Atrial Septal Defect In Adults Research Articles

Abstract WMP100: Cardiovascular Outcomes in Adult Patients With Atrial Septal Defect: A Nationwide Population-Based Study

Objective: It is currently unknown whether closing atrial septal defects (ASDs) could reduce cardiovascular events and mortality in adult patients with ASD. This study aims to investigate the long-term effects of different ASD closure methods on cardiovascular events in adults. Methods: We conducted a retrospective analysis of the Korean National Health Insurance Service benefit records spanning from 2002 to 2020. From this dataset, we identified patients aged 20 years or older who received a diagnosis of ASD based on ICD-10 codes between 2004 and 2015. Participants were categorized into three groups: observation, device closure, and surgery closure, based on the method of ASD closure. To mitigate imbalances among the groups, we employed propensity score matching (PSM) in a 2:1:1 ratio, considering variables such as sex, age, comorbidities, and medications. We utilized the Cox proportional hazard model to compare the occurrence of major adverse cardiovascular events (MACE), including stroke, myocardial infarction (MI), and all-cause death, and each component among the three groups. Results: A total of 20,643 ASD patients were initially included in the study. After PSM, 6,636 patients were assigned in the observation group, and 3,318 patients were selected in each of the device and surgery closure groups. Over a 5-year follow-up period, the adjusted hazard ratios (aHRs) for MACE were 0.72 (0.66-0.79) in the surgery group and 0.85 (0.78-0.92) in the device group, using the observation group as the reference. For stroke, the aHRs were 0.46 (0.39-0.56) in the surgery group and 0.47 (0.39-0.57) in the device group. Regarding MI, the effect between the surgery/device closure groups and the observation group was comparable [0.83 (0.64-1.06) and 0.98 (0.77-1.25), respectively]. The aHRs for all-cause death were 0.43 (0.34-0.55) in the surgery group and 0.18 (0.12-0.26) in the device group. Conclusions: The favorable cardiovascular outcomes observed after ASD closure (surgery or device) were sustained even in adult ASD patients when compared to the observation group. Moreover, the preventive effect on each cardiovascular outcome after ASD closure varied depending on the treatment approach.

The Risk Factors of Mitral Regurgitation Deterioration After Secundum Atrial Septal Defect Closure.

Association between secundum Atrial Septal Defect (ASD) and mitral valve (MV) disease has been recognized for decades. Secundum ASD closure can reduce mitral regurgitation (MR) degree. However, in some patients, deterioration of MR after ASD closure has been observed. We aimed to identify the risk factors of MR deterioration after ASD closure. This was an observational retrospective cohort study. Data were collected from the registry and echocardiogram report. We evaluated all patients with ASD closure by surgery and transcatheterization without MR intervention from January 2012 until June 2021 at Dr. Sardjito General Hospital, Yogyakarta. We excluded patients with multiple ASD and ASD with severe MR requiring MV intervention. Risk factors for MR deterioration were evaluated using multivariate logistic regression. A total of 242 patients who underwent post-secundum ASD closure were included. In multivariate analysis, ASD closure by surgery, large left atrial (LA) diameter (>40 mm), low left ventricular ejection fraction (LVEF; <55%), and MV regurgitation degree were significant risk factors for MR worsening after ASD closure, with OR of 2.103 (95% CI 1.124-3.937); 2.871 (95% CI 1.032-7.985); 5.531 (95% CI 1.368-22.366); and 2.490 (95% CI 1.339-4.630) respectively. ASD closure by surgery, large LA diameter (>40 mm), low LVEF (<55%), and MV regurgitation degree are independent significant risk factors for MR deterioration in post-secundum ASD closure patients. In adult ASD patients with reduced LV function, it is recommended to perform balloon testing and consider fenestrated closure, as low LVEF <55% has the highest risk of causing new or deteriorating MR.

Artificial intelligence-enabled 8-lead ECG detection of atrial septal defect among adults: a novel diagnostic tool.

