Korean Circ J.  2021 Dec;51(12):1017-1029. 10.4070/kcj.2021.0076.

Association between the Use of Diuretics and Size Reduction in Pediatric Atrial Septal Defect

• Lee JS
• Kim GB
• Lee WJ
• Song SH
• An HS
• Lee SY
• Song MK
• Kwon HW
• Bae EJ

• KMID: 2523154
• DOI: http://doi.org/10.4070/kcj.2021.0076

Abstract

Background and Objectives
While diuretics are sometimes used in atrial septal defect (ASD) treatment, their effect on ASD size reduction remains unclear. We aimed to evaluate the efficacy of diuretics in ASD size reduction in pediatric patients.
Methods
We retrospectively reviewed the medical records of patients with secundum ASD (size ≥10 mm), between 2005 and 2019. Patients were divided into two groups based on the diuretic administration.
Results
Of the 73 enrolled patients, 40 received diuretics. The initial age at ASD diagnosis (2.8±1.7 vs. 2.5±2.0 years, p=0.526) and follow-up duration (22.3±11.4 vs. 18.7±13.2 months, p=0.224) were not significantly different between the groups. The ASD diameter at the initial diagnosis (13.7±2.0 vs. 13.5±3.4 mm, p=0.761) and the indexed ASD diameter (25.5±5.9 vs. 26.9±10.3 mm/m² , p=0.493) were also not significantly different between two groups. The ASD diameter significantly increased in the non-diuretic group during follow-up (0.0±2.9 vs. +2.6±2.0 mm, p<0.001). The indexed ASD diameter significantly decreased in the diuretic group during follow-up (−5.7±6.5 vs. +0.2±3.9 mm/m 2 , p<0.001). In the linear mixed model analysis, diuretic use was associated with ASD diameter decrease (p<0.001) and indexed ASD diameter reduction (p<0.001) over time. Device closure was more frequently performed in the diuretic (75.0%) than in the non-diuretic group (39.4%).
Conclusions
Patients receiving diuretics are less likely to undergo surgery. The diuretics administration may be associated with the use of smaller ASD devices for transcatheter treatment through ASD size reduction.

Keyword

Atrial septal defect; Diuretics; Pediatrics; Device; Surgery

Figure

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  Figure 1 ASD size changes over time. (A, B) Patients who received diuretics showed a significantly decreasing tendency of absolute ASD diameter (mm) over time (p for interaction<0.001). (C, D) Patients who received diuretics showed a significantly decreasing tendency of indexed ASD diameter (mm/m2) over time (p for interaction<0.001).ASD = atrial septal defect.

• 

  Figure 2 Distribution of ASD diameter change (mm) in the two groups. The absolute ASD diameter was decreased in 20.0%, maintained in 45.0%, and increased in 35.0% of the patients in the diuretic group. In the non-diuretic group, there was no decrease in the absolute ASD diameter; in 18.2% of the patients, the value was maintained and in 81.8%, it was increased (p<0.001).ASD = atrial septal defect.

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  Figure 3 TV annulus z-score changes over time. The TV annulus z-score change showed a significant difference over time in the two groups according to the use of diuretics (p for interaction=0.019).TV = tricuspid valve.

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  Figure 4 Distribution of ASD treatment in the two groups. The treatment distribution for ASD according to the diuretic administration. The patients with diuretics underwent more non-invasive treatments such as observation or device closure than surgical closure with statistical significance (p=0.001).ASD = atrial septal defect.

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