Atrial Septal Defect Repair Research Articles

Analysis of the therapeutic effect of right mid-axillary approach in the surgical treatment of ASD and VSD in children

BackgroundTo compare the therapeutic effects of right vertical infra-axillary thoracotomy (RVIAT) and Standard Median Sternotomy (SMS) in the repair of atrial septal defect (ASD) and ventricular septal defect (VSD), and to evaluate the safety and effectiveness of right subaxillary incision technique in the surgical treatment of common congenital heart disease (CHD) in children.MethodsData of children diagnosed with ASD repair or VSD repair at our center from September 2019 to September 2022 were collected. Based on propensity score matching, 214 children (107 in the RVIAT group and 107 in the SMS group) who completed ASD repair surgery and 242 children (121 in the RVIAT group and 121 in the SMS group) who completed VSD repair surgery were selected for the study. The perioperative and follow-up data of the two surgical approaches were compared to evaluate clinical efficacy.ResultsThere was no statistically significant difference (p > 0.05) between the two surgical approaches in terms of surgical time, aortic occlusion time, total amount of ultrafiltration fluid, ICU stay time, and hospital stay; The intraoperative blood loss and total postoperative drainage fluid in the RVIAT group were lower than those in the SMS group (p < 0.05); The incidence of postoperative thoracic deformities in the SMS group is higher than that in the RVIAT group.ConclusionThe safety and effectiveness of the two approaches are similar, but RVIAT has less intraoperative bleeding, less postoperative drainage fluid and tube time, and better concealment and cosmetic effects, which is worthy of further clinical promotion and application.

Totally endoscopic robotic repair of coronary sinus atrial septal defect with concomitant tricuspid annuloplasty

BackgroundThe coronary sinus type of atrial septal defect is rare. Standard treatment typically involves intracardiac repair using conventional sternotomy or thoracotomy incisions; however, robotic technology can offer a feasible alternative due to its ability to provide a high-quality surgical view of this anomaly.Case presentationA 72-year-old man presented with asymptomatic atrial septal defect. Echocardiography revealed a direct communication between the left atrium and CS with left-to-right shunt flow and a Qp/Qs ratio of 2.1:1. The coronary sinus type of atrial septal defect was indicated for the totally endoscopic robotic repair considering few comorbidities. We present a successful robotic repair of coronary sinus atrial septal defect with concomitant tricuspid annuloplasty via the right atrium, properly identifying the boundary between the mitral annulus and coronary sinus through a high-quality surgical view.ConclusionRobotic repair can serve as a viable and therapeutically effective alternative for cases of coronary sinus atrial septal defect with concomitant tricuspid annuloplasty.

Surgical Repair of Atrial Septal Defect with Severe Pulmonary Hypertension: A Case Report

This case report details the successful surgical repair of an atrial septal defect (ASD) in a 28-year-old female with severe pulmonary arterial hypertension (PAH), who presented with dyspnea, fatigue, and palpitations. The patient had a large secundum ASD (26 mm size) with bi-directional shunt and severe PAH, with a Pulmonary Arterial Systolic Pressure (PASP) of 107 mmHg and Mean Pulmonary Arterial Pressure (mPAP) of 57 mmHg, as revealed by echocardiography. The patient was optimized medically with diuretics, oxygen, and pulmonary vasodilators (Sildenafil &amp; Ambrisentan), and was deemed eligible for surgical closure of the ASD. A pericardial patch was used to close the defect, and the patient's postoperative recovery was uneventful. Follow-up echocardiography showed a significant reduction in mPAP and right ventricular size. Although surgical closure of an ASD with severe PAH is a high-risk procedure, it can be safely performed in carefully selected patients with appropriate preoperative evaluation, medical optimization, and careful surgical technique. Timely closure of the defect can result in a considerable improvement in the patient's hemodynamic status and quality of life. Cardiovasc j 2024; 16(2): 110-113

Recurrent mitral regurgitation after repair of Barlow's disease in a single-center retrospective cohort study.

Barlow's disease (BD) is a common etiology of degenerative mitral valve (MV) disease, often causing significant mitral regurgitation (MR). The pathology of BD is challenging for surgeons performing MV repair (MVR). However, most MVR effectiveness studies have been based on survival and risk of reoperation. The aim of this study was to analyze the safety, efficacy, and durability of MVR in patients with BD and to identify factors that influence recurrent MR. We retrospectively analyzed the clinical outcomes of 274 patients undergoing MVR for BD at a tertiary hospital (Guangdong People's Hospital, Guangzhou, China) between January 2010 and June 2022. To analyze the results of MVR and identify the risk factors for MR recurrence, we defined two groups: a total of 240 patients with MR grade <2+ (group A) and a total of 34 patients who had recurrent MR after MVR (group B; the patients with MR ≥2+). All patients were operated on using standard repair techniques. Recurrent MR was the primary outcome. Secondary outcomes were death and reoperation after MVR. Patients were followed up until March 2023. Patients were followed up by clinic visits, telephone calls, and postal or electronic questionnaires. The median [range] patient age was 46.00 [16-75] years and 186 (67.9%) patients were male. Concomitant procedures were performed in 123 patients: tricuspid valve repair 71 (25.9%), maze or pulmonary vein isolation (PVI) 12 (4.4%), atrial septal defect (ASD) repair 3 (1.1%), and left atrial appendage (LAA) closure 28 (10.2%). Hospital mortality was 0.4%. Long-term complications included radiofrequency ablation in 7 patients (2.6%), pacemaker implantation in 1 patient (0.4%), and stroke in 3 patients (1.1%). The median follow-up was 3.28 (range, 0-12.39) years. Considering the competing risk of mortality, the cumulative incidence of MR progression 2+ or more grades was 2.6%, 5.9%, 14.5%, and 27.7% at 1 month, 1, 5, and 10 years, respectively. Overall survival at 1, 5, and 10 years was 99.3%, 98.6%, and 98.6%, respectively. The immediate postoperative MR area [hazard ratio (HR) =1.723; 95% confidence interval (CI): 1.051-2.824; P=0.031], postoperative left ventricular end-diastolic dimension (LVEDD) (HR =1.149; 95% CI: 1.016-1.300; P=0.027), and postoperative MR grade {HR = Exp[4.500 - 0.544 × ln(t + 20)]; P=0.008} were associated with an increased risk of MR recurrence, whereas a higher left ventricular ejection fraction (LVEF) (HR =0.931; 95% CI: 0.868-0.999; P=0.049) was associated with a decreased risk. MVR in patients with BD can be performed with low mortality and complications and is associated with superior long-term outcomes. However, MVR was associated with a certain risk of MR recurrence, especially in those with high postoperative LVEDD, residual MR >1+, and decreased postoperative LVEF. We recommend MVR for patients with BD, especially for those with early-stage disease. However, future randomized controlled trials are needed to confirm this.

Feasibility and accuracy of virtual reality for surgical and interventional planning for sinus venosus atrial septal defect repair

Feasibility and accuracy of virtual reality for surgical and interventional planning for sinus venosus atrial septal defect repair

Early Outcomes of Surgical Repair of Atrial Septal Defect with Right Anterolateral Minithoracotomy versus Traditional Median Sternotomy

Early Outcomes of Surgical Repair of Atrial Septal Defect with Right Anterolateral Minithoracotomy versus Traditional Median Sternotomy

Outcomes of maze procedure and mitral valve surgery in atrial functional mitral regurgitation: a retrospective study

BackgroundAtrial functional mitral regurgitation (AFMR) is a newly discovered condition associated with longstanding atrial fibrillation. This retrospective study aimed to analyze the outcomes of the maze procedure and mitral regurgitation (MR) surgery in AFMR and atrial fibrillation in comparison with those in degenerative MR (DMR).MethodsPatients who underwent mitral valve repair/replacement with a maze procedure at a hospital (July 2012–August 2021) were included. We excluded patients aged below 18 years undergoing concomitant coronary artery bypass grafting or atrial septal defect repair and those with MR etiology other than ARMR or DMR.ResultsWe included 35 patients with AFMR and 50 patients with DMR. Patient characteristics and postoperative outcomes were not significantly different between the two groups. Long-term outcomes revealed no significant differences in the ratio of cardiac mortality, stroke, or hospital readmission. However, after the maze procedure, the sinus rhythm restoration rate was significantly lower (62% vs. 28.5%, p < 0.001), a junctional rhythm state (p < 0.001) and permanent pacemaker insertion for sick sinus syndrome (SSS) (p = 0.03) were significantly more common in AFMR than DMR. On postoperative transthoracic echocardiography (TTE), the pulmonary artery systolic pressure was significantly less decreased in the AFMR group than in the DMR group compared with that on preoperative TTE (p = 0.04).ConclusionsAFMR showed excellent mitral valve surgery outcomes, similar to DMR, but had a significantly higher risk of pacemaker insertion for SSS after the maze procedure.

997 Ascending Aorta Pseudoaneurysm 40 Years Following Surgical Atrial Septal Defect Repair

Abstract Background Ascending aorta pseudoaneurysm is a rare postoperative complication of cardiac surgery. It is often attributed to infection and dehiscence at sites of aortotomy, cannulation, cross-clamp placement, and proximal coronary anastomoses. Mortality risk is 29-46% and this requires prompt surgical intervention. Case summary A 48-year-old woman who underwent atrial septal defect repair at 8 years of age, presented with chest pain radiating to the right shoulder and dyspnoea. Cardiac-gated CT angiography demonstrated a 21mm pseudoaneurysm arising anteriorly from the proximal ascending aorta, 6mm above the right coronary artery ostium, likely the site of previous cardioplegia cannula. There was active blood flow from the aorta into the pseudoaneurysm sac. It was heavily calcified, apart from a thinned irregular wall inferiorly, from which rupture was imminent. She underwent emergency surgery. Using femoro-femoral cardiopulmonary bypass, the chest was safely re-entered. Under mild hypothermia and distal ascending aorta cross-clamping, the pseudoaneurysm was resected and aorta repaired using a Gelweave patch. The patient recovered uneventfully and was discharged home after one week. Discussion Accurate imaging, primarily via cardiac-gated CT angiography, is crucial for diagnosis and surgical planning in patients presenting with aortic pseudoaneurysm, particularly those close to the aortic valve and coronary arteries. Operative strategy, including need for deep hypothermic circulatory arrest and/or graft replacement of aorta, depends on pseudoaneurysm anatomy. It is recommended that preventative measures are taken during the primary operation, inserting the cardioplegia cannula tip through full-thickness purse-strings and/or addition of separate oversewing sutures after decannulation. Alternative techniques of pseudoaneurysm repair are also discussed.

Effect of Ciprofol on Left Ventricular Myocardial Strain and Myocardial Work in Children Undergoing Cardiac Surgery: A Single-center Double-blind Randomized Noninferiority Study

ObjectiveTo compare the effect of ciprofol and propofol on left ventricular (LV) systolic function and myocardial work by noninvasive speckle-tracking echocardiography (STE) in children undergoing surgical repair of atrial septal defect (ASD) or ventricular septal defect (VSD). DesignSingle-center double-blind randomized non-inferiority study. SettingAt a tertiary care center affiliated to Shanghai Jiao Tong University, China. ParticipantsOne hundred and twelve children aged 1 month to 16 years old undergoing ASD or VSD surgery with cardiopulmonary bypass. InterventionsOne hundred and twelve children were allocated randomly into receiving ciprofol (n = 67) and propofol (n = 45) in a 1.5:1 ratio. Ciprofol or propofol were IV infused at loading doses of 0.4 mg/kg or 2.0 mg/kg respectively over 30 seconds depending on the physical condition of each patient. When the bispectral index was maintained between 45 - 55 after induction, transthoracic echocardiography including apical two-chamber, three-chamber and four-chamber views were collected at bedside. Measurements and Main ResultsOf total 112 patients enrolled, 104 completed the study. The global longitudinal strain (GLS) of ciprofol and propofol groups after anesthesia was -17.3% (95% CI, -18.0% to -16.6%) and -17.8% (-18.7 to -17.0%) in the full analysis set (FAS) and -17.5% (95% CI, -18.2% to -16.9%) and -17.8% (-18.7% to -17.0%) in the per-protocol set (PPS) respectively. The noninferiority margin was set as 2% and confirmed with a lower limit of two-sided 95% CI for the inter-group difference of 1.58% and 1.34% in the FAS and PPS. There were no significant differences between two groups in LV systolic and diastolic function and myocardial work indices. Postoperative vasoactive-inotropic score, NT-proBNP, duration of mechanical ventilation, length of stay in cardiac intensive care unit and hospital were also comparable between two groups (all p > 0.05). ConclusionsCiprofol did not show different effect from propofol on myocardial function and postoperative outcomes. Furtherly on sensitive cardiac systole marker GLS, ciprofol had noninferiority to propofol. Ciprofol might be alternative solution for cardiac anesthesia in CHD children with mild lesion.

