Surgery For Atrial Septal Defect Research Articles

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.

Comparison of ultrafast and fast track extubation after secundum atrial septal defect surgery in pediatric age group

Bacground Patients who underwent ultrafast track on the operating table and fast track extubation in the pediatric intensive care unit for 2 to 6 h after secundum atrial septal defect surgery in the pediatric age group were compared. Methods Between January 2013 and February 2017, 60 pediatric patients (24 boys, 36 girls; Mean age 7.5 ± 4.6 years) whose secundum atrial defect was closed were retrospectively analyzed. The patients were separated as those who were extubated on the operating table (Group1,n = 28) and those extubated in the pediatric intensive care unit within 2-6 h postoperatively (Group2,n = 32). Results No difference was found in demographic data and preoperative catheter information between the groups. Cardiopulmonary bypass time was 20(18–25)/27.5(20–30)minutes (p:0.001), the cross-clamp time was 10(10–15)/15(11–20)minutes(p:0.004), the postoperative drainage amount was 50(25-50)/60(32.5–100)ml(p:0.013), the length of stay in the intensive care unit was 1(1-–1)/1(1–2)day(p:0.025), the length of stay after intensive care was 3(2–3)/3(3–4)days(p:0.001) and the total hospital stay was 4(3–4)/5(4–5.5) days (p < 0.001), which were respectively shorter for the group 1 compared to 2. Postoperative blood product replacement, positive inotrope support, pericardial effusion, mortality, and morbidity were not detected in either groups. Conclusion In this study, it was observed that the UFT extubation was safe for the patients who were operated for secundum ASD, in the pediatric age group, and had a cross-clamp time not exceeding 15 min. It was found that the amount of drainage, length of stay in the intensive care unit, post-intensive care unit, and the total hospital stay of patients extubated on the operating table were shorter.

Effect of tidal volume change on pressure-based prediction of fluid responsiveness in children.

It is known that pulse pressure variation and systolic pressure variation cannot predict fluid responsiveness in children. In adults, the ability of these dynamic parameters to predict fluid responsiveness is improved by increasing tidal volume. We planned to investigate whether pulse pressure variation or systolic pressure variation can predict fluid responsiveness in children when augmented by increasing tidal volume by conducting a prospective study. We enrolled children younger than 7 years who underwent cardiac surgery for atrial septal defect or ventricular septal defect. After sternum closure, pulse pressure variation and systolic pressure variation were continuously recorded while changing the tidal volume to 6, 10, and 14 mL/kg. Fluid loading was done with 10 mL/kg of crystalloids for 10 min, and stroke volume index was measured via transesophageal echocardiography. Children whose stroke volume index increased by more than 15% after the fluid loading were defined as responders to fluid therapy. We set primary outcome as the predictability of pulse pressure variation and systolic pressure variation for fluid responsiveness and measured the area under the curve of receiver operating characteristics curve. Twenty-six children were included, of which 15 were responders. At the tidal volume of 14 mL/kg, the area under the curves of receiver operating characteristics curves of pulse pressure variation and systolic pressure variation were 0.576 (p = .517) and 0.548 (p = .678), respectively. The differences in dynamic parameters between responders and nonresponders were not significant. Failure of pulse pressure variation or systolic pressure variation at augmented tidal volume in children may be due to difference in their arterial compliance from those of adults. Large compliance of thoracic wall may be another reason. Augmented pulse pressure variation or systolic pressure variation due to increased tidal volume cannot predict fluid responsiveness in children after simple cardiac surgery.

Total Thoracoscopic versus Robotic Surgery for Repair of Atrial Septum Defect: A Propensity Matching Score Analysis.

Robotic surgery can provide less surgical trauma than conventional surgery, but differences between robotic and thoracoscopic surgery for atrial septal defect (ASD) repair are not well documented. To explore whether ASD can be repaired by thoracoscopic surgery or robotic surgery, which procedure is less invasive, and the difference in outcomes between these two procedures, this article studies 160 patients undergoing ASD repair at our institution. Sixty-five patients underwent total thoracoscopic surgery and 95 patients underwent total endoscopic robotic surgery. Propensity score matching yielded 64 well-matched patient pairs. Surgical data and early postoperative outcomes between the two matched groups were analyzed and compared. The results show that thoracoscopic and robotic surgery to repair ASD are both safe and reliable, and the early curative effect is good. However, regardless of similar complication rates, robotic surgery has a shorter time, less postoperative drainage, and faster recovery than thoracoscopic surgery.

