Large Secundum Atrial Septal Defect Research Articles

Surgical anastomosis of vertical vein to left atrial appendage: A case report of technical aspects

Management of partial anomalous pulmonary venous connection (PAPVC) differs significantly between the defect on the left side, which is adjacent to left atrial appendage, and that on the right one adjacent to the interatrial septum. Here, we report two patients operated at our center. The first case is an adult diagnosed with the left-sided PAPVC draining to an innominate vein through a left-sided vertical vein, and with a large ostium secundum atrial septal defect. The second case is a neonate with mixed-type total anomalous pulmonary venous connection with all right pulmonary veins opening into the coronary sinus, and all the left pulmonary veins connecting to the innominate vein through a left-sided vertical vein. Both patients experienced severe pulmonary arterial hypertension, necessitating surgical treatment involving disconnection of the vertical vein from its junction, or, ligation of the vertical vein-innominate vein junction, coupled with its redirection to the left atrial appendage. We employed different surgical procedures on these patients, given the distinct age difference, intending to anastomose their respective vertical veins to the adjacent left atrial appendage. In this report, the technical aspects of anastomosing vertical vein to left atrial appendage, to avoid pulmonary venous obstruction in these two patients, are discussed.

Managing a Challenge Case: Transesophageal Echocardiography-Guided Transcatheter Closure of a Large Secundum Atrial Septal Defect in a Pregnant Woman

Background: The management of complex cardiovascular conditions during pregnancy poses unique challenges, and in the case of a large secundum atrial septal defect (ASD), achieving successful closure through a transcatheter approach guided by transesophageal echocardiography (TEE) requires careful navigation and expertise. This study sought to present a case that exemplifies the contemporary approach of using TEE guidance for the closure of an ASD in pregnant women Case presentation: A 31-year-old woman with multigravida, diagnosed with secundum ASD and pulmonary hypertension, underwent TEE. The TEE examination revealed a significant ASD measuring 2.8-3.1 cm with inadequate surrounding rims. Subsequently, our intention was to employ a device to address this defect. TEE was utilized to guide the placement of a 14F delivery sheath into the left upper pulmonary vein and left atrium. Using a catheter, we successfully deployed a 40 mm ASD Occluder (MemoPart), concluding the intervention without any complications. Given the concerns regarding the potential risks of radiation exposure and teratogenic effects on fetal development, particularly in young patients and during pregnancy, it is crucial to prioritize TEE-guided closure of ASD for the safety of both the mother and the fetus. Conclusion: Closure of ASD with zero fluoroscopy proved to be a safe and effective procedure, demonstrating feasibility and significant benefits for pregnant women with ASD. Keyword: Atrial Septal Defect, Pregnant Woman, Transcatheter Closure, Transesophageal Echocardiography.

Improvement Functional Capacity In Adult After Percutaneous ASD Closure

This case report describes a 24-year-old woman with a secundum atrial septal defect (ASD) who underwent successful percutaneous ASD closure with significant improvement in symptoms and functional capacity. The patient presented with easy fatigue and shortness of breath on exertion for 10 years. Echocardiography revealed a large secundum ASD with moderate to severe tricuspid regurgitation, mild mitral regurgitation, mild pulmonary regurgitation, and dilatation of the right atrium and ventricle. Right heart catheterization confirmed a large left-to-right shunt and pulmonary hypertension. The patient underwent ASD closure with a Figulla Flex II device, resulting in immediate improvement of hemodynamics. Follow-up at 3 and 6 months demonstrated decreased right ventricular size, improved left ventricular function, and increased exercise caapacity. This case highlights the benefits of ASD closure in improving symptoms and cardiac function, even in patients with longstanding right ventricular dilation.

