Correction Of Atrial Septal Defect Research Articles

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.

Heart rate variability is markedly abnormal following surgical repair of atrial and ventricular septal defects in pediatric patients

BackgroundAbnormalities in heart rate variability (HRV) have been associated with increased morbidity and mortality. Adults with a history of successful correction of atrial septal defects (ASDs) and ventricular septal defects (VSDs) have clinically relevant abnormalities in HRV. The etiology of these abnormalities is unknown as is when they occur in the natural history of these lesions. We sought to determine whether the abnormalities described in adult patients are identifiable in pediatric patients. Materials and methodsEighty-five ASD patients, 105 VSD patients, and 142 non-cardiac surgical comparison patients aged 0–18 years were studied during post-operative admission to the critical care unit using continuously monitored bedside electrocardiographic (ECG) data. ResultsASD and VSD patients had statistically significantly lower time-domain heart rate variability parameters, i.e., standard deviation of NN interval duration, and lower frequency-domain heart rate variability parameters, i.e., power in the high frequency band and power in the low frequency band, compared to the comparison cohort. The lower frequency band to high frequency band power ratio was lower in ASD patients and higher in VSD patients compared to the comparison cohort. The abnormalities identified correlate well with patterns described in adult patients. ConclusionPost-surgical ASD and VSD patients have markedly abnormal heart rate variability patterns indicative of reduced parasympathetic activity and predominance of sympathetic activity. The HRV abnormalities described in adult patients are identifiable as early as the postoperative period in childhood. This finding warrants prospective study to identify drivers of this phenomenon.

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.

Clinical Significance of Partial Anomalous Pulmonary Venous Connections (Isolated and Atrial Septal Defect Associated) Determined by Cardiovascular Magnetic Resonance.

Partial anomalous venous connections (PAPVC) are associated with left to right shunting and right heart dilatation. Identification of PAPVC has increased with widespread use of cross-sectional imaging modalities. However, management strategies are mostly based on expert opinion given the scarcity of data from large series. We aimed to define types and significance of isolated and atrial septal defect (ASD) associated PAPVC detected by cardiovascular magnetic resonance. We retrospectively reviewed our cardiovascular magnetic resonance database from 2002 to 2018 to identify isolated or ASD-associated PAPVC cases. A total of 215 patients (median age 46 years; range, 6-83) with isolated or ASD-associated PAPVC were identified among 102 135 clinical cardiovascular magnetic resonance studies. Of these, 104 were isolated and 111 were associated with an ASD. Anomalous connection of right upper pulmonary vein was the most common single venous anomaly (99/215), but in the isolated PAPVC group there were more anomalous left than right upper pulmonary veins (39 versus 34). The Qp/Qs was significantly higher for isolated anomalous single right upper pulmonary vein than left upper pulmonary vein (1.6 versus 1.4 respectively; P=0.01) as were right ventricular end-diastolic volumes (113.7±30.9 versus 90 [57-157] mL/m2, P=0.004). In the PAPVC with an ASD group, sinus venosus ASDs (82%) were associated with right-sided PAPVCs while both right and left-sided venous anomalies were seen in secundum ASDs (18%). In a substantial number of patients (30 out of 91) with sinus venosus ASDs, PAPVCs were more complex and involved more than a single anomalous right upper pulmonary vein; and in 5 patients with ASD, PAPVC was identified only after the ASD closure. This large series provides descriptive and hemodynamic features for isolated and ASD-associated PAPVCs. Anomalous isolated right upper pulmonary vein may cause a significant shunt (Qp/Qs >1.5). PAPVC associated with sinus venosus and secundum ASDs might be more complex than a single anomalous pulmonary vein and missed before ASD correction.

Elevated Left and Right Atrial Pressures Long-Term After Atrial Septal Defect Correction: An Invasive Exercise Hemodynamic Study.

