C  2009, the Authors Journal compilation C  2009, Wiley Periodicals, Inc. DOI: 10.1111/j.1540-8175.2009.00941.x Right Ventricular Remodeling after Transcatheter Closure of Atrial Septal Defect Jiandong Ding, M.D., ∗ Genshan Ma, M.D., ∗ Yaoyao Huang, M.D., ∗ Chen Wang, M.D., ∗ Xiaoli Zhang, M.D., ∗ Jian Zhu, M.D., ∗ and Fengxiang Lu, M.D.† ∗ Department of Cardiology, Zhongda Hospital and School of Clinical Medicine, Southeast University, Nanjing, China, and †Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China Background: Right ventricular (RV) volume overload is a well-known cardiac consequence of atrial septal defect (ASD) shunt, accounting for most of its long-term complications. Thus cardiac volu- metric unloading is a major aim of transcatheter ASD closure. We set to study the right ventricular remodeling after transcatheter ASD closure in patients with secundum ASD. Methods: We enrolled 46 patients who underwent successful transcatheter closure of ASD. We performed routine transtho- racic echocardiographic studies, including three-dimensional echocardiography and right ventricu- lar myocardial performance index (RVMPI), before transcatheter ASD closure, and 3 days, 1 month after transcatheter ASD closure. Results: We found that: (1) the right ventricular end-diastolic vol- ume (RVEDV) and right ventricular end-systolic volume (RVESV) (respectively 106.54 ± 25.97 vs 69.78 ± 10.46 mL, P < 0.05; 59.73 ± 17.59 vs 33.84 ± 7.18 mL, P < 0.05) were enlarged in patients with ASD compared with those in control subjects, resulting in a marked decrease of the right ven- tricular ejection fraction (RVEF) (44.82% ± 4.51% vs 54.11% ± 5.89%, P < 0.05) from normal values; (2) the isovolumic relaxation and isovolumic contraction times (respectively [77.61 ± 16.49] ms vs (64.09 ± 11.82) ms, P < 0.05; [28.04 ± 9.57] ms vs [20.45 ± 6.53] ms, P < 0.05) were prolonged and ejection time ([250.02 ± 24.21] ms vs [272.73 ± 20.51] ms, P < 0.05) was shortened in patients with ASD compared with that in control subjects, resulting in a marked increase of the MPI (0.41 ± 0.07 vs 0.31 ± 0.05, P < 0.05) from normal values; and (3) after transcatheter closure, the RVEDV and RVESV decreased and the RVEF increased markedly and RVMPI decreased markedly. Conclusions: Transcatheter closure of ASD results in rapid normalization of RV volume overload and improvement of RV function. (ECHOCARDIOGRAPHY, Volume 26, November 2009) heart, atrial septal defect, right ventricular function, three-dimensional echocardiography, myocar- dial performance index Secundum atrial septal defect (ASD) ac- counts for 10% of congenital heart diseases at birth, and as much as 30% to 40% in adults who present with congenital heart problems. 1 Right ventricular (RV) volume overload oc- curs in patients with significant shunting of blood of ASD. 2 Patients with ASD may present with symptoms of fatigue, dyspnea, recurrent lower respiratory tract infection, palpitations, Conflict of Interest: All authors read the manuscript and approved the final manuscript to submit to the journal. There are no conflicts of interest among authors. Address for correspondence and reprint requests: Jiandong Ding, M.D., Department of Cardiology, Zhongda Hospital and School of Clinical Medicine, Southeast University, 87 Ding Jia Qiao Road, Nanjing, 210009, P. R. China. Fax: 86-25-83272042; E-mail: dingjiandong@163.com and thromboembolic events. Surgical closure of the defect aims at relieving the heart and pulmonary circulation from the hemodynamic burden. Although patients benefit from surgi- cal repair of ASD, they still suffer from cardio- vascular morbidity after the operation. There- fore, transcatheter closure of ASD has become an accepted alternative to surgical treatment. It corrects cardiac anatomic malformations, de- creases left-to-right-shunt, and will surely give rise to advantageous effect on RV function. Sev- eral devices are now available, achieving com- plete closure of the ASD in more than 90% of the cases with a low complication rate. 3 How- ever, quantification of RV volume and function by conventional two-dimensional echocardiog- raphy (2DE) is challenging and has been lim- ited because the RV is not as ellipsoidal as 1146 ECHOCARDIOGRAPHY: A Jrnl. of CV Ultrasound & Allied Tech. Vol. 26, No. 10, 2009