Atrial Septal Defect Patients Research Articles

Fluid accumulation after closure of atrial septal defects: the role of colloid osmotic pressure.

Following paediatric cardiac surgery with cardiopulmonary bypass (CPB), there is a tendency for fluid accumulation. The colloid osmotic pressure of plasma (COPp) and interstitial fluid (COPi) are determinants of transcapillary fluid exchange but only COPp has been measured in sick children. The aim of this study was to assess the net colloid osmotic pressure gradient in children undergoing atrial septal defect closure. Twenty-three patients had interventional and 18 had surgical atrial septal defect closures. Interstitial fluid was harvested using a wick method before and after surgery with CPB with concomitant blood samples. COP was measured using a colloid osmometer for small fluid samples. Baseline COP was compared with data from healthy children. COPp at baseline was 21.9 ± 2.8 and 21.4 ± 2.2 mmHg in the interventional and surgical groups, respectively, and was significantly lower than in healthy children (25.5 ± 3.1 mmHg) (P < 0.001). In the surgical group, the use of CPB significantly reduced COPp to 16.9 ± 2.9 mmHg (P < 0.001) and the colloid osmotic gradient [ΔCOP (COPp - COPi)] to 2.9 ± 3.8 mmHg (P < 0.001) compared with interventional procedure. One hour after the procedure, COPi was 15.6 ± 3.8 mmHg and 9.9 ± 2.1 mmHg (P < 0.001) and the ΔCOP was 5.4 ± 3.0 mmHg and 9.1 ± 3.1 mmHg (P < 0.003) in the interventional and surgical groups, respectively. Baseline COPp and COPi were lower in atrial septal defect patients compared with healthy children. The significantly lower COP gradient during CPB may explain the tendency for more fluid accumulation with pericardial effusion in the surgical group. The increased COP gradient after CPB may represent an oedema-preventive mechanism.

Research and application of transnasal transesophageal echocardiography probe.

The intubation of conventional transesophageal echocardiography (TEE) probes into patients causes serious esophagus irritation, and thus the use of TEE probes in pediatric practice is limited. In this study, we aimed at the development of a special probe which could be inserted through the nasopharyngeal cavity into the esophagus to obtain the same high-quality echocardiography images as those obtained by conventional TEE and improve patients' experience. During the examination, the patients felt relaxed for a longer time and cooperated with the sonographers in the process of cardiac catheterization conducted in the surgery room or the intensive care unit (ICU), resulting in improved accuracy of the diagnosis and timely administration of appropriate treatment. Two years ago, Prof. Xin-fang WANG put theories into practice by inserting the probe through the nasal cavity and pharynx into the esophagus of volunteers to successfully detect the heart and great vessels at the retrocardiac space. Later, Prof. Ming-xing XIE performed the transnasal TEE examination in 12 atrial septal defect (ASD) patients and proved the safety and reliability of this method, which could become a new way for clinical diagnosis and treatment.

GW28-e1155 Effectiveness and safety of percutaneous left atrial appendage closure in atrial septal defect and atrial fibrillation patients

GW28-e1155 Effectiveness and safety of percutaneous left atrial appendage closure in atrial septal defect and atrial fibrillation patients

An alternative technique of atrial septectomy during bidirectional superior cavopulmonary anastomosis.

An atrial septectomy is often required to create or enlarge a pre-existing restrictive atrial septal defect in patients with univentricular hearts undergoing the bidirectional superior cavopulmonary anastomosis. We describe an alternative surgical technique through the transected cardiac end of the superior vena cava without a right atriotomy successfully performed in 26 patients.

Risk Assessment in Pulmonary Arterial Hypertension According to Right Atrial Pressure and Correlation Between Mean Pulmonary Arterial Pressure with Right Atrial Pressure in Uncorrected Atrial Septal Defect Patients at Dr. Sardjito General Hospital

Risk Assessment in Pulmonary Arterial Hypertension According to Right Atrial Pressure and Correlation Between Mean Pulmonary Arterial Pressure with Right Atrial Pressure in Uncorrected Atrial Septal Defect Patients at Dr. Sardjito General Hospital

Midterm follow-up of transthoracic device closure of an atrial septal defect using the very large domestic occluder (44\u201348\xa0mm), a single Chinese cardiac center experience

