Correction Of Septal Defect Research Articles

Endovascular correction of postinfarction ventricular septal defect: own successful experience

Despite the current development of cardiology, postinfarction rupture of the interventricular septum (IVS) is one of the most hazardous, life-threatening complications of acute myocardial infarction. The paper describes a clinical case of a 63-year-old female patient with a history of an acute ST-elevation myocardial infarction complicated by IVS rupture. The difficulties in the management of this patient and a comparative analysis of our treatment strategy with the available modern literature data on this issue are also presented.

Effect of breast milk oral care in infants who underwent surgical correction of ventricular septal defect - EXPRESSION OF CONCERN.

Effect of breast milk oral care in infants who underwent surgical correction of ventricular septal defect - EXPRESSION OF CONCERN.

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.

The choice of tactic for surgical treatment of aortic arch hypoplasia with ventricular septal defect in infants

Aim: to determine the optimal tactic for surgical correction of aortic arch hypoplasia and ventricular septal defect (VSD) in infants based on the comparison of immediate and follow-up outcomes of one- and two-stage repair.Materials and methods. Between 2011 to 2019, 138 patients under the age of one year underwent surgical repair of aortic arch hypoplasia with VSD in the leading Ukrainina cardiosurgical institutions – National M. Amosov Institute of Cardiovascular Surgery Affilated to National Academy of Medical Sciences of Ukraine and Center for Pediatric Cardiology and Cardiac Surgery. Patients were divided into two groups: group I involved 66 (47.8 %) patients who underwent one-stage repai of aortic arch hypoplasia and VSD, group II included 72 (52.2 %) patients with two-stage repair, consisting of aortic arch reconstruction and pulmonary banding at the first stage, and correction of VSD at the second stage.Results. The total hospital mortality was 3.6 % (n = 5). In group I, hospital mortality was 3.0 % (n = 2), in group II – 4.2 % (n = 3), but this difference is not statistically significant (P > 0.05). Follow-up was from 1 month to 11 years. Mortality rate over follow-up period was 0 %. Aortic arch restenosis developed in 16 (11.6 %) patients: 6 (9.1 %) patients in group I and 10 (13.9 %) patients in group II. There was no statistically significant difference in restenosis development between two groups. Compression of the trachea and left main bronchus developed in two patients of group II (2.8 %). There were no residual VSDs which would need repeated repair.Conclusions. Both one-stage and two-stage tactic for surgical treatment of aortic arch hypoplasia with VSD in infants is effective and safe showing good immediate and long-term follow-up results. The study indicates that one- stage correction is more acceptable in infants with hypoplasia of segment C or all aortic arch segments. Stage tactic can be used in hypoplasia of segments B and A.

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.

Abstract 13374: Larger Atria and Increased Atrial Filling Pressures in Corrected Atrial Septal Defect Patients

Introduction: After atrial septal defect (ASD) correction, pulmonary arterial pressures drop and the right-sided chambers start to remodel. Full normalization may not occur, which can explain the increased morbidity and mortality observed later in life. We described cardiac physiology in adults with a corrected ASD in order to understand the long-term morbidity and mortality. Hypothesis: ASD patients have enlarged right atria and increased pulmonary arterial pressures despite correction. Methods: Participants (percutaneously (n=19) and surgically (n=19) corrected ASD patients and 11 controls of similar age) underwent echocardiography, International Physical Activity Questionnaire, right heart catheterization, cardiopulmonary exercise test, and Holter-monitoring 15-20 years after ASD correction as part of a larger study. Echocardiographic measurements and invasive pressures obtained at rest are reported. Results: Right and left atrial end-systolic volumes, volume index, and filling pressures are higher in corrected ASD patients (particularly the surgically corrected) when compared with controls. Conclusion: ASD patients (particularly surgically corrected) have higher atrial volumes compared with healthy matched controls 15-20 years after correction, while still within the normal range. During systole, the peak atrial pressures are increased in ASD corrected patients, which correlate well with the atrial volumes seen on echocardiography. These findings show that cardiac remodeling has occurred post-correction, but full normalization is not reached. The differences in atrial size and filling pressure in corrected ASD compared to that in controls may be a marker of ASDs leading to myocardial disease and explain why ASD patients experience increased morbidity and mortality later in life.

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

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

Результаты торакоскопической коррекции дефекта межпредсердной перегородки в условиях искусственного кровообращения

Результаты торакоскопической коррекции дефекта межпредсердной перегородки в условиях искусственного кровообращения

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.

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 (<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.

Case report of combined correction of postinfarction ventricular septal defect

We present a case of successful combined correction (endovascular and surgical) of postinfarction ventricular septal defect in a woman at a late stage after acute myocardial infarction onset.

