Ostium Secundum Defect Research Articles

Sinus venosus defect of the pulmonary vein-type: An easily missed diagnosis.

Atrial septal defects are one of the most common forms of congenital heart disease, however sinus venosus communications, particularly pulmonary vein-type defects, are rare and are easily misdiagnosed. Patients with pulmonary vein-type sinus venosus defects often present earlier than those with ostium secundum defects with significant right heart dilation. Correct diagnosis has important implications for management. We discuss the clinical courses and review multimodality imaging of three patients correctly diagnosed with pulmonary vein-type defects after an initial diagnosis of an ostium secundum atrial septal defect, in order to promote understanding of the unique anatomy of this entity.

Percutaneous closure of a secundum atrial septum defect performed under hypnosis: a case report

Atrial septal defects (ASDs) are the third most common type of congenital heart diseases with ostium secundum defects (ASDsII) being responsible for approximately 75% of these defects. The treatment consists of either a transcatheter closure or a surgical intervention. The transcatheter approach offers a less invasive alternative for patients who fulfill anatomical and size criteria and is therefore increasingly used as the preferred primary intervention. As general anaesthesia is sometimes contra-indicated for some patients needing ASD or PFO closure and intracardiac echocardiography (ICE) is not always readily available, alternative “supportive” techniques as hypnosis could be of interest. In our case, a relative contra-indication for general anaesthesia was pronounced due to the severely impaired pulmonary function caused by severe deformative torsional scoliosis. Over the years several reviews have been published on hypnotic analgesia used together with usual care suggesting that hypnotic analgesia is a promising non-pharmacologic adjunct treatment for ameliorating pain and surgical distress. Also, various cardiological procedures under hypnosis have already been described in literature, but this is the first time that percutaneous ASD closure under virtual reality (VR) hypnosis is mentioned in literature.

Atrial Septal Defect.

Atrial septal defects are common congenital heart defects, characterized by insufficient/absent tissue at the interatrial septum. An unrepaired defect may be associated with right heart volume overload, atrial arrhythmia or pulmonary arterial hypertension. The 3 major types of atrial septal defect are: ostium secundum defect, ostium primum defect, and sinus venosus. Characteristic physical findings include a midsystolic pulmonary flow or ejection murmur, accompanied by a fixed split-second heart sound. Small defects may spontaneously close; larger defects may persist and result in hemodynamic and clinical sequelae requiring percutaneous or surgical intervention. Severe pulmonary arterial hypertension is a contraindication to closure.

Value of P wave dispersion in pediatric patients with secundum atrial septal defect

Objective:Ostium secundum defect is the common cause of RA enlargement. The aim in this study is to evaluate P wave dispersion in children to the size of atrial septal defect.Method:Forty–one children with isolated secundum atrial septal defect (and 41 age-matched controls evaluated. Using the same 12 lead ECG device in resting position, P maximum and P dispersion measured.Results:Mean P dispersion in atrial septal defect children is prolonged compare to the controls (P dispersion: 29.1±10.1 vs. 25.3±5.5 ms, P=0.009). And children with right atrial dilation had significantly longer P maximum (101.2±14.1 vs. 81.7±12.3 ms, P<0.001) and larger P dispersion (35.0±11.4 vs. 26.5±8.3 ms, P=0.003) compared to those without right atrial dilation.Conclusion:Children with moderate to large sized ASD are valuable to have prolonged. Atrial conduction time in the form of P duration and P dispersion. Also, it’s a good tool for diagnosing ASD in places where echocardiography imaging is not available. We can also differentiate between small ASD and large one based on P dispersion.

Iatrogenic pulmonary artery dissection in patient with ostium secundum interatrial septum defect

Pulmonary artery dissection is a rare and lethal condition. Few cases are reported in the literature, and most are derived from autopsies. In most cases, pulmonary artery dissection is a complication of chronic pulmonary hypertension leading to pulmonary artery aneurysm but there are other causes. We describe a case of iatrogenic pulmonary artery dissection in an elderly patient with ostium secundum defect. In particular, we describe the role of cardiac magnetic resonance in making this diagnosis and guiding future therapeutic decisions.