BackgroundThe purpose of this study was to outline the midterm follow-up results and complications in patients who underwent transthoracic device closure of an atrial septal defect (ASD) with the very large domestic occluder (44–48 mm).MethodsThe data of 35 patients who underwent transthoracic device closure of an ASD with the very large domestic occluder (44–48 mm) at our institution were collected prospectively between January 2010 and January 2015. All patients were invited for an outpatient visit and contrast TTE for 12–70 months after ASD closure.ResultsThirty-four patients were occluded successfully under this approach and 1 patient was transferred for surgical repair for dislodgement of the occluder. The most frequent complication was transient cardiac arrhythmia. A new third degree atrioventricular block occurred in 1 patient who recovered 1 week later. During the follow-up period, we found no recurrence, no thrombosis, no device embolization, no device failure, and no cases of death. The total occlusion rate was 94.1% in the 12 months of follow-up, and the intracardiac structure and cardiac function were significant improved contemporaneously.ConclusionTransthoracic device closure of an atrial septal defect with the very large domestic occluder (44–48 mm) is a safe and feasible technique. However, long-term follow-up is required to better assess the safety and feasibility of this method for the closure of very large ASDs in patients.

Simplified percutaneous closure of patent foramen ovale and atrial septal defect with use of plain fluoroscopy: Single operator experience in 110 consecutive patients

ObjectivePercutaneous closure of patent foramen ovale (PFO) and atrial septal defect (ASD) is routinely performed under general anesthesia or deep sedation and use of transesophageal (TEE) or intracardiac echocardiography, incurring longer duration and higher cost. We have used a simplified, economical, fluoroscopy-only guided approach with local anesthesia, and herein report our data. MethodsThe study includes 112 procedures in 110 patients with PFO (n=75) or ASD (n=35), with use of an Amplatzer occluder, heparin and prophylactic antibiotics. Balloon sizing guided ASD-device selection. All patients received aspirin and clopidogrel for 6 months, when they all underwent TEE. ResultsAll PFOs but one (98.7%) and all (100%) ASDs were successfully closed with only one complication (local pseudoaneurysm). At the 6-month TEE, there was no residual shunt in PFO patients, but 2 ASD patients had residual shunts. During long-term (4.3-year) follow-up, no stroke recurrence in PFO patients, and no other problems were encountered. Among 54 patients suffering from migraine, symptom relief or resolution was reported by 45 (83.3%) patients. ConclusionPercutaneous placement of an Amplatzer occluder was safe and effective with use of local anesthesia and fluoroscopy alone. There were no recurrent strokes over >4 years. Migraine relief was reported by >80% of patients.

Dynamic characteristic mechanism of atrial septal defect using real-time three-dimensional echocardiography and evaluation of right ventricular functions.

