Speckle tracking right ventricular myocardial strain post-percutaneous closure of atrial septal defects in children

Author(s): Fatma Aboalsoud Taha

Background: Atrial Septal Defects (ASDs) can induce Right Ventricular (RV) volume overload and dysfunction. The RV has complex morphology; thus makes the quantitative assessment of its function challenging. Speckle tracking Global Longitudinal Strain (GLS) could be applied to estimate RV function. This study aimed to evaluate the changes in RV myocardial function by 2D speckle tracking global longitudinal strain in children with secundum ASD pre- and 3-month post-percutaneous device closure.

Methods and findings: Thirty-one children who underwent percutaneous ASD closure were prospectively examined. LV Ejection Fraction (EF), Estimated Systolic Pulmonary Artery Pressure (ESPAP), Tricuspid Annulus Plane Systolic Excursion (TAPSE), Fractional Area Change (FAC), and RV-GLS were calculated and analyzed prior- and 3-month after device closure. The mean age of patients was 8.15 ± 3.43 years with a mean weight of 17.31 Kg. ± 6.17 Kg. Sixteen (51.61%) patients were females. The pulmonary to systemic blood flow (QP/QS) ratio was 1.6 ± 0.56. The vertical, horizontal, and oblique diameters of the ASD were 15.06 mm ± 4.95 mm, 12.84 mm ± 3.12 mm, and 16.17 mm ± 4.29 mm respectively, and the device diameter was 16.94 mm ± 4.80 mm. After 3-month, there was a significant decrease in RA diameters, RV diameters, and ESPAP (P<0.001). TAPSE increased significantly from 14.32 mm ± 1.44 mm to 20.32 mm ± 1.57 mm (P<0.001), FAC enhanced significantly from 33.31% ± 11.14% to 39.15% ± 18.17 %, and RVGLS improved significantly from -17.26% ± 2.32% to -24.79% ± 3.41% (P<0.001). There were negative correlations between RV-GLS with RA diameters, RV diameters, and ESPAP (P<0.05), and positive correlations between RV-GLS with TAPSE, and FAC (P<0.05).

Conclusion: Speckle tracking-based GLS is a quantitative calculator of the subtle RV function impairment in children with ASDs that showed significant improvement to normal values in mid-term 3-month follow-up post-percutaneous device closure. Such a validated tool can be used in volume overloaded conditions to predict early ventricular dysfunction and to guide the initiation of percutaneous closure management strategy.