Ostium Secundum Type Research Articles

Effect of percutaneous closure on atrium and appendage functions in patients with secundum atrial septal defects.

The study aimed to assess the impact of percutaneous transcatheter atrial septal defect (ASD) closure on atrium and atrial appandage functions among patients with ostium secundum ASDs. A total of 101 patients (34,7% male, 65,3% female, 37,6 ± 12) with the diagnosis of ostium secundum type ASD underwent transthorasic (TTE) and transesophageal echocardiography (TEE) before and six months after percutaneous transcatheter ASD closure. Pulmonary venous flow and atrial appendage flow velocities were obtained from the TEE recordings. The offline evaluation of the global and segmental atrial appendage strains were evaluated with speckle tracking echocardiography (STE) via EchoPac 6,3 (GE Vingmed, Horten, Norway). Mean values of pulmonary artery pressure, right ventricular, left atrium, left ventricular end-diastolic and end-systolic diameters were significantly decreased 6 months after ASD closure. Statistically significant changes were documented in pulmonary venous and left atrial appendage flow velocities after ASD closure. Both left and right atrial appendage flow velocities and global strains of atrial appandages were improved after ASD closure. The mean left atrial appendage global strain value was - 11.45 ± 4.13% before the procedure, this value was - 16.82 ± 3.78% sixth months after the procedure (P < 0.001).The mean right atrial appendage global strain was - 13.31 ± 4.84% before the procedure and - 18.53 ± 4.69% sixth months after the procedure (P < 0.001). Left and right atrial appendage flow velocities and global strains of left and right atrial appandage can be improved after transcatheter ASD closure. Percutaneous transcatheter closure of ASDs not only improves atrial and left ventricular dimensions but also have a positive impact on left and right atrial appandage functions.

A rare case of pulmonary artery to left atrium fistula

BackgroundThe first description of right pulmonary artery-to left atrium communication was done by Friedlich and coauthors in 1950. The right pulmonary artery and left atrium are directly connected by the right pulmonary artery to left atrial fistula through a thin-walled aneurysm. Here, we describe a female adult patient who underwent investigation for dyspnea and had Type 1 right pulmonary artery to left atrium connection.Case presentationTwenty-two-year-old female presented with history of breathlessness (New York Heart association classification grade III) for 3 years. On initial examination, her saturation was 60% with no clinical evidence of cyanosis. Initial radiographic examination and CT pulmonary angiogram revealed a dilated communication between the right inferior pulmonary artery and left atrium. The patient was then referred for cardiac MRI. The MR imaging showed the following findings: Dilated right ventricle and atrium with Ostium secundum type of atrial septal defect. Large focal outpouching was noted arising from the right inferior pulmonary artery whose inferomedial portion appeared to communicate with left atrium. The final diagnosis was right pulmonary artery to left atrial fistula-Type I with ostium secundum type atrial septal defect. Midline sternotomy was performed for ligation of this fistula with septal correction. Post surgery, patient began to improve clinically and her saturation in room air increased to 92%ConclusionsRight pulmonary artery to left atrial fistula is different from the pulmonary AV fistula and its rarity directs the need for imaging to diagnose the condition and for management selection. The fistulous connection, which most frequently originates from the posterior wall of the descending branch of RPA and inserts into the LA, is readily seen on CT/catheter angiography. Due to the rarity of this entity and much fewer evidences in imaging, we have reported a type 1 right pulmonary artery to left atrium connection.

Sufficient versus deficient rims during percutaneous closure of ostium secundum type atrial septal defect: A systematic review and meta-analysis