BackgroundDespite correction of the atrial septal defect (ASD), patients experience atrial fibrillation frequently and have increased morbidity and mortality. We examined physical capacity, cardiac performance, and invasive hemodynamics in patients with corrected ASD.Methods and ResultsThirty‐eight corrected patients with isolated secundum ASD and 19 age‐matched healthy controls underwent right heart catheterization at rest and during exercise with simultaneous expired gas assessment and echocardiography. Maximum oxygen uptake was comparable between groups (ASD 32.7±7.7 mL O2/kg per minute, controls 35.2±7.5 mL O2/kg per minute, P=0.3), as was cardiac index at both rest and peak exercise. In contrast, pulmonary artery wedge v wave pressures were increased at rest and peak exercise (rest: ASD 14±4 mm Hg, controls 10±5 mm Hg, P=0.01; peak: ASD 25±9 mm Hg, controls 14±9 mm Hg, P=0.0001). The right atrial v wave pressures were increased at rest but not at peak exercise. The transmural filling pressure gradient (TMFP) was higher at peak exercise among patients with ASD (10±6 mm Hg, controls 7±3 mm Hg, P=0.03). One third of patients with ASD demonstrated an abnormal hemodynamic exercise response defined as mean pulmonary artery wedge pressure ≥25 mm Hg and/or mean pulmonary artery pressure ≥35 mm Hg at peak exercise. These patients had significantly elevated peak right and left atrial a wave pressures, right atrial v wave pressures, pulmonary artery wedge v wave pressures, and transmural filling pressure compared with both controls and patients with ASD with a normal exercise response.ConclusionsPatients with corrected ASD present with elevated right and in particular left atrial pressures at rest and during exercise despite preserved peak exercise capacity. Abnormal atrial compliance and systolic atrial function could predispose to the increased long‐term risk of atrial fibrillation.Registration Informationclinicaltrials.gov. Identifier: NCT03565471.

Age-related aspects of heart remodeling in children after transcatheter correction of atrial septal defect

<h3>ЦЕЛЬ ИССЛЕДОВАНИЯ</h3> Анализ 3-месячных результатов и особенностей ремоделирования сердца (РС) у детей разного возраста после транскатетерной коррекции дефекта межпредсердной перегородки (ДМПП). <h3>МАТЕРИАЛ И МЕТОДЫ</h3> В проспективное исследование включены 48 детей с изолированным вторичным ДМПП, которым была выполнена эндоваскулярная коррекция с начала 2017 г. до середины 2019 г. Пациенты распределены в две группы по возрастному признаку: 1-я группа (<i>n</i>=24) — дети дошкольного возраста (&lt;8 лет), средний возраст 3,5 [2,5; 6] года; 2-я группа (<i>n</i>=24) — дети школьного возраста (8—18 лет), средний возраст 12 [9,5; 14,5] лет. В исследуемом периоде оценивались следующие показатели: успех вмешательства, осложнения на протяжении всего срока наблюдения, показатели РС по данным расширенного протокола эхокардиографии (ЭхоКГ), полученные в госпитальном, 30-дневном и 3-месячном периодах наблюдения. <h3>РЕЗУЛЬТАТЫ</h3> Всем детям было успешно выполнено эндоваскулярное закрытие ДМПП. Осложнений не выявлено. Анализ динамики ЭхоКГ в обеих группах выявил ряд достоверных изменений показателей и их возрастные особенности, свидетельствующие о положительном РС на протяжении всего периода наблюдения. В 30-дневный период наблюдения, начиная с 1-х суток после транскатетерной коррекции, в обеих группах происходили интенсивные изменения структурно-функциональных показателей камер сердца. К 3-му месяцу эти процессы замедлялись. В группе детей школьного возраста отмечены более выраженные изменения показателей РС по сравнению с детьми дошкольного возраста, что было связано с исходно более выраженным патологическим РС у детей старшего возраста, не получивших раннюю коррекцию ДМПП. <h3>ВЫВОД</h3> Эндоваскулярная коррекция ДМПП — эффективный и безопасный метод лечения пациентов. Ранняя окклюзия септального дефекта у детей младшего возраста оправданна ввиду менее выраженных и стойких патологических изменений, чем у детей старшей возрастной группы.

Diagnóstico ocasional de cisto ovariano durante procedimento de oclusão percutânea de comunicação interatrial

We present a case report in which a conventional intervention for the correction of atrial septal defect resulted in an exploratory videolaparoscopy and exeresis of an ovarian cyst. Atrial septal defect is one of the primary congenital cardiopathies diagnosed in adults; ovarian cysts present a high prevalence and are frequently asymptomatic. The possible relation between atrial septal defect and ovarian cyst is debated. The femoral venous puncture techniques, guided by anatomic landmarks and by ultrasonography, are analyzed from the perspective of current scientific evidence.