Patients with atrial septal defect (ASD) exhibit distinctive electrocardiogram (ECG) patterns. However, ASD cannot be diagnosed solely based on these differences. Artificial intelligence (AI) has been widely used for specifically diagnosing cardiovascular diseases other than arrhythmia. Our study aimed to develop an artificial intelligence-enabled 8-lead ECG to detect ASD among adults. In this study, our AI model was trained and validated using 526 ECGs from patients with ASD and 2,124 ECGs from a control group with a normal cardiac structure in our hospital. External testing was conducted at Wuhan Central Hospital, involving 50 ECGs from the ASD group and 46 ECGs from the normal group. The model was based on a convolutional neural network (CNN) with a residual network to classify 8-lead ECG data into either the ASD or normal group. We employed a 10-fold cross-validation approach. Statistically significant differences (p < 0.05) were observed in the cited ECG features between the ASD and normal groups. Our AI model performed well in identifying ECGs in both the ASD group [accuracy of 0.97, precision of 0.90, recall of 0.97, specificity of 0.97, F1 score of 0.93, and area under the curve (AUC) of 0.99] and the normal group within the training and validation datasets from our hospital. Furthermore, these corresponding indices performed impressively in the external test data set with the accuracy of 0.82, precision of 0.90, recall of 0.74, specificity of 0.91, F1 score of 0.81 and the AUC of 0.87. And the series of experiments of subgroups to discuss specific clinic situations associated to this issue was remarkable as well. An ECG-based detection of ASD using an artificial intelligence algorithm can be achieved with high diagnostic performance, and it shows great clinical promise. Our research on AI-enabled 8-lead ECG detection of ASD in adults is expected to provide robust references for early detection of ASD, healthy pregnancies, and related decision-making. A lower number of leads is also more favorable for the application of portable devices, which it is expected that this technology will bring significant economic and societal benefits.

Sinus venosus atrial septal defect in adults: Surgical repair using partial thoracoscopic approach

Sinus venosus atrial septal defect in adults: Surgical repair using partial thoracoscopic approach

Tackling Atrial Septal Defects in Adults

Tackling Atrial Septal Defects in Adults

Assessment of morphological and hemodynamic changes in adult atrial septal defect before and after percutaneous trans-catheter closure: the initial result in Vietnamese patient.

This study aimed to evaluate the change of morphology and hemodynamics in a relatively large number of patients with atrial septal defect (ASD) and provide the initial result in Vietnamese patients. This longitudinal, prospective case-control study was done at the Vietnam National Heart Institute from January 2012 to December 2017. The participants were divided into two groups: the ASD group, which included patients with ASDs, and the control group, which included healthy individuals or individuals without cardiac-related disorders. There were 94 participants in the ASD group and 83 participants in the control group. Most patients with ASDs in the study group were female, and the average age was 38.65 ± 14.8. The success rate of the ASD group was 98.9%. The right ventricle morphology and function showed right ventricular diameter, pulmonary trunk gradually decreased, FAC and ET increased, IVCT and IVRT decreased, and Tei index gradually decreased after each examination. Morphology and function of the left ventricle after ASD closure showed that the left ventricular diameter gradually increased, and EF% in 3 months after ASD closure increased statistically significantly. IVCT, IVRT, and LV Tei index decreased, and ET increased statistically significantly. After six months from ASD closure, the proportion of patients with NYHA I was 90.3%, with no patient with NYHA IV, and pulmonary vascular resistance gradually decreased. Percutaneous trans-catheter closure in Vietnamese adult atrial septal defect was an effective technique. Ventricle morphological and hemodynamic abnormalities following closure recovered statistical significance over time, particularly in the left ventricle.