The dynamic characteristics of the area of the atrial septal defect (ASD) were evaluated using the technique of real-time three-dimensional echocardiography (RT 3DE), the potential factors responsible for the dynamic characteristics of the area of ASD were observed, and the overall and local volume and functions of the patients with ASD were measured. RT 3DE was performed on the 27 normal controls and 28 patients with ASD. Based on the three-dimensional data workstations, the area of ASD was measured at P wave vertex, R wave vertex, T wave starting point, and T wave terminal point and in the T-P section. The right atrial volume in the same time phase of the cardiac cycle and the motion displacement distance of the tricuspid annulus in the corresponding period were measured. The measured value of the area of ASD was analyzed. The changes in the right atrial volume and the motion displacement distance of the tricuspid annulus in the normal control group and the ASD group were compared. The right ventricular ejection fractions in the normal control group and the ASD group were compared using the RT 3DE long-axis eight-plane (LA 8-plane) method. Real-time three-dimensional volume imaging was performed in the normal control group and ASD group (n=30). The right ventricular inflow tract, outflow tract, cardiac apex muscular trabecula dilatation, end-systolic volume, overall dilatation, end-systolic volume, and appropriate local and overall ejection fractions in both two groups were measured with the four-dimensional right ventricular quantitative analysis method (4D RVQ) and compared. The overall right ventricular volume and the ejection fraction measured by the LA 8-plane method and 4D RVQ were subjected to a related analysis. Dynamic changes occurred to the area of ASD in the cardiac cycle. The rules for dynamic changes in the area of ASD and the rules for changes in the right atrial volume in the cardiac cycle were consistent. The maximum value of the changes in the right atrial volume occurred in the end-systolic period when the peak of the curve appeared. The minimum value of the changes occurred in the end-systolic period and was located at the lowest point of the volume variation curve. The area variation curve for ASD and the motion variation curve for the tricuspid annulus in the cardiac cycle were the same. The displacement of the tricuspid annulus exhibited directionality. The measured values of the area of ASD at P wave vertex, R wave vertex, T wave starting point, T wave terminal point and in the T-P section were properly correlated with the right atrial volume (P<0.001). The area of ASD and the motion displacement distance of the tricuspid annulus were negatively correlated (P<0.05). The right atrial volumes in the ASD group in the cardiac cycle in various time phases increased significantly as compared with those in the normal control group (P=0.0001). The motion displacement distance of the tricuspid annulus decreased significantly in the ASD group as compared with that in the normal control group (P=0.043). The right ventricular ejection fraction in the ASD group was lower than that in the normal control group (P=0.032). The ejection fraction of the cardiac apex trabecula of the ASD patients was significantly lower than the ejection fractions of the right ventricular outflow tract and inflow tract and overall ejection fraction. The difference was statistically significant (P=0.005). The right ventricular local and overall dilatation and end-systolic volumes in the ASD group increased significantly as compared with those in the normal control group (P=0.031). The aRVEF and the overall ejection fraction decreased in the ASD group as compared with those in the normal control group (P=0.0005). The dynamic changes in the area of ASD and the motion curves for the right atrial volume and tricuspid annulus have the same dynamic characteristics. RT 3DE can be used to accurately evaluate the local and overall volume and functions of the right ventricle. The local and overall volume loads of the right ventricle in the ASD patients increase significantly as compared with those of the normal people. The right ventricular cardiac apex and the overall systolic function decrease.

Atrial flutter/fibrillation in patients receiving transcatheter closure of atrial septal defect.

Atrial flutter/fibrillation (AFL/Af) is a common late complication in atrial septal defect (ASD) patients even after occluder implantation. We try to delineate the risk factors of persistent AFL/Af. From 1998 to 2010, all patients older than 18years of age who received ASD occluder implantation in our hospital were enrolled, and their records were retrospectively reviewed. In addition, renin-angiotensin system gene polymorphisms including angiotensinogen gene, A1166C polymorphism on the angiotensin II type I receptor gene, and insertion/deletion (I/D) patterns on the angiotensin-converting enzyme gene were checked using direct sequencing. A total of 517 patients (male/female 127/390) were enrolled. The mean age of patients receiving occluder deployment was 41.5±14.5years. Prior to occluder deployment, 3.9% of patients had persistent Af, 3.1% of patients had paroxysmal Af, and 0.8% had AFL. After a follow-up of 1894 patient-years, 3.5% had persistent Af and 1.9% of patients had paroxysmal Af. The greatest risk factors of AFL/Af genesis included age, occluder size, presence of multiple ASDs, and underlying thyroid or mitral valve disorder (p<0.001, p<0.001, p=0.033, p=0.016, and p=0.012, respectively). Preoperative AFL/Af status is the most important factor in determining AFL/Af resolution and progression after an intervention. The renin-angiotensin system gene polymorphisms had no association with AFL/Af genesis, and progression or resolution after intervention. AFL/Af is common after ASD occluder implantation, and predisposed by older age, larger and multiple ASDs, and underlying disorders. Preoperative atrial arrhythmia status is the most important predictor of AFL/Af progression or resolution. Renin-angiotensin system gene polymorphisms had no association with AFL/Af.

Atrial arrhythmia after transcatheter closure of secundum atrial septal defects in patients ≥40 years of age.