Хирургическая коррекция дефекта межпредсердной перегородки и фибрилляции предсердий у пациента 66 лет

Хирургическая коррекция дефекта межпредсердной перегородки и фибрилляции предсердий у пациента 66 лет

Right Minithoraсotomy as a Standard Approach for Mitral Valve Surgery

&#x0D; Background. Minimally invasive mitral valve surgery provides many advantages for patients.&#x0D; The aim. To investigate and represent our own experience in minimally invasive mitral valve surgery, and to describe the operative technique.&#x0D; Materials and methods. The study was included 100 consecutive patients who underwent a minimally invasive mitral valve repair or replacement through the right lateral minithoracotomy from June 2017 to December 2019.&#x0D; Results. Mitral valve repair was performed in 87 patients (87%), and 13 patients (13%) were required mitral valve replacement. In 24 patients (24%), concomitant procedures were performed: tricuspid valve repair, atrial septal defect repair and left atrial myxomectomy. Ring anuloplasty was performed in all patients who underwent mitral valve repair. Additional methods of correction were used in accordance to the lesion anatomy: neochords implantation, cleft and leaflet perforation closure, leaflet resection, Alfieri (edge-to-edge) stitch, posterior leaflet plication. There was no in-hospital and 30-day mortality. Post-operative strokes were not reported. No wound complications were observed in the femoral cannulation area. The total length of stay in a hospital was 6 ± 1.46 (3–9) days. There were no cases of mitral valve insufficiency greater more than mild degree after mitral valve repair at the time of discharge.&#x0D; Conclusions. Minimally invasive mitral valve surgery can be performed as a routine standard approach, provides safe and effective correction of the mitral valve defects, allows excellent results of mitral valve repair and replacement in various abnormalities. Minimally invasive approach enables to perform a large number of reconstructive valve techniques and perform simultaneous correction of atrial septal defects, tricuspid valve repair and atrial neoplasm removal.

Sinus septal defect closure with correction of partial anomalous pulmonary vein drainage through mini-thoracotomy

Mini-thoracotomy is one of the most popular minimally invasive approaches. This approach is used in the treatment of congenital and acquired heart diseases and characterized less surgical trauma, intraoperative blood loss, pain syndrome severity, risk of infectious complications and better cosmetic results. Successful correction of atrial septal defect (ASD) through right-sided mini-thoracotomy is reported in the article.

Результаты торакоскопической коррекции дефекта межпредсердной перегородки в условиях искусственного кровообращения

Результаты торакоскопической коррекции дефекта межпредсердной перегородки в условиях искусственного кровообращения

Natural history of secundum atrial septal defect in adults over 60 years

Atrial septal defect (ASD) is one of the most common causes of congenital heart disease manifested in adulthood and a subgroup of patients may not develop symptoms until late adulthood. The aim of our study was to describe clinical and likelihood picture of adults over 60 years born with an ASD type II. We performed a retrospective analysis of adult's ASD referred to our institution from 2010 through 2018. Clinical, electrocardiographic, echocardiographic and hemodynamic data were reviewed. For follow up study, patients were investigated by echocardiography, ECG and assessed for quality of life by a questionnaire. Among forty ASD type II manifested in adulthood, which were referred to our department of cardiology, five cases of ASD manifested in octogerian. Two men and three woman. Complaints were dyspnea and palpitations in 4 cases and chest pain in only one patient. Complete right bundle branch block and right ventricular hypertrophy were found in all cases. Three patients presented atrial fibrillation. Echocardiographic data revealed large secundum ASD (mean 20 mm,), severe systolic pulmonary pressure in two cases and moderate in one case. All patients were studied by venous cardiac catheterisation. The arterial saturation was markedly reduced in patients who had small right to left shunt. Three patients underwent percutaneous atrial septal defect closure. There were no deaths. At mean follow up of 50 months, most survival patients remain in good clinical condition. Two patients were in chronic atrial fibrillation developed during follow up. There is a lack of evidence regarding treatment options for adults with an ASD aged more than 60 years. Percutaneous correction of ASD is associated with low morbidity and mortality, and should be as early as possible to prevent hemodynamic complications, such as the development of pulmonary hypertension and cardiac arrhythmias.

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 remodelling after surgery. surgical correction of ASD in adults is safe and efficacious. Cardiac remodelling 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 remodelling.