Self- and informant-reported executive function in young adults operated for atrial or ventricular septal defects in childhood.

Adults with simple congenital heart defects(CHD) have increased risk of neurodevelopmental challenges including executive dysfunction. It is unknown if the executive dysfunction is universal or if it is driven by dysfunction in specific clinical subscales and how it might affect psychosocial aspects of everyday life. The self-reported and informant-reported executive function of adults with an average age of 26 ± 5 (range 18-41) who underwent childhood surgery for atrial septal defects (n = 34) or ventricular septal defects (n = 32) and matched controls (n = 40) were evaluated using the Behavior Rating Inventory of Executive Functions - Adult version (BRIEF-A). The CHD group reported having more executive dysfunction than controls in all BRIEF-A clinical subscales (p < 0.020) and more than their informants reported on their behalf (p < 0.006). The CHD group had received three times more special teaching (44% compared to 16%) and pedagogical psychological counselling (14% compared to none) and had a three times higher occurrence of psychiatric disorders than controls (33% compared to 11%). Lower educational levels and psychiatric disorders were associated with higher BRIEF-A scores (p < 0.03). Adults operated for septal defects in childhood report more challenges with all aspects of the executive functions than controls and more than relatives are aware of.

COMPARATIVE EVALUATION OF IMMEDIATE RESULTS OF PLASTIC ATRIAL SEPTAL DEFECT IN ADULT PATIENTS, LIVING IN HIGH ALTITUDE CONDITIONS

The article gives a comparative assessment of the results of surgery for atrial septal defect (ASD) surgery in patients living in low and high altitude conditions. sizes of the right ventricle were practically equal, but at the same time higher than the norm. Objective. To conduct a comparative analysis of the direct results of ASD plastic in patients living in low, medium and high mountains Material and methods. The study material included 30 patients with ASD living in highlands; the control group consisted of 30 patients living in flat areas. Using clinical methods and instrumental studies, an analysis of operated patients, ASD plastic in adult patients with complicated pulmonary hypertension, heart failure, cardiac arrhythmias and functional tricuspid insufficiency was performed. Results. The authors studied pulmonary arterial pressure (PAP) indices between the groups both in the preoperative and postoperative periods, the analysis showed significant differences. The parameters of the right ventricle (RV) in the preoperative period had significant differences, however, in the postoperative period, the sizes of the right ventricle were practically equal, but at the same time higher than the norm. Conclusion. Our observation data show a significant decrease in PAP in patients living in high altitude conditions. However, the decrease in the PAP indicators remained slightly higher than the standard indicators.

Demonstration of Double-Wave-Like Reentry Using Activation and Propagation Map in a Patient with Atrial Flutter and Previous Atrial Septal Defect Surgery

Three-dimensional electroanatomic maps have revolutionized the management of complex arrhythmia. By providing a visual display of various arrhythmia mechanisms these maps have not only helped with the mechanism of the tachycardia but also allowed for precise localization of the critical isthmus. Herein, we present an interesting propagation map of a 55-year-old female with scar-related right-sided atrial flutter. The propagation map helped in localizing the critical isthmus and subsequent successful ablation.

Percutaneous closure of residual atrial septal defect after surgical closure.

Residual atrial septal defect (ASD) after surgical closure is rare, but some cases are seen during follow-up period. Redo surgery for residual ASD is often declined, while percutaneous closure can be acceptable. However, the indication of percutaneous closure for residual ASD has not been established. We reviewed our experience with percutaneous closure of residual ASD using medical and procedural records. Between 2006 and 2018, residual ASD was seen in seven patients. The median age of patients was 66years (range 50-81years), and the median period after surgical closure of ASD was 39years (range 13-48years). All patients had symptoms related to ASD. Percutaneous closure of residual ASD was successfully performed in all seven patients. No residual shunts were detected during the median follow-up period of 4.2years (range 0.5-11years) after percutaneous closure. Based on transesophageal echocardiographic findings and operative records for surgical closure, we considered two mechanisms causing residual ASD, such as the tear of surgical suture line and the overlooking of defect during surgical closure. Percutaneous closure of residual ASD was safely performed without any complications, suggesting that percutaneous is an effective therapeutic strategy for residual ASD after surgical closure.