Kiosk 1Q-TA-02 - Assessment of Ebstein Severity in a 28-year-old Male with Multiple Large Ostium Secundum Atrial Septal Defects

Kiosk 1Q-TA-02 - Assessment of Ebstein Severity in a 28-year-old Male with Multiple Large Ostium Secundum Atrial Septal Defects

Atrial septal defect occluder devices and embolization – a case series

Introduction: Atrial Septal Defect (ASD) secundum is a commonly occurring congenital heart disease. Patients with unstable hemodynamic may require closure, which can be accomplished either percutaneous transcatheter of an atrial septal occluder (ASO) device or open surgery. Closure using an occluder carries the risk of device embolization (DE). Case Presentation: This case series presents two patients who had dislodgement after ASD closure using ASO. The demographic data, comorbidities, surgical details, and follow-up results are all summarized. A 9-year-old girl and a 12-year-old boy admitted to our centre. The girl echocardiography evaluation revealed dislodgment of ASD occluder in a large secundum ASD, right upper PV blockage, and a high chance of pulmonary hypertension (PH). While the boy showed the occluder device that was misplaced and positioned in the right ventricle. A secundum ASD with a left to right shunt and moderate TR with a peak pressure gradient of 21.5mmHg were also found. During the procedure, we discovered that the girl had an occluder in the superior rim of ASD II 3x2 cm, which was dislodged towards the lower right PV, above the mitral valve, and the posterior occluder leaflet was removed by replacing a section of the rim. We discovered a secundum ASD with a dimension of 2x1cm on the boy The occluder was found behind the anterior cusp of the tricuspid valve. The retrieved occluder device appeared intact, and the tricuspid valve was injured, but no rupture. Conclusion: The occurrence of ASO migration is uncommon, necessitating further surgery for device removal, closure of the remaining defect, and ensure there is no cardiac erosion or rupture. Surgery can also alleviate symptoms including shortness of breath and palpitations

Transcatheter closure of large ostium secundum atrial septal defects in symptomatic small children: A single-center retrospective study

ABSTRACT Background: In general, the risks associated with transcatheter atrial septal defect (ASD) device closure are reported to be relatively low, but the evidence stems from trials involving adults and older children. Current guidelines do not recommend ASD device closure in children with defect sizes >20 mm due to limited data available in this group of patients. This retrospective study sought to determine the clinical and procedural characteristics of successful transcatheter ASD device closure in small children with large defects and assess the complication rates and reasons for unsuccessful device closure. Methods: We retrospectively reviewed the data of all patients who underwent elective transcatheter closure of ostium secundum ASD in our department between September 2013 and February 2022. All children weighing <20 kg, requiring a device of size 20 mm or greater, were included. Major and minor complications were predefined and indications for referral were evaluated. Echocardiogram reports were reviewed from the time of referral, postcatheterization day 1, and at 1-year follow-up. Results: We identified 40 patients meeting inclusion criteria with a median (interquartile range [IQR]) procedural age of 5 (4–7) years and median (IQR) weight of 14 (12–18) kg. Successful device closure was achieved in 39 patients with a success rate of 97.5%. The total complication rate was 2.5% (95% confidence interval: 0.44%– I2.8%) with only 1 major complication. All children had right heart enlargement and exertional dyspnea, 30% of patients had recurrent lower respiratory tract infections, and 10% had failure to thrive. At 1-year follow-up, a transthoracic echocardiogram showed a well-endothelialized device in a stable position in all the patients, and none of the patients had a residual shunt. Conclusion: In experienced centers, percutaneous ASD closure of large defects in symptomatic small children can be done effectively and safely with a great degree of predictability and a low complication rate.

Combination of modified techniques for percutaneous closure of a large secundum atrial septal defect.

Combination of modified techniques for percutaneous closure of a large secundum atrial septal defect.

Anaesthethetic management of craniotomy for recurrent astrocytoma in case of large atrial septal defect with severe pulmonary hypertension: A case report

In adult population after bicuspid aortic valve, atrial septal defect (ASD) is the most common congenital acyanotic heart disease, with high prevalence in females. Large ASD with pulmonary hypertension (PAH) posted for non-cardiac surgery poses a challenge to anaesthesiologists because intraoperative hypercarbia, hypoxemia, and hyperthermia can result in increased pulmonary vascular resistance (PVR), which can result in shunt reversal, congestive heart failure, and fatal arrhythmias. We report successful anaesthetic management of 48yrs female case of recurrent astrocytoma posted for craniotomy. Patient was having large ostium secundum ASD (35 mm in diameter), with severe PAH having PASP 75mmhg by TR jet, with dilated RA/RV, moderate TR and LVEF 55% under GA, with titrated induction, avoiding rise in PVR and maintaining systemic vascular resistance (SVR) with vasopressors intraoperatively to avoid shunt reversal.:To concludepatients with severe PHT due to large ASD, require meticulous intraoperative management to prevent any rise in PAH, and maintenance of systemic vascular resistance with optimal oxygen delivery and excellent postoperative analgesia for excellent outcome.

