1
|
Sjöberg P, Clausen H, Arheden H, Liuba P, Hedström E. Atrial septal defect closure in children at young age is beneficial for left ventricular function. EUROPEAN HEART JOURNAL. IMAGING METHODS AND PRACTICE 2024; 2:qyae058. [PMID: 39224095 PMCID: PMC11367966 DOI: 10.1093/ehjimp/qyae058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 05/23/2024] [Indexed: 09/04/2024]
Abstract
Aims Atrial septal defects (ASDs) lead to volume-loaded right ventricles (RVs). ASD closure does not always alleviate symptoms or improve exercise capacity, which is possibly explained by impaired left ventricular (LV) haemodynamics. This study evaluated the effect of ASD closure in children using non-invasive LV pressure-volume (PV) loops derived from cardiac magnetic resonance (CMR) imaging and brachial blood pressure, compared with controls. Methods and results Twenty-three children with ASD underwent CMR, and 17 of them were re-examined 7 (6-9) months after ASD closure. Twelve controls were included. Haemodynamic variables were derived from PV loops by time-resolved LV volumes and brachial blood pressure. After ASD closure, LV volume increased [76 (70-86) vs. 63 (57-70) mL/m2, P = 0.0001]; however, it was still smaller than in controls [76 (70-86) vs. 82 (78-89) mL/m2, P = 0.048]. Compared with controls, children with ASD had higher contractility [2.6 (2.1-3.3) vs. 1.7 (1.5-2.2) mmHg/mL, P = 0.0076] and arterial elastance [2.1 (1.4-3.1) vs. 1.4 (1.2-2.0) mmHg/mL, P = 0.034]. After ASD closure, both contractility [2.0 (1.4-2.5) mmHg/mL, P = 0.0001] and arterial elastance [1.4 (1.3-2.0) mmHg/mL, P = 0.0002] decreased. Conclusion Despite the left-to-right atrial shunt that leads to low LV filling and RV enlargement, the LV remains efficient and there is no evidence of impaired LV haemodynamics in children. Closure of ASD at young age while the ventricle is compliant is thus beneficial for LV function. LV volumes, however, remain small after ASD closure, which may impact long-term cardiovascular risk and exercise performance.
Collapse
Affiliation(s)
- Pia Sjöberg
- Clinical Physiology, Department of Clinical Sciences, Lund, Lund University, Box 188, 221 00 Lund, Sweden
- Department of Clinical Physiology, Skåne University Hospital, Entrégatan 7, 221 85 Lund, Sweden
| | - Henning Clausen
- Paediatric Cardiology, Children’s Heart Centre, Skåne University Hospital, Entrégatan 7, 221 85 Lund, Sweden
- Paediatrics, Department of Clinical Sciences, Lund, Lund University, Box 188, 221 00 Lund, Sweden
| | - Håkan Arheden
- Clinical Physiology, Department of Clinical Sciences, Lund, Lund University, Box 188, 221 00 Lund, Sweden
- Department of Clinical Physiology, Skåne University Hospital, Entrégatan 7, 221 85 Lund, Sweden
| | - Petru Liuba
- Paediatric Cardiology, Children’s Heart Centre, Skåne University Hospital, Entrégatan 7, 221 85 Lund, Sweden
- Paediatrics, Department of Clinical Sciences, Lund, Lund University, Box 188, 221 00 Lund, Sweden
| | - Erik Hedström
- Clinical Physiology, Department of Clinical Sciences, Lund, Lund University, Box 188, 221 00 Lund, Sweden
- Department of Clinical Physiology, Skåne University Hospital, Entrégatan 7, 221 85 Lund, Sweden
- Diagnostic Radiology, Department of Clinical Sciences, Lund, Lund University, Box 188, 221 00 Lund, Sweden
- Department of Radiology, Skåne University Hospital, Entrégatan 7, 221 85 Lund, Sweden
| |
Collapse
|
2
|
Sjöberg P, Stephensen S, Arheden H, Heiberg E, Carlsson M. Patients with volume-loaded right ventricle - quantification of left ventricular hemodynamic response to intervention measured by noninvasive pressure-volume loops. Front Physiol 2023; 14:1291119. [PMID: 38124715 PMCID: PMC10730652 DOI: 10.3389/fphys.2023.1291119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/24/2023] [Indexed: 12/23/2023] Open
Abstract