Minimally Invasive Surgery vs Device Closure for Atrial Septal Defects: A Systematic Review and Meta-analysis.

Device closure is the first-line treatment for most atrial septal defects (ASDs). Minimally invasive cardiac surgery (MICS) has been found safe and effective for ASD closure with comparable mortality/morbidity and superior cosmetic results compared to conventional median sternotomy. Our goal was to compare percutaneous versus MICS of ASDs. A systematic review was performed using PubMed and the Cochrane Library (end-of-search date on May 22, 2019). Meta-analyses were conducted using fixed and random effects models. In the present systematic review, we analyzed six studies including 1577 patients with ASDs who underwent either MICS (n = 642) or device closure (n = 935). Treatment efficacy was significantly higher in the MICS (99.8%; 95% CI 98.9-99.9) compared to the device closure group (97.3%; 95% CI 95.6-98.2), (OR 0.1; 95% CI 0.02-0.6). Surgical patients experienced significantly more complications (16.2%; 95% CI 13.0-19.9) compared to those that were treated with a percutaneous approach (7.1%; 95% CI 5.0-9.8), (OR 2.0; 95% CI 1.2-3.2). Surgery was associated with significantly longer length of hospital stay (5.6 ± 1.7days) compared to device closure (1.3 ± 1.4days), (OR 4.8; 95% CI 1.1-20.5). Residual shunts were more common with the transcatheter (3.9%; 95% CI 2.7-5.5) compared to the surgical approach (0.95%; 95% CI 0.3-2.4), (OR 0.1; 95% CI 0.06-0.5). There was no difference between the two techniques in terms of major bleeding, hematoma formation, transfusion requirements, cardiac tamponade, new-onset atrial fibrillation, permanent pacemaker placement, and reoperation rates. MICS for ASD is a safe procedure and compares favorably to transcatheter closure. Despite longer hospitalization requirements, the MICS approach is feasible irrespective of ASD anatomy and may lead to a more effective and durable repair.

Pediatrik Yaş Grubunda Normotermik Kardiyopulmoner By-Pass ve Normotermik Kan Kardiyoplejisi İle Atriyal Septal Defekt Cerrahisi

Pediatrik Yaş Grubunda Normotermik Kardiyopulmoner By-Pass ve Normotermik Kan Kardiyoplejisi İle Atriyal Septal Defekt Cerrahisi

P1006Conduction disorders in patients with congenital heart disease and right atrial volume overload: an intraoperative epicardial mapping study

Abstract Background Various atrial regions may contribute to the arrhythmogenic substrate for atrial tachyarrhythmias, including atrial fibrillation (AF), in patients with right atrial (RA) volume overload in congenital heart disease (CHD). It is widely recognized that structural and electrical remodelling of the RA occurs, but a previous endovascular mapping study showed that the left atrium (LA) was also affected in patients with atrial septal defect (ASD). The role of Bachmann's bundle (BB) and posterior left atrium (PLA) is yet unknown. Purpose To quantify and compare prevalence and severity of conduction disorders during sinus rhythm between atrial regions in patients with CHD and RA volume overload, using intraoperative high-resolution epicardial mapping. Methods Thirty-one patients (female: n=18, age: 48.5±13.8 years, history of AF: n=5) undergoing cardiac surgery for secundum ASD (n=18), sinus venosus defect (n=11) or isolated partial abnormal pulmonary venous return (n=2) were included. Intra-operative epicardial mapping (N=128/192 electrodes, interelectrode distance: 2mm) of the RA, BB, LA and PLA was performed during sinus rhythm. Conduction delay (CD) and block (CB) were quantified per region as proportion (%), length of lines (mm) and maximum conduction time (Δ local activation time between two adjacent electrodes). Results Proportion of CD on BB was 3.9% (2.3–4.9), RA 3.1% (1.9–3.8), PLA 2.4% (1.2–3.6) and LA 2.3% (1–3) and was higher on BB compared to PLA (p=0.002) and LA (p&lt;0.001) but not RA (p=0.063). Proportion of CB on BB was 2.1% (1.2–5.4), RA 2.2% (1.1–3.4), PLA 0.8% (0.1–2.4) and LA 0.8% (0.3–1.6) and was smaller on LA compared to BB (p=0.001) and RA (p=0.004). There were no significant differences in length of CD/CB lines between regions, except that length of the longest CB line per patient was longer in the RA compared to LA (p=0.008). Maximum conduction time was highest in the RA (median 40ms) as opposed to BB (31ms), LA (21ms) and PLA (18ms; all p&lt;0.0083 with Bonferroni correction), suggesting conduction disorders were more severe in the RA. For sub analysis, the RA surface was divided into 1) the crista terminalis region and 2) the lateral RA wall. In the crista terminalis region, proportions of CD and CB were higher, CD/CB lines were longer and maximum conduction times were higher (all p&lt;0.05). Differences between patients with and without AF were solely observed on BB: patients with AF had a higher proportion and longer lines of CB (p&lt;0.05), though outcomes should be interpreted with caution due to the small number of patients with AF. Conclusions In adult patients with CHD and RA volume overload, both RA and BB were affected by conduction disorders. More specifically, conduction disorders in the RA were mainly concentrated in the crista terminalis region. These findings suggest that not only the RA but also BB may be involved in the arrhythmogenic substrate for atrial tachyarrhythmias in these patients. Acknowledgement/Funding Dutch Heart Foundation [no 2012T0046]; LSH-Impulse [no 40-43100-98-008]; CVON [no 914728] and VIDI [no 91717339] to N.M.S. de Groot.