STEMI and CVA in Hypercoagulable State with Ostium Secundum Defect.

Atrial septal defect (ASD) is a risk factor for multiple vascular thrombotic events, which can occur either sequentially or simultaneously. In this report we present a case of ST-elevation myocardial infarction (STEMI) and cerebrovascular accident (CVA). The severity of adverse cardiovascular or cerebrovascular events can be increased by the presence of specific type of ASD, such as a patent foramen ovale (PFO) or osteum secundum defect. This case report discusses a unique presentation of a 48-year old male on warfarin therapy for a history of cerebral venous thrombosis (CVT) who subsequently presented with simultaneous STEMI with CVA, and who was incidentally found to have an ostium secundum defect on echocardiography. He was emergently taken for cardiac catheterization, which revealed significant proximal LAD occlusion. There has been a long standing debate within the international scientific communities regarding the therapeutic benefit of PFO closure for long-term secondary prevention of recurrence CVA. We discuss the different points of view regarding PFO closure for secondary prevention of CVA with a review of the literature on this rather controversial topic.

Two-dimensional speckle tracking echocardiography for assessment of both atria functions in patients with atrial septal defect

Background: of all the types of congenital heart disease, ASDs represent the second most common and account for 7% to 10% of all congenital heart defects. The most common type of atrial septal communication is an ostium secundum defect, representing 80% of all ASDs. In unaffected individuals, the chambers of the left side of the heart are under higher pressure than the chambers of the right side. In the case of ASD, which may result in a clinically remarkable left-to-right shunt, blood shunts from the left atrium to the right atrium. This extra blood from the left atrium may cause a volume overload of the right side. Aim of the Work: The aim of this work was to assess feasibility of using 2-dimensional speckletracking echocardiography (2D-STE) for evaluation of left and right atrial function in patients with unrepaired atrial septal defect, to compare both LA & RA function in patients with unrepaired atrial septal defect with those apparently healthy individuals, and to correlate both LA & RA function with the size of inter-atrial shunting. Patients and Methods: The ethical approval was obtained from the hospital Ethical Research Committee and each patient entering the study signed an informed consent. Thirty patients included in this study with secundum atrial septal defect. All were under the age of sixteen at time of diagnosis. They were recruited from cardiovascular department at Sayed Galal University Hospitals during the period from December 2016 to November 2018. Results: Speckle tracking echo of both atria showed a significant correlation with QP/QS, ASD maximal size, ASD minimal size, RA to LA area ratio and pulmonary pressure. Patients with PH were older (33.4+/-14.6 vs. 23.8 +/- 12.2 years; p<0.06) and had larger defects (17.8+/4.6 mm vs. 14.5.1+/- 5.0 mm; p<0.08). The proportion of women was nearly similar in both groups (55% in patients with PH vs. 63% in those without; p=NS). Most patients with PH had ASDs with more complex shapes on echocardiography. However, some patients with simpler and smaller defects, such as central ASD with a diameter of <5 mm, also developed PH. Conclusion: The new echocardiographically-derived myocardial deformation indexes, which reflect structural changes assessed by transthoracic echocardiography, can be used to detect abnormalities in atrial function before clinical deterioration

Recent advances in managing septal defects: atrial septal defects

The purpose of this review is to discuss the management of atrial septal defects (ASD), paying particular attention to the most recent developments. There are four types of ASDs: ostium secundum, ostium primum, sinus venosus, and coronary sinus defects. The fifth type, patent foramen ovale—which is present in 25 to 30% of normal individuals and considered a normal variant, although it may be the seat of paradoxical embolism, particularly in adults—is not addressed in this review. The indication for closure of the ASDs, by and large, is the presence of right ventricular volume overload. In asymptomatic patients, the closure is usually performed at four to five years of age. While there was some earlier controversy regarding ASD closure in adult patients, currently it is recommended that the ASD be closed at the time of presentation. Each of the four defects is briefly described followed by presentation of management, whether by surgical or percutaneous approach, as the case may be. Of the four types of ASDs, only the ostium secundum defect is amenable to percutaneous occlusion. For ostium secundum defects, transcatheter closure has been shown to be as effective as surgical closure but with the added benefits of decreased hospital stay, avoidance of a sternotomy, lower cost, and more rapid recovery. There are several FDA-approved devices in use today for percutaneous closure, including the Amplatzer® Septal Occluder (ASO), Amplatzer® Cribriform device, and Gore HELEX® device. The ASO is most commonly used for ostium secundum ASDs, the Gore HELEX® is useful for small to medium-sized defects, and the cribriform device is utilized for fenestrated ASDs. The remaining types of ASDs usually require surgical correction. All of the available treatment modes are safe and effective and prevent the development of further cardiac complications.