Data on arrhythmia outcome following device closure of atrial septal defect (ASD) are lacking. This study provides medium-term follow-up data on atrial arrhythmias in patients who were ≥40 years of age at the time of transcatheter ASD closure. It is a retrospective review. Mean age of the 159 patients was 57 years. Median follow-up was 3.6 years (range 6 months-10.9 years). Patients were classified, according to arrhythmia status prior to ASD closure, into Group I, no history of atrial arrhythmia (n = 119, mean age 55.5 years); Group II, paroxysmal atrial arrhythmia (n = 18, mean age 55.7 years); and Group III, persistent atrial fibrillation (n = 22, mean age 65.7 years). Group III patients were significantly older, had larger left atrial size, and had higher mean pulmonary arterial pressure than Group I and II patients (P < 0.001). Prior to closure, radiofrequency ablation was carried out in 12/18 (66%) of Group II and 3/22 (14%) of Group III. After device closure, 7 patients (6%) of Group I developed new atrial fibrillation. Fifty per cent (9/18) of Group II but only 9% (2/22) of Group III were in sinus rhythm on follow-up. Device closure alone in patients with persistent atrial arrhythmia is not likely to restore sinus rhythm in the medium term. New atrial arrhythmia occurred in 6% of patients who were in sinus rhythm prior to device closure. At least 50% of the patients with paroxysmal atrial arrhythmia continue to have significant atrial arrhythmia following device closure, and the role of ablation prior to closure in patients with a history of arrhythmia requires refinement.

Right Ventricular Outflow Tract (RVOT) Changes in Children with an Atrial Septal Defect: Focus on RVOT Velocity Time Integral, RVOT Diameter, and RVOT Systolic Excursion.

Aim of the study was to determine the influence of right heart volume overload in children with atrial septal defect (ASD) on right ventricular outflow tract (RVOT) variables. A prospective study was conducted in 115 children (age range: 2days-18.1years) with a moderate to large ASD. We determined effects of age, body length (BL), body weight (BW), and body surface area (BSA) on the variables RVOT diameter, RVOT velocity time integral (VTI), and RVOT systolic excursion (SE), and tested the predictive value of published normal values for age, BW, BL, and BSA in our ASD patients. In our pediatric ASD patients, the age-specific RVOT diameter (z-score: +2.2, 95% CI: 2.0-2.4, P<0.001) was significantly increased compared to normal values with 54% of our ASD patients having a z-score >2.0. The age-specific RVOT VTI z-score (z-score: +3.6, 95% CI: 3.2-3.9, P<0.001) was significantly increased compared to normal values with 81% of our ASD patients having a z-score >2.0. The age-specific RVOT SE z-score was not increased but slightly lower compared to normal values (z-score: -0.5, 95% CI: -0.7 to -0.3, P<0.001) with 3% of our ASD patients having a z-score >2.0 while 12% of the patients had a z-score <-2. In our study population, we show the RVOT VTI and diameter to be relevant predictors in identifying an enlarged RVOT size and flow in children with moderate to large ASD.

Changes in blood volume shunting in patients with atrial septal defects: assessment of heart function with cardiovascular magnetic resonance during dobutamine stress.

BackgroundThe purpose of this study was to determine the effect of stress on left-to-right shunting in patients with atrial septal defect (ASD) and to investigate if the degree of shunting, cardiac output (CO), and right ventricular (RV) volumes are related to exercise capacity.MethodsTwenty-six patients with a secundum ASD and 16 healthy volunteers were studied with rest/stress cardiac magnetic resonance using 20 µg/kg/min dobutamine and 0.25–0.75 mg atropine to quantify CO, pulmonary to systemic flow ratio (QP/QS), and left ventricular (LV) and RV volumes. Peak oxygen uptake (VO2peak) was determined on ergospirometry.ResultsIn patients with ASD the QP/QS decreased from 2.0 ± 0.2 at rest to 1.5 ± 0.1 (P < 0.001) during dobutamine stress (n = 20) and shunt volume per heartbeat decreased from 70 ± 9 to 38 ± 9 mL (P < 0.001). However, absolute shunt volume per minute was unchanged (5.1 ± 0.8 vs. 4.5 ± 1.0 L/min, P = 0.32) explained by a higher increase in systemic CO during stress (90 ± 11%) compared with pulmonary CO (43 ± 7%, P < 0.001). In ASD patients, VO2peak correlated with aortic CO during stress (r = 0.77) and QP/QS at rest (r = −0.48) but not during stress (P = 0.09). VO2peak did not correlate with RV volumes in patients.ConclusionPulmonary to systemic flow ratio and shunt volume per heartbeat decrease during stress in ASD patients. This may be explained by an enhanced LV diastolic function during stress and may have implications to detect disturbances in LV compliance in ASD patients. A high systemic CO during stress is a strong predictor of exercise capacity.