Standard median sternotomy, right minithoracotomy, totally thoracoscopic surgery, percutaneous closure, and transthoracic closure for atrial septal defects in children: A protocol for a network meta-analysis.

Background:Atrial septal defect (ASD) is one of the most common congenital heart diseases, with an average of 1.64 per 1000 newborns with the ASD. Empirical studies suggest that surgery should be performed early in the presence of right atrium and or right ventricular enlargement, even for asymptomatic patients. Many surgical procedures can be used to treat ASD. But which method is the best choice remains unclear. This study aims to compare the efficacy and safety of standard median sternotomy, right minithoracotomy, totally thoracoscopic surgery, percutaneous closure, transcutaneous by echocardiography, and transcutaneous by radiotherapy for ASDs in children using Bayesian network meta-analysis (NMA).Methods:We will perform a comprehensive literature search using PubMed, EMBASE.com, the Cochrane Library, Web of Science, and Chinese Biomedical Literature Database to identify relevant studies from inception to April 2019. Randomized controlled trials, prospective or retrospective cohort studies that reported the efficacy and safety of surgical procedures for the treatment of atrial septal defects will be included. Risk of bias of the included randomized controlled trials and prospective or retrospective cohort studies will be evaluated according to the Cochrane Handbook 5.1.0 and the risk of bias in non-randomized studies of interventions, respectively. A Bayesian NMA will be performed using R 3.4.1.Results:The results of this NMA will be submitted to a peer-reviewed journal for publication.Conclusion:This NMA will summarize the direct and indirect evidence to assess the efficacy and safety of different surgical procedures for the treatment of ASDs.Ethics and dissemination:Ethics approval and patient consent are not required as this study is a network meta-analysis based on published trials.PROSPERO registration number:CRD42019130902.

Successful Retrieval of Embolized Amplatzer Septal Occluder from Descending Thoracic Aorta: A Surgical Emergency.

Amplatzer septal occluder is widely used by the cardiac interventionists as an effective alternative to traditional surgery for atrial septal defects. However, although rare, device may embolize during or after procedure due to several reasons. We report a case of device embolization into the descending thoracic aorta during percutaneous closure of ASD in a 14-year-old girl which was successfully retrieved by emergency surgery at Department of Cardiac Surgery, University Cardiac Centre, Bangabandhu Sheikh Mujib Medical University, Bangladesh.&#x0D; University Heart Journal Vol. 15, No. 1, Jan 2019; 37-39

A CASE OF SUCCESSFUL TREATMENT OF A PATIENT WITH HIGH PULMONARY HYPERTENSION BY IMPLANTATION OF AN OCCLUDER IN AN ATRIAL SEPTAL DEFECT