BackgroundThe aim of this meta-analysis was to compare the efficacy and adverse events of percutaneous occlusion among patients with sufficient and deficient rims. MethodsA systematic review of all articles published in the Pubmed, MEDLINE and Google Scholar databases was performed. Odds ratio (OR) and 95% CI were used as a measure of effect of the combination of studies. I2 with 95% CI was estimated to assess study heterogeneity. For the meta-analysis, a random effects model was used. ResultsThe systematic search identified ten studies which included 4355 patients; 2661 of those had sufficient rim and the remaining 1694 patients showed some rim deficiency. Implant failure rate was 4.13% CI 95% 3.53–4.72%. Compared to frequency of failures in the group with a deficient rim (5.43% CI 95% 4.35–6.50%), implant failure in patients with a sufficient rim was significantly lower (3.30% CI 95% 2.62–3.97%), OR 2.27 CI 1.34–3.83 (p 0.002).The combined adverse events were 5.19% CI 95% 4.22–6.35% vs 2.7% CI 95% 2.08–3.31% in the deficient vs sufficient rim groups respectively (OR 2.21 CI 0.93–5.29; p 0.07). Implant failures and adverse events were more frequent in patients with posterior inferior rim deficiency. ConclusionPatients presenting a posteroinferior rim deficiency are associated to both, an increased incidence of closure failure and a combined adverse events occurrence. More studies on posterior rim deficiency are necessary to ensure the feasibility and safety of the percutaneous approach.

Comunicación interauricular extensa tipo ostium secundum en un paciente canino de edad avanzada

Shunt lesions in the septum separating the two atrial chambers are among the most common congenital heart malformations. It is in most cases associated with morbidity and mortality. A 12-year-old mixed-breed female canine was referred for a detailed examination due to symptoms, such as exercise intolerance and peritoneal fluid leakage. Echocardiographic examination revealed an atrial septal defect (ASD) of the ostium secundum type (left to right shunt). The patient lived for 8 months after the diagnosis. Upon performing the necropsy, a defect of 21 mm in diameter was detected in the atrial septum. Based on the location, an ostium secundum type atrial septal defect was diagnosed. The peculiarity of this case is that the patient lived for over 13 years, in an asymptomatic state, with a large atrial septal defect, relative to the animal’s size and weight.

PS-C28-10: HYPERTENSIVE CARDIOMYOPATHY AS MOST FREQUENT ECHOCARDIOGRAPHIC FINDING IN PATIENTS HOSPITALIZED FOR ISCHEMIC STROKE.

Objective: In Spain occurs about 120,000 strokes per year. Initial study usually requires echocardiography to rule out cardioembolic source. We describe most common echocardiographic features in neurological patients and traditional risk factors in them. Methods: From August 2020 to August 2021, 502 consecutive Neurology echocardiograms were analysed, collecting data in SPSS for subsequent descriptive and analytical statistical analysis. Results: 45% were women. Most frequent study reason was ischemic stroke (66%), followed by transient ischemic attack (TIA) (11%), haemorrhagic stroke (2%) and miscellaneous (fever, cardiac enzyme release, dyspnoea, coma) (15%). Highest frequent risk factor was hypertension (HBP) (70%), followed by obesity (51%), dyslipidaemia (46%), diabetes (32%), and kidney failure (15%). Atrial fibrillation (AF) had been documented in 13%, while De novo AF was discovered in an additional 14.5%. Systemic inflammation disorders were present in 19% and hypercoagulability in 9%. 10% had suffered a previous stroke (90% ischemic), and 2.6% TIA. About treatment 27% had antiaggregation drugs on stroke moment and 12% were anticoagulated (5.6% VKA and 6.6% DOAC). In echo images, absence of structural heart disease was the most frequent finding (49%), followed by LA dilatation (48%) and ventricular hypertrophy &gt; 13 mm (34%), both characteristic of hypertensive heart. 5% showed valve disease (more frequent mitral regurgitation) and 5% Cor pulmonale. Cardiomyopathy was found in 3% (Dilated 2.6%). Patent foramen ovale, and aneurysm of the interatrial septum were rare (1% each). Ostium secundum type ASD only one case (0.2%). In the follow-up 5% had a new event (stroke or TIA) in next 12 months and additional 4.4% evidence of AF was found, this variable being related to left atrial dilatation in statistical analysis. Conclusions: In our sample of patients with ischemic stroke the abnormal finding most recurrent was hypertensive heart disease (HBP, LA dilatation, and LVH). LA dilation was related to the development of AF during follow-up, this relationship being statistically significant (p &lt; 0.001) by chi-square test. The percentage of de novo AF discovered in the same stroke episode (14.5%) is noteworthy. The ineffectiveness of antiaggregation (27% took it) and that anticoagulation does not completely eliminate risk either. Presence of structural anomalies such ASD, PFO or thrombus was rare (less than 1%).