Atrial septal defect and concomitant significant pulmonic stenosis in an adult patient

We report a case of an adult male with continued hypoxia and polycythemia after repair of significant pulmonic valve stenosis. A large ostium secundum atrial septal defect was found to be causing these symptoms. We discuss the workup at his initial visit and return to hospital, the diagnosis, and treatment of the pulmonic stenosis and atrial septal defect. We discuss the sudden onset of symptoms in this adult patient and the importance of further screening for a right-to-left shunt through an atrial septal defect in an adult patient with pulmonic stenosis.

Feasibility of Transcatheter Closure of Large Secundum Atrial Septal Defect with Absent Superior or Inferior Rim.

Introduction Surgical closure of a large secundum atrial septal defect (ASD) with an absent superior or inferior rim is the standard method of management, but transcatheter closure of such a defect is possible and feasible. Objectives To evaluate the feasibility, effectiveness, and safety of transcatheter closure of large secundum ASD with an absent superior or inferior rim through implantation of a cheatham platinum (CP) stent at the entrance of the superior vena cava (SVC) or inferior vena cava (IVC) into the right atrium (RA) to create a suitable rim for subsequent complete closure of the defect using a septal occluder. Patients and Methods. This case series was carried out at Ibn Al-Bitar Center for Cardiac Surgery, Baghdad, Iraq from 2014 to 2019, five patients underwent such transcatheter approach for closure of large secundum ASD with the absent superior or inferior rim by implantation of CP stent at the entrance of vena cave into the RA. Result The ages and weights of patients who were enrolled in this study ranged from 9–31 years (15.2 ± 9 years) and 31.5–62 kg (42.6 ± 12 kg). Three patients had absent superior rims, and the other two had absent inferior rims. The Qp/Qs was ranged from 1.9–3.2 (2.78 ± 0.29), and the mean pulmonary arterial pressure ranged from 22–29 mmHg (25.4 ± 3 mmHg). The defects with an absent superior rim were closed successfully by implantation of CP stents of 45, 45, and 39 mm to create a rim which supported the left atrial disc of 30, 38, and 32 mm atrial septal occluder (ASO), respectively, while large secundum ASD with an absent inferior rim could be effectively closed by implantation of two overlapping bare CP stents of 45 mm to create an IVC rim that supported 34 mm and 30 mm atrial septal occluder. Conclusion and recommendation. Transcatheter closure of large secundum ASD with absent superior or inferior rim is possible and effective by implantation of covered and bare CP stents at the entrance of SVC and IVC, respectively. Although these procedures are relatively difficult and challenging, especially in the closure of large defects associated with absent inferior rim, they carry a high risk of stent migration (8 zig, 45 mm), so we recommend using a CP-stent (10 zig, 60 mm).

2q37.3 Deletion with Complex Heart Defects Suggesting Interruption of Early Ventricular Looping

A maternally inherited 828 kb microdeletion of 2q37.3 manifested in a 3-week-old premature boy as left juxtaposition of the atrial appendages associated with tricuspid atresia, double outlet infundibulum, subvalvar pulmonary atresia, large secundum atrial septal defect, and right aortic arch with mirror-image branching, consistent with developmental arrest early in heart looping. To the best of our knowledge, no previous 2q37 deletion syndrome has been reported with such a severe cardiac dysmorphology. Hence, this case adds to the cardiac phenotypes identified in 2q37 deletion syndrome.

Early inflammatory reaction and thrombus formation post Gore® Septal Occluder Device insertion for an atrial septal defect

A 40-year-old man with an incidental large secundum atrial septal defect (sASD) with left to right shunt (Qp:Qs 2.7:1) and right ventricular dilatation presented for elective percutaneous closure with a 44mm Gore® Septal Occluder (GSO) device. Single dose cephazolin was given peri-procedurally. Implantation was uncomplicated and the patient was commenced on aspirin and clopidogrel post-operatively.