Aim: the purpose of this publication is to demonstrate the safety and efficacy of the endovascular method of treatment for long-existing, neglected, and fairly common congenital heart defects such as an atrial septal defect with high pulmonary hypertension.Material and Methods. We present a clinical case of the successful X-ray endovascular treatment of a 48-year-old female patient with a high pulmonary hypertension diagnosed with congenital heart disease, atrial septal defect. Clinical and instrumental examination included standard resting electrocardiography, echocardiography, and catheterization of the right heart and the pulmonary artery. Surgical treatment consisted in an X-ray endovascular implantation of the 40-mm atrial septal defect closure device via the transfemoral access. Post-operative follow up care lasted for 15 months.Results. Echocardiography study showed the left ventricular ejection fraction of 53 mL; congenital heart disease was characterized by 2.5-cm secondary central atrial septal defect and a variable pressure release. Pulmonary artery systolic pressure was 120 mmHg. Catheterization of the right heart and the pulmonary artery showed blood flow with the presence of leftto-right shunting equal to Qp/Qs=2.0/1. An X-ray endovascular atrial septal defect surgery was conducted in an X-ray operation room via a standard transfemoral access. The surgery consisted in X-ray endovascular atrial septal defect occlusion with an implantation of an atrial septal defect closure device with 40-mm neck diameter. Intraoperative echocardiography study showed that the closure device was placed correctly with no signs of residual bleeding. The final echocardiography performed in three days showed the condition after atrial septal defect closure device implantation. The defect was tightly closed. Pulmonary artery systolic pressure was 83 mmHg. Hospital stay lasted for three days. Follow-up echocardiography study at 15 months showed the condition after atrial septal defect closure device implantation. The defect was tightly closed. Pulmonary artery systolic pressure was 46 mmHg.Conclusion. There are currently two types of treatment: open surgery such as suturing or plastic urgery with extracorporeal blood circulation and X-ray endovascular occlusion of the atrial septal defect by implantation of a special device. The X-ray endovascular treatment of an atrial septal defect with a closure device implantation is a highly effective and safe procedure. The main advantages of this method are as follows: surgery does not require anesthesia, incision, and heart-lung bypass whereas reimplantation and repositioning of the device is always feasible.

Minimally invasive surgery for atrial septal defects: a 20-year experience at a single centre.

Our goal was to evaluate the results of our 20-year experience with minimally invasive surgical approaches for closing ostium secundum atrial septal defects, focusing on clinical results, patient satisfaction and cost-effectiveness. We included 538 patients who underwent surgical ostium secundum atrial septal defects closure with minimally invasive approaches. The minimally invasive approaches included right anterior minithoracotomy (n = 335, 62%), midline lower ministernotomy (135, 25%) and right lateral minithoracotomy (n = 68, 13%). Central cannulation was used in 374 patients (69%), whereas, more recently, a remote cardiopulmonary bypass with peripheral cannulation was used in 164 selected patients (31%). Median intensive care unit and postoperative hospitalization stays were 1 day [interquartile range (IQR) 1-1 day] and 5 days (IQR 5-6 days), respectively. Thirty-one patients had postoperative complications (5.8%); postcardiotomy syndrome was the most frequent complication (n = 20/538, 3.7%). Decreases in the length of postoperative hospitalization (P < 0.001) and in hospital costs (P = 0.009) were achieved over time. At a median follow-up of 12.1 years (IQR 0.6-14 years), all patients are in good clinical condition with no limitations to physical activity. The vast majority of patients (524/538 patients, 97%) were very satisfied with the result of the minimally invasive approaches (99/100 patients, 99% in the last 5 years). Minimally invasive approaches for closing ostium secundum atrial septal defects proved safe and effective both in children and in adults with a very high satisfaction rate for the cosmetic result. A continuous evolution of our minimally invasive approaches, with a constant quest for less invasive procedures, led us to a miniaturization of the surgical accesses, reducing hospitalization time and hospital costs.

Reversibility of Pulmonary Hypertension Following Surgical Atrial Septal Defect Closure in Children with Down Syndrome.

