Left atrial shape and function after endovascular and surgery atrial septal defects correction in children

Introduction. Atrial septal defects (ASD) are one of the most common congenital heart defects, accounting for about 10-15% of all congenital heart defects. Currently, endovascular treatments for ASD are considered the method of choice in most patients with secondary ASD. ASD occluders, after fixation on the atrial septum, close the shunt, eliminating the intercameral communication. However, these devices increase the stiffness of the septum, limit its mobility and presumably disrupt the mechanical function of the left atrium (LA).Aim: To study the effect of surgical and endovascular correction on the size, shape and function of the left atrium and left ventricle in children.Material and Methods. We retrospectively studied sequential echocardiograms of patients who underwent endovascular and surgical treatment of ASD in the period from 2006 to 2016 at the cardiology center in Tomsk, Russia. 756 patients with ASD were examined, 564 of them before and after endovascular closure and 192 after surgical correction. The duration of follow-up ranged from 1 day to 10 years, with an average of 3.6 years in the group receiving hardware treatment and 4.2 years in the group undergoing surgery. The control group consisted of 3393 healthy patients of the same age group. Echocardiographic images were obtained using an iE33 ultrasound scanner, Philips Ultrasound. Standard echo indicators of heart sizes and volumes were evaluated, including taking into account the body surface area and deviations of the studied parameters as a percentage of the predicted norm.Results. 15 days after ASD closure, both groups showed a significant increase in the volume of the left ventricle and a decrease in the right chambers. During follow-up in the group receiving the devices, left atrial shape index (LASI) was significantly reduced, while in patients undergoing surgery, there was no significant increase in LASI. A change in the shape of the left atrium and a decrease in its volume were combined with a change in the effort in the left atrium (LAEF), determined by the Manning method.Discussion. The study showed that both endovascular and surgical methods are effective in correcting ASD and lead to favorable results with respect to left atrial function. However, there is still uncertainty about the long-term effects after implanted devices used in endovascular procedures. Although these devices offer a minimally invasive solution, there is a problem associated with increased stiffness and limited mobility of the partition. Such changes can potentially alter the normal dynamics of atrial filling and contraction, affecting the overall function of the left atrium over time.Conclusion. Endovascular correction of ASD in 35% of children was accompanied by a change in the shape of the left atrium a decrease in sphericity and an increase in ellipsoid. Changes in the shape of the left atrium persisted in 22% of patients after transcatheter correction in the long term. These changes were not accompanied by any disorders of contractility and volume of the heart chambers. In the group of children after surgical correction of ASD, the contractility and volume of the heart chambers did not significantly differ from those in the device group.