The Role of Transesophageal Echocardiography in Adolescents and Adults with Congenital Heart Disease

There is frequent dropout of atrial septal echoesin the region of the fossa ovalis in the standard precordial echocardiographic imaging planes, that can be minimized by use of the subcostal imaging approach. The diagnostic sensitivity of this approach was reviewed in 154 patients (mean age 31 years, range 18years to 45 yrs) with documented atrial septal defect in whom a satisfactory image of the atrial septum could be obtained.Subcostal two-dimensional and color Doppler echocardiography successfully visualized 93 (89%) of the 105 ostium secundum atrial septal defects, all 32 (100%) ostium Primum defects and 7 (44%) of the 16 sinus vinosus defects. A defect was not visualized (false negative response) in 12 patients (11 %) with an ostium secundum defect and in 9 patients (56%) with a sinus venosus defect. In three of the former and five of the latter, a two-dimensional echocardiographic contrast examination and transesophageal echocardiography established the presence of the inter-atrial shunt. Forty eight patients (32 %) with clinical findings of uncomplicated atrial septal defect confirmed by two-dimensional,color Doppler and Transesophageal echocardiography underwent surgical repair of the defect without preoperative cardiac catheterization. There were no perioperative complications.University Heart Journal Vol. 11, No. 2, July 2015; 63-67

Congenital heart disease in the older adult: a scientific statement from the American Heart Association.

The population of adults with congenital heart disease (ACHD) has increased dramatically over the past few decades, with many people who are now middle-aged and some in the geriatric age range. This improved longevity is leading to increased use of the medical system for both routine and episodic care, and caregivers need to be prepared to diagnose, follow up, and treat the older adult with congenital heart disease (CHD). The predictable natural progression of CHD entities and sequelae of previous interventions must now be treated in the setting of late complications, acquired cardiac disease, multiorgan effects of lifelong processes, and the unrelenting process of aging. Despite the advances in this field, death rates in the population from 20 to >70 years of age may be twice to 7 times higher for the ACHD population than for their peers.1 This American Heart Association (AHA) scientific statement will focus on the older adult (>40 years old) with CHD. It is meant to be complementary to the 2008 American College of Cardiology (ACC)/AHA guidelines for ACHD and orient the reader to the natural history, ramifications of childhood repair, and late initial diagnosis of CHD in the older adult. This population with CHD is unique and distinct from both the pediatric and young adult populations with CHD. Much of the information we provide is from scientific research combined with clinical experience from longitudinal care. We emphasize that this is the beginning of a discussion regarding this rapidly growing population, and continued research aimed at the progression of disease and complications reviewed here is necessary to advance the field of ACHD with the scientific rigor it deserves. ACHD encompass a broad range of presentations. There are people who are diagnosed for the first time in adulthood, as well as those with prior palliative repair …

PP-085 Prenatal Diagnosis of Isolated Ostium Secundum Defect by Ultrasound in the Second Trimester

The heart consists of four chambers. Of these, two of them are named as atriums. These chambers at the heart's upper floor are separated by a membrane wall. The holes of various sizes and locations on this membranous wall is called as Atrial Septal Defect(ASD). ASD has four major types: A-) Secundum ASD: at the Fossa ovalis, the most common B-) Primum ASD: Partial AVSD, C) Sinus venosus ASD and D) Coronary sinus ASD. Sinus venosus ASD and coronary sinus ASD are rare. We aimed to present a secundum ASD case detected in the second-trimester detailed obstetric US examination.