Relationship between atrial septal defects and asthma-like dyspnoea: the impact of transcatheter closure.

BackgroundPatients with atrial septal defects (ASD) are often misdiagnosed as asthma patients and accordingly receive erroneous bronchodilator treatment. In order to characterise their symptoms of dyspnoea to explain this clinical observation, we investigated the prevalence of asthma-like symptoms in patients with secundum ASD who then underwent successful percutaneous closure.MethodsA total of 80 ASD patients (74 % female, mean age 46.7 ± 16.8 years, median follow-up 3.0 [2.0–5.0] years) retrospectively completed dyspnoea questionnaires determining the presence and extent of cough, wheezing, chest tightness, effort dyspnoea and bronchodilator use on a 7-point scale (0 = none, 6 = maximum) before and after ASD closure. The Mini Asthma Quality of Life (Mini-AQLQ) and Asthma Control Questionnaire with bronchodilator use (ACQ6) were administered.ResultsA total of 48 (60 %) patients reported cough, 27 (34 %) wheezing, 26 (33 %) chest tightness and 62 (78 %) effort dyspnoea. Symptom resolution or reduction was found in 64 (80 %) patients after ASD closure. Asthma symptom scores decreased significantly on the Mini-AQLQ and ACQ6 (both p < 0.001). The number of patients using bronchodilators decreased from 16 (20 %) to 8 (10 %) patients after ASD closure (p = 0.039) with less frequent use of bronchodilators (p = 0.015).ConclusionsA high prevalence of asthma-like symptoms and bronchodilator use is present in ASD patients, which exceeds the low prevalence of bronchial asthma in this study population. Future prospective research is required to confirm this phenomenon. The presence of an ASD should be considered in the differential diagnosis of patients with asthma-like symptoms, after which significant symptom relief can be achieved by ASD closure.

Frequencies of Different Morphological Types and Clinical Presentation of Atrial Septal Defect (ASD) Undergoing Surgical Repair in Bangladesh

Background: Atrial septal defect (ASD) is one of the important congenital anomaly. Objective: The present study is designed to determine how the different morphological types of ASD are distributed among Bangladeshi Bengali patients undergoing surgical repair and to see the clinical features of the above patients. Methodology: This cross-sectional descriptive study was carried out on the 50 ASD patients undergoing surgical repair at the National Institute of Cardiovascular Diseases (NICVD) or the National Heart Foundation and Research Institute (NHF &amp; RI) in Dhaka, during the period of July 2010 to June 2011 to explore different morphological types and clinical presentation. The morphological types of ASD were revealed by echocardiography and confirmed preoperatively. Result: A total number of 50 patients were recruited in this study of which ostium secundum type was found in 96% cases and sinus venosus type in 4% cases. Evaluation of patients showed that 14% of the patients were asymptomatic and they were detected incidentally. The most common symptoms were palpitation, dyspnea, recurrent RTI, fatigue, failure to thrive and chest pain. The commonest signs at diagnosis included loud S1, wide and fixed splitting S2, systolic murmur, tachycardia, shifting of the apex beat and left parasternal lift. Surgical closure has been the mainstream of treatment. Conclusion: In conclusion ostium secundum is the most common type of ASD.

Mid-to-long-term follow-up results of transcatheter closure of atrial septal defect in patients older than 40years.

We investigated the mid-to-long-term results of transcatheter closure of atrial septal defect (ASD) in patients ≥40years since there are issues with patients presenting with pulmonary hypertension and arrhythmia at the time of closure. In an 8.8 year period, transcatheter closure of ASD was successful in 179 patients aged ≥40years, but failed in 2. Of the 179 patients (44 males, median 53years), NYHA functional class, presence of arrhythmia and severity of pulmonary hypertension were compared before and after closure. Patients with pulmonary hypertension (n=43, 24%) were significantly older (60±11 vs. 52±9years, p<0.01) and required larger devices (27±7 vs. 24±7mm, p=0.04) than those without. Arrhythmia before intervention was documented in 31 patients (17.3%): 22 atrial fibrillation (AF), 4 atrial flutter and 5 supraventricular tachycardia. Patients with AF or atrial flutter (n=26) were significantly older (63±10 vs. 53±10years, p=0.048) and had a higher pulmonary artery mean pressure (29.2±12.6 vs. 20.2±7.6mmHg, p=0.041) than those without. The mean follow-up period was 3.8±2.1years. Early new-onset arrhythmia was documented in 23 patients of whom 1 had persistent AF, 1 developed sick sinus syndrome and others were in sinus rhythm at latest visit. There was significant improvement in NYHA functional class after closure (p<0.001). Of the 22 patients with AF, 10 were in sinus rhythm, 1 had paroxysmal AF, and 11 had persistent AF. Pulmonary hypertension persisted in 13 patients. Transcatheter closure of atrial septal defect in patients above 40years is beneficial in terms of NYHA functional class, pulmonary artery pressure and cardiac rhythm.

