Repair Of ASD Research Articles

Accurate anatomic repair of obstetric anal sphincter damage or rectovaginal fistula aided by prior ultrasonograghy: a cohort study.

A retrospective review of patients who underwent transvaginal surgical repair of RVF and ASD was undertaken. Patients were preoperatively assessed for pathology and incontinence degree. Anorectal ultrasonography was used to define ASD or RVF and the associated scar preoperatively. Repair of RVF or ASD entails total excision of the scar with accurate anatomical layers reconstruction of healthy tissues. There were 23 patients, 8 RVF with a mean (SD) