Congenital Atrial Septal Defect Research Articles

Transcatheter PFO closure for cryptogenic stroke: current approaches and future considerations.

Patent Foramen Ovale (PFO) is a common congenital atrial septal defect present in 20%-35% of the general population. Although generally considered a benign anatomic variant, a PFO may facilitate passage of a thrombus from the venous to arterial circulation, thereby resulting in cryptogenic stroke or systemic embolization. A PFO is detected in nearly one half of patients presenting with cryptogenic stroke and often considered the most likely etiology when other causes have been excluded. In this review, we discuss the contemporary role of transcatheter closure of PFO in the treatment of cryptogenic stroke, including devices currently available for commercial use in the United States (Amplatzer PFOTM Occluder and GoreTM Cardioform Septal Occluder) and a novel suture-mediated device (NobleStitchTM EL) under clinical investigation. To provide the best care for cryptogenic stroke patients, practitioners should be familiar with the indications for PFO closure and corresponding treatment options.

Brevundimonas diminuta Infection in a Congenital Atrial Septal Defect Patient: A Case Report

Brevundimonas species are aerobic, non fermenting Gram negative bacilli. Brevundimonas diminuta (B. diminuta) is not believed to be a significant pathogen, and its virulence is generally low, being rarely isolated from clinical samples. Only a few clinical cases of serious opportunistic infections, particularly in patients with compromised immunity, have been reported for B. diminuta. All known species of Brevundimonas spp. show strong resistance to most antibiotics, according to the Centers for Disease Control and Prevention (CDC). Here, a case of B. diminuta infection in an eight-year-old female child is described. The patient also had a minor Patent Ductus Arteriosus (PDA) and a known congenital Atrial Septal Defect (ASD). Following isolation from the blood sample, the VITEK 2 compact system identified B. diminuta.

A Rare Case of Lutembacher’s Syndrome

Lutembacher’s syndrome, a rare cardiac condition characterised by the combination of congenital Atrial Septal Defect (ASD) and acquired mitral stenosis, presents significant clinical challenges. Hereby, the authors present a case report of a 28-year-old female exhibiting mild symptoms, including dysapnoea, intermittent palpitations, and lower limb swelling. Examination revealed characteristic findings, including elevated jugular venous pressure, cardiomegaly, and murmurs indicative of mitral stenosis and tricuspid regurgitation. Transthoracic echocardiography confirmed the presence of ASD and moderate mitral stenosis. The patient was ultimately diagnosed with Lutembacher’s syndrome. Prompt initiation of rheumatic heart disease prophylaxis and diuretics led to symptomatic improvement. The present case underscores the need for early recognition and intervention in Lutembacher’s syndrome, particularly in regions with high rates of rheumatic heart disease. Future research should focus on optimising treatment strategies to enhance patient outcomes. Sharing such cases contributes to a deeper understanding of this complex condition and advocates for improved management approaches.

Abstract 13650: Trends in Women Cardiac Operators of Structural and Interventional Procedures in the United States

Background: Women have historically been underrepresented in cardiology workforces. Throughout the United States, there is a major underrepresentation of women in cardiology as operators within structural proceduralists and interventional cardiology (IC). Methods: We extracted data from the Medicare Provider Utilization and Payment Database (MPUPD) from 2013 to 2020. The MPUPD is an administrative database of services rendered to Medicare patients enrolled in a fee-for-service program. We sought operators who performed >10 procedures using procedure codes for percutaneous transcatheter closure of congenital atrial septal defect (ASD) with implant and percutaneous coronary intervention, transcatheter mitral valve replacement via transcutaneous edge to edge repairs (TEER), and percutaneous left atrial appendage closure (PLAAO) using relevant CPT codes. The proportion of women operators was analyzed across the 8-year period. Results: Between 2013 and 2020, women on average represented 3.02% of the 1,260 cardiac operators identified. Despite the number of total structural operators performing 10 or more procedures increasing from 9 to 871 over the 8-year period, the proportion of women remained unchanged at less than 4.5% (P = 0.712) (Figure 1). By procedure, the total ASD, TEER, and PLAAO operators have increased, though the proportion of women operators remained constant over time (P = .913, .725 and .891). Over the studied period, there were no women operators identified with over 10 operations in 28 states (56%) for any structural procedures, 49 states (98%) for ASD procedures, 39 states (78%) for TEER, and 33 states (66%) of PLAAO. Conclusion: Women continue to represent an overwhelming minority of structural cardiac operators. Despite a rapid rise in the total number of operators, the proportion of female operators has not increased. Prospective studies are needed to investigate the underlying factors contributing to these sex-related differences.

Anaesthetic management of an infant with severe protein C deficiency and septal cardiac defects—a case report

BackgroundProtein C deficiency is a rare genetic disorder with varying severity of symptoms and disease. The disorder may vary in presentation from a complete symptomless state to a less severe form like venous thromboembolism. The most severe form of disease is a rare condition called neonatal purpura fulminans (NPF) which is characterized with sudden progressive dermal hemorrhage and necrosis due to vascular thrombosis and disseminated intravascular coagulation. In contrast, congenital atrial and ventricular septal defects are the commonest congenital heart diseases found in pediatric population. An infant presenting with systemic vascular thromboembolism secondary to protein C deficiency along with the cardiac septal defects posted for surgery will be a very challenging task to manage in perioperative period. Also, physiological mechanisms during perioperative period and surgery will promote thromboembolism leading to worsening of the situation further. So, perioperative management of such patient pose a great challenge to the anaesthesiologist. Due to rarity of the condition, there is very limited literature available.Case presentationWe report the perioperative management of a 2-month-old child suffering with neonatal purpura fulminans with atrial and ventricular septal cardiac defect, scheduled for bilateral foot amputation. The patient was a diagnosed with complete occlusion of abdominal aorta leading to foot gangrene. After initiation of anticoagulant therapy, symptoms were relieved and patient was posted for amputation of gangrenous feet.ConclusionsThere could be an increased risk of thromboembolism and bleeding due to protein C abnormality along with the chances of shunt reversal, paradoxical embolism, and other cardiac morbidities secondary to septal defects. Wise selection of anaesthetic agents like limiting the use of nitrous oxide, ketamine as much as possible to be considered. Conditions like tachycardia, hypotension, and hypothermia should also be prevented perioperatively as these could increase the chances of thrombosis.

Detection rate and shunt grading with synchronous testing of contrast transcranial Doppler and contrast transthoracic echocardiography: Preliminary findings.

Patent foramen ovale, a common congenital atrial septal defect, may lead to cardiac right-to-left shunting (RLS), which has been associated with various diseases. Reliable techniques for detecting RLS are essential for diagnosis and assist with treatment decision-making. Contrast transcranial Doppler (c-TCD), contrast transthoracic echocardiography (c-TTE), and contrast transesophageal echocardiography can be used to detect RLS. However, it is still unclear which ultrasound modalities are the most practical and cost-effective. To evaluate the efficacy of synchronous c-TCD and c-TTE in detecting cardiac RLS. We prospectively designed and continuously recruited 100 patients with cryptogenic stroke, migraines, transient ischemic attack, unexplained syncope, or dizziness admitted at the First Affiliated Hospital of Shenzhen University between February 2020 and August 2020. Ninety-five patients underwent synchronous c-TCD and c-TTE (during a single contrast-enhanced ultrasound session). We compared synchronous test results with the results of c-TCD alone and c-TTE alone. Ninety-five patients successfully underwent synchronous c-TCD and c-TTE, with the data analyzed for each individual. The positive detection rates of Grade I, II, and III shunts with synchronous c-TCD and c-TTE were higher than those with c-TTE or c-TCD alone (P = .047, P = .002, and P = .024, respectively). Overall, the positive detection rates of synchronous tests, c-TCD alone, and c-TTE were 69.5%, 51.6%, and 31.6%, respectively (P = .000, and P = .012). Among the 66 patients who were double-RLS-positive (both c-TTE and c-TCD showed positive results), as detected by the synchronous test, 26 (39.3%) patients who underwent c-TTE alone had higher shunt grades detected than those who underwent c-TCD alone. Conversely, 5 (7.6%) patients who underwent c-TCD alone had higher shunt grades detected than those who underwent c-TTE alone (P = .000). Synchronous c-TCD and c-TTE testing can significantly improve the detection rate, accuracy, and test process efficacy for quantifying RLS, and reduce the testing risk, workload, and medical costs.