Atrial Septal Defect in Two Nigerian Adults: 2 Case Reports

ASD is one of the most common asymptomatic congenital heart defects manifesting in adulthood. We report two cases managed in a tertiary facility in Nigeria. The first case is a 31-year-old woman who came to the hospital with overt symptoms of heart failure. Color Doppler showed a left to right shunt in the inter-atrial septum (Ostium Primum type). She subsequently improved with anti-failure regimen and anticoagulants. The second case is a 32-year-old man who presented with easy fatigability of four months. Transthoracic echocardiogram revealed a mid-inter-atrial septal defect (Ostium Secundum type) with dilated heart chambers. He is for surgery pending when finances permit.

Congenital hypopituitarism and multiple midline defects in a newborn with non-familial Cat Eye syndrome

BackgroundCat eye syndrome (CES) is a rare chromosomal disease, with estimated incidence of about 1 in 100,000 live newborns. The classic triad of iris coloboma, anorectal malformations, and auricular abnormalities is present in 40% of patients, and other congenital defects may also be observed. The typical associated cytogenetic anomaly relies on an extra chromosome, derived from an inverted duplication of short arm and proximal long arm of chromosome 22, resulting in partial trisomy or tetrasomy of such regions (inv dup 22pter-22q11.2).Case presentationWe report on a full-term newborn, referred to us soon after birth. Physical examination showed facial dysmorphisms, including hypertelorism, down slanted palpebral fissures, and dysplastic ears with tragus hypoplasia and pre-auricular pit. Ophthalmologic evaluation and heart ultrasound identified left chorioretinal and iris coloboma and ostium secundum type atrial septal defect, respectively. Based on the suspicion of cat eye syndrome, a standard karyotype analysis was performed, and detected an extra small marker chromosome confirming the CES diagnosis. The chromosomal abnormality was then defined by array comparative genome hybridization (a-CGH, performed also in the parents), which identified the size of the rearrangement (3 Mb), and its de novo occurrence. Postnatally, our newborn presented with persistent hypoglycemia and cholestatic jaundice. Endocrine tests revealed congenital hypothyroidism, cortisol and growth hormone (GH) deficiencies, which were treated with replacement therapies (levotiroxine and hydrocortisone). Brain magnetic resonance imaging, later performed, showed aplasia of the anterior pituitary gland, agenesis of the stalk and ectopic neurohypophysis, confirming the congenital hypopituitarism diagnosis. She was discharged at 2 months of age, and included in a multidisciplinary follow-up. She currently is 7 months old and shows a severe global growth failure, and developmental delay. She started GH replacement treatment, and continues oral hydrocortisone, along with ursodeoxycholic acid and levothyroxine, allowing an adequate control of glycemic and thyroid profiles as well as of cholestasis.ConclusionsCES phenotypic spectrum is wide and highly variable. Our report highlights how among the possible associated endocrine disorders, congenital hypopituitarism may occur, leading to persistent hypoglycemia and cholestasis. These patients should be promptly assessed for complete hormonal evaluations, in addition to major malformations and midline anomalies. Early recognition of such defects is necessary to decrease fatal events, as well as short and long-term related adverse outcomes.

DYSPNEA IN AN ADULT WITH ATRIAL SEPTAL DEFECT AND SJÔGREN’S SYNDROME: WHO’S TO BLAME?