Early follow-up results of simple transesophageal echocardiography to guide the right jugular internal vein for closure of atrial septal defect

Objective To summarize the preliminary experience and early-stage follow-up results of simple transesophageal echocardiography(TEE) to guide right jugular internal vein for closure of atrial septal defect (ASD), and to investigate its feasibility. Methods A total of 24 ASD patients(12 male, 12 female) treated by transcatheter ASD closure under solely guidance of TEE were summarized in Children Heart Center, People's Hospital of Zhengzhou University from February 2015 to February 2016.Mean age, body weight and average diameter of the 24 cases of ASD were 5-18 (12.4±5.6) years old, 16-60 (34.1±9.6) kg, 5-20 (11.0±2.5) mm, respectively.All patients were treated by right jugular internal vein transcatheter closure under solely guidance of TEE.The efficiency of imme-diate post-operation under TEE was estimated, and follow-ups were done at 24 hours, 1 month, 3, 6 and 12 months after the procedures by transthoracic echocardiography, X-ray examination and electrocardiogram. Results A total of 23 patients were treated successfully under solely guidance of TEE.The diameter of devices was (14.5±3.6) mm.The procedural time was(20.5±7.2) min.One patient who had 2 ASD was treated by traditional thoracic surgery, because the small ASD had 5 mm residual shunt after the procedures.There were 3 cases with trivial residual shunt after the procedures immediately.All patients could move at once after operation.The average follow-up time was(5.6±1.2) months.No patients suffered from residual shunt, occluder malposition, peripheral vascular injury, pericardial effusion or cardiac perforation during the follow-up. Conclusions For some selected patients, simple TEE guiding right jugular internal vein for closure of ASD is applicable.The method not only prevents injury from radiation, but also shortens the in-bed time and avoid the lower limbs braking, with good early-stage follow-up results are desirable. Key words: Atrial septal defect; Transesophageal echocardiography; Catheterization

Recall of patients discharged from follow-up after repair of isolated congenital shunt lesions

BackgroundDischarge from follow-up after closure of isolated congenital shunt lesions in childhood was common practice in the past. The aim of the present study was to recall these patients to evaluate their current status. MethodsPatients included in the database of pediatric and congenital heart disease of our tertiary center with repaired secundum atrial septal defect (ASD) or ventricular septal defect (VSD) before the age of 18years, and discharged from follow-up, were invited for clinical and echocardiographic check-up. ResultsForty-six ASD patients (age 30±7years, 37% male) responded. Median age at ASD repair was 6 (IQR 4–8) years. All but one functioned in NYHA class I. Eight (17%) patients reported palpitations. No patient developed pulmonary hypertension (PH). Right ventricular (RV) dilatation was present in 7 (15%). RV fractional area change (FAC) was <35% in 7 (15%), TAPSE <17mm in 12 (26%).Forty-seven VSD patients (age 34 (IQR 29–40) years, 57% male) participated. Median age at VSD repair was 4 (IQR 1–5) years. Six (13%) patients functioned in NYHA class II. Seventeen (36%) patients reported palpitations. Four (9%) patients presented PH. Left ventricular dilatation was present in 4 (9%), RV dilatation in 6 (13%). RV FAC was <35% in 7 (15%), TAPSE <17mm in 17 (36%). Seven (15%) patients had dilated ascending aorta. ConclusionsPatients with closure of isolated secundum-type ASD in childhood do well, but some have persistent RV dilatation and dysfunction. By contrast, more patients after VSD closure were symptomatic and presented with RV dilatation and dysfunction, PH, and a dilated ascending aorta.