Robotic repair of atrial septal defect: Pre-groove vertical right atriotomy approach

ObjectiveMinimally invasive repair using robotic systems has been accepted as an attractive alternative in the surgical repair of atrial septal defects (ASDs). Clear exposure of the entire rim of the ASD is often hindered during a robotic approach. Here, we describe an approach using vertical right atriotomy along the interatrial groove that may enhance the exposure of the ASD. MethodsPatients who underwent ASD closure using the da Vinci Si surgical system (Intuitive Surgical) from 2007 to 2021 were included. During ASD closure procedures, right atriotomy was performed either conventionally in an oblique manner or parallel to the interatrial groove. A comparative analysis was performed in terms of all-cause mortality, complications, and durations of cardiopulmonary bypass, aortic crossclamp, intensive care unit stay, and hospital stay. The inverse probability of treatment weighting was utilized to balance baseline characteristics across different surgical approaches. ResultsA total of 114 consecutive patients (mean age, 38.7 ± 12.8 years) constituted the study cohort. There were no cases of mortality or surgical complications in either group. After adjusting for potential covariates, the cardiopulmonary bypass (92.8 ± 31.5 minutes vs 143.1 ± 40.7 minutes) and aortic crossclamp (30.7 ± 21.3 minutes vs 60.8 ± 23.5 minutes) times were significantly shorter in the group using vertical right atriotomy than in the group using conventional approach (P < .001 for both). ConclusionsPerforming vertical right atriotomy adjacent to the interatrial groove optimized ASD exposure compared with the conventional approach during robotic ASD repair, leading to reduced cardiopulmonary bypass and aortic crossclamp times.

High-Throughput Genomics Identify Novel FBN1/2 Variants in Severe Neonatal Marfan Syndrome and Congenital Heart Defects.

Fibrillin-1 and fibrillin-2, encoded by FBN1 and FBN2, respectively, play significant roles in elastic fiber assembly, with pathogenic variants causing a diverse group of connective tissue disorders such as Marfan syndrome (MFS) and congenital contractural arachnodactyly (CCD). Different genomic variations may lead to heterogeneous phenotypic features and functional consequences. Recent high-throughput sequencing modalities have allowed detection of novel variants that may guide the care for patients and inform the genetic counseling for their families. We performed clinical phenotyping for two newborn infants with complex congenital heart defects. For genetic investigations, we employed next-generation sequencing strategies including whole-genome Single-Nucleotide Polymorphism (SNP) microarray for infant A with valvular insufficiency, aortic sinus dilatation, hydronephrosis, and dysmorphic features, and Trio whole-exome sequencing (WES) for infant B with dextro-transposition of the great arteries (D-TGA) and both parents. Infant A is a term male with neonatal marfanoid features, left-sided hydronephrosis, and complex congenital heart defects including tricuspid regurgitation, aortic sinus dilatation, patent foramen ovale, patent ductus arteriosus, mitral regurgitation, tricuspid regurgitation, aortic regurgitation, and pulmonary sinus dilatation. He developed severe persistent pulmonary hypertension and worsening acute hypercapnic hypoxemic respiratory failure, and subsequently expired on day of life (DOL) 10 after compassionate extubation. Cytogenomic whole-genome SNP microarray analysis revealed a deletion within the FBN1 gene spanning exons 7-30, which overlapped with the exon deletion hotspot region associated with neonatal Marfan syndrome. Infant B is a term male prenatally diagnosed with isolated D-TGA. He required balloon atrial septostomy on DOL 0 and subsequent atrial switch operation, atrial septal defect repair, and patent ductus arteriosus ligation on DOL 5. Trio-WES revealed compound heterozygous c.518C>T and c.8230T>G variants in the FBN2 gene. Zygosity analysis confirmed each of the variants was inherited from one of the parents who were healthy heterozygous carriers. Since his cardiac repair at birth, he has been growing and developing well without any further hospitalization. Our study highlights novel FBN1/FBN2 variants and signifies the phenotype-genotype association in two infants affected with complex congenital heart defects with and without dysmorphic features. These findings speak to the importance of next-generation high-throughput genomics for novel variant detection and the phenotypic variability associated with FBN1/FBN2 variants, particularly in the neonatal period, which may significantly impact clinical care and family counseling.