BACKGROUNDMany Down syndrome (DS) patients have an atrial septal defect (ASD) and associated pulmonary hypertension (PH) from early childhood. ASD closure in DS patients with PH is often controversial due to concerns regarding exacerbation of PH. The aim of this study was to investigate the clinical outcome following surgical ASD closure in children with DS.METHODSWe retrospectively reviewed the medical records of DS patients who underwent surgical ASD patch closure from January 2000 to December 2016.RESULTSA total of 15 patients underwent surgery for ASD. Prior to ASD patch closure, nine patients were diagnosed with PH, three of whom took medications for PH. The mean age of patients at ASD patch closure was 17.3 months, and the mean diameter of the ASD was 10.2 mm. Three patients who took medications for severe PH underwent ASD patch closure at ages 7, 12, and 25 months. Two patients continued medication for an additional 13 and 21 months, and one patient remained on medication 52 months after ASD closure. PH did not recur following discontinuation of selective pulmonary vasodilators in two patients. Although a moderate degree of PH remained in one patient due to a chronic lung problem, it was improved compared to before ASD closure. No PH was observed in the remaining 12 patients following ASD closure.CONCLUSIONSA large ASD can be closed even in DS patients with severe PH during early childhood with the support of multiple selective pulmonary vasodilators.

Abstract 17051: Neurocognitive Disorders on Long-Term Follow up of Congenital Heart Disease Patients Undergoing Procedures in Childhood

Introduction: Neurocognitive disorders (NCD) are a growing concern in congenital heart disease (CHD) patients. We hypothesized that early life cardiopulmonary bypass (CBP) as well as age at intervention (AAI) were risk factors for NCDs on long-term follow-up in CHD patients. Methods: Data source was the Quebec CHD database. We defined NCD based on ICD 9 and 10 codes including autism spectrum disorder, global developmental disorder, specific developmental disorder, attention deficit hyperactive disorder, intellectual disability or specific learning deficit. We compared NCD risk from 1983-2010 in 3 cohorts of patients undergoing procedures in childhood: percutaneous atrial septal defect (ASD) closure (no CBP group), surgical ASD closure (short CBP group), and complex CHD lesion repair surgeries (long CBP group). Patients were followed from intervention until NCD diagnosis, death, or administrative censoring whichever came first. Results: By 27 years of follow-up, the cumulative risk of NCD was significantly higher in the complex surgery group compared to the ASD surgery group (crude, 24.9% and 13.4%; p&lt;0.0001) and with adjustments for AAI and sex (Cox regression, p=0.043). By 12 years of follow-up, the cumulative risk of NCD was significantly higher in the complex surgery group compared to the other two groups where the risk was almost identical. Cox models with different follow-up lengths identified younger AAI and male sex being significantly associated with increased risk in NCD. Conclusions: In long-term follow-up of CHD patients, younger AAI of CBP and male sex were associated with increased risk of NCD. Our findings suggest that CBP duration in a wide range of CHD lesions and cohort effects are important predictors of NCD. &lt;!--EndFragment--&gt;

The Effect of Preoperative Pulmonary Arterial Hypertension on Incidence of Postoperative Atrial Fibrillation after Surgical Closure of Atrial Septal Defect (Secundum)

Background: Atrial tachyarrhythmias are common among adults with ASD and contribute to substantial morbidity. Atrial flutter and atrial fibrillation are well-described complications of atrial septal defect (ASD) and are associated with substantial morbidity. The cause of AF in ASD is multifactorial in nature. It has been proposed that it is related to atrial dilatation, the increase in pulmonary pressure, and ventricular dysfunction. Early surgical intervention may reduce the long-term risk of developing atrial arrhythmias. Studies demonstrated that cardiac remodeling occurred after closure of an ASD, even in older patients. This study aimed to find out the pulmonary hypertension (PAH) as a predictor of postoperative atrial fibrillation in patients after surgery for secundum type atrial septal defect closure.Methods: This Prospective Observational Study carried out in department of cardiac surgery, National Institute of Cardiovascular Disease (NICVD) and Hospital, Dhaka, Bangladesh during the period of July, 2015 to June, 2016. Total 54 patients are taken and then grouped into group A and group B. Each group contains 27 patients. Group A include Patients with ASD secundum without PAH. Group B Patients with ASD secundum with PAH. All patients were evaluated with M-mode, 2D and color Doppler transthoracic echocardiography and ECG before operation, at discharge, after one month and at 3 months follow-up. Statistical analysis of the results was obtained by windows based computer software with statistical package for the social sciences program (SPSS version 21).Results: To compare atrial fibrillation postoperative at discharge and postoperative after 1 and 3 months follow-up it was found In group B 8 (29.62%) patients had AF postoperatively, during discharge 8 (29.62%) patients had AF, after 1 month 7 (25.93%) patient had AF, after 3 months 6 (22.22%) patients had AF. No AF was found in Group A patients during postoperatively, during discharge, after 1 month &amp; 3 months follow up. Statistical significant difference was found in between two groups (p&lt;0.05).Conclusion: The surgical correction of atrial septal defect (ASD) is safe and effective procedure. Our studyshowed that the haemodynamic and electrophysiological results of the surgical repair of ASD secundum was superior before the development of pulmonary arterial hypertension. After surgical correction of ASD secundum raised pulmonary artery pressure became lower gradually. Atrial fibrillation developed in patient group with pulmonary arterial hypertension in postoperative period remain persistent in most patients in the follow up period, few converted to sinus rhythmUniversity Heart Journal Vol. 13, No. 1, January 2017; 17-20

