Utility of Follow-Up Echocardiograms in Uncomplicated Surgical Secundum Atrial Septal Defect Closures: Preliminary Analysis

Ritika Gupta; May Ling Mah; Jessica Bowman; Clifford L Cua

doi:10.1007/s40119-023-00327-4

Utility of Follow-Up Echocardiograms in Uncomplicated Surgical Secundum Atrial Septal Defect Closures: Preliminary Analysis

Cardiol Ther. 2023 Sep;12(3):525-531. doi: 10.1007/s40119-023-00327-4. Epub 2023 Aug 7.

Authors

Ritika Gupta¹, May Ling Mah¹, Jessica Bowman¹, Clifford L Cua²

Affiliations

¹ Heart Center, Nationwide Children's Hospital, Columbus, OH, 43054, USA.
² Heart Center, Nationwide Children's Hospital, Columbus, OH, 43054, USA. clcua@hotmail.com.

Abstract

Introduction: Though less common in the current era, surgical closure of secundum atrial septal defects (ASD2) is still performed in certain clinical situations. Guidelines currently recommend lifelong follow-up with transthoracic echocardiograms (TTE) for patients who have undergone a surgical ASD2 closure. The goal of this study was to determine the utility of follow-up TTE in patients who underwent an uncomplicated ASD2 closure.

Methods: Chart review was performed on patients who had a surgical ASD2 closure between April 1, 1996, and August 30, 2021. Patients were excluded if they had other congenital heart disease, had a diagnosis of a residual ASD2, atrial/ventricular arrhythmias, pulmonary hypertension, heart failure, or did not have a follow-up TTE > 6 months after the procedure. The most recent TTEs and clinic notes were evaluated.

Results: A total of 30 patients met the criteria. The median age at ASD2 surgery was 4.0 years (IQ; 1.9-10.5). ASD2 was closed via patch repair in 16 patients and primarily closed in 14 patients. The most recent TTE was performed a median of 9.5 years (IQ; 4.0, 14.7) after ASD2 closure. Two patients had mild right atrial and ventricular dilation, one patient had mild right atrial dilation, and one patient had mild right ventricular dilation. All other patients had qualitatively normal right-sided chamber sizes. All patients had normal biventricular function (left ventricular fractional shortening (median 36% (IQ; 33, 42)), no evidence of residual atrial shunts, and no evidence of pulmonary hypertension. No patient was on any cardiac medications at last clinic visit. Four patients were discharged from cardiology clinic and 10 patients were lost to follow-up. There were no deaths. Twenty-four patients had 46 repeat echocardiograms > 1 year after ASD2 with no change in clinical management.

Conclusion: In patients who underwent an uncomplicated ASD2 closure, there were no significant abnormalities noted on follow-up TTEs. The need for repeat lifetime TTEs and their frequency, in this uncomplicated population, should be reassessed if larger studies with longer follow-up confirm these initial findings.

Keywords: Atrial septal defects; Congenital heart disease; Echocardiogram.