Genetic Analysis of Variants of the MYH6 Gene Promoter in Congenital Atrial Septal Defects

Background: Atrial septal defect (ASD) is one of the common congenital heart diseases. The MYH6 gene has a critical role in cardiac development but the role of MYH6 promoter variants in patients with ASD has not been explored. Methods: In 613 subjects including 320 ASD patients, we investigated the MYH6 gene promoter variants and verified the effect on gene expression by using cellular functional experiments and bioinformatics analysis. Results: Eleven variants were identified in the MYH6 gene promoter, of which four variants were found only in ASD patients, and two variants (g.3434G>C and g.4524C>T) were identified for the first time. Cellular functional experiments indicated that all four variants reduced the transcriptional activity of the MYH6 gene promoter (p < 0.05). Subsequent analysis through the JASPAR (A database of transcription factor binding profiles) suggests that these variants may alter transcription factor binding sites, which may in turn lead to changes in myocardin subunit expression and ASD formation. Conclusions: Our study for the first time focuses on variants in the promoter region of the MYH6 gene in Chinese patients with ASD and the discovered variants have functional significance. The study provides new insights in the role of the MYH6 gene promoter region to better understand the genetic basis of ASD formation and facilitates clinical diagnosis.

Lutembacher’s Syndrome in a young female treated Surgically: A Case Report

Lutembacher’s syndrome is a rare clinical condition presenting with a combination of congenital atrial septal defect (ASD) and acquired mitral stenosis (MS). Lutembacher’s syndrome is more prevalent in developing countries and its prevalence depends on the prevalence of rheumatic fever in that geographical area. The syndrome can present at any age but is usually more commonly observed in young female adults. Echocardiography remains the gold standard for diagnosis and evaluation of Lutembacher’s syndrome (LS). Now a days many treatment options are available for LS – either percutaneous intervention or surgical correction. But pericardial patch closure of atrial septal defect and prosthetic mitral valve replacement is the treatment of choice for Lutembacher’s syndrome. Bangladesh Heart Journal 2022; 37(2): 143-147

“Cardiac Remodeling after Surgical Patch Closure of Adult Congenital Atrial Septal Defects: Perspective of Bangladesh”

Introduction: Atrial septal defect is one of the congenital heart diseases. An atrial septal defect (ASD) represents a communication between the left and right atrium leading to left to right shunt. It makes up about 10% of all congenital heart diseases after delivery and up to 30—40% of heart defects diagnosed in patients aged over 40 years. Objectives: To identify the status of cardiac remodeling after surgical patch closure of adult congenital atrial septal defects. Methodology: The descriptive and observation study was carried out atDepartment of Cardiac Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January 2013 to April 2015. The patients both male and female undergoing surgical closure of atrial septal defect, Department of Cardiac Surgery, BSMMU, Dhaka, Bangladesh. Total sixty (60) patients were studied, thirty (30) in each group. Group A: Thirty (30) patients of surgical closure of ASD at or before age of 25 years. Group B: Thirty (30) patients of surgical closure of ASD at or after age of 25 years. A purposive sampling technique was used for sample selection. The sample size was determined by using the standard formula for comparison between two proportions. To make it more convenient and reduce the error sample size of this study was fixed at 60 (30 in each group). Careful history regarding the complaints of Exerttional dyspnoea, Palpitation, Fatigability, General weakness, Electrocardiography (ECG), Chest X ray, Echocardiography (Echo), Left atrial diameter (LA), -Left ventricular internal diameter at the end of diaslole (LVIDd), -Left ventricular internal diameter at the end of systole (LVIDs), Interventricular septal thickness (IVST), Posterior wall thickness (PWT), Fractional shortening (FS), Ejection fraction (EF) were measured. Results: From the result it was found that exertional dyspnoea in 60.0%, palpitation in 70.0%, fatigue in 66.6% and general weakness in 53.33% in group A and in group B exertional dyspnoea in 80.0%, palpitation in 73.33%, fatigability in 63.33% and general weakness in 80.0%. There was no significant difference in presenting complaints distribution in between two groups. From the ECG findings between two study groups it was found that arrhythmia in 13.33%, left axis deviation in 10.0%, right axis deviation 23.330% and in group B arrhythmia in 16.67%, left axis deviation in 13.33%, right axis deviation 36.67%. There were differences between two groups regarding ECG findings. In early age group there was few complains but complains are more in late age group. From the types of ASD between two study groups it was revealed that septum secundum defect is 66.67%, Septum primum 20 % and sinous venosus defect in 13.33 % in group A. In group B septum secundum defect is 76.67%, Septum primum 13.33 % and sinous venosus defect in 10 %. There was no significant difference in type of ASD in between two groups. Conclusion: This study concluded that cardiac remodeling occurs after surgical closure of atrial septal defect in all age group and degree of cardiac remodeling was better in early age group (up to 25 years) compared with late age group (&gt;25 years).