PROCEDURAL AND SHORT-TERM RESULTS OF PERCUTANEOUS ATRIAL SEPTAL DEFECT CLOSURE IN ADOLESCENTS AND ADULTS

Objectives: To evaluate the procedural and short-term results of percutaneous atrial septal defect (ASD) closure in adults. Methodology: We retrospectively analysed 149 consecutive patients with a secundum ASD who underwent percutaneous closure from September 2011 to January 2021. Procedural and short-term results, including arrhythmia, device embolisation and residual shunt, were assessed at 2 days and 4 weeks and 6 months after percutaneous closure of atrial septal defect. Results: The patients were 14 to 77 (37.7 ± 15.0) years old and 101 (67.8%) were female. Maximum defect size was 18.0 ± 6.3 mm measured on transoesophageal echocardiography. The device diameter used in patients who underwent closure was 21.9 ± 6.9 mm (6–38 mm). Percutaneous closure procedure success rate was 93.3%. In our study, the rates of device embolisation, arrhythmia and residual shunt were 3.6%, 1.4%, and 2.2%, respectively. Conclusion: Transcatheter closure of ASDs in adults was feasible in our centre with good short-term outcome. The procedure should be performed in experienced centres by cardiologists specialised in the treatment of structural heart diseases due to potentially severe complications.

Correlation between Age and Defect Size with Increased Pulmonary Arterial Pressure in Adult Atrial Septal Defect (ASD) Patients at Cardiology and Vascular Medicine Department dr. Seotomo Public Hospital Surabaya 2019-2021

Abstract: Atrial Septal Defect (ASD) is one of the three most common types of congenital heart disease in the world. Pulmonary arterial hypertension (PAH) is a complication that can be found in patients with secundum type of ASD. There is no research that shows the relationship between patient’s age and defect size with increased pulmonary artery pressure in secundum type of ASD patients in Indonesia, so further research needs to be done. Material and Methods: This study is a retrospective study using an observational analytical research design with cross sectionalapproach. The data from this study were taken from the medical records of ASD patients at the Cardiology and Vascular Department of Dr. Soetomo Public Hospital Surabaya. Results: Sex distribution of patients with secundum ASD was dominated by female patients with a total of 53 people (81.5%), the age distribution of patients was dominated by patients in the age group of 20-24 years as many as 18 people (27.7%). The most common comorbidities in adult secundum ASD patients were hypertension (3.08%) and minor CAD (3.08%). The mean diameter of the secundum ASD defect was 28.03±9.57 mm, and the data for the smallest defect diameter was 4 mm and the largest was 48 mm. Complications of increased PA pressure were dominated by 20 patients with mild PH (30.8%) and the mean mPAP pressure was 39.87±19.03. There were no patients with Eisenmenger syndrome.Conclusion: There was no correlation between patient age and inter-atrial septal diameter with mPAP pressure.

Transcatheter Closure of Large Atrial Septal Defects in Adults

ObjectiveTo examine the outcomes of percutaneous closure of large atrial septal defects (ASDs) (≥25 mm). BackgroundData on long-term results after closure of large ASDs are limited. MethodsWe reviewed the records of 275 consecutive patients who underwent transcatheter closure of large (≥25 mm) ASDs from January 1999 until December 2016 in our center. The most common indication for closure was a large left-to-right shunt. Follow-up (FU) was performed at regular intervals thereafter. Results after closure of ASDs with diameters of 25–30 mm, >30–35 mm and >35 mm were compared. ResultsPercutaneous closure was technically successful in 99.6%. Mean FU time was 4.8 years (0–15.5 years). Peri-operative (30-day) adverse events occurred in 20.4% and included death in 0.7% (one unrelated to the procedure and one of unknown cause), device erosion in 0.7%, device embolization in 2.9%, pericardial effusion in 5.5%, air embolism in 0.4%, new onset atrial fibrillation in 10.5%, transient supraventricular tachycardia in 0.4% and fever in 0.7%. Late (>30 days after the procedure) atrial fibrillation occurred in 5.8%. There was one device erosion >15 years after the implantation treated successfully surgically. Complete defect closure was achieved in 95.6%. ConclusionDevice closure of large ASDs is feasible, safe and effective with high technical success and low risk of serious periprocedural complications. Nevertheless, in very large defects (>40 mm), both options, surgery and percutaneous closure should be considered. Device or procedural long-term adverse events are rare.