ASD and more frequently the ostium secundum type is a relatively common adult congenital heart disease. Sjogren’s syndrome on the other side is the second most frequent auto immune disease, Involving the lungs in 9–20% of patients. We report the case of a 69 years old woman, complaining of a long-standing dyspnea and was diagnosed with Sjogren’s syndrom. Her CT scan and pulmonary function tests were normal. That lead to investigate for pulmonary hypertension as a potential cause for her dyspnea. A TTE was performed and estimated her systolic pulmonary pressure at 30 mmhg, and showed an OS ASD with left to right shunt. Right heart catheterization calculated her mPaP at 20 mmhg. She is scheduled for percutaneous closure of her OS ASD. There are only few cases reporting an association between ASD and Sjogren’s syndrome in polyendocrine syndrome, and even fewer without polyendocrine syndrome. Farook and Al. discussed a case of a women presenting OS ASD with SS complicated with PAH, suggesting an association between the two pathologies by inflammatory process, and Inoue et Al. presented a case of a women with polyartritis rheumatoid and Sjogren’s syndrome complicated with PAH, inducing a right to left shunt through a patent foramen oval. In our case, the ostium secundum type ASD with left to right shunt with mild pulmonary hypertension is probably the reason for her dyspnea, as there was no interstitial lung disease with normal CT and PFT.Unfortunately, there is no sufficient data suggesting an eventual association between ASD and Sjogren’s syndrome without polyendocrine syndrome. The learning point is the importance of screening for congenital heart disease in adult with unexplained dyspnea.

Persistent left superior vena cava with absent right superior vena cava in the setting of viscero-atrial situs solitus: a rare systemic venous drainage

A 34-year-old male with complaints of dyspnoea on exertion underwent transthoracic echocardiography which revealed ostium secundum type atrial septal defect (ASD) with moderate tricuspid regurgitat...

P1246 The Eustachian valve: a structure not so innocent

Abstract Background The eustachian valve is an embryological remnant of the inferior vena cava (IVC) valve. It is usually absent or inconspicuous and has no known function in the normal adult. However, there are reports suggesting that the EV is not as innocent as we thought. The EV can be a site of infective vegetations or be mistaken for a thrombus or tumor. The EV can also make interventional procedures (closure of ASD (atrial septal defect) or ablation for atrial flutter) more laborious. Clinical Case A 80 year-old female patient was referred to the emergency department after an episode of acute palpitations, right chest pain, followed by syncope. She had a previous medical history of type 2 diabetes and epilepsy. On admission she was normotensive (104/67mmHg). The ECG showed atrial fibrillation with heart rate of 180 beats per minute. The echocardiogram show slight dilation of the right ventricle and bilateral atrial dilatation. The blood tests documented an elevated D-dimers 2,73 μg/mL, troponin (hs-TNT 27ng/L) and NT-proBNP 4339pg/ml, with a normal renal function. Computed tomographic (CT) pulmonary angiography revealed filling defects on the segmentar and subsegmentar inferior lobes, compatible with the diagnosis of pulmonary embolism and also revealed a dilatation of the main pulmonary trunk (35mm). Based on this result the patient start anticoagulation with low molecular weight heparin and heart rate control with bisoprolol. However besides of this strategy the patient remain in atrial fibrillation without a controlled hear rate and an transesophageal echocardiography (TOE) was performed. The TOE shown a small freely mobile mass – thombi - at the inferior vena cava-right atrium (IVC-RA) junction tethered at the eustachian valve; a small atrial septal defect (4mm) – ostium secundum type – with a left to right shunt; and a preserved biventricular function (figure 1). Based on this exams we optimize the therapy with digoxin and amiodarone with a good control of the heart rate and patient was discharge on warfarine, bisoprolol and digoxin asymptomatic and to be reevaluated on cardiology clinic. Discussion/Conclusion: The eustachian valve in adult is an embryological remainder of the fetal venous sinus valve. This structure is located in the right atrium and is a common, not pathological, echocardiographic finding. It is known that a small percentage of the pulmonary embolisms, thrombi are discovered in the right side of the heart; however, their presence on the Eustachian valve is very unusual. Besides this in our particular case in the present we will have also to ensure that the anticoagulation is effective to avoid that the trombi migrates into the systemic circulation by the atrial septal defect. Abstract P1246 Figure.