Very large Atrial Septal Defect Device Closure: Feasibility and safety

Objectives: There is limited data regarding feasibility and safety of very large ASD devices deployment. Percutaneous closure of very large atrial septal defect (ASD) is a valid alternative to surgical approach. But complications like erosion, cardiac perforation, atrioventricular block, pericardial effusion, infective endocarditis, or cardiac arrhythmias may occur following ASD device closure.
 Methods: Forty four patients with very large ostium secundum ASD were studied in a tertiary medical centre. Adult patients with defect size of 38 mm or more and device size of 40 mm or more were selected for device closure. Patients having suitable anatomy, significant left to right shunt(>1.5:1) ,right ventricular volume overload and without significant pulmonary arterial hypertension were chosen for device closure.
 Results : There were thirty six female patients and eight male patients in our study. Majority of our patients (twenty four) were in forty to fifty years age group. Device could be deployed successfully in forty two (95.5%). Twelve patients had device size of 46 mm (27%). Eight patients had 44 mm devices(18%). Forty two millimeter devices were used in sixteen patients (36%). Eight patients had device size of 40 mm(18%).Device embolization occurred in two patients. There were two cases of pericardial effusion and pericardiocentesis was needed in one patients. Transient complete heart block was seen in one patient. Four patients had suffered from transient and self terminating atrial arrhythmias. There was no mortality or erosion in our study.
 Conclusion: Percutaneous closure of very large ASD is feasible and associated with low complication rate

Atrial septal defect presenting as intractable congestive heart failure in an infant with dismal outcome: A Case report

Congenital heart disease is a major cause of morbidity and mortality in children. We are presenting a 2-month-old infant with large ostium secundum atrial septal defect (ASD) with congestive heart failure. Isolated ASD usually does not present at this age. We are presenting this case due to unusual early presentation with isolated ASD.

Prevalence and Spectrum of Complex Congenital Heart Disease in the Neonatal Intensive Care Unit at High Altitude in China

Background: Previous studies from high altitudes have reported significantly higher prevalence of congenital heart disease (CHD), consisting almost solely of simple CHD. Little is known about the occurrence of complex CHD. Neonates with complex CHD are likely admitted to NICU. We examined the prevalence and spectrum of complex CHD in NICU in order to depict a truer picture of CHD at high altitude. Methods: We reviewed charts of 4,214 neonates admitted to NICU in Qinghai province (average altitude 3,000 m). Echocardiography was performed in 1,943 babies when CHD was suspected based on clinical examinations. Results: CHD was diagnosed in 1,093 (56.3% of echoed babies). Mild CHD in 96.8% (1058 babies). Moderate CHD in 0.8% (9) included 1 (0.1%) large secundum atrial septal defect, 3 (0.3%) moderate pulmonary stenosis, 2 (0.2%) aortic stenosis and 3 (0.3%) partial anomalous pulmonary venous connection. Severe CHD in 2.4% (26) included 6 (0.5%) complete atrioventricular septal defect, 5 (0.5%) complete transposition of the great arteries, 5 (0.5%) hypoplastic right heart, 3 (0.3%) hypoplastic left heart, 3 (0.3%) double outlet right ventricle, 3 (0.3%) tetralogy of Fallot, 2 (0.2%) truncus arteriosus, 2 (0.2%) total anomalous pulmonary venous connection, 2 (0.2%) severe aortic stenosis, 2 (0.2%) interrupted aortic arch and 2 (0.2%) severe pulmonary stenosis and 1 (0.1%) single-ventricle abnormality. At two-years follow-up in 737 (67.4%) patients, 18 (90%) with severe CHD and 38 (5.3%) with mild and moderate CHD died, and 15 underwent cardiac surgery with 1 early death. Conclusions: At high altitude, a wide spectrum of CHD exists, with many heretofore unreported complex CHD. There is urgent need for routine echocardiography and early interventions in newborns particularly in NICU.