A boy with fatigue and heart block: what's the mechanism?

When the atrioventricular node is damaged, accessory pathways can perform primary atrioventricular conduction but may spontaneously degrade during childhood. After surgical atrial septal defect repair during infancy, an adolescent male presented with fatigue due to iatrogenic complete atrioventricular node block with a degrading antegrade accessory pathway resulting in symptomatic bradyarrhythmia.

Early and late Results after Surgical Mitral Valve Repair: A High-Volume Center Experience.

Surgical mitral valve repair is the gold standard treatment of severe primary mitral valve regurgitation (MR). In the light of rapidly evolving percutaneous technologies, current surgical outcome data is essential to support heart team-based decision making. This retrospective, high-volume, single-center study analyzed in 1779 patients with primary MR early morbidity and mortality, postoperative valve function, and long-term survival after mitral valve repair. Surgeries were performed between 2009 and 2022. Surgical approaches included full sternotomy (FS) and right-sided mini-thoracotomy (MIC). Of the surgeries (mean age: 59.9 (SD:11.4) years; 71.5% males), 85.6% (n=1527) were mini-thoracotomies. Concomitant procedures were performed in 849 patients (47.7%), including tricuspid valve and/or atrial septal defect repair, cryoablation and atrial appendage closure. The majority of patients did not need erythrocyte concentrates. Mediastinitis and re-thoracotomy for bleeding rates were 0.1 and 4.3%, respectively. Reoperation before discharge for failed repair was necessary in 12 patients (0.7%). Freedom from more than moderate MR was >99%. Thirty-day mortality was 0.2% and did not differ significantly between groups (P=0.37). Median follow-up was 48.2 months with a completeness of 95.9%. Long term survival was similar between groups (P=0.21). In the FS and MIC groups, 1-year, 5-year and 10-year survival was 98.8 and 98.8%, 92.9 and 94.4%, and 87.4 and 83.1%, respectively. Mitral valve surgery, both minimally-invasive and via sternotomy, is associated with high repair rates, excellent perioperative outcomes, and long-term survival. Data underscore the effectiveness of surgical repair in managing MR, even in the era of advancing interventional techniques.

Early Post-operative ECG Changes as a Predictor of Post-pericardiotomy Syndrome Following Atrial Septal Defect Repair

To identify risk factors associated with post-pericardiotomy syndrome (PPS) in patients undergoing surgical repair of atrial septal defects (ASD). A single-center retrospective study. Tertiary academic hospital. Included were patients of all ages who underwent surgical ASD repair, while exclusion criteria included the absence of post-operative electrocardiogram (ECG), lack of follow-up post-discharge and factors hindering ECG interpretation. Demographic and clinical data, including ECG changes indicative of pericardial inflammation, were collected. The primary outcome measure was the development of PPS, determined based on the standardized European Society of Cardiology (ESC) criteria. Among 190 patients who underwent surgical ASD repair, 154 (81%) met the inclusion criteria. Of these, 25 (16%)in total developed PPS, of which 60% were ≥ 18 years of age and 56% female. Significant associations relating both early ECG changes and pre-discharge pericardial effusion with subsequent occurrence of PPS were found in both univariate and multivariate analyses. The study establishes correlations of both early post-operative ECG changes indicative of inflammation and pre-discharge pericardial effusion with subsequent occurrence of PPS in patients undergoing surgical ASD repair. Both utilizing the standardized ESC definition of PPS and incorporating a physician-validated ECG evaluation strengthened the methodologic approach in establishing these relationships. The results also highlight the importance of considering age as a potential risk factor for PPS. Further research is needed to validate these findings and explore additional risk factors predicting early identification and management of patients at high risk for PPS following surgical ASD repairs.