Atrial septal defects: the role in the development of cerebral circulation disorders caused by paradoxical embolism

The article presents a case report of a patient with cardioembolic ischemic stroke (IS), which was the first clinical manifestation of congenital atrial septal defect (ASD), asymptomatic until adulthood. The issues of anatomical classification, restructuring of intracardiac hemodynamics depending on the size and localization of ASD, its role in the development of IS are discussed. The diagnostic algorithm in patients with IS caused by paradoxical embolism is described, the current possibilities of ASD treatment and prevention of related disorders of cerebral circulation are discussed.

Spinal Anesthesia in Patient with Congestive Heart Failure due to Congenital Atrial Septal Defect, and Pulmonary Hypertension Undergoing Cesarean Section Procedure: A Case Report

Introduction. In patients suffering from heart disease, pregnancy is a risk factor for mortality. Heart disease in pregnant women can be in form of rheumatic heart disease, cardiomyopathy, or congenital heart disease. This case report is about the successful spinal anesthesia technique in cesarean section (C-section) patients with congestive heart failure due to congenital atrial septal defect, and pulmonary hypertension (PH).&#x0D; Case presentation. A pregnant woman, 24 years old, planned to have an emergency C-section. She complained about shortness of breath for 2 days before admission. Three months ago, the patient started to feel shortness of breath during activity and also complained her legs swelled. She has a history of congenital heart i.e. atrial septal defect (ASD), but not routinely been treated. Her examination showed tachypnea, murmur, bibasilar fine crackles lung sound, and pretibial pitting edema. Echocardiography showed ASD with pulmonary hypertension. Spinal Anesthesia using 0.5% isobaric bupivacaine 7.5 mg and fentanyl 25 µcg was given before surgery. Drugs was injected in L3-L4 level with the upper target was as high as T6. the head position is raised 30 degrees. Procedure went well and the APGAR score was 8/9, Patient was admitted to the ICU for one day and discharged from hospital at the 5 days of hospital care.&#x0D; Conclusion. Spinal single-shot spinal anesthesia with small doses of bupivacaine and adjuvant can be used as an alternative technique in emergency C-section for patients with congestive heart failure due to congenital atrial septal defect, and pulmonary hypertension.

A novel missense mutation of FOXC1 in an Axenfeld\u2013Rieger syndrome patient with a congenital atrial septal defect and sublingual cyst: a case report and literature review

BackgroundAxenfeld–Rieger syndrome (ARS) is a rare autosomal dominant hereditary disease characterized primarily by maldevelopment of the anterior segment of both eyes, accompanied by developmental glaucoma, and other congenital anomalies. FOXC1 and PITX2 genes play important roles in the development of ARS.Case presentationThe present report describes a 7-year-old boy with iris dysplasia, displaced pupils, and congenital glaucoma in both eyes. The patient presented with a congenital atrial septal defect and sublingual cyst. The patient’s family has no clinical manifestations. Next generation sequencing identified a pathogenic heterozygous missense variant in FOXC1 gene (NM_001453:c. 246C>A, p. S82R) in the patient. Sanger sequencing confirmed this result, and this mutation was not detected in the other three family members.ConclusionTo the best of our knowledge, the results of our study reveal a novel mutation in the FOXC1 gene associated with ARS.

