.6%) underwent new-onset atrial fibrillation, and five patients (6.4%) took diuretics within one-year after closure. Some patients ( = 21; 27%) exhibited paradoxically increased tricuspid regurgitant velocity (TRV) one-day postprocedure; they also were older with lower e', glomerular filtration rate, and LV ejection fraction and a higher LA volume index. However, even in these patients, TRV deceased below baseline levels one-year later. Both E/e' and LA volume index significantly increased immediately after device closure, but all decreased one-year later. Larger defect size and higher TRV were significantly correlated with immediate E/e' elevation.

Conclusion: In older, renal, diastolic, and systolic dysfunctional patients with larger LA and scheduled for larger device implantation, peri-interventional preload reduction therapy would be beneficial.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7834785PMC
http://dx.doi.org/10.1155/2021/8846656DOI Listing

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