15-Year Analysis of Surgical Approaches and Outcomes for Coarctation in 132 Neonates and Infants.

A variety of surgical approaches exist to treat aortic coarctation in neonates and infants. Our institutional approach is designed to match the surgical approach to the individual anatomy of the patient. The objective of this study is to evaluate operative characteristics and outcomes of all neonates and infants who underwent surgical repair of coarctation of the aorta or hypoplastic aortic arch at University of Florida from 2006 to 2021, inclusive, either in isolation or with concomitant repair of atrial septal defect (ASD) and/or ventricular septal defect (VSD). A retrospective review was performed of 132 patients aged 0-1 year who underwent surgical repair of aortic coarctation or hypoplastic aortic arch between 2006 and 2021, inclusive, either in isolation or with concomitant repair of ASD and/or VSD. Patients were divided into two groups based on the surgical approach: Group 1=Median Sternotomy and Group 2=Left Lateral Thoracotomy. Continuous variables are presented as median (minimum-maximum); categorical variables are presented as N (%). The most common operative technique in Group 1 was end-to-side reconstruction with ligation of the aortic isthmus. The most common operative technique in Group 2 was extended end-to-end repair. Operative Mortality was one patient (1/132 = 0.76%). Transcatheter intervention for recurrent coarctation was performed in seven patients (7/132 = 5.3%). Surgical re-intervention for recurrent coarctation was performed in three patients (3/132 = 2.3%). From these data, one can conclude that a strategy of matching the surgical approach to the anatomy of neonates and infants who underwent surgical repair of aortic coarctation or hypoplastic aortic arch, either in isolation or with concomitant repair of ASD and/or VSD, is associated with less than 1% Operative Mortality and less than 3% recurrent coarctation requiring reoperation.

Pediatric precision: navigating the complexity of mycotic pseudoaneurysms in ascending aorta post-atrial septal defect repair—a case report

BackgroundThis case report elucidates the exceptional rarity and intricacies surrounding mycotic pseudoaneurysms in the ascending aorta, specifically post-pediatric cardiac surgery.Case presentationThe case report presents a distinctive case of a 7-year-old female developing complications 10 days after atrial septal defect repair, characterized by sternal wound infection attributed to Pseudomonas aeruginosa. Imaging revealed a substantial pseudoaneurysm, necessitating a meticulous surgical strategy involving femoral cannulation, redo sternotomy, and adept management of intraoperative challenges, such as a fragile sternum and dense adhesions. The successful postoperative course, marked by weaning and comprehensive management, contributes significant insights into the evolving landscape of mycotic pseudoaneurysms in pediatric populations. The discussion delves into the historical context, mechanisms, and causative organisms, emphasizing the heightened vigilance required in the postoperative care of this vulnerable demographic.ConclusionThis report enhances our understanding of pediatric cases, underscoring the imperative for increased awareness and strategic management in addressing post-cardiac surgery complications.

Comparing clinical course and patients out comes in patients undergoing Open surgical Versus Thoracoscopic closure of the atrial and ventricular septal defects in children

