Background:The latest guidelines recommend early intervention in adult atrial septal defect (ASD) patients with signs of right ventricular (RV) enlargement. However, the criteria of RV enlargement for optimal intervention remain unclear. We investigated the preoperative determinants for normalizing the RV volume after transcatheter closure of ASD in adults.

Methods and Results:We retrospectively analyzed 52 ASD patients who underwent transcatheter closure. Cardiac magnetic resonance imaging (CMR) measured RV volume before and 1 year after the closure. The patients were divided into normalized (postoperative RV end-systolic volume index [RVESVI] <47 mL/m²and end-diastolic volume index [RVEDVI] <108 mL/m²) and non-normalized (postoperative RVESVI ≥47 mL/m²or RVEDVI ≥108 mL/m²) groups. Preoperative RVESVI was significantly smaller (72 mL/m²vs. 80 mL/m²) and RVEF was higher (56% vs. 51%) in the normalized group compared with the non-normalized group. Receiver-operating characteristic analysis for the normalization of postoperative RV volume showed that the preoperative threshold value of RVESVI was 75 mL/m². In addition, multivariate analysis showed that preoperative RVESVI was an independent predictor for normalization of RV volume.

Conclusions:Preoperative RVESVI is an independent predictor for normalization of RV volume at 1 year after transcatheter closure of ASD in adults. Early intervention before RVESVI reaches 75 mL/m²may confer optimal timing for normalizing RV volume.

背景：最新指南建议对具有右心室（RV）增大迹象的成人房间隔缺损（ASD）患者进行早期干预。但是，RV扩大的最佳干预标准仍不清楚。我们调查了成人经导管关闭ASD后使RV体积正常化的术前决定因素。

方法和结果：我们回顾性分析了52例经导管置入术的ASD患者。心脏磁共振成像（CMR）在闭合前和闭合后1年测量RV量。将患者分为正常组（术后RV收缩期末容积指数[RVESVI] <47 mL / m ²和舒张末期体积指数[RVEDVI] <108 mL / m ²）和非正常组（术后RVESVI≥47mL/ m）。 m ²或RVEDVI≥108mL / m ²）组。术前RVESVI明显较小（72 mL / m ²与80 mL / m ²）和RVEF在标准化组比未标准化组更高（56％比51％）。术后右室容积归一化的接受者操作特征分析表明，RVESVI的术前阈值为75 mL / m ²。此外，多变量分析表明术前RVESVI是RV量正常化的独立预测因子。

结论：术前RVESVI是成人经导管ASD关闭后1年RV体积正常化的独立预测因子。在RVESVI达到75 mL / m ²之前进行早期干预可能为使RV体积正常化提供最佳时机。