Percutaneous device closure is an established treatment for secundum atrial septal defects (ASDs). 26 consecutive patients undergoing percutaneous ASD closure underwent prospective echocardiography at baseline, 24 hours post-, and 6-8 weeks post-closure. Echo parameters were analysed by a single blinded operator.

Mean age of the study population was 46 years (+/-17.8). 69% were female. Mean device size was 27mm (range 11-40mm). Right atrial (RA) area fell by 4.2cm² over 8 weeks (p<0.05), whilst mean right ventricular (RV) diameter fell by 0.9cm (p<0.05). RV diastolic and systolic areas also fell by statistically significant amounts.

Fractional area change (FRAC) of the RV decreased by a mean of 6.6% on day 1 post-ASD closure, and by a total of 11.7% at 8 weeks (p<0.05). Mean RV tricuspid annular plane systolic excursion (TAPSE) decreased by 0.24cm on day 1, and by 0.49cm at 8 weeks (p<0.05). Mean septal mitral annular E/E’ ratio increased from 12.4 to 16.4 on day 1, and to 20.3 at 8 weeks (p<0.05). Mean lateral mitral annular E/E’ ratio showed similar statistically significant increases.

The study confirms that RV remodeling occurs following ASD closure. It demonstrates for the first time that certain echocardiographic effects are evident as early as the first post-procedural day. These effects are presumably related to decreases in RV volume loading consequent on ASD closure, and continue to at least 8 weeks post-closure. Further correlation studies are required to elucidate whether certain pre-closure parameters can accurately predict favourable RV remodeling following ASD device closure.