The current study is aimed at evaluation of the impact of different surgical approaches while correcting congenital heart diseases (CHD). Clinical outcomes like; operative time, complications, hospital stay were evaluated in children undergoing surgical repair of atrial septal defect (ASD) and ventricular septal defect (VSD).&#x0D; Patients and methods: Between 2015 and 2019, a total of 111 patients surgically managed for CHD with male: female ratio of…. and mean age 10.42±3.24 years. Two surgical approaches: open either right anterolateral thoracotomy or sternotomy and thoracoscopic were used. The study conducted to determine the operative time, ICU stay, complications, recovery period and long term follow up of the patients in both the groups.&#x0D; Results: 67 patients with ASD and 44 patients with VSD underwent cardiac surgery. Mean operation time was significantly longer in TS patients in comparison with TT and ST groups. However, mean intensive care unit (ICU) stay and hospital stay were significantly shorter in TS group in comparison with TT and ST patients.&#x0D; Conclusion: TS approach in repair of congenital heart defects not only resulted of good cosmetic effect, but also reduces time in ICU and hospital stay in comparison with “classical” operational techniques. In this article we tried to show the whole results of research.&#x0D; Bangladesh Journal of Medical Science Vol. 23 No. 01 January’24 Page : 115-120

Atrial septal defect and zero positive end-expiratory pressure: A case report

This case report aims to investigate the impact of zero Positive End-Expiratory Pressure (PEEP) on the respiratory parameters of a patient following atrial septal defect repair who requires mechanical ventilation. We present the case of a 33-year-old patient who had been experiencing recurrent chest infections accompanied by copious cough with greenish sputum since 2009, without experiencing shortness of breath. The patient had no significant childhood illnesses and had initially been treated with frequent antibiotics at a local health center, which did not lead to symptom improvement. Subsequently, the patient was referred to a tertiary level University Hospital and underwent a series of diagnostic investigations. Transesophageal echocardiography revealed a defect in the superior and posterior location of the interatrial septum, measuring approximately 16mm with left-to-right flow. This defect was situated at the insertion of the superior vena cava, consistent with a superior sinus venosus atrial septal defect. The examination also revealed a moderately dilated right atrium and mild-to-moderate tricuspid regurgitation. Consequently, the patient underwent intracardiac repair of the atrial septal defect on cardiopulmonary bypass. In light of the ongoing increase in symptoms, right ventricle remodeling, and pulmonary artery pressure as the patient ages, it is essential to consider recommencing atrial septal defect closure early after diagnosis, regardless of the presence of symptoms..

Transseptal Puncture and Cryoballoon Ablation of Atrial Fibrillation in Patients with Atrial Septal Occluder or Atrial Septal Defect Surgical Repair: A Single Center Experience.

Atrial fibrillation (AF) is a common arrhythmia in patients with atrial septal defect (ASD). Cryoballoon ablation (CA) is a safe and efficient method for pulmonary vein (PV) isolation in the treatment of AF. Achieving left atrial access may be difficult in patients with atrial septal occluders (ASO) or surgical repair of ASD. The aim of this study was to present our experience with the efficacy and safety of transseptal puncture and AF ablation in CA in this subset of patients. We retrieved our data about patients with ASO or surgical repair of ASD undergoing cryoballoon AF ablation procedures at our center between August 2019 and January 2022. Nine patients (age 43.88 ± 9.73 years) with AF (5 paroxysmal and 4 persistent) and ASO or surgical repair of ASD were enrolled. All three patients had a 28 mm Amplatzer ASO device which occupied the whole septum, and direct puncture through the ASO was performed. Sequential balloon dilatation was performed in 2 patients with surgical ASD repair and all 3 patients with ASO. Four of 6 patients (66.7%) in the surgical repair group required transesophageal echocardiography during transseptal puncture. The endpoint of the procedure, isolation of all PVs, was achieved in all 9 patients. None of the patients had evidence of an interatrial shunt or pericardial effusion at the end of the procedure. Total procedural time (123 ± 28 minutes vs. 63 ± 21 minutes, P = .024) and total fluoroscopy time (41 ± 5 minutes vs. 23 ± 8 minutes, P = .024) were significantly higher in the percutaneous closure group. In patients with ASO or surgical repair of ASD, CA of AF might be feasible, safe, and effective. The balloon dilatation of the interatrial septum (IAS) might assist transseptal access through the ASO or a surgically repaired thickened IAS.

Transnasal humidified rapid insufflation ventilatory exchange combined with intravenous anesthesia and nerve block without endotracheal intubation for atrial septal defect repair: a case report

Transnasal humidified rapid insufflation ventilatory exchange combined with intravenous anesthesia and nerve block without endotracheal intubation for atrial septal defect repair: a case report