Ebstein’s anomaly during pregnancy: experience from a tertiary care centre – a case series and review of literature

Pregnancy complicated with uncorrected Ebstein’s anomaly is uncommon and may pose a serious threat to maternal and foetal life in the clinical setting of altered hemodynamics of pregnancy. Data of eight pregnancies in four women with Ebstein’s anomaly who delivered in a tertiary care institute was analysed. Among the four women, one had associated atrial septal defect, one had pulmonary hypertension and three had right bundle branch block. There were two miscarriages and six successful pregnancies resulting in live births. Three of the pregnancies were delivered by caesarean section. There was one pregnancy complicated by severe preeclampsia, no preterm births or maternal cardiac complications. There was one neonate with congenital ostium secundum atrial septal defect. All patients were managed by a multidisciplinary team involving Obstetrician, Cardiologist, Anaesthesiologist and Neonatologist. IMPACT STATEMENT What is already known on this subject? Ebstein’s anomaly is a rare congenital anomaly with apical displacement of the septal tricuspid leaflet in association with leaflet dysplasia. It may cause varied presentation in pregnancy depending on the severity of the lesion. What do the results of this study add? Ebstein’s anomaly may become symptomatic for the first-time during pregnancy. Patients with NYHA class II symptoms and no cyanosis generally tolerate pregnancy well. Miscarriages and intrauterine growth restriction may occur in the presence of this condition. Vaginal delivery is advised and caesarean is done only for obstetric indications. What are the implications of these findings for clinical practise and/or future research? The management of pregnancy with uncorrected Ebstein’s anomaly is highly challenging especially in a low resource setting and requires tertiary centre care. Multidisciplinary team involvement can help to improve the outcomes in such pregnancies.

Electrical storm after correction of an uncomplicated congenital atrial septal defect in an adult: a case report

BackgroundThere is a paucity of published literature describing electrical storm after the correction of uncomplicated atrial septal defect (ASD) in an adult.Case presentationWe present a 49-year-old woman with a congenital ASD combined with mild tricuspid regurgitation who denied any history of arrhythmia or other medical history. She suffered from electrical storm (≥ 3 episodes of ventricular tachycardias or ventricular fibrillations) in the early stage after ASD repair with combined tricuspid valvuloplasty. During electrical storm, her electrolytes were within normal ranges and no ischemic electrocardiographic changes were detected, which suggested that retained air embolism or acute coronary thrombosis were unlikely. Additionally, echocardiographic findings and her central venous pressure (5–8 mmHg during the interval between attacks) failed to support the diagnosis of pericardial tamponade. After a thorough discussion, the surgeons conducted an emergent re-exploration and repeated closure of the ASD with combined DeVega's annuloplasty. Eventually, the patient recovered uneventfully, without reoccurring arrhythmias during follow-up. Although we fail to determine the definite cause, we speculate that the causes probably are iatrogenic injury of the conduction system due to a rare anatomic variation, poor intraoperative protection, latent coronary distortion during tricuspid valvuloplasty, or idiopathic or secondary abnormalities of the conduction system.ConclusionsFor most surgeons, performing re-exploration without a known etiology is a difficult decision to make. This case illustrates that re-exploration could be an option when electrical storm occurs in the early stage postoperatively. Nevertheless, surgeons should assess the benefit-risk ratio when taking this unconventional measure.

Coronary artery fistula features associated with clinical symptoms in adults with non coronary artery disease detected with coronary computed tomography angiography