Disturbed diastolic left ventricular inflow vortex ring formation in patients with corrected atrioventricular septal defect: quantitative three-dimensional vortex core analysis from 4DFlow MRI

Background Vortex formation in the left ventricle (LV) is suggested to contribute to efficient blood pumping and altered vortex formation is associated with diastolic dysfunction. Patients after atrioventricular septal defect (AVSD) correction present abnormalities in valve morphology and subsequently develop altered inflow patterns (Calkoen et al. JMRI 2014), which may disturb normal vortex formation. We aimed to analyze vortex ring formation in AVSD-corrected patients compared to healthy controls and to evaluate association with inflow angle.

Reply to Arslan et al.

[1] Yan L, Zhou Z-C, Li H-P, Lin M, Wang H-T, Zhao Z-W et al. Right vertical infra-axillary mini-incision for repair of simple congenital heart defects: a matched-pair analysis. Eur J Cardiothorac Surg 2013;43: 136–41. [2] Massetti M, Nataf P, Babatasi G, Khayat A. Cosmetic aspects in minimally invasive cardiac surgery. Eur J Cardiothorac Surg 1999; 16:73–5. [3] Mishaly D, Ghosh P, Preisman S. Minimally invasive congenital cardiac surgery through right anterior minithoracotomy approach. Ann Thorac Surg 2008;85:831–5. [4] Vida VL, Tessari C, Fabozzo A, Padalino MA, Barzon E, Zucchetta F et al. The evolution of the right anterolateral thoracotomy technique for correction of atrial septal defects: cosmetic and functional results in prepubescent patients. Ann Thorac Surg 2013;95:242–7. [5] Ohuchi H, Kyo S, Asano H, Tanabe H, Yokote Y, Omoto R. Development and clinical application of minimally invasive cardiac surgery using percutaneous cardiopulmonary support. Jpn J Thorac Cardiovasc Surg 2000;48:562–7.

Mycobacterium fortuitumEndocarditis Associated with Cardiac Surgery, Serbia

To the Editor: Mycobacterium fortuitum is a member of the group of rapidly growing nontuberculous mycobacteria. It is a well-known causative agent of skin and soft tissue infections, postsurgical wound infections, and other health care–associated infections (1). Only sporadic cases of endocarditis caused by this bacterium have been reported (2–4). We describe a cardiac surgery–related outbreak of endocarditis caused by M. fortuitum in 3 children. Over a 3-week period during 2009, eight children consecutively underwent surgery for correction of ventricular septal defect (VSD) by insertion of a bovine pericardial patch at the University Children’s Hospital in Belgrade, Serbia. None of them had previous cardiac surgery. The same patch, SJM Pericardial Patch with EnCap Technology (St. Jude Medical, St. Paul, MN, USA), was used as a source for smaller, tailored patches for all patients. Sterile scissors and forceps were used to tailor a piece of the patch needed for a corresponding VSD closure. During repeated performances of this procedure and between surgeries, the patch had been continuously stored in 2% propylene oxide (PO) provided by the manufacturer. Each tailored piece of the patch had been immersed into freshly prepared sterile saline for 6 min before defect patching. The postoperative course had been uneventful for all patients, and they were discharged 7 days after the procedure. However, 3 patients were readmitted to the hospital because of prolonged fever and increasing fatigue. Patients 1, 2, and 3 (Table) had been the fourth, sixth, and eighth patients undergoing VSD repair, respectively. Diagnosis of infective endocarditis in these patients was established by transthoracic echocardiography findings and blood cultures positive for acid-fast bacteria (Table). Acid-fast bacteria also were recovered from the patch and vegetation taken during reoperation in patient 3 (Table). The isolates were identified as M. fortuitum by the GenoType Mycobacterium CM assay (Hain Lifescience, Nehren, Germany) (5). Empiric treatment with vancomycin and ceftriaxone was switched to amikacin, ciprofloxacin, and imipenem. After 6 weeks of treatment, the patients were discharged, and all were asymptomatic 12 months later. Table Characteristics of patients in an outbreak of Mycobacterium fortuitum endocarditis, Serbia* The cultural characteristics and susceptibility patterns of all the isolates obtained were indistinguishable. To explore their possible clonal relatedness, we genotyped 3 M. fortuitum strains isolated from blood cultures (1 isolate per patient) and 2 M. fortuitum isolates recovered from samples taken during reoperation in 1 of the patients. The enterobacterial repetitive intergenic consensus PCR was used (6), and all isolates produced identical patterns. Nosocomially acquired M. fortuitum endocarditis has been reported but only sporadically in adults, and these cases usually were fatal (3,4,7). In contrast, we describe 3 related cases of M. fortuitum endocarditis in children who recovered. The relatedness of the cases is strongly supported by the following. First, epidemiologic links are obvious because the 3 patients underwent surgery in the same operating room, and the same patch was used in all of them. Second, M. fortuitum strains isolated from the 3 patients were phenotypically and genotypically identical. Repeated use of the same patch in multiple surgeries strongly suggests the contaminated patch was the source of M. fortuitum infection in the 3 patients. This possibility could not be corroborated by bacteriologic examination of the patch because the remaining unusable fragments had been discarded after the surgeries (i.e., ≈3 months before the outbreak became evident). Although contamination of the patch during manufacture is possible (8), it seems more reasonable to assume that the contamination occurred intraoperatively. The common factor in nosocomially acquired M. fortuitum infections is presumed to be exposure to a liquid contaminated with this organism (1,9). The patch was not exposed to solutions other than the PO in which it had been stored and the sterile saline used during the rinsing procedure. Because only a piece of the patch tailored for a particular patient was exposed to a saline freshly prepared for each surgery, contamination of the PO by M. fortuitum presumably led to contamination of the patch. Liquid PO is used as a chemical sterilant for bioprostheses intended for single use. However, multiple use of the same patch implied repeated exposure of the PO solution to the environment and prolonged storage at 4°C between surgeries. Because PO effectiveness is markedly reduced at temperatures <16°C (10), the specific circumstances could have compromised the sterilizing capacity of the PO solution and enabled contamination by ubiquitous M. fortuitum. We are well aware that the patch was intended for single use only and that application of the same patch in multiple patients is not a practice in industrialized countries. However, it is a practice in some resource-limited countries. The outbreak of M. fortuitum endocarditis we describe is a clear warning that such practice is associated with high risk and thus should be discontinued.