Superior Sternal Cleft – A Rare Congenital Anomaly Associated with Atrial Septal Defect

The sternal cleft is a rare anomaly occurring in 1 in 50, 000 – 100, 000 births. It results from either partial or total failure of sternal fusion early in embryological development. A few causes such as riboflavin deficiency, alcohol abuse during pregnancy, and disruption in the HOX-B4 gene have been postulated. Although asymptomatic, clinical diagnosis is easily made at birth due to the obvious chest defect and abnormal movements of the thorax. Surgery is indicated to prevent mediastinal injury, respiratory and hemodynamic sequelae, allow optimal growth of the chest, and cosmesis. We report a case of superior sternal cleft and skin defect associated with isolated ostium secundum type of atrial septal defect in an apparently healthy term female newborn. This is to create awareness among Paediatricians on this very rare type of congenital anomaly that should warrant further investigation for aetiologies and full evaluation in Nigeria. Also, to share the knowledge that will aid counseling of affected families because of possible environmental/social causes, and concerning recurrence in other siblings due to a genetic predisposition.

Rare association of celiac disease with congenital heart disease

Celiac disease (CD) is an autoimmune enteropathy caused by exposure to dietary gluten in genetically predisposed individuals. CD is a multisystem disease involving gastrointestinal, hepatobiliary, nervous, hematologic, and cardiovascular systems. Few associations of congenital heart disease have been reported with CD. We report a case of an 8-year-old female, who was presented to the hospital with severe anemia and undernutrition. She had severe pallor, clubbing, hepatomegaly, and a Grade ? systolic ejection murmur. Echocardiography revealed a large ostium secundum type of atrial septal defect and patent ductus arteriosus. The increased levels of serum IgA anti-tissue transglutaminase (anti-TTG) antibody have arisen suspicion of CD, which was confirmed after the histopathological study of the duodenal biopsy. We are reporting this case to highlight the rare association of the CD with congenital heart disease.

Second-degree Atrioventricular (Mobitz 1) Heart Block in a 52-hour-old Newborn: A Very Rare Case Report

Background: Cardiac conduction disorders are rare syndromes in neonates and children. According to the literature atrial septal defect, especially ostium secundum type, is associated with atrioventricular (AV) block. Wenckebach conduction heart block is very rare in a neonate; however, there is a dearth of research on the prevalence of this type of heart block regarding the neonates and pediatrics literature. This disorder has only been addressed earlier in thalassaemia major and dengue fever in Pediatrics. There have been different anatomical and metabolic and genetic etiologies for this condition. Wenckebach block is a gradual delay in sending the electrical signal from the sinoatrial node to the ventricles with each beat until there is a single dropped beat, which could be uneventful or problematic later in life. This study aimed to present a deep investigation of a rare case of congenital Wenckebach conduction heart block. Case report: The case in this study was a 52-hour-old female neonate who was diagnosed to suffer from Mobitz type 1 or Wenckebach heart block possibly due to a small ostium secundum atrial septal defect. Therefore, it was suggested to provide supportive care and regular follow-up visit. Conclusion: Precise antenatal care and investigation are required to reduce the morbidity and mortality rate of such condition.

Spectrum of morphological abnormalities and treatment outcomes in ostium secundum type of atrial septal defects: Single center experience in >500 cases

BackgroundTranscatheter closure (TCC) has emerged as the first line treatment option for secundum type of atrial septal defects (ASD). Outcomes of TCC depend upon proper delineation of defect anatomy by transesophageal echocardiography (TEE). Stability and proper placement of the device mandates adequate rims and proper alignment to the septum. Failed or unfavorable morphology for TCC requires referral for surgical repair. MethodsWe prospectively analyzed the ASD patients who were referred for treatment. The morphological features of the defect were evaluated and the outcomes of TCC studied. Patients who undergo TCC and surgical repair were followed for immediate and long-term outcome comparison. ResultsOf the 512 patients who underwent treatment, TCC was attempted in 430/512 (83.2%) patients. It was successful in 393/430 (91.3%) patients. The remaining 119 patients underwent surgical patch closure. Twenty patients had failure of device alignment and device embolization occurred in 17 patients. Very large defect size ≥35 mm, absent or deficient posterior rim, absent/deficient inferior naval rim showed high chances for failure and formed major reasons for surgical referral. The surgical group had higher success (100%) across all anatomic variables. However, they had longer intensive care unit (ICU) and hospital stay (p < 0.001). ConclusionTCC offered a success rate of 91% in complex defects after TEE selection. Very large size and deficient inferior, posterior rims predicted failure of TCC. Surgery offered 100% success and it involved a longer hospital and ICU stay. The long-term clinical results were identical with both treatment modalities.

