Functional Echocardiographic and Serum Biomarker Changes Following Surgical and Percutaneous Atrial Septal Defect Closure in Children

Jelle P.G. van der Ven, Eva van den Bosch, Vivian P. Kamphuis, Covadonga Terol, Devi Gnanam, Ad J.J.C. Bogers, Johannes M.P.J. Breur, Rolf M.F. Berger, Nico A. Blom, Laurens Koopman, Arend D.J. Ten Harkel, Willem A. Helbing*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

BACKGROUND: Ventricular performance is temporarily reduced following surgical atrial septal defect closure. Cardiopulmonary bypass and changes in loading conditions are considered important factors, but this phenomenon is incompletely under-stood. We aim to characterize biventricular performance following surgical and percutaneous atrial septal defect closure and to relate biomarkers to ventricular performance following intervention. METHODS AND RESULTS: In this multicenter prospective study, children scheduled for surgical or percutaneous atrial septal defect closure were included. Subjects were assessed preoperatively, in the second week postintervention (at 2-weeks follow-up), and 1-year postintervention (1-year follow-up). At each time point, an echocardiographic study and a panel of biomarkers were obtained. Sixty-three patients (median age, 4.1 [interquartile range, 3.1– 6.1] years) were included. Forty-three patients underwent surgery. At 2-weeks follow-up, right ventricular global longitudinal strain was decreased for the surgical, but not the percutaneous, group (−17.6±4.1 versus −27.1±3.4; P<0.001). A smaller decrease was noted for left ventricular global longitudinal strain at 2-weeks follow-up for the surgical group (surgical versus percutaneous, −18.6±3.2 versus −20.2±2.4; P=0.040). At 1-year follow-up, left ventricular performance returned to baseline, whereas right ventricular performance improved, but did not reach preintervention levels. Eight biomarkers relating to cardiovascular and immunological processes differed across study time points. Of these biomarkers, only NT-proBNP (N-terminal pro-B-type natriuretic peptide) correlated with less fa-vorable left ventricular global longitudinal strain at 2-weeks follow-up. CONCLUSIONS: Right, and to a lesser degree left, ventricular performance was reduced early after surgical atrial septal defect closure. Right ventricular performance at 1-year follow-up remained below baseline levels. Several biomarkers showed a pattern over time similar to ventricular performance. These biomarkers may provide insight into the processes that affect ventricular function.

Original languageEnglish
Article numbere024072
JournalJournal of the American Heart Association
Volume11
Issue number16
DOIs
Publication statusPublished - 5 Aug 2022

Bibliographical note

Funding Information:
Drs van der Ven, van den Bosch, and Kamphuis are supported by a research grant from the Dutch Heart Foundation (grant 2013T091).

Publisher Copyright:
© 2022, American Heart Association Inc. All rights reserved.

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