Evaluation of Cardiac Remodeling After Surgical Closure of Atrial Septal Defect in Different Age Groups

Background &amp; objective: Cardiac remodeling manifested clinically as changes in size, shape and function of the heart. The extent of remodeling depends on initial morphological changes. So the time at which the surgical correction of atrial septal defect (ASD) done is important. Apparently surgical outcome and remodeling is better at earlier age in comparison to adult age. The aim of this study was to find whether surgical correction of ASD is beneficial at younger age (up to 18 years) in comparison to adult age (above 18 years).&#x0D; Methods: This prospective cohort study was carried out on a total of 70 patients who underwent surgical closure of atrial septal defect over a period of twenty three months (23) months (from February 2013 to December 2014) in the Department of Cardiac Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka. The recruited patients were divided into two groups – Group-A (comprised of ≤ 18 years old patients) and Group-B (comprised of &gt;18 years old patients) 35 patients in each. Condition of the heart was evaluated preoperatively by echocardiography and the result was compared with postoperative echocardiographic findings at follow-ups after 1 and 3 months after surgery.&#x0D; Results: The comparison of echocardiographic parameters between baseline (preoperative) and those at 1 and 3 months after surgery in Group-A demonstrated that statistically significant remodeling occurred after 1st month (p &lt; 0.001) and it further improved at 3 months. In Group-B the comparison of echo parameters between baseline and at 1 month revealed that all the parameters responded significantly indicating that remodeling occurred well after 1 month. But the same parameters when compared between baseline and at months after repair revealed insignificant differences in all the parameters, except PWT indicating that remodeling that occurred at month 1 regressed at 3 months interval. Cardiac remodeling occurred in both groups, but the degree of remodeling between patients of early age (Group-A) and late age (Group-B) revealed that ASD repair at early age responded well with respect to all the echocardiographic variables of remodeling.&#x0D; Conclusion: Cardiac remodeling occurs after surgical closure of atrial septal defect. But the degree of remodeling is better if the closure is done at earlier age (at or below 18 years).&#x0D; Ibrahim Card Med J 2018; 8 (1&amp;2): 48-52

Simultaneous Percutaneous Coronary Intervention and Endovascular Closure of Atrial Septal Defect in Adults

to assess clinical efficacy and expediency (appropriateness) of simultaneous single stage combined coronary stenting and closure of atrial septal defect. Of total number of patients who underwent endovascular correction of atrial septal defect (ASD) (n=91), in 6 (6.6 %) the procedure of endovascular repair of secondary ASD was combined with performed at same session oronary stenting. Mean age of these patients was 63±6.4 years. Mean diameter of ASD according to transesophageal echocardiography was 13.7±3.1 мм (from 10 to 17 mm). Two patients had dysplasia of atrial septum with pronounced aneurysmal protrusion in the right atrial cavity. Estimate of coronary arteries (CA) involvement SYNTAX score was 14.5±4.9. At initial stage we performed coronary stenting, then ASD closure with occluder. Technical success of combined endovascular procedures was 100 %. Six ASD occluders were implanted in 6 patients. Mean occluder diameter was 21±7,3 mm. Immediately after occluder implantation complete defect closure was achieved in 5 cases, in one case small residual shunt was observed. CA stenting procedure, in one patient after successful recanalization of chronic CA occlusion, in all cases was fulfilled without complications. At control examination after 13.5±1.5 months complete closure of defects was preserved. In all cases significant reduction of right heart chambers occurred. According to echocardiography right atrial volume decreased from 48.6±5.6 to 32.6±3.3 cm3, right ventricular volume - from 45.2±5.1 to 33.4±3.8 cm3, systolic pulmonary pressure fell from 49.7±8.6 to 32.6±6.9 mm Hg. According to control coronary angiography good effect of endovascular procedures was preserved. Tolerance to exercise rose from 68.5±11.8 до 85.3±12.4 W. Same time CA stenting and endovascular ASD closure appears to be safe and effective procedure. The strategy used was not associated with additive risk for a patient and shortened duration of hospital stay.

Long-term outcome of catheter ablation for atrial tachyarrhythmias in patients with atrial septal defect.