Volume loading of the right ventricle (RV) in patients with atrial septal defect (ASD) and patients with repaired Tetralogy of Fallot (rToF) affects the pumping mechanics of the left ventricle (LV). Intervention of the lesion will relieve the RV volume load however quantifiable impact on exercise capacity, arrhytmias or death are limited. A possible explanation could be remaining effects on the function of the LV. The aim of this study was therefore to investigate if hemodynamics of the LV differs between patients with RV volume load due to ASD or rToF and healthy controls and if they change after intervention. Eighteen patients with ASD, 17 patients with rToF and 16 healthy controls underwent cardiac magnetic resonance imaging (CMR) and maximal exercise test with continuous gas analysis. Reexamination was performed 13 ± 2 months after closure of the ASD in 13 of the patients and 10 ± 4 months after pulmonary valve replacement (PVR) in 9 of the patients with rToF. Non-invasive PV-loops from CMR and brachial pressures were analyzed. Stroke work (SW) and potential energy (PE) increased after ASD closure but not in ToF patients after valve repair. Patients with ASD or rToF had higher contractility and arterial elastance than controls. No major effects were seen in LV energetics or in peak VO2 after ASD closure or PVR. Peak VO2 correlated positively with SW and PE in patients with ASD (r = 0.54, p < 0.05; r = 0.61, p < 0.01) and controls (r = 0.72, p < 0.01; r = 0.53, p < 0.05) to approximately the same degree as peak VO2 and end-diastolic volume (EDV) or end-systolic volume (ESV). In ToF patients there was no correlation between PV loop parameters and peak VO2 even if correlation was found between peak VO2 and EDV or ESV. In conclusion, the LV seems to adapt its pumping according to anatomic circumstances without losing efficiency, however there are indications of persistent vascular dysfunction, expressed as high arterial elastance, which might have impact on exercise performance and prognosis. Future studies might elucidate if the duration of RV volume load and decreased LV filling have any impact on the ability of the vascular function to normalize after ASD closure or PVR.
Collapse
Affiliation(s)
- Pia Sjöberg
- Clinical Physiology, Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden
- Department of Clinical Physiology, Skåne University Hospital, Lund, Sweden
| | - Sigurdur Stephensen
- Clinical Physiology, Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden
- Department of Clinical Physiology, Skåne University Hospital, Lund, Sweden
| | - Håkan Arheden
- Clinical Physiology, Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden
- Department of Clinical Physiology, Skåne University Hospital, Lund, Sweden
| | - Einar Heiberg
- Clinical Physiology, Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden
- Department of Clinical Physiology, Skåne University Hospital, Lund, Sweden
- Wallenberg Centre for Molecular Medicine, Lund University, Lund, Sweden
| | - Marcus Carlsson
- Clinical Physiology, Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden
- Department of Clinical Physiology, Skåne University Hospital, Lund, Sweden
| |
Collapse
|
3
|
Kemna MS, Shaw DW, Kronmal RA, Ameduri RK, Azeka E, Bradford TT, Kindel SJ, Lin KY, Möller T, Reardon LC, Schumacher KR, Shih R, Stendahl GL, West SC, Wisotzkey B, Zangwill S, Menteer J. Posterior reversible encephalopathy syndrome (PRES) after pediatric heart transplantation: A multi-institutional cohort. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
|
4
|
Hirono K, Origasa H, Tsuboi K, Takarada S, Oguri M, Okabe M, Miyao N, Nakaoka H, Ibuki K, Ozawa S, Ichida F. Clinical Status and Outcome of Isolated Right Ventricular Hypoplasia: A Systematic Review and Pooled Analysis of Case Reports. Front Pediatr 2022; 10:794053. [PMID: 35529333 PMCID: PMC9069111 DOI: 10.3389/fped.2022.794053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 03/14/2022] [Indexed: 11/15/2022] Open
Abstract