Atrial septal defect closure through a right thoracotomy in adults

Background: Minimally invasive approaches have become a feature of cardiac surgery. We compared the outcomes of atrial septal defect closure through either a right thoracotomy or a median sternotomy in adults. Methods: Patients who underwent atrial septal defect closure of ostium secundum defects through either a right thoracotomy ( n = 14) or a median sternotomy ( n = 7) were analyzed. The atrial septal defect was closed with cardiac arrest of the ascending aorta clamped under a cardiopulmonary bypass in both groups. Results: The preoperative characteristics of the two groups did not significantly differ. The durations of cardiopulmonary bypass and of cardiac arrest were significantly longer, but the amount of intraoperative blood loss was significantly lower, in the right thoracotomy than in the median sternotomy group. The early postoperative course did not significantly differ between the groups, whereas postoperative minor complications developed in three and two patients in the right thoracotomy and median sternotomy groups, respectively. Conclusion: The outcomes of atrial septal defect closure through a right thoracotomy and a median sternotomy were comparable, suggesting that right thoracotomy is a safe and effective alternative to median sternotomy for atrial septal defect closure in adults.

Anaesthetic management of a patient with Atrial Septal Defect with Pulmonary Hypertension posted for Total Abdominal Hysterectomy: a Case Report

An asymptomatic 52 year old lady with Atrial Septal Defect of Ostium Secundum type with mild Pulmonary Hypertension was admitted in our hospital with complains of menorrhagia. After a thorough pre- operative evaluation, adequate preparation she underwent total abdominal hysterectomy under combined epidural and general anaesthesia. By providing proper intraoperative and postoperative care, patient was managed without any complication and was discharged home within a week. 1 . Based on the portion of atrial septum that has failed to develop normally, ASDs are anatomically classified into four types: ostium secundum (85%), ostium primum (10%), sinus venosus(5%), and coronary sinus defects(rare). Spontaneous closure occurs by 18 months in almost all patients born with ASDs 8mm rarely close spontaneously and may require surgery later in life 2 . The majority of ASDs are detected in childhood although a significant minority is only diagnosed in adult life. Initially right ventricular compliance is substantially greater than the left ventricle and this is associated with the development of a left-to-right shunt. Pulmonary blood flow is increased and pulmonary hypertension develops with increasing age. A consequence of these physiological changes is dilatation of both left and right atria, the right ventricle and the pulmonary arteries in order to accommodate the increased blood volume. Ultimately either the right ventricle fails, or right ventricular compliance falls, resulting in a reduction in the magnitude of shunting, or even flow reversal 3 . Presentation depends upon the magnitude of the left to right shunt. Effort dyspnea is seen in 30% of patients by the third decade and more than 75% of patients by the fifth decade. Atrial arrhythmias (atrial fibrillation and flutter) are common and are secondary to atrial dilatation. Clinical examination reveal fixed splitting of the second heart sound coupled with a pulmonary flow murmur. The classically described electrocardiogram of an ASD is right bundle branch block (RBBB) and axis deviation (right for secundum and left for primum) 4 . Complications of ASD in adults include: paradoxic emboli, effort dyspnea, atrial tachyarrhythmia, right sided heart failure with pregnancy, pulmonary hypertension and mitral insufficiency 5 .

Mixed Atrial Septal Defect

A 19-year-old woman admitted to the our cardiology department with progressive dyspnea on effort and palpitations. Her blood pressure 115/85 mmHg, heart rate 70/min, and respiratory rate 20/min. Cardiac auscultation revealed 2/6 grade systolic ejection murmur at the left upper sternal border. Electrocardiography demonstrated sinus rhythm with incomplete right bundle branch block. Transthoracic echocardiography revealed right atrial and ventricular enlargement and a left-to-right shunt within the atrial septum. In Doppler echocardiography demonstrated moderate tricuspid regurgitation. Pulmonary artery pressure was 38 mmHg and the Qp/Qs ratio was 1.6. Transesophageal echocardiography showed an ostium secundum defect, 5 mm in diameter (Figure 1, arrow), and a sinus venous defect, 15 mm in diameter (Figure 2, arrow).

