Objective: To study the cardiac geometric changes after transcatheter closure of large atrial septal defects(ASDs) according to patient age at the time of the procedure. Design: Prospective echocardiographic follow-up study. Setting: Tertiary referral centre. Patients and intervention: 25 asymptomatic patients younger than 16 years(median 8 years; group 1) and 21 asymptomatic adults(median 38 years; group 2) underwent percutaneous closure of large ASD with the Amplatzer septal occluder device(mean 25(SD 7) mm). Main outcome measures: Cardiac remodelling was assessed by M mode and two dimensional echocardiography one and six months after ASD closure. Results: By six months, right atrial volume decreased from 31(15) to 19(5) ml/m2(p< 0.001) and right ventricular(RV) transverse diameter decreased from 29.8(8.6) to 23.2(5.6) mm/m2(p< 0.001). Conversely, left atrial volume did not change significantly(from 18(6) to 20(6) ml/m2, NS) and left ventricular(LV) transverse diameter increased from 27.8(6.4) to 31.8(7.3) mm/m2(p< 0.05). Ventricular remodelling resulted in an RV∶LV diameter ratio decrease from 1.1(0.2) to 0.7(0.1)(p< 0.001). The magnitude and time course of cardiac remodelling did not differ significantly between the age groups. Indeed, right atrial volume decreased by 33(26)%versus 37(23)%, RV diameter decreased by 26(10)%versus 20(13)%, LV diameter increased by 17(15)%versus 15(10)%, and RV∶LV diameter ratio decreased by 36(8)%versus 27(15)%in groups 1 and 2, respectively. Conclusions: Cardiac remodelling after percutaneous ASD closure seems to be independent of the patient’s age at the time of the procedure up to early adulthood. Thus, postponing ASD closure for a few years may be a reasonable option for potentially suitable asymptomatic children.
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