Holt-Oram Syndrome: A Variety of Heart-Hand Syndrome

Holt-Oram syndrome (HOS) is a heart-upper limb malformation complex , is a rare autosomal dominant disorder, caused by a mutation in the TBX5 gene located on chromosome 12 and near complete penetrance but variable expression. Holt and Oram first described this syndrome in 1960. Approximately 40% of cases represent new mutations. The syndrome is associated with defective development of cardiac structures that results in atrial septal defect(ASD), most commonly the secundum type; heart block of varying degree or both.The syndrome is characterized by cardiac malformations and aplasia or hypoplasia of the thumb. The incidence of HOS is estimated at 1:100,000 live births. In the literature, it is also known as atriodigital syndrome, heart-hand syndrome, upper limb-cardiovascular syndrome, cardiac-limb syndrome, or cardiomelic syndrome. Herein, we report a 45-year-old female case of HOS presenting a large ostium secundum type ASD along with congenitally fusion of carpal bones in both hands and absence of right first metacarpal bone with triphalagial thumb where as hypoplastic proximal phalange. In left hand, hypoplastic first metacarpal bone and hypoplastic thumb with syndactyly of both thumb with index finger.University Heart Journal Vol. 13, No. 2, July 2017; 67-71

Associated Valvular Heart Diseases among ASD Patients Undergoing Surgical Repair

Background: Congenital heart diseases (CHD) are one of the most common developmental errors in humans.Objectives: The purpose of the present study was to see the frequencies of various types of atrial septal defect (ASD) and associated cardiovascular disorders in patients undergoing surgical repair.Methodology: This cross-sectional study was conducted on patients undergoing surgical repair at the National Institute of Cardiovascular Diseases (NICVD) or the National Heart Foundation and Research Institute (NHF &amp; RI) in Dhaka, during the period of July, 2010 to June, 2011. Patients presented with ASD at any age of both sexes were selected as study population. Diagnoses were revealed with echocardiography and confirmed preoperatively by registered cardiac surgeons.Results: The morphological types of ASD were ostium secundum type in 96% cases and sinus venosus type in 4% cases. Atrial septal defects were either small or larger defects associated with pulmonary hypertension in 38 (76%) cases, varying degree of tricuspid regurgitation was seen in 33 (66%) patients and dilated pulmonary artery was noted in 24 (48%) cases. Ventricular septal defect in 4 (8%) cases, tricuspid atresia in 2 (4%) cases and mitral valve prolapse in 6 (12%) cases were also observed.Conclusions: Ostium secundum type of ASD is found to be the commonest type of ASDJournal of Current and Advance Medical Research 2018;5(2):60-63

Congenital heart defects in molecularly proven Kabuki syndrome patients.

The prevalence of congenital heart defects (CHD) in Kabuki syndrome ranges from 28% to 80%. Between January 2012 and December 2015, 28 patients had a molecularly proven diagnosis of Kabuki syndrome. Pathogenic variants in KMT2D (MLL2) were detected in 27 patients, and in KDM6A gene in one. CHD was diagnosed in 19/27 (70%) patients with KMT2D (MLL2) variant, while the single patient with KDM6A change had a normal heart. The anatomic types among patients with CHD included aortic coarctation (4/19 = 21%) alone or associated with an additional CHD, bicuspid aortic valve (4/19 = 21%) alone or associated with an additional CHD, perimembranous subaortic ventricular septal defect (3/19 = 16%), atrial septal defect ostium secundum type (3/19 = 16%), conotruncal heart defects (3/19 = 16%). Additional CHDs diagnosed in single patients included aortic dilatation with mitral anomaly and hypoplastic left heart syndrome. We also reviewed CHDs in patients with a molecular diagnosis of Kabuki syndrome reported in the literature. In conclusion, a CHD is detected in 70% of patients with KMT2D (MLL2) pathogenic variants, most commonly left-sided obstructive lesions, including multiple left-sided obstructions similar to those observed in the spectrum of the Shone complex, and septal defects. Clinical management of Kabuki syndrome should include echocardiogram at the time of diagnosis, with particular attention to left-sided obstructive lesions and mitral anomalies, and annual monitoring for aortic arch dilatation.