Advanced therapies in Eisenmenger syndrome

BackgroundThis is a case report of a patient diagnosed with Eisenmenger syndrome in adult life.Case presentationThe patient had a large secundum atrial septal defect diagnosed incidentally in her twenties, with established pulmonary vascular disease and thus the defect was not closed. Over several years the patient showed signs of progressive disease with premature right ventricular dysfunction, preceding any significant symptomatic decline. Her medical therapy was escalated with the addition of intravenous epoprostenol, resulting in both objective and symptomatic improvement.ConclusionsEarly medical intervention and treatment can positively impact on the outcome of patients with pulmonary arterial hypertension associated with congenital heart disease.

Left ventricular rotational deformation changes by speckle tracking imaging before and 24hours after transcatheter closure of large secundum atrial septal defects in children.

Large atrial septal defects (ASDs) in children cause increased volume overload of the right side of the heart which in turn lead to impairment of left ventricular (LV) performance. The aim of this study was to evaluate immediate LV rotational deformation changes in children with large ASDs post-device closure and removal of right ventricle (RV) volume overload. Twenty children who underwent transcatheter closure (TCC) of large secundum ASDs were included in the study. LV rotational deformation was assessed pre- and 24hours post-device closure using speckle tracking imaging (STI). 55% were females with mean age 6.1±3.5years. LV peak basal clockwise rotation improved significantly (-6.9±2.6° before vs -10.3±4.1° after TCC, P=.005), and time to peak clockwise rotation (345.1±124.7 milliseconds (ms) before vs 282.2±82.9ms after closure, P=.02). There was no significant difference in apical rotational parameters including peak counterclockwise rotation (P>.05 for both). LV twist (11.3±3.8° before vs 17.5±7.1° after closure, P=.001) and torsion (2.1±0.7°/cm before vs 3.1±1.2°/cm after closure, P=.01) were significantly improved, mainly as the result of improvement of LV basal rotation. LV revealed a significant increase in LV end-diastolic volumes (P=.02) 24hour after TCC with no significant change (P>.05) in end-systolic volumes after closure. Increased peak LV twisting and torsion were attributed to the improved peak systolic clockwise basal rotation after TCC of large ASDs in children.

Long-Term Follow-Up of Transthoracic Echocardiography-Guided Transcatheter Closure of Large Atrial Septal Defects (≥ 30 mm) Using the SHSMA Occluder

Transcatheter closure of large atrial septal defects (ASDs) remains controversial. The aim of this study was to evaluate the feasibility and safety of transthoracic echocardiography (TTE)-guided transcatheter closure of large ASDs. Patients with large secundum ASDs (≥ 30mm) who underwent device closure were retrospectively reviewed. TTE was performed to guide ASD occluder positioning and assess the immediate and long-term outcomes. A total of 60 patients (median age 43.5years, range 15-78years) were enrolled in the study. The median ASD size was 35mm (range 30-42mm). Mild to moderate pulmonary hypertension was observed in 36 patients (60%). Thirty-one patients (51.7%) had one short rim, and 18 patients (30.0%) had two deficient rims. Placement of the device was successful in 57 patients (95%), and the median device size was 42mm (range 40-50mm). Dislodgement of the device occurred in three patients with two deficient rims: a larger device was redeployed in one case, and two patients required surgical repair. During a median follow-up of 37months (range 6-83months), no residual shunts, erosion, or embolization were noted, and pulmonary hypertension resolved in 75% of the patients. Thus t vast majority (95%) of large ASDs can be successfully closed percutaneously using the Chinese-made Shanghai Shape Memory Alloy (SHSMA) occluder under TTE guidance. Long-term follow-up showed that transcatheter closure could become a safe and effective alternative to surgery in select large ASDs.

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.

A Novel Minimally Invasive Technique of Temporary Caval Occlusion for Right Heart Surgery

Right heart surgery is challenging in the minimally invasive cardiac surgery setting, particularly in terms of caval isolation procedures in patients with enlarged and pressurized atria. We describe a novel minimally invasive caval occlusion technique with the use of a balloon catheter designed for temporary large vessel occlusion. A patient with a large ostium secundum atrial septal defect and significant shunt flow underwent a successful minimally invasive closure of the pathological connection between atria with a bovine pericardial patch. The utilized occlusion technique provided excellent visibility of the surgical site and may facilitate minimally invasive procedures in various clinical scenarios.