Impaired left and right systolic ventricular capacity in corrected atrial septal defect patients

Resting right ventricular (RV) systolic function has in some studies been shown to be impaired after correction of an atrial septal defect (ASD) whereas impairment of left ventricular (LV) systolic function is uncertain. In the present study we examine the LV and RV systolic response to exercise in patients with a previously corrected ASD in order to investigate the myocardial capacity. Thirty-six adult ASD patients with a corrected isolated secundum ASD and eighteen adult age-matched controls underent a semi-supine exercise stress echocardiographic examination. At rest, LV parameters were comparable between groups, and RV global longitudinal strain (RV-GLS) was lower for the ASD group (−18.5%, 95% CI −20.0—−17.0%) compared with controls (−24.5%, 95% CI −27.7—−22.4%, p < 0.001). At peak exercise, LV ejection fraction (LVEF) was lower for ASD patients (61%, 95% CI 58–65%) compared with controls (68%, 95% CI 64–73% p = 0.01). Peak LV global longitudinal strain (LV-GLS) was borderline significantly lower (ASD: -18.4%, 95% CI −20.2—−16.6%, controls: −21.3%, 95% CI −23.6—−19.0%, p = 0.059). Both RVEF (ASD: 64%, 95% CI 60–68%, controls: 73%, 95% CI 65–80%, p = 0.05) and tricuspid annular plane systolic excursion (TAPSE) (ASD: 2.5 cm, 95% CI 2.3–2.7 cm, controls: 3.2 cm, 95% CI 2.9–3.6 cm, p < 0.001) at peak exercise were lower for ASD patients. Exercise assessed peak oxygen uptake was comparable between groups (ASD: 32.8 mL O2/kg/min, 95% CI 30.3–35.5 mL O2/kg/min, controls: 35.2 mL O2/kg/min, 95% CI 31.6–38.8 mL O2/kg/min, p = 0.3). Corrected ASD patients demonstrate a reduced LV and RV systolic exercise response decades after ASD correction whereas resting parameters of LV and RV systolic function were within normal range. The presence of subclinical systolic myocardial dysfunction during exercise might be associated with the long-term morbidities documented in this patient group.

Outcomes and complications of percutaneous device closure in adults with secundum atrial septal defect.

To assess immediate outcome and complications of Amplatzer septal occluder percutaneous device for closure of secundum atrial septal defect in adults, and to determine regression in right ventricular size, reduced pulmonary arterial systolic pressure and incidence of device embolization at follow-up. The single-cohort, ambi-directional, observational study was conducted at the Tabba Heart Institute, Karachi, from January 2013 to July 2018, and comprised patients admitted consecutively for percutaneous atrial septal defect closure. Pre-closure trans-oesophageal echocardiogram was performed in all cases to ensure adequacy of defect margins necessary for device stability. Immediate procedure success and complications were determined by trans-oesophageal echocardiogram, while transthoracic echo was done on follow-up. Data was analysed using SPSS 21. Of the 64 patients, 41(71.9%) were females. The overall mean age was 36.6±14 years. Median size of atrial septal defect was 21mm (interquartile range: 17-26mm). Immediate success was observed in 59(92.2%) patients, and there were 5(8%) acute device embolization events. Small residual atrial septal defect was found in 4(6.3%) cases. On 20-month follow-up, 54(84.4%) patients showed improved symptoms. Repeat transthoracic echo was performed in 39(60.1%) cases, and there were no late embolic events or residual atrial septal defect. Right ventricular size normalized in 34(89.5%) cases, mean pulmonary arterial systolic pressure reduced significantly compared to pre-closure measurement (p<0.001). Percutaneous atrial septal defect closure was found to be safe and effective in adults with secundum atrial septal defect. Timely closure resulted in improved symptoms, right ventricular remodelling and reduced pulmonary arterial systolic pressure at intermediate-term follow-up.

