Short and Mid-Term Outcomes of Percutaneous Ostium Secundum Atrial Septal Defect Closure in a Single-Centre Adult Population within the National Program of Percutaneous Procedures in Adults with Congenital Heart Disease

Abstract

Abstract Background Atrial septal defect (ASD) is the most common congenital heart defect diagnosed in adulthood, causing a left-to-right shunt with subsequent right ventricle (RV) volume overload, increased pulmonary flow and overloading of the pulmonary circulation. Surgical or percutaneous closure of ASD is associated with reverse right heart remodelling, improved functional class and exercise capacity, irrespective of age. In the present study we aimed to assess the short and mid-term outcomes of ASD closure in terms of hemodynamic response, cardiac remodelling and clinical data in a population of adult patients with ostium secundum ASD eligible for percutaneous closure. Methods Patients with ostium secundum ASD referred to our institution from November 1st 2017 to September 30th 2021 were assessed for percutaneous closure within the National Program for percutaneous procedures in adults with congenital heart disease. All patients underwent a clinical and echocardiographic evaluation; demographics and biological data were collected. A transo esophageal echocardiography was available for all patients in order to assess the feasibility of percutaneous closure. Results The study population included 37 adult patients (29 women, mean age 43.5 ± 14.4 years) and 33 age- and gender-matched healthy volunteers. Eight patients had a history of supraventricular arrhythmias. The ASD patients had a significant RV and right atrial (RA) dilation, a higher pulmonary artery (PA) size and systolic pressures, a smaller left ventricle diastolic diameter. At least 1 follow-up visit data was available in 23 patients and the mean follow-up was 12 ± 8 months. The functional class significantly improved after ASD closure; 4 patients presented with supraventricular arrythmias after ASD closure. Data showed a significant decrease in RV and RA size after the ASD closure, the RV longitudinal function parameters also decreased. At the follow-up visit, the PA trunk diameter and the systolic PAP were significantly lower (p <0.001) compared with the pre-procedural values. The LV end-diastolic diameter increased after ASD closure. The reverse remodelling of the right chambers was similar in patients aged less and more or equal to 60 years, but the decrease in estimated systolic PAP was higher in older patients. Conclusion In adult patients with ostium secundum ASD, percutaneous closure leads to significant changes in functional class and echocardiographic parameters of right and left heart size and RV function and in pulmonary artery size and pressure. The beneficial effect seems to be similar in patients younger and older than 60 years.