Pulmonary Artery Pressure Profile in Atrial Septal Defect (ASD) Patients

The objective of this study was to see the incidence of pulmonary hypertension and its age distribution in atrial septal defect (ASD) patients in our population. A total of 58 ASD (secundum type) patients were included in the study. The diagnosis was done with echocardiography. Subsequently patients under went cardiac catheterization and their pulmonary artery (PA) mean pressure was measured. It was seen that pulmonary pressure increases with age. Severe PA hypertension (mean pressure &gt; 40 mm Hg) was found in 14 patients (24.14%), age range was 10-55 years but most of them were more than 20 years old.Bangladesh Heart Journal 2015; 30(1) : 27-28

Clinical characteristics of adult uncorrected secundum atrial septal defect: a pilot study

ABSTRACT Atrial septal defect (ASD) is the most frequent congenital heart disease in adulthood. Pulmonary hypertension (PH) complicating ASD compels patients seeking medical assistance because of its disabling symptom. Most adult ASD develop PH which render significant morbidity and mortality. The aim of the study is to characterize the clinical profiles of adult patients with ASD. The study design was cross sectional. The subjects were enrolled consecutively from outpatient clinics and inpatient wards. The demography, medical and imaging data were collected and recorded in case report form. Descriptive statistics was applied to characterize the subjects. Seventy-six subjects were enrolled. The majority were women (77.6 %) in the productive and child-bearing ages (63.2%). The most common symptoms were dyspneu on effort, fatigue, and palpitation. Most subjects had functional capacity of WHO class functional II (70.2 %). The mean oxygen saturation was 96.4 %. Based on the echocardiography examination, 77.6% of subjects had suffered from PH. The mean longest diameter of defects were 2.7 cm. The direction of blood flow was mostly left to right (77.6 %). Left and right ventricle function were within normal limit. Right heart catheterization showed mean left atrial pressure 11.5 mmHg, which confirmed the precapillary or arterial PH. Mean pulmonary artery pressure was 42.0 mmHg. The pulmonary artery resistance index mostly less than 4 Wood Unit/ m2 (63.7 %), indicating the feasibility to close the defect. Whereas 24.6 % of subjects were contraindicated for closing. Pulmonary artery hypertension (PAH) was diagnosed in 77.6 % subjects, meanwhile 13.2 % had borderline PAH. In conclusion, most adult ASD patients had developed PAH, mostly young women in productive ages, mainly visited hospital due to symptom of PH, the direction of flow predominantly left to right side and mostly had reduced functional capacity.

Right to Left Ventricular Diameter Ratio ≥0.42 is the Warning Flag for Suspecting Atrial Septal Defect in Preschool Children: Age- and Body Surface Area-Related Reference Values Determined by M-Mode Echocardiography.

It is not always easy to observe and screen atrial septal defects (ASD) using echocardiography. In addition, there are no established echocardiographic reference indices for screening patients with ASDs. We retrospectively reviewed our database and recruited 151 isolated ASD patients and 2769 healthy subjects. In total, 307 echocardiographic studies were performed for ASD patients. Surgical repairs were done in 75 of the ASD patients. The ratio of right to left ventricular end-diastolic dimensions (RVD/LVD), which was determined by M-mode echocardiography, was used as an index of RV dilatation. After obtaining age- and body surface area (BSA)-related RVD/LVD nomograms in healthy subjects, we calculated the z-scores of RVD/LVD for all subjects and obtained the optimal cut-off values to differentiate patients with ASD from healthy subjects. The optimal cut-off values were high in neonates and gradually decreased with an increase in the age and BSA, but were almost constant in children aged >4 years or whose BSA was >0.65 m(2). The cut-off values of RVD/LVD for suspected ASD were ≥0.42 in children aged >4 years or those whose BSA was >0.65 m(2). Those for an ASD operation were ≥0.46 in those whose BSA > 0.65 m(2). The RVD/LVD determined by M-mode echocardiography is a useful index to evaluate RV dilatation in patients with ASDs. The RVD/LVD ≥ 0.42 is the warning flag for suspecting ASD in preschool children and that ≥0.46 may be a clinical important sign to determine ASD operation.