Atrial Septal Defect (ASD) and Associated Cardiovascular Disorders in Patients Undergoing Surgical Repair

Background: Congenital heart diseases (CHD) are one of the most common developmental errors in humans.Objectives: The purpose of the present study was to see the frequencies of various types of atrial septal defect (ASD) and associated cardiovascular disorders in patients undergoing surgical repair.Methodology: This cross-sectional descriptive study was conducted on patients undergoing surgical repair at the National Institute of Cardiovascular Diseases (NICVD) and National Heart Foundation and Research Institute (NHF&amp;RI) in Dhaka during the period of July, 2010 to June, 2011. Patients presented with ASD at any age of both sexes were selected as study population. Diagnoses were revealed with echocardiography and confirmed preoperatively by registered cardiac surgeons.Results: The morphological types of ASD were Ostium secundum type in 96% cases and sinus venosus type in 4% cases. Atrial septal defects were either small or larger defects associated with pulmonary hypertension in 38(76%) cases, varying degree of tricuspid regurgitation was seen in 33(66%) patients and dilated pulmonary artery was noted in 24(48%) cases. Ventricular septal defect in 4(8%) cases, tricuspid atresia in 2(4%) cases and mitral valve prolapse in 6(12%) cases were also observed.Conclusions: Ostium secundum type of ASD is found to be the commonest type of ASD.J Shaheed Suhrawardy Med Coll, 2015; 7(1):18-21

Asymptomatic late embolization of Amplatzer septal occluder device

Atrial septal defects of Ostium Secundum type with suitable anatomy and margins are commonly closed with septal occluder devices. With the increasing number of catheterization laboratories and increasing availability of different devices, the device closure procedure is very commonly performed in different institutes. Embolization of the septal occluder is one of the most dreaded complications of this procedure, which usually occurs in the early hours or days after the procedure. We report a case of silent embolization of the Amplatzer septal occluder, detected seven months after its use to close an Ostium Secundum atrial septal defect, which was detected during pre-anaesthetic evaluation and echocardiography for non-cardiac surgery. The patient denied having any symptom in-between. The device was retrieved and the defect was closed surgically.

Frequencies of Different Morphological Types and Clinical Presentation of Atrial Septal Defect (ASD) Undergoing Surgical Repair in Bangladesh

Background: Atrial septal defect (ASD) is one of the important congenital anomaly. Objective: The present study is designed to determine how the different morphological types of ASD are distributed among Bangladeshi Bengali patients undergoing surgical repair and to see the clinical features of the above patients. Methodology: This cross-sectional descriptive study was carried out on the 50 ASD patients undergoing surgical repair at the National Institute of Cardiovascular Diseases (NICVD) or the National Heart Foundation and Research Institute (NHF &amp; RI) in Dhaka, during the period of July 2010 to June 2011 to explore different morphological types and clinical presentation. The morphological types of ASD were revealed by echocardiography and confirmed preoperatively. Result: A total number of 50 patients were recruited in this study of which ostium secundum type was found in 96% cases and sinus venosus type in 4% cases. Evaluation of patients showed that 14% of the patients were asymptomatic and they were detected incidentally. The most common symptoms were palpitation, dyspnea, recurrent RTI, fatigue, failure to thrive and chest pain. The commonest signs at diagnosis included loud S1, wide and fixed splitting S2, systolic murmur, tachycardia, shifting of the apex beat and left parasternal lift. Surgical closure has been the mainstream of treatment. Conclusion: In conclusion ostium secundum is the most common type of ASD.