Surgery for Functional Tricuspid Regurgitation in Adult Atrial Septal Defect - An Increasing Subject in a Decreasing Matter.

IntroductionFunctional tricuspid regurgitation (TR) is known to complicate adult atrial septal defect (ASD), but its management is still under debate. We reviewed our experience in ASD surgery, focusing on associated functional TR and its treatment.MethodsThis retrospective study (2005-2019) included 206 consecutive adult ASD surgical cases without associated valve pathology, except functional TR. Variables were statistically compared on TR classes and surgery-defined groups.ResultsMean age of the patients was 40.3±13 years; 19.9% had sinus venosus syndrome. TR severity was directly related to age, pulmonary systolic pressure, right ventricular and tricuspid annulus diameters, and heart failure class. TR ≥ 2 was found in 134 (65%) patients, while TR ≥ 3 in 56 (27.2%) patients. Tricuspid surgery was associated to shunt closure in 66 (32%) patients, almost all through valve repair; indication was directly related to age, right ventricular and tricuspid annulus diameters, and heart failure class ≥ 3. Tricuspid surgery was more efficient than isolated shunt closure in decreasing TR (79±23% vs. 36±26%; P=1.8 E-18). Device closure availability (last four years of the study) was associated with 1/3 reduction of surgical cases but increased the share of cases with TR>2 (> 51% vs. < 31%; P<0.05).ConclusionIn the era of device closure, surgery for adult ASD is less frequent, but the share of significant TR cases is in net increase. To avoid long-term postoperative TR, we plead for valve repair in all patients with severe TR and for considering repair in moderate TR at risk of persistence.

Pulmonary hypertension crisis management in adult atrial septal defect surgical closure: A case report

Atrial Septal Defect (ASD) is the most common congenital disorder found in adulthood, accounting for 35% of Adult Congenital Heart Disease (ACHD). In ASD, there is a defect in the septum/wall between right and left atria, resulting in left-to-right shunt which lead to an increase of the right heart volume and pulmonary circulation. If left untreated, increased pulmonary resistance develop to pulmonary hypertension (PH) which results in a progressive decrease in right ventricular function, causing right heart failure and death. Although ASD surgical closure is not a complicated procedure, patients with complication of PH and right heart failure have a high mortality rate if not managed properly. Increase in mortality was mainly due to perioperative pulmonary hypertensive crisis (PH crisis), condition of an acute increase in mean pulmonary arterial pressure (mPAP) exceeding mean systemic arterial pressure (MAP). In this case report, we will discuss the management of postoperative adult patients with ASD closure complicated by intraoperative pulmonary hypertensive crisis who are treated in the intensive care unit (ICU).

Cardiac remodeling and factors determining occurrence of atrial arrhythmia after surgical closure of atrial septal defect in adults

The purpose of this study was to assess cardiac remodeling and to determine factors predicting the occurrence of atrial arrhythmia after surgical closure of atrial septal defect (ASD) in adults. Retrospective study including 33 adult patients (> 20 years old, mean age: 34 ± 11 years, 26 women) who underwent surgical closure of secundum or sinus venosus ASD. Before operation, all patients had dyspnea and 15% were in NYHA III-IV. Sinus rythm was present in 85% of patients. The ratio of pulmonary to systemic blood flow was calculated, yielding a mean of 2,8 ± 1 and pulmonary artery hypertension (PAH) was observed in 80% of patients with a mean value of 41,3 ± 10 mmHg. The ASD were closed by pericardial or Dacron patch in 97% of cases. Operative death was observed in 2 cases. In survival patient, with a follow-up of 97 ± 57 months, regression of right ventricular dilatation and PAH occurred in the first post-operative month and was maintained at late follow-up. Atrial arrhythmia occurred in 5 patients and were determined by older operative age (P = 0.003) and the absence of cardiac remodeling after surgery. Surgical correction of ASD in adults is safe and efficacious. Cardiac remodeling after ASD closure in the adult is a common and an early event and prevents late morbidity which is in most cases due to arrhythmias. The mode of closure does not seem to significantly impact remodeling.