Background Isolated right ventricular hypoplasia (IRVH), not associated with severe pulmonary or tricuspid valve malformation, is a rare congenital myocardial disease. This study aims to evaluate the clinical status and outcome of IRVH. Methods A systematic search of keywords on IRVH was conducted. Studies were searched from MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Igaku Chuo Zasshi (Ichushi) published between January 1950 and August 2021. Results Thirty studies met the inclusion criteria. All of these studies were case reports and included 54 patients (25 males and 29 females). The median age of the patients was 2.5 years old (0-15.3 years). Of the 54 patients, 13 (24.1%) reported a family history of cardiomyopathy. Moreover, 50 (92.6%), 19 (35.2%), and 17 (31.5%) patients were diagnosed with cyanosis, finger clubbing, and dyspnea, respectively. Furthermore, 53 (98.2%) patients had a patent foramen ovale or an atrial septal defect (ASD). Z-score of the tricuspid valve diameter on echocardiogram was -2.16 ± 1.53, concomitant with small right ventricular end-diastolic volume. In addition, 29 (53.7%), 21 (38.9%), 7 (13.0%), and 2 (3.7%) patients underwent surgery, ASD closure, Glenn operation, and one and a half ventricular repair, respectively. Among them, nine (20.4%) patients expired, and the multivariable logistic regression analysis showed that infancy, heart failure, and higher right ventricular end-diastolic pressure were risk factors for death. Conclusions IRVH was diagnosed early in children with cyanosis and was associated with high mortality. This systematic review and pooled analysis provided evidence to assess the of IRVH degree in order to evaluate the clinical status and outcome of IRVH.
Collapse
Affiliation(s)
- Keiichi Hirono
- Departments of Pediatrics, Graduate School of Medicine, University of Toyama, Toyama, Japan
| | - Hideki Origasa
- Biostatistics and Clinical Epidemiology, Graduate School of Medicine, University of Toyama, Toyama, Japan
| | - Kaori Tsuboi
- Departments of Pediatrics, Graduate School of Medicine, University of Toyama, Toyama, Japan
| | - Shinya Takarada
- Departments of Pediatrics, Graduate School of Medicine, University of Toyama, Toyama, Japan
| | - Masato Oguri
- Departments of Pediatrics, Graduate School of Medicine, University of Toyama, Toyama, Japan
| | - Mako Okabe
- Departments of Pediatrics, Graduate School of Medicine, University of Toyama, Toyama, Japan
| | - Nariaki Miyao
- Departments of Pediatrics, Graduate School of Medicine, University of Toyama, Toyama, Japan
| | - Hideyuki Nakaoka
- Departments of Pediatrics, Graduate School of Medicine, University of Toyama, Toyama, Japan
| | - Keijiro Ibuki
- Departments of Pediatrics, Graduate School of Medicine, University of Toyama, Toyama, Japan
| | - Sayaka Ozawa
- Departments of Pediatrics, Graduate School of Medicine, University of Toyama, Toyama, Japan
| | - Fukiko Ichida
- Department of Pediatrics, International University of Health and Welfare, Tokyo, Japan
| |
Collapse
|
5
|
Nakamura Y, Sohara H, Ihara M. Iatrogenic atrial septal defect after HotBalloon ablation of atrial fibrillation. Heart Vessels 2022; 37:1418-1424. [DOI: 10.1007/s00380-022-02039-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 02/03/2022] [Indexed: 11/24/2022]
|
6
|
Yoshiba S, Kojima T, Oyanagi T, Toda K, Osada Y, Muraji S, Imamura T, Nakano S, Makita S, Kobayashi T, Sumitomo N. Late recovery of the cardiopulmonary exercise capacity after transcatheter amplatzer device closures for atrial septal defects in adults. Heart Vessels 2021; 36:710-716. [PMID: 33386922 DOI: 10.1007/s00380-020-01741-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 11/27/2020] [Indexed: 10/22/2022]
Abstract
Transcatheter atrial septal defect (ASD) closures using an Amplatzer Septal Occluder (ASO) have been widely performed. Compared to children, we sometimes experience late recovery of exercise performance in adult patients. Our study aimed to evaluate the change in the cardiopulmonary exercise capacity in asymptomatic or mildly symptomatic adult patients after a transcatheter ASD closure using an ASO. The subjects consisted of 29 patients (age 39.5 ± 13.6 years) that underwent cardiopulmonary exercise testing (CPX) before, 3, 6, and 12 months after a transcatheter secundum ASD closure using an ASO. The peak oxygen consumption (peak VO2), anaerobic threshold (AT), and slope of the correlation between the ventilation and carbon dioxide production (VE/VCO2 