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CC BY-NC-ND 4.0 · Thorac Cardiovasc Surg 2026; 74(S 03): e17-e22
DOI: 10.1055/a-2809-8816
Pediatric and Congenital Cardiology

Predictors of Mitral Regurgitation and Subsequent Cardiac Geometric Changes Following Secundum Atrial Septal Defect Closure

Authors

  • Chunyu Liu 

    1   Shanxi Cardiovascular Hospital, Taiyuan, Shanxi, China

  • Zhibiao Zhang

    1   Shanxi Cardiovascular Hospital, Taiyuan, Shanxi, China

  • Jicheng Xi

    1   Shanxi Cardiovascular Hospital, Taiyuan, Shanxi, China
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Abstract

Background

Mitral regurgitation (MR) associated with atrial septal defect (ASD) has been observed to improve following ASD closure; however, aggravation of preexisting MR can occur postprocedure, with the underlying mechanisms of these adverse outcomes remaining poorly understood.

Method

This retrospective study evaluated 95 patients who underwent surgical secundum ASD closure, all of whom received preoperative and postoperative transthoracic echocardiography (TTE). Patient characteristics from preoperative TTE, as well as sex and age, were analyzed to identify predictors of MR. Follow-up TTE was conducted at 1 month, 3 months, 6 months, 1 year, and 2 years postprocedure, with all patients successfully completing the 2-year follow-up.

Results

The univariate logistic regression analysis indicated that age, gender, LA, RA-VD, RA-HD, RV, ASD diameter, AS diameter, PAP, and peak tricuspid regurgitation velocity may serve as predictors of MR worsening. Subsequent multiple logistic regression analysis revealed that LA size was an independent predictor of MR worsening and acted as a protective factor. Our research indicates a marked reduction in the right cardiac system after ASD closure, with significant remodeling of the LA within the first 6 months. The relative size of the LV increased notably within 2 years. The postoperative changes in LA differed between the worsening MR group and the nonworsening MR group.

Conclusion

In conclusion, “prophylactic” mitral annuloplasty during ASD surgery may prove advantageous for patients with an enlarged LA, and the presence of additional risk factors associated with mitral annuloplasty heightens the recommendation for concurrent intervention.

Keywords

predictor - mitral regurgitation - atrial septal defect closure - cardiac geometric change

Contributors' Statement

C.L. contributed to data curation, formal analysis, investigation, methodology, project administration, software, supervision, and writing—original draft. Z.Z. contributed to formal analysis, investigation, methodology, project administration, validation, and writing—review and editing. J.X. contributed to conceptualization, formal analysis, methodology, project administration, resources, supervision, visualization, and writing—review and editing.




Publication History

Received: 23 July 2025

Accepted: 09 February 2026

Accepted Manuscript online:
16 February 2026

Article published online:
03 March 2026

© 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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