Preoperative Left Ventricle End Diastolic Volume Index as a Predictor for Low Cardiac Output Syndrome After Surgical Closure of Secundum Atrial Septal Defect With Small-Sized Left Ventricle.

Introduction: Low cardiac output syndrome is one of the postoperative complications that are associated with significant morbidity and mortality after surgical closure of atrial septal defect (ASD) with small-sized left ventricle (LV). This study investigated whether preoperative left ventricular end-diastolic volume index (LVEDVi) could accurately predict low cardiac output syndrome (LCOS) after surgical closure of ASD with small-sized LV.Method: This retrospective cohort study involved adult ASD patients with small-sized LV from January 2018 to December 2019 in National Cardiovascular Center Harapan Kita. Preoperative MRI data to assess the left and right ventricle volume were collected. A bivariate analysis using independent Student's t-test was done. Diagnostic test using receiver operating characteristic (ROC) curve was also done to obtain the area under the curve (AUC) value. The best cutoff point was determined by Youden's index.Result: Fifty-seven subjects were involved in this study [age (mean ± SD) 32.56 ± 13.15 years; weight (mean ± SD) 48.82 ± 12.15 kg]. Subjects who had post-operative LCOS (n = 30) have significantly lower LVEDVi (45.0 ± 7.42 ml/m2 vs. 64.15 ± 13.37 ml/m2; p < 0.001), LVEDV (64.6 ± 16.0 ml vs. 85.9 ± 20.7 ml; p < 0.001), LVSV (38.97 ± 11.5 ml vs. 53.13 ± 7.5 ml; p < 0.001), and LVSVi (27.28 ± 8.55 ml/m2 vs. 37.42 ± 5.35 ml/m2; p < 0.001) compared to subjects who did not have post-operative LCOS (n = 27). ROC analysis showed that the best AUC was found on LVEDVi (AUC 95.3%; 95% confidence interval: 90.6–100%). The best cutoff value for LVEDVi to predict the occurrence of LCOS after surgical closure of ASD was 53.3 ml/m2 with a sensitivity of 86.7% and a specificity of 85.2%.Conclusion: This study showed that preoperative LVEDVi could predict LCOS after surgical closure of ASD with small-sized LV with a well-defined cutoff. The best cutoff value of LVEDVi to predict the occurrence of LCOS after surgical ASD closure was 53.5 ml/m2.

OR1. A novel double heterozygote variation of NKX2-5 gene in adult patients with atrial septal defect

Abstract Background and Aim It is still unclear whether the NKX2-5 variant is involved in congenital heart disease patients in Indonesia. Here, we investigate the genetic variation of NKX2-5 in adult atrial septal defect (ASD) patients at RSUP Dr Sardjito Yogyakarta, Indonesia. Methods and Results We screened 97 patients with ASD for genetic variations of NKX2-5. DNA samples were extracted from venous blood. The whole two coding exons of the NKX2-5 gene were amplified by PCR and sequenced using the Sanger method. The sequence was compared with the reference genome taken from NCBI using SerialCloner software. We identified three NKX2-5 genetic variants: c.63 A&amp;gt;G (rs2277923) at exon 1, c.413 G&amp;gt;A (rs1366528649) and c.561G&amp;gt;A (rs767559311) at exon 2. The variation in rs2277923 was detected in 83 patients (85.6%), including 41 subjects (42.3%) with heterozygous A&amp;gt;G and 42 subjects (43. 3%) with homozygous A&amp;gt;G. However, it has a similar amino acid sequence. The variant of rs1366528649 and rs767559311 were heterozygous and found in the same locus (double heterozygous variation). Interestingly, rs1366528649 and rs767559311 were only identified in familial ASD (3 patients, 3,1%). The rs1366528649 variant replaces arginine (a basic amino acid) with glutamine (an acidic amino acid). Meanwhile, the rs767559311 variant substitutes glutamine with histidine (a basic amino acid). Conclusion We discovered a novel double heterozygote variation of the NKX2-5 gene (rs1366528649 and rs767559311) and may contribute to familial ASD risk. Moreover, rs2277923 is the most common variation in ASD patients in Indonesia.