slope) were evaluated. We also evaluated the left-ventricular end-diastolic diameter (LVEDD), right-ventricular end-diastolic dimension (RVEDD) by echocardiography, and hemodynamic values by cardiac catheterization before the ASO procedure. The peak VO2 did not show any improvement 3 months after the ASO procedure; however, a significant improvement was displayed 6 and 12 months (baseline: 23.4 ± 6.3, 3 months: 23.6 ± 6.4, 6 months: 25.1 ± 5.6, 12 months: 26.4 ± 5.3 mL/kg/min; p < 0.001) after the ASO. The LVEDD (before: 38.1 ± 3.6, 3 months: 43.4 ± 3.4 mm; p < 0.001) and RVEDD (before: 33.6 ± 5.3, 3 months: 26.3 ± 2.6 mm; p < 0.001) on echocardiography quickly improved 3 months after the ASO. Although the LVEDD and RVEDD normalized 3 months after the ASO, the peak VO2 still decreased; however, the peak VO2 improved to almost a normal range 6 months after the ASO.
Collapse
Affiliation(s)
- Shigeki Yoshiba
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Takuro Kojima
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Takayuki Oyanagi
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Koichi Toda
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Yousuke Osada
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Shota Muraji
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Tomohiko Imamura
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Shintaro Nakano
- Department of Cardiology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Shigeru Makita
- Department of Cardiac Rehabilitation, Saitama Medical University International Medical Center, Saitama, Japan
| | - Toshiki Kobayashi
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan.
| |
Collapse
|
7
|
Nakayama R, Takaya Y, Akagi T, Watanabe N, Miki T, Nakagawa K, Toh N, Ito H. Efficacy and safety of atrial septal defect closure using Occlutech Figulla Flex II compared with Amplatzer Septal Occluder. Heart Vessels 2021; 36:704-709. [PMID: 33386412 DOI: 10.1007/s00380-020-01739-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/20/2020] [Indexed: 11/25/2022]
Abstract
Few studies have reported the efficacy of Occlutech Figulla Flex II (FFII) device compared with Amplatzer Septal Occluder (ASO) device. The aim of this study was to examine the efficacy and safety of FFII compared with ASO for transcatheter atrial septal defect (ASD) closure. We retrospectively evaluated 190 patients using FFII and 190 patients using ASO who underwent transcatheter ASD closure. ASD characteristics were evaluated by transesophageal echocardiography. The prevalence of procedural complications, including erosion, device embolization, stroke, and new-onset atrial arrhythmia, and the presence of a residual shunt were evaluated between the two groups during 12-month follow-up. FFII was used more frequently than ASO in patients with a deficient aortic rim or septal malalignment (P = 0.02, P < 0.01, respectively). The procedural complications of erosion, device embolization, and stroke did not occur in any patients. New-onset atrial arrhythmia occurred in 3 patients of the FFII group and 4 patients of the ASO group, and the difference between the two groups was not significant (P = 0.70). A large residual shunt (≥ 3 mm) was observed in 6 patients of the FFII group and 5 patients of the ASO group, and the difference between the two groups was not significant (P = 0.76). FFII was used frequently in patients with high-risk ASD morphology; however, there was no difference in the prevalence of procedural complications or efficacy between patients using FFII and those using ASO.
Collapse
Affiliation(s)
- Rie Nakayama
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Yoichi Takaya
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
| | - Teiji Akagi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Nobuhisa Watanabe
- Division of Medical Support, Okayama University Hospital, Okayama, Japan
| | - Takashi Miki
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Koji Nakagawa
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Norihisa Toh
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| |
Collapse
|