Short-term results of the Warden technique: a retrospective single-center study

Results Besides the anomalous pulmonary venous connection to the superior vena cava, 5 (56%) patients also presented an ostium secundum or patent foramen ovale atrial defect and 2 (22%) presented persistent left superior vena cava. One patient presented Turner Syndrome. Before surgery, 3 (33%) patients presented some form of conduction disorder: two right bundle branch block and one atrial extrasystole. The mean age at surgery was 10.8 ± 7.6 (min = 2, max = 29.7) years, and the distribution of the sexes was 2:1, the majority being male. None patient underwent reoperation or evolved to death during the follow-up period. After surgical repair, a forth patient presented with right bundle branch block. The degree of right chambers dilatation improved significantly at both atrial (p = 0,002) and ventricular (p = 0,046) level, after surgical repair. Three (33%) patients had postoperative tricuspid and/or pulmonary insufficiency. No venous obstruction occured.

Update on Heart Failure, Heart Transplant, Congenital Heart Disease, and Clinical Cardiology

In the year 2012, 3 scientific sections—heart failure and transplant, congenital heart disease, and clinical cardiology—are presented together in the same article. The most relevant development in the area of heart failure and transplantation is the 2012 publication of the European guidelines for heart failure. These describe new possibilities for some drugs (eplerenone and ivabradine); expand the criteria for resynchronization, ventricular assist, and peritoneal dialysis; and cover possibilities of percutaneous repair of the mitral valve (MitraClip®). The survival of children with hypoplastic left heart syndrome in congenital heart diseases has improved significantly. Instructions for percutaneous techniques and devices have been revised and modified for the treatment of atrial septal defects, ostium secundum, and ventricular septal defects. Hybrid procedures for addressing structural congenital heart defects have become more widespread. In the area of clinical cardiology studies have demonstrated that percutaneous prosthesis implantation has lower mortality than surgical implantation. Use of the CHA2DS2-VASc criteria and of new anticoagulants (dabigatran, rivaroxaban and apixaban) is also recommended. In addition, the development of new sequencing techniques has enabled the analysis of multiple genes.

Actualización en insuficiencia cardiaca, trasplante cardiaco, cardiopatías congénitas y cardiología clínica

In the year 2012, 3 scientific sections—heart failure and transplant, congenital heart disease, and clinical cardiology—are presented together in the same article. The most relevant development in the area of heart failure and transplantation is the 2012 publication of the European guidelines for heart failure. These describe new possibilities for some drugs (eplerenone and ivabradine); expand the criteria for resynchronization, ventricular assist, and peritoneal dialysis; and cover possibilities of percutaneous repair of the mitral valve (MitraClip®). The survival of children with hypoplastic left heart syndrome in congenital heart diseases has improved significantly. Instructions for percutaneous techniques and devices have been revised and modified for the treatment of atrial septal defects, ostium secundum, and ventricular septal defects. Hybrid procedures for addressing structural congenital heart defects have become more widespread. In the area of clinical cardiology studies have demonstrated that percutaneous prosthesis implantation has lower mortality than surgical implantation. Use of the CHA2DS2-VASc criteria and of new anticoagulants (dabigatran, rivaroxaban and apixaban) is also recommended. In addition, the development of new sequencing techniques has enabled the analysis of multiple genes.Full English text available from:www.revespcardiol.org/en

An isolated cleft of the anterior leaflet of mitral valve in an infant: a case report