Sinus venosus atrial septal defect in adults: Where we are and where we go? Initial experience of percutaneous repair

Percutaneous repair of sinus venosus atrial septal defect (SV ASD) has emerged with promising preliminary results. We sought to expose the modified management strategy for this pathology in our tertiary center. Since March 2020, date of the first percutaneous procedure, therapeutic strategy for SV ASD patients has changed and was based on cardiac CT and 3D STL models for anatomic analysis in all patients. Flow-MRI and 3D printing were produced in selected cases to upgrade anatomic understanding and strategy decision ( Fig. 1 ). Forecast success and issues were studied based on anatomic findings. Safety, efficiency and follow-up with both technics were noticed for decision making. From March 2020 to March 2021, 18 adults patients were reffered for SV ASD closure. Median age was 47 years old (18 to 84 years old) ( Fig. 2 ). Surgical correction was performed in 5 patients (27.8%) using patch baffle (3/5) or Warden technique (2/5). Length of hospital stay was 8 ± 3 days and no major event occurred. Immediate surgical results were excellent in all cases. Percutaneous closure was performed in 4 cases (22.2%). Procedures were simulated on 3D printed models in all cases. Procedures were guided using transesophageal echocardiography, fusion between fluoroscopy and echography, and fusion between CT scan and fluoroscopy. One residual shunt occurred but disappeared on the cath control at month 3. Stents used were covered CP10Z80, CP10Z70, CP 10Z60, and Bentley begraft aortic in one case. In two cases, covered stents were stabilized by adding bare metal stents. All 4 patients were discharged at day 3 with acetylsalicylic acid therapy. Eight of nine pending patients for percutaneous closure will be planned in 2021. Percutaneous management of SVASD was safe and efficient in selected cases. Pre-procedural multimodality imaging including 3D modeling appears to be a necessary condition for a tailored patient's selection.

Time Trends in Simple Congenital Heart Disease Over 39 Years: A Danish Nationwide Study.

BackgroundWe describe calendar time trends of patients with simple congenital heart disease.Methods and ResultsUsing the nationwide Danish registries, we identified individuals diagnosed with isolated ventricular septal defect, atrial septal defect, patent ductus arteriosus, or pulmonary stenosis during 1977 to 2015, who were alive at 5 years of age. We reported incidence per 1 000 000 person‐years with 95% CIs, 1‐year invasive cardiac procedure probability and age at time of diagnosis stratified by diagnosis age (children ≤18 years, adults >18 years), and 1‐year all‐cause mortality stratified by diagnosis age groups (5–30, 30–60, 60+ years). We identified 15 900 individuals with simple congenital heart disease (ventricular septal defect, 35.2%; atrial septal defect, 35.0%; patent ductus arteriosus, 25.2%; pulmonary stenosis, 4.6%), of which 75.7% were children. From 1977 to 1986 and 2007 to 2015, the incidence rates increased for atrial septal defect in adults (8.8 [95% CI, 7.1–10.5] to 31.8 [95% CI, 29.2–34.5]) and in children (26.6 [95% CI, 20.9–32.3] to 150.8 [95% CI, 126.5–175.0]). An increase was only observed in children for ventricular septal defect (72.1 [95% CI, 60.3–83.9] to 115.4 [95% CI, 109.1–121.6]), patent ductus arteriosus (49.2 [95% CI, 39.8–58.5] to 102.2 [95% CI, 86.7–117.6]) and pulmonary stenosis (5.7 [95% CI, 3.0–8.3] to 21.5 [95% CI, 17.2–25.7]) while the incidence rates remained unchanged for adults. From 1977–1986 to 2007–2015, 1‐year mortality decreased for all age groups (>60 years, 30.1%–9.6%; 30–60 years, 9.5%–1.0%; 5–30 years, 1.9%–0.0%), and 1‐year procedure probability decreased for children (13.8%–6.6%) but increased for adults (13.3%–29.6%) were observed.ConclusionsIncreasing incidence and treatment and decreasing mortality among individuals with simple congenital heart disease point toward an aging and growing population. Broader screening methods for asymptomatic congenital heart disease are needed to initiate timely treatment and follow‐up.

