Effect of Catheter Device Closure of Atrial Septal Defect on Diastolic Mitral Annular Motion Aleksandra Lange, MD, David M. Coleman, MBBS, Przemyslaw Palka, MD, Darryl J. Burstow, MBBS, James L. Wilkinson, MD, and Michael J. Godman, MD A mong the different echocardiographic techniques, pulse-wave Doppler tissue echocardiography (DTE) is regarded as the most accurate for the eval- uation of mitral and tricuspid annulus motion. 1–7 The aim of this study was to evaluate whether the Am- platzer (AGA Medical Corporation, Golden Valley, Minnesota) atrial septal defect (ASD) occluder 8 –11 affects mitral and tricuspid longitudinal annular ve- locities assessed by pulse-wave DTE. ••• A group of 35 patients (age 23  20 years, 18 men) was studied before and within the first 2 days after percutaneous ASD closure (Table 1). Forty-one age- matched subjects served as a control group. All recruited patients underwent successful percutaneous ASD closure in 3 independent centers: The Royal Hospital for Sick Children, Edinburgh, United Kingdom; Royal Children’s Hospital, Melbourne, Australia; and The Prince Charles Hospital, Brisbane, Australia. Data were analyzed in each center separately by 3 experienced cardiologists who were blinded to each other results. An Amplatzer septal occluder was used in all patients (size 12 to 36 mm). None of the patients had a significant valvular lesion (more than mild). Patients with ASDs who had other forms of congenital heart disease and/or life-threat- ening ventricular arrhythmias were not included in the study. Before ASD closure, right ventricular systolic pressure was 30 mm Hg in 16 patients (mean 34.3  7.8). Abnormal septal motion was noted in 22 patients (4 patients had paradoxic septal motion and 18 had flat- tened septal motion). The Amplatzer device size corresponds to the di- ameter of the conjoint defect stretching waist and not to the diameter of either the left atrial disc, which is 14 mm larger than the conjoint waist in devices 10 mm, or the right atrial disc, which is 10 mm greater than the waist in all device sizes. Thirteen of 34 patients with ASDs were studied 6 to 12 months after device place- ment to assess a potential change in measured param- eters over time. All patients were invited for the fol- low-up and those that returned were restudied. All patients were examined at rest in the left lateral decubitus position. Studies were performed with a commercially available ultrasound system equipped with DTE software (Acuson 128XP/10, Acuson Se- quoia, Mountain View, California). A variable fre- quency transducer (2.5 to 8.0 MHz) was used in all M-mode and Doppler examinations. ASD dimensions were established from combined apical and subcostal views. Doppler studies (both mitral inflow and DTE) were recorded using an apical 4-chamber view. A standard technique was used to record mitral inflow. Parameters measured were: peak E wave, peak A wave, E-wave deceleration time, and isovolumic re- laxation time. To record mitral annulus velocities by DTE, a 2-dimensionally guided 10-mm Doppler gate was placed at the site of the medial and lateral mitral annulus and the lateral tricuspid annulus. For DTE studies, the spectral pulsed Doppler signal was ad- justed to obtain a Nyquist limit of 40 cm/s, with low-wall filter settings and minimum optimal gain. Parameters measured were peak velocities (centime- ters per second) in early diastole in the medial mitral annulus (E mm ), lateral mitral annulus (E ml ), and lateral tricuspid annulus (E tl ), and peak velocities in late diastole (A mm ,A ml ,A tl ). 1–7 The time from the begin- ning of the QRS complex on the simultaneously re- corded electrocardiogram to peak systolic velocity and both the onset and the peak of diastolic annular ve- locities was also calculated. All measurements were obtained at end-expiration and averaged from 3 car- diac cycles. The data are expressed as mean value  SD for continuous variables and as frequency number (per- centages) for dichotomous variables. Analysis of vari- ance with Scheffe’s F adjustment for multiple com- parisons was used to assess the differences between age-matched controls and ASD patients’ pre- and postpercutaneous device closure. Unpaired and paired t tests were used when appropriate. Linear regression From the Department of Cardiology, The Royal Hospital for Sick Children, Edinburgh, United Kingdom; Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia; and Department of Car- diology, Royal Children’s Hospital, Melbourne, Australia. Dr. Lange’s address is: Heart Institute, St. Andrew’s War Memorial Hospital, 457 Wickham Terrace, Brisbane GPO Box 764, Queensland 4001, Australia. E-mail: AlekLange@hotmail.com. Manuscript received May 23, 2002; revised manuscript received and accepted August 23, 2002. TABLE 1 Clinical Characteristics of Study Subjects Patients with ASD (n = 35) Controls (n = 41) Age (yrs) (range) 23  20 (3–70) 22  20 (1–70) Men/Women 16/19 16/25 Atrial fibrillation 2 (6%) — New York Heart Association classification 0–I 23 (66%) — II–III 12 (34%) Heart rate (beats/min) Pre-ASD device closure 85  20 75  16 Post-ASD device closure 81  19 Systolic blood pressure (mm hg) 120  18 118  10 Body surface area (m 2 ) 1.40  0.57 1.43  0.53 Data are presented as a mean  SD or number with percentage. 104 ©2003 by Excerpta Medica, Inc. All rights reserved. 0002-9149/03/$–see front matter The American Journal of Cardiology Vol. 91 January 1, 2003 PII S0002-9149(02)03013-8