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https://doi.org/10.14300/mnnc.2019.14159

Longitudinal left atrial mechanics and function in children after transcatheter closure of secondary atrial septal defect

[Pediatrics]
Yuri Semenovich Sinelnikov; Ekaterina Nikolaevna Orekhova; Tatyana Vladimirovna Matanovskaya;

In this article we evaluated the dynamics of longitudinal mechanics and phase function of the left atrium (LA) in infants with secondary atrial septal defect (ASD) after transcatheter closure. We examined 38 children of 2.1±0.7 years old, with secondary ASD 10.4±2.5 mm, Qp/Qs 1.86±0.2, with performed transcatheter correction of defect The functional (passive and active emptying fraction, PEF, AEF, expansion index – EI) and mechanical (longitudinal strain – S and strain rate – SR during the contraction phase, time to peak strain in the systolic phase – TTP Spump) LA parameters were evaluated initially, in the first day after surgery and after 6 months. All data were compared with the results obtained in 23 healthy children, comparable in age, gender, weight. In children with ASD, all functional and longitudinal mechanical parameters of LA are reduced in all phases of its activity. After transcatheter correction, the functional and mechanical parameters of the LA in the reservoir and pump phases are improved, but remain reduced by more than two times compared with the group of healthy children. Conduit function of the LA increases compensatory. A relationship was found between LA AEF and stroke index of the left ventricle (LV) 6 months after surgery (RS=0.63, p=0.0001) and LA AEF and LV EF (RS=0.4, p=0.011). An inverse correlation was found between the size of the installed occluder and reservoir longitudinal mechanics of LA after 6 months of observation (S-RS=–0.64, p=0.0001, SR-RS=–0.51, p=0.001), a direct relationship between the parameters of longitudinal mechanics of LA in the systolic phase of the LA and TTP Spump (S-RS=0.86, p=0.0001; SR-RS=0.7, p=0.0001, respectively). Thus, 6 months after transcatheter correction of the ASDs, signs of LA dysfunction persist in the form of inhibition of the pumping and reservoir functional and mechanical components of LA activity and a compensatory increase in conduit functional contribution.

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Keywords: atrial septal defect, left atrial, longitudinal stain