Background : Isolated cleft of the anterior leaflet of the mitral valve is the occurrence of mitral cleft without ostium primum or ostium secundum defect and it is rare. It results from various degrees of failure of fusion of early embroyonic atrioventricular endocardial cushions and occurs more in children with trisomy 21. It commonly presents with mitral incompetence which worsens as the child grows. Aim : To document a case of congenital isolated cleft of the anterior leaflet of the mitrial valve in an infant. Findings : A nine month old boy presented in our clinic with a two month history of fast breathing, cough, and loss of weight. He was found not to be cyanosed but pale, tachypnoeic, dyspnoeic with basal crepitations. Cadiovascular system examination revealed he had a precordial bulge with tachycardia, cardiomegaly and a holosystolic murmur maximum at the apex. There was tender hepatomegaly. He was diagnosed as having congestive cardiac failure with broncho- pneumonia secondary to an acyanotic congenital heart disease. Plain chest X-ray confirmed the cardiomegaly and bronchopneumonia while an electrocardiography showed bilateral atrial enlargement with right ventricular hypertrophy. The cardiac failure was treated but he represented with recurrent heart failure upto three times within six months. An echocardiogram done on the third admission showed an isolated cleft of the anterior leaflet of the mitral valve and he has been referred for surgery. Conclusion : Isolated cleft of the mitral valve commonly presents with mitral incompetence and eventual heart failure as in our patient. Early surgical intervention is adviced as the width of the cleft tend to increase as the child grows leading to worsening of the mitral insufficiency. The definitive treatment is direct closure of the cleft. The presentation also highlights the challenges of medical practice in resource-poor countries. Keywords : Congenital , heart, isolated cleft, mitral valve, ostium primum, ostium secundum

Clinical analysis on interventional treatmen for patients with ostium secundum defect

ObjectiveTo evaluate the clinical efficacy of interventional therapy for patients with ostium secundum atrial septal defect (ASD).MethodsOne hundred and fifty patients (male-90, female-60), age at 2–71 (12±5) years old. Diagnosis...

Transseptal puncture through atrial septal closure devices

Ostium secundum defects involve the region of the fossa ovalis and represent 80% of all atrial septal defects (ASDs). They account for approximately 7% of all congenital malformations. 1 Warnes C.A. Liberthson R. Danielson G.K. et al. Task force 1: the changing profile of congenital heart disease in adult life. J Am Coll Cardiol. 2001; 37: 1170-1175 Abstract Full Text Full Text PDF PubMed Scopus (1054) Google Scholar Small defects (<1 cm) may be left alone, but some patients develop right heart dilation later in life due to increased left ventricular end-diastolic pressure (LVEDP) and left-to-right shunting. Considerable shunt (Qp/Qs >1.5), right atrial/right ventricular enlargement, and paradoxical embolism are the main indications for ASD closure. 2 Warnes C.A. Williams R.G. Bashore T.M. et al. ACC/AHA 2008 guidelines for the management of adults with congenital heart disease. J Am Coll Cardiol. 2008; 52: e1-e121 Abstract Full Text Full Text PDF PubMed Scopus (239) Google Scholar , 3 Baumgartner H. Bonhoeffer P. De Groot N.M. et al. ESC Guidelines for the management of grown-up congenital heart disease (new version 2010). Eur Heart J. 2010; 31: 2915-2957 Crossref PubMed Scopus (1848) Google Scholar Recently, device closure has emerged as the treatment of choice for secundum ASD when the anatomy is suitable. 2 Warnes C.A. Williams R.G. Bashore T.M. et al. ACC/AHA 2008 guidelines for the management of adults with congenital heart disease. J Am Coll Cardiol. 2008; 52: e1-e121 Abstract Full Text Full Text PDF PubMed Scopus (239) Google Scholar , 3 Baumgartner H. Bonhoeffer P. De Groot N.M. et al. ESC Guidelines for the management of grown-up congenital heart disease (new version 2010). Eur Heart J. 2010; 31: 2915-2957 Crossref PubMed Scopus (1848) Google Scholar Transseptal access and atrial fibrillation ablation guided by intracardiac echocardiography in patients with atrial septal closure devicesHeart RhythmVol. 8Issue 11PreviewPercutaneous positioning of closure devices is a well-established treatment of atrial septal defects (ASDs). However, patients who have undergone the procedure are at increased risk for developing atrial fibrillation (AF), and treatment by catheter ablation is underutilized due to the perceived difficulty of obtaining transseptal access in the presence of the closure device. Full-Text PDF