Minimal Invasive Technique in Atrial Septal Defect Surgery.

BackgroundMedian sternotomy with minimal skin incision (MSWMSI) and modified anterior mini-thoracotomy (MAMT) approach that both are innovative techniques modified from previous documented techniques are important alternative to conventional median sternotomy in atrial septal defect (ASD) repair. Our aim is to explain the details of two performed techniques in our center and explain the results.MethodsTotally 54 children with ASD (20 female and 34 male) were operated with two different techniques i.e. MAMT and MSWMSI in Imam Ali heart surgery center between May 2010 and May 2013. Intra and postoperative variables such as cardiopulmonary bypass time and aortic cross-clamp time, intensive care unit stay time, length of incision, postoperative hematoma and seroma, dehiscence mortality, exploration for postoperative bleeding, neurologic complication, infection and amount of blood transfusion were recorded.ResultsMean cardiopulmonary bypass time was 30 ± 11 min, and mean aortic cross-clamp time was 7 ± 2 min. The mean amount of blood transfusion was 150 ± 39 mL, and the mean chest tube drainage after surgery was 140 ± 57 mL. Superficial skin infection occurred in three patients. Subcutaneous hematoma and seroma were founded in six patients. In 50 cases the defect was secundum type, in two patients it was sinus venosus type, and in two with associated perimembranous ventricular septal defect repair.ConclusionBoth approaches are safe and may be the surgical techniques of choice for secundum ASD repair in all age groups; and we can also utilize these techniques for more complicated kinds of surgery, for instance, sinus venosus type ASD with or without partial anomalous defect.

Extrinsic compression of left main coronary artery by aneurysmal pulmonary artery in severe pulmonary hypertension: its correlates, clinical impact, and management strategies.

Although left main coronary artery (LMCA) compression (Co) by pulmonary artery (PA) aneurysm (A) has been reported in some pulmonary hypertension (PH) series, clinical importance and management of this complication remain to be determined. In this single-centre prospective study, we evaluated correlates, clinical impact, and management strategies of LMCA-Co in patients with PH. Our study group comprised 269 (female 166, age 52.9 ± 17.3 years) out of 498 patients with confirmed PH who underwent coronary angiography (CA) because of the PAA on echocardiography, angina or incidentally detected LMCA-Co during diagnostic evaluation with multidetector computed tomography. The LMCA-Co ≥ 50% was documented in 22 patients (8.2%) who underwent CA, and stenosis were between 70% and 90% in 14 of these. Univariate comparisons revealed that a younger age, a D-shaped septum, a higher PA systolic, diastolic, and mean pressures and pulmonary vascular resistance, a larger PA diameter, a smaller aortic diameter and pulmonary arterial hypertension associated with patent-ductus arteriosus, atrial or ventricular septal defects were significantly associated with LMCA-Co. Bare-metal stents were implanted in 12 patients and 1 patient underwent PAA and atrial septal defect surgery and another one declined LMCA stenting procedure. Our study demonstrates that LMCA-Co is one of the most important and potentially lethal complications of severe PH, and alertness for this risk seems to be necessary in specific circumstances related with PAA. However, long-term benefit from stenting in this setting remains as a controversy.