Cardiac Remodeling After Percutaneous ASD Closure: Should It Be Immediate or Progressive?

Atrial septal defect (ASD) is a common congenital heart disease that generates a left-to-right shunt, leading to right-side chamber overload and a risk of pulmonary hypertension (PH), heart failure, and arrhythmia. Percutaneous closure is the standard treatment, although the prospective studies that describe in detail the early structural and functional changes following the procedure are very few. This study used serial echocardiography to assess the magnitude and timing of cardiac remodeling at 1 and 6 months after percutaneous ASD closure in adults.

Researchers conducted a prospective observational study in 112 consecutive patients undergoing percutaneous ASD closure. Sixty-seven percent were women, with a mean age of 38.8 ± 12.1 years. Baseline, 1-month, and 6-month transthoracic echocardiograms were performed, assessing right ventricular internal diameter (RVID), right ventricular systolic pressure (RVSP), pulmonary artery pressure (PAP), right atrial volume index (RAVI), left ventricular ejection fraction (LVEF), right ventricular ejection fraction by 3D (RVEF), tricuspid regurgitation (TR) severity, and heart rhythm. The most frequently used device was Figulla Flex (70.5%). The median ASD diameter was 21.3 ± 5.1 mm; the baseline LVEF was 53.2 ± 3.3% and the RVID was 3.85 ± 0.49 cm. Most patients were in sinus rhythm (94.6%).

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The primary endpoint assessed changes in continuous echocardiographic parameters (dimensions and pressures) at 1 and 6 months. Secondary endpoints analyzed categorical changes in TR severity, RVEF functional class, and heart rhythm modifications.

Right Ventricular Remodeling After Percutaneous ASD Closure: Early and Sustained Changes

There were significant improvements in right heart remodeling and pulmonary hemodynamics as early as the first month. The RVSP decreased steadily (r = −0.30, p <0.001), with an average reduction of 6–7 mmHg. The PAP showed a similar decrease (r = −0.30, p <0.001). The RAVI decreased progressively (r = −0.16, p = 0.0026), with an approximate reduction of 4–5 mL/m². The RVID showed the most marked change (r = −0.49, p <2.2e−16), consistent with significant structural remodeling of the right ventricle (RV).

RV function showed a favorable trend (tricuspid annular plane systolic excursion [TAPSE] r = +0.10, p = 0.065). Accordingly, 31% of patients improved their RVEF functional category at six months (p <0.01). There was also a marked regression in TR, with 18 patients improving at one month and 34 at six months (p <0.001). In contrast, LVEF remained stable (ΔLVEF r = +0.02, p = 0.67), with no relevant changes in LV volumes. Heart rhythm remained stable, with only two new cases of atrial fibrillation (p >0.05).

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Initial defect size did not modify the magnitude of remodeling: size×time interaction analyses were not significant for any parameter (p >0.20).

Hemodynamic and Functional Impact of ASD Closure: Reduction in Pulmonary Pressures and Improvement of the Right Ventricle

In conclusion, percutaneous ASD closure results in rapid and sustained right-heart remodeling, accompanied by a reduction in pulmonary pressures and an improvement in RV function, without negative impact on the LV or heart rhythm. These benefits manifest early and are independent of ASD size, supporting the safety and efficacy of percutaneous closure in adults.

Original Title: Short-Term Cardiac Functional Change Following Transcatheter Atrial Septal Defect Closure: A Prospective Echocardiographic Study.

Reference: Zahra Khajali et al. Catheterization and Cardiovascular Interventions, 2025.