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): National Cardiovascular Center Harapan Kita, Jakarta, Indonesia Background Coronary artery fistula (CAF) is rare coronary artery anomaly (&amp;lt;1% in general population). It is often diagnosed accidentally during coronary angiography. Most of CAF cases have no clinical significance, however, some may present with hemodynamic instabilities, requiring invasive or surgical intervention. Recently, coronary computed tomography angiography (CCTA) has been increasingly used to detect CAF at higher rates. Correlation between CAF and significance of clinical presentation, however, remains unclear. Purpose To evaluate association of CAF features with any symptomatic trends present in non coronary artery disease (CAD) patients. Methods This was a single-center, observational, analytic cross-sectional study. A total 45 cases of CAF with no documented CAD or non-significant stenosis CAD diagnosed by coronary CT angiography were collected from 10,175 consecutive patients in National Cardiovascular Center Harapan Kita spanning 5-years from January 2015 to December 2019. The imaging findings, morphologic features and relevant clinical history were recorded and analyzed. Results The prevalence of CAF determined with CCTA in our study was 0.44%. Among 45 patients with CAF, thirty (67%) were female. Mean age was 49.4 ± 12.9 years. Most common symptoms reported, in decreasing frequency, were chest pain (60%), dyspnea (22.2%), palpitation/arrhythmia (11.2%), syncope (4.4%) and general weakness (2.2%). Most common site of CAF origin was the left anterior descending artery (66.7%), followed by right coronary artery (51.1%). The fistula most commonly terminated in the main pulmonary artery (75.5%). The CAF size, in descending order, were small (35.6%), medium (33.3%), and large (20%). Mixed and multiple CAF were presented in 5 cases (11.1%). Aneurysm formation were identified in 10 cases (22.2%). CAF were mainly associated with congenital atrial and ventricular septal defects (6.7%; 4.4%, respectively). Other coexistent cardiac abnormalities presented with CAF were pulmonary hypertension (8.9%), infective endocarditis (4.4%), and pericardial effusion (2.2%). Large-sized CAF was significantly associated with chest pain and palpitation/arrhythmia (p = 0.017; p = 0.003, respectively). Aneurysm formation revealed to be significantly associated with chest pain and palpitation/arrhythmia (p = 0.044; p = 0.006, respectively) as well. Mixed and multiple CAF were significantly correlated with syncope (p = 0.003). CAF with concomitant cardiac diseases (congenital heart disease, pulmonary hypertension, valvular heart disease) were significantly associated with symptoms of chest pain and palpitation/arrhythmia as compared to isolated CAF only (p = 0.004; p = 0.007, respectively). Conclusion CAF features (large-sized, mixed and multiple, aneurysmal and presence of concomitant cardiac disease) were associated with significant trends of clinical symptoms in adults without CAD.

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.

Mycobacterium mucogenicum and Klebsiella pneumoniae Pulmonary Infection in a Patient Following Cardiac Surgery: A Case Report

Introduction: Mycobacterium mucogenicum belongs to the rapidly growing mycobacteria, and it is a rare conditional pathogen. Although recent studies suggested that the incidence of M. mucogenicum infection was increased worldwide, there are no case reports of M. mucogenicum and Klebsiella pneumoniae pulmonary infection. Case Presentation: A 32-year-old non-smoking male was diagnosed with congenital atrial septal defect and pulmonary arterial hypertension. After cardiac surgery, lung infections were observed in the patient and then rapidly developed acute respiratory distress syndrome. The cefoperazone-sulbactam, vancomycin, ceftazidime, carbapenem, tigecycline, and micafungin were used for the treatment of pulmonary infection but did not work well. Ultimately, M. mucogenicum and K. pneumoniae were identified as pathogens by using next-generation sequencing. The patient was treated successfully with the administration of clarithromycin, linezolid, tigecycline, and ceftazidime-avibactam. The clinical outcome of this patient was favorable without relapse of infection. Conclusions: This case demonstrates that M. mucogenicum pulmonary infection may result in severe outcomes. The next-generation sequencing technology is important for the identification of M. mucogenicum. Additionally, the clinicians and clinical pharmacists should remain awareness in dealing with M. mucogenicum infection to avoid delaying appropriate treatment.

Prevalence of congenital septal defects among congenital heart defect patients in East Africa: A systematic review and meta-analysis.

IntroductionCongenital heart defects (CHDs) are the most common congenital defects and accounts for nearly one-third of all major congenital anomalies. It is the leading causes of birth defect-associated morbidity, mortality, and medical expenditures. Of all CHD types, ventricular septal defect (VSD) and atrial septal defect (ASD) accounted 51% of cases with an increasing trend over time.ObjectiveThe aim of this review is to estimate the pooled prevalence of ventricular septal defect and congenital atrial septal defect among congenital heart diseases patients in East African context.MethodsUsing PRISMA guideline, we systematically reviewed and meta-analyzed studies that examined the prevalence of Ventricular septal defect and atrial septal defect in East Africa, from Medline (PubMed), Cochrane Library, HINARI, and Google Scholar. A weighted inverse variance random-effects model was used to estimate the pooled prevalence of ventricular septal defect and atrial septal defect.ResultsA total of 2323 studies were identified; 1301 from PubMed, 12 from Cochrane Library, 1010 from Google Scholar and 22 from other sources. The pooled prevalence of ventricular septal defect and atrial septal defect in East Africa was found to be 29.92% (95% CI; 26.12–33.72; I2 = 89.2%; p<0.001), and 10.36% (95% CI; 8.05–12.68; I2 = 89.5%; p<0.001) respectively.Conclusions and future implicationsBased on this review, the pooled prevalence of VSD and ASD is still high and alarming; this signifies that the emphasis given for congenital heart defect in East African countries is limited. Special attention and efforts should be applied for early detection to prevent serious complications and for a better prognosis of all forms of CHD. A screening program for CHD should be instituted during the perinatal period. Furthermore, early referral of suspected cases of congenital cardiac anomalies is mandatory for better management till the establishment of cardiac centers in different regions of the continent.

