Left and right ventricular speckle tracking study before and after percutaneous atrial septal defect closure in children

Objectives: To analyze the acute and short-term deformation changes of both right (RV) and left (LV) ventricular wall before and after transcatheter closure of atrial septal defect (ASD) secundum in children. Outcome measures: To determine the feasibility of tissue Doppler and myocardial deformation imaging for evaluating RV and LV functions in children undergoing transcatheter ASD closure. Patients and methods: A prospective study was performed for 32 children with hemodynamic significant ASD secundum before and 6 months after percutaneous ASD closure in the Pediatric Cardiology Division of Specialized Pediatric Hospital, Cairo University. Speckle tracking echocardiography (STE) of LV and RV global analysis (longitudinal and circumferential strain) before and after ASD transcatheter closure was performed. Results: The mean age of the patients was 6.01 +/- 3.19 (range: 3-9) years with a female to male ratio of 1.3:1. There was an improvement in the RV and LV myocardial performance index (MPI) 6 months post-ASD closure (RVMPI = 0.46 +/- 0.069 vs. 0.38 +/- 0.05, p < 0.0001; LVMPI = 0.49 +/- 0.12 vs. 0.38 +/- 0.08, p < 0.0001, respectively). By 2D STE, there was a significant improvement in the RV global longitudinal strain (GLS) 6 months post-ASD closure (-20.17 +/- 3.14% vs. -25.86 +/- 5.02%, p < 0.0001). There was a significant increase in the LV end-diastolic volume (EDV) and LV end-systolic volume (ESV) using 4D STE after device closure (LVEDV = 32.96 +/- 10.99 mL vs. 44.024 +/- 14.9017 mL, p < 0.0001; LVESV = 15.16 +/- 6.08 mL vs. 21.76 +/- 8.34 mL, p < 0.0001, respectively). Additionally, there was a significant improvement in the LV GLS after device occlusion (-19.17 +/- 3.67% vs. -22.36 +/- 4.72%, p = 0.009) using 4D TomTec software. There was a significant decrease in the RVEDV (54.65 +/- 10.05 mL vs. 15.73 +/- 8.67 mL) and RV stroke volume (25.15 +/- 6.36 vs. 20.06 +/- 7.2) after device occlusion using 4D TomTec software. Conclusion: By using 4D STE, the LV GLS was significantly improved; in contrast, by 2D STE, the RV volume overload decreased and the RV GLS was improved on short term after transcatheter ASD secundum closure in children.