الفهرس 
Embryology and anatomyOnly 14 pages are availabe for public view
 |  | from | 240 |  |  |
| | | from | 240 | | |
Abstract
ASD can cause volume overload of the right side of the heart with the potential for subsequent development of right heart failure, elevated pulmonary vascular resistance or atrial arrhythmias. Closure of these defects is recommended to lessen the risk of late complications. Evidence of right heart enlargement by echocardiographic imaging has gained acceptance as an indication for defect closure as it has been shown to accurately estimate the degree of shunt.
Our study aimed to investigate the short and intermediate- term effects of transcatheter ASD closure on cardiac remodeling in children and adult patients.
This study was performed in Ain Shams University hospitals for 30 patients with secundum ASD referred for possible transcatheter device closure where all patients were subjected to adequate history taking, proper physical examination ; electrocardiographic parameters and transthoracic echocardiographic examination were evaluated before the ASD closure, then 1 day, 1 month and 6 month (15 patients) afterwards. Transcatheter ASD closure was successfully performed for the 30 patients (100%), with two patients having trivial residual shunts after closure by 24hours that disappeared during the 1 month follow up.
The patients’ age ranged from 2.5 to 49 years with median of 6 years, 53.3% of the patients were males and 46.7% were females.
The mean ASD diameter measured by TTE was 16.13+- 6.51 mm and that measured by TEE was 18.67+- 6.63 mm, and the mean diameter stretched with a sizing balloon was 18.78+- 6.38 mm.
There was a strong linear correlation between the size of ASD measured by both TTE (r=0.937) and TEE (r=0.966), with that measured by balloon sizing.
At the end of the mean follow-up period of 6 month, the RVEDD had decreased from 25.67+-5.50mm to 17.80+- 2.7 mm (p = 0.001), and the LVEDD had increased from 33.17+- 6.44 mm to 37.53+-5.15mm/m2 (p = 0.002). Mean PAP decreased from 16.97+- 3.37 mmHg to 9.22+-1.37 mmHg (P=0.000). RVSP decreased from 30.77+-4.69mmHg to 18.8+-2.11 mmHg (P=0.000).
At the 6 month follow up electrocardiographic examination, the P dispersion had decreased from 49.73+- 9.01ms to 30.53 ± 5.08 ms (p = 0.004), and the QT dispersion had decreased from 67.6 ± 5.31ms to 51.13 ± 5.73 ms (p = 0.003).The QRS duration decreased from 134.4+-4.97 to 116.20+-3.47ms.(P=0.002) and the PR interval decreased from 188.87+-6.06ms to 168.00+-6.16ms (P=0.002).One of thirty patients experienced recurrence of his preclosure arrhythmias (paroxysmal atrial flutter) and also experienced an attack of wide complex tachycardia.
The quantitative measurement of the RV showed that after 1 month the number of patients that their RV became normal in size increased from 63.3% to 83.3%. and at the 6 month follow up 14 patient (93.3%) of the 15 patient had normal RV size.
Right heart volume load is decreased after ASD device closure. Thus, reduction in PAP and right heart cavity dimensions is established.
Transcatheter ASD closure leads to a significant improvement in heart cavity dimensions in adults and children, as shown by the short and intermediate- term follow-up evaluation. Transcatheter ASD closure can reverse electrical and mechanical changes in atrial myocardium, resulting in a subsequent reduction in QT dispersion and P dispersion times