Percutaneous Closure of Post-infarction and Iatrogenic Ventricular Septal Ruptures Using Amplatzer Occluder®: A Systematic Review.

Ventricular septal rupture (VSR) is a rare complication of myocardial infarction (MI), open heart surgery, and cardiac-based procedures, such as septal myectomy and valve replacement. VSR is associated with high mortality rates and the reported 30-day survival rate is less than 10% without any interventional therapy. Hence, prompt diagnosis and aggressive medical treatment with appropriate surgical intervention are necessary to improve survival. Immediate surgical intervention which is the standard treatment of VSR has a mortality rate of 19-60%. Due to persistent high mortality rate and challenging management of VSR, alternatives to surgical repair has been proposed; transcatheter approach as a new alternative method has been used for the closure of post-surgery residual defects or as a bridge to surgery and in some cases as a definitive therapy instead of surgical repair. Amplatzer Occluder® (AO), a type of transcatheter closure devices, is an approved method of repairing congenital atrial septal defects and it is being used as an alternative method of treatment in VSR. In this systemic review, we assessed the cases of VSR who underwent septal repair by using AO. The study shows that the total mortality rate of percutaneous VSR repair with AO is 20% which is comparable to 19-60% rate of death in patients who undergo surgery. While early intervention is necessary to prevent biventricular dysfunction, immediate surgical intervention on soft and friable tissue surrounding the infarction increases the risk of residual shunt and reoperation. However, this study reveals that the mortality rate of primary percutaneous VSR closure within 7 days of VSR detection was 37 % which is significantly lower than 60% in surgical repair in the same period. In conclusion, given that the prevalence of residual leak in both interventions are similar and close to 20%, percutaneous VSR closure with AO device could be superior to the surgical repair as a primary intervention in unstable or high-risk surgical patients.

Spinal Anesthesia in Patient with Congestive Heart Failure due to Congenital Atrial Septal Defect, and Pulmonary Hypertension Undergoing Cesarean Section Procedure: A Case Report

Introduction. In patients suffering from heart disease, pregnancy is a risk factor for mortality. Heart disease in pregnant women can be in form of rheumatic heart disease, cardiomyopathy, or congenital heart disease. This case report is about the successful spinal anesthesia technique in cesarean section (C-section) patients with congestive heart failure due to congenital atrial septal defect, and pulmonary hypertension (PH).&#x0D; Case presentation. A pregnant woman, 24 years old, planned to have an emergency C-section. She complained about shortness of breath for 2 days before admission. Three months ago, the patient started to feel shortness of breath during activity and also complained her legs swelled. She has a history of congenital heart i.e. atrial septal defect (ASD), but not routinely been treated. Her examination showed tachypnea, murmur, bibasilar fine crackles lung sound, and pretibial pitting edema. Echocardiography showed ASD with pulmonary hypertension. Spinal Anesthesia using 0.5% isobaric bupivacaine 7.5 mg and fentanyl 25 µcg was given before surgery. Drugs was injected in L3-L4 level with the upper target was as high as T6. the head position is raised 30 degrees. Procedure went well and the APGAR score was 8/9, Patient was admitted to the ICU for one day and discharged from hospital at the 5 days of hospital care.&#x0D; Conclusion. Spinal single-shot spinal anesthesia with small doses of bupivacaine and adjuvant can be used as an alternative technique in emergency C-section for patients with congestive heart failure due to congenital atrial septal defect, and pulmonary hypertension.