Coronary sinus atrial septal defects in adults over the past 20\u2009years at new Tokyo hospital: case series

BackgroundAn isolated coronary sinus (CS) atrial septal defect (ASD) is defined as a CS unroofed in the terminal portion without a persistent left superior vena cava or other anomalies. This defect is rare and part of the wide spectrum of unroofed CS syndrome (URCS). Recently, several reports have described this finding. The database of New Tokyo Hospital was searched to determine the incidence of this defect. Additionally, to raise awareness of this condition, the findings from five patients with CS ASD who underwent surgical repair at New Tokyo Hospital are discussed.Case presentationThe patients were three women and two men with an age range of 63–77 years. All patients underwent transthoracic echocardiography and computed tomography, and one underwent magnetic resonance imaging. In two patients, the defect was found unexpectedly intraoperatively; left-to-right shunting was apparent in the other three patients preoperatively. The pulmonary-to-systemic blood flow ratio ranged from 1.42 to 3.1 following cardiac catheterization, and oxygen saturation step-up was seen on the right side of the heart. Valvular regurgitation was seen in 4/5 patients with different combinations and degrees of mitral, tricuspid, and aortic valve involvement. Right atrial and ventricular dilation were seen in 4/5 patients; three patients had left atrial dilation. Three patients experienced atrial fibrillation, and one of these also experienced paroxysmal ventricular contractions. All patients underwent surgical repair, and some underwent multiple procedures. One patient who had previously undergone kidney transplantation died approximately 1 year postoperatively; the remaining four patients are currently experiencing good activities of daily living without symptoms.ConclusionsCS ASD (Kirklin and Barratt–Boyes type IV URCS) comprised 1.3% of adult congenital heart surgeries and 0.07% of adult open-heart surgeries at New Tokyo Hospital from 1999 to 2019. At New Tokyo Hospital, cardiac surgery is performed mainly for patients with acquired cardiac disease, and CS ASD is rare. Early diagnosis is important, as well as early surgical repair in symptomatic patients, especially those with blood access shunts, which may overload the heart. The case of a poor prognosis in this series is noteworthy, as similar cases have not been reported previously.

Patent Foramen Ovale-A Not So Innocuous Septal Atrial Defect in Adults.

Patent foramen ovale (PFO) is a common congenital atrial septal defect with an incidence of 15–35% in the adult population. The development of the interatrial septum is a process that begins in the fourth gestational week and is completed only after birth. During intrauterine life, the foramen ovale allows the passage of highly oxygenated blood from the right to the left atrium and into the systemic arteries, thus bypassing the pulmonary circulation. In 75% of the general population, the foramen ovale closes after birth, and only an oval depression, called fossa ovalis, remains on the right side of the interatrial septum. Patent foramen ovale can be associated with various clinically important conditions, including migraine and stroke, or decompression illness in divers. The aim of this review is to summarize the PFO developmental and anatomical features and to discuss the clinical risks associated with this atrial septal defect in adults.