Right Heart Remodeling and Autonomic Function After Atrial Septal Defect Closure in Children: Surgical Versus Transcatheter Approaches.

Atrial septal defect (ASD) closure relieves chronic right ventricular (RV) volume overload; however, the extent to which RV mechanics and autonomic regulation normalize in the mid-term remains uncertain. Patients with isolated secundum ASD who had undergone surgical or transcatheter closure were compared with healthy controls of similar age, sex, and body surface area. Despite successful closure, ASD patients demonstrated subclinical impairment in RV systolic function and persistent enlargement of parasternal RV end-diastolic diameter (p < 0.001). Autonomic assessment revealed a higher LF/HF ratio despite preserved parasympathetic indices, indicating subtle sympathovagal imbalance. Right atrial size correlated positively with parasympathetic markers (RMSSD, pNN50) and inversely with LF/HF. Surgically treated patients exhibited lower TAPSE values and a higher prevalence of abnormal RV S' compared with transcatheter closure. These findings suggest that ASD closure does not uniformly restore RV mechanics or autonomic balance. Larger prospective studies are needed to clarify the clinical significance of these observations.