Successful Two-Stage Correction of Ventricular Septal Defect and Patent Ductus Arteriosus in a Patient with Fixed Pulmonary Hypertension

We report a case of a 6-year-old boy with fixed severe pulmonary artery hypertension secondary to a ventricular septal defect (VSD) together with a patent ductus arteriosus (PDA). As a preliminary step, PDA embolization was performed following therapy with inhaled prostacyclin over a period of 6 months. Further, the patient underwent successful surgical VSD closure. We postulate that a staged procedure with long-term prostaglandin therapy might be capable of reducing pulmonary artery resistance and permitting total correction in a patient once considered to have inoperable pulmonary arteriopathy.

Results after surgical correction of secundum atrial septal defect in adults

Results after surgical correction of secundum atrial septal defect in adults

Atrial natriuretic peptide levels in adult patients before and after surgery for correction of atrial septal defects: relationship with atrial arrhythmias.

In the present study, we have examined whether increased N-ANP (N-terminal pro-ANP) levels before and after surgery in patients with ASD (atrial septal defect) along with echocardiographic findings provide a better insight into the pathophysiology and increased morbidity and mortality following corrective surgery. Eighteen adult ASD patients (> 20 years of age; six male and 12 female) with shunts (Qp/Qs > or = 2, where Qp/Qs is the pulmonary blood flow/systemic blood flow) had complete echocardiographic, clinical and laboratory parameters evaluated before and 6 months after surgery. Eight age- and sex-matched individuals (three male and five female) were enrolled as a control group. Blood samples for N-ANP analysis were obtained in both groups. N-ANP levels in the peripheral blood sample from ASD patients before surgery were significantly higher than those in the control group. In patients with ASD, mean N-ANP levels obtained from the pulmonary artery were significantly higher than that obtained from the peripheral vein. RA (right atrial) area, adjusted for body surface area, and RA long-axis and short-axis measurements were significantly higher in the patient group than the control group. N-ANP was correlated significantly with these parameters. Following corrective surgery, N-ANP values and RA area, RA long-axis and short-axis normalization decreased significantly and were accompanied by a decrease in systolic mean pulmonary artery pressure. N-ANP levels were normalized following septal closure in most patients, except in those with atrial fibrillation attacks following corrective surgery. In conclusion, we have shown correlations among variables indicating changes in the architecture of the right atrium along with temporal changes in ANP providing insights into the pathophysiology of post-operative atrial arrhythmias.

Influence of surgical correction of atrial septal defect on heart rate variability in children

Influence of surgical correction of atrial septal defect on heart rate variability in children

Influence of surgical correction of atrial septal defect on heart rate variability in children

Influence of surgical correction of atrial septal defect on heart rate variability in children

Abnormal pattern of flow in the superior caval vein in children after open heart surgery.

To investigate the pattern of flow in the superior caval vein in children after open heart surgery, we examined the flow velocity curves in 37 patients who had undergone surgical correction of either ventricular or atrial septal defects. The control group consisted of 64 age-matched children. We used pulsed Doppler examinations to record the velocity curves. We measured the highest and lowest peak flow velocities during systole and diastole, and calculated ratios for the various measurements. We found that the velocity of the wave in systole is lower than that of the wave in diastole in the postoperative patients, which is contrary to the normal pattern. The velocity in systole increases more than that in diastole during inspiration, which is also different from the normal pattern. The change in pattern of flow velocity curve during respiration was smaller in patients after surgery than in normal subjects, which might indicate that there is less reserve ability in the right atrium in postoperative patients.