This study aimed to evaluate efficacy, safety, and long-term outcome of radiofrequency catheter ablation (RFCA) for atrial tachyarrhythmia (ATa) in patients with atrial septal defect (ASD). Seventy-five ASD patients with ATa (52% atrial fibrillation, AF) were enrolled. Electrophysiological study and RFCA were performed, with endpoints of index and multiple procedures as follows: (a) atrial tachycardia/atrial flutter (AT/AFL), absence of inducibility of any atrial arrhythmia and (b) AF, circumferential pulmonary vein ablation (CPVA, paroxysmal AF), bidirectional block of lines, and disappearance of complex fractionated atrial electrograms (persistent and long-standing persistent (LSP)-AF). Cumulative success rate at 1-year follow-up was 79.9% and dropped to 59.0% at a median follow-up of 63months (range, 14-114months) for multiple procedures (mean 1.6 ± 0.7 [1-3]). Freedom from ATa after multiple procedures was achieved in 75% patients with AT/AFL and 43.6% patients with AF (P = 0.006 for comparison). In multivariate analysis, older age at ASD correction (HR, 1.033 [95% CI, 1.008-1.059]; P = 0.01), ASD diameter before correction (HR, 1.054 [95% CI, 1.006-1.105]; P = 0.027), and first-diagnosed ATa type (AF; HR, 2.25 [95% CI, 1.03-4.92]; P = 0.042) were significant independent predictors of ATa recurrence. Patients with more risk factors had higher risk of ATa recurrence. The long-term outcome of RFCA for ATa outcome was favorable for AT/AFL while mediocre for AF. ATa recurrence was more common in patients with older age at ASD correction, larger ASD diameter before correction, and first-diagnosed AF. Patients with more risk factors had higher ATa recurrence risk.

Assessment of ventricular function in patients of atrial septal defect by strain imaging before and after correction.

Background:Atrial septal defect (ASD) is a common congenital heart disease associated with volume overload of Right ventricle (RV) with variable effect on Left ventricle (LV). Two-dimensional (2D) Strain analysis is a new tool for objective analysis of myocardial function. This prospective study evaluated the systolic function of right and left ventricle by conventional 2D echo and strain echo and measured changes in cardiac hemodynamics that occurred in patients of ASD before and after correction.Patients and Methods:2D echo and strain analysis of each patient before and at 48 hrs, 3 months and 6 months after correction was performed. Routine 2D echo parameters and global longitudinal strain of both ventricles were measured.Result:Improvement in LV ejection fraction (P = 0.0001) and myocardial performance index (MPI) (P < 0.0001) occurred at the end of 6 months, whereas decrease in RV MPI (P < 0.0001) and tricuspid annular plane systolic excursion (P < 0.0001) became statistically significant after 3 months of ASD correction. In comparison to conventional 2D echo, global longitudinal strain of RV decreased significantly only after 48 hours of ASD correction while there was no improvement in left ventricular global longitudinal strain after 6 month of correction.Conclusion:There was improvement in RV function with subtle change in LV function by strain imaging and most of these changes were completed within 6 months of ASD correction and nearly correlated with conventional 2DEchocardiography.

Results of endovascular correction of atrial septal defect and early heart remodeling in children of preschool and school age

Aim. To analyze the results and features of early cardiac remodeling (CR) in children of preschool and school age after endovascular correction of atrial septal defect (ASD).Material and methods. A prospective study included 27 children with secondary ASD who underwent endovascular correction for one year (from the beginning of 2017 to the beginning of 2018). The patients were divided into two groups. The first (n=12) — children of preschool age (&lt;8 years old), mean age 4,5 [3;6], and the second (n=15) — school age (8­18 years old), mean age 12 [9;14]. The following indicants were assessed during hospitalization: the success of the intervention, hospital complications, functional data characterizing CR according to echocardiography before and after the correction of the defect.Results. It was shown that all children successfully completed endovascular closure of ASD. Complications were not identified. We find several statistically significant changes in echocardiogram data before and after the intervention. In the preschool age group, the size of the right ventricle (RV) decreased from 1,66 to 1,45 cm (p=0,028), the right atrium (RA) decreased from 3,58 to 3,1 cm (p=0,003), and the longitudinal size of RV decreased from 3 to 2 cm (p=0,032) and basal size of RV — from 5,98 to 4,4 cm (p=0,005), the volume of RA decreased from 25,7 to 20,7 ml (p=0,005). In the group of school age, the size of the RV changed from 2,08 to 1,8 cm (p=0,038), the size of the RA — from 3,72 to 2,71 cm (p=0,007), the RV area in diastole — from 12,4 to 10,6 mm2. The gradient has changed from 2 to 1,54 mm Hg (p=0,043), the frontal size of the tricuspid valve (TV) decreased from 2,7 to 2,48 cm (p=0,010). The basal size of RV decreased from 3 to 2,6 cm (p=0,015), the median size — from 2,73 to 2,37 cm (p=0,017) and the longitudinal size — from 5,97 to 5,45 cm (p=0,007). No significant differences in CR among the groups were found.Conclusion. We made conclusion about the efficacy and safety of endovascular correction of ASD, which has a positive effect on early HR in children, both in early and in old age.

Invited Commentary

Invited Commentary

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