EVALUATION OF RIGHT VENTRICULAR FUNCTION BEFORE AND AFTER CLOSURE OF ATRIAL SEPTAL DEFECT IN PEDIATRIC PATIENTS

Abstract

Background: ASD is one of the most common congenital heart defects (CHD). Although surgical closure of secundum type ASD has been considered the standard treatment for many years with very low rate of complication, trans-catheter ASD closure has become an important alternative to surgical repair with an excellent outcome.
Objectives: We aim to evaluate the right and left ventricular functions in children with ASD before and after ASD closure and to compare RV functions between post-surgical versus post trans-catheter ASD closure.
Patients and methods: This study was conducted on 30 children with large atrial septal defect, who underwent successful ASD closure either surgical (20 patients) or trans-catheter device (10 patients). All cases were assessed by; conventional echocardiography, tissue Doppler imaging, deformation imaging and 3- D echocardiography.
Results: Tissue Doppler Imaging (TDI) assessment of systolic functions for tricuspid velocity in cases showed, no significant difference after ASD device closure. The tricuspid E/E` ratio showed significant decrease in ASD patients after device and surgical closure The TAPSE showed significant decrease after ASD closure in both surgical and device closure groups. The RVMPI showed significant decrease after ASD closure in both surgical and device closure groups. Three dimensional (3-D) RV end-diastolic volume, 3-D RV end-systolic volume and 3-D RV EF showed significant decrease after ASD closure either surgical or device closure.
Conclusion: A significant shunt in the secundum ASD affects right and left ventricular sizes, systolic and diastolic functions. Three-dimensional (3D) echocardiography, TDI and deformation imaging are promising tools in estimating RV dysfunction in those cases.
Key Words: right ventricle, atrial septal defect, transthoracic echocardiography, three dimensional echocardiography