Left atrial functional remodeling following percutaneous closure of atrial septal defect secundum in adult patients

Atrial septal defect secundum (ASDs) is one of the congenital heart diseases that is common in adults and frequently associated with volume overload and functional impairment of the right heart. Percutaneous device closure has become the preferred treatment because of its efficacy and lower complication rates. While right heart remodeling post-closure is well established, the effects on left atrial (LA) function, especially phasic components involving reservoir, conduit, and contraction strain, remain less understood. Two-dimensional speckle tracking echocardiography (2D STE) enables early and sensitive detection of LA functional changes. This retrospective cohort study included adult patients (aged 18–65 years) with ASDs who underwent percutaneous device closure between December 2022 and October 2023 at Dr. Sardjito Hospital, Yogyakarta, Indonesia. Echocardiographic evaluations, including LA strain analysis (LASr, LAScd, LASc), were performed pre-closure, within 6 months (1st semester), and between ≥ 6–12 months (2nd semester) post-device closure. Patients with significant valvular disease, persistent arrhythmias, or suboptimal acoustic windows were excluded. Statistical analysis was conducted using repeated measures ANOVA or Friedman tests with Bonferroni correction. A total of 21 patients (mean age 40.86 ± 14.74 years; 76% female) were included. LA reservoir strain (LASr) significantly declined in the 1st semester post-device closure compared to baseline (p = 0.003) and showed partial recovery by the 2nd semester (p = 0.016 vs. baseline). LA conduit strain (LAScd) and contraction strain (LASc) also significantly decreased in the 1st semester (p = 0.030 and p = 0.025, respectively), while LASc did not significantly improve at the 2nd semester follow-up. No significant changes were observed in LA geometry. Interobserver agreement for all strain measurements was excellent (ICC ≥ 0.99). LA functional impairment was observed in the 1st semester after percutaneous device closure, marked by a noticeable decline in all strains of the LA (LASr, LAScd, and LASc). Partial recovery of LASr was observed at one year, whereas LASc did not show significant improvement after the initial reduction. These findings highlight that the LA strain may be a sensitive marker for predicting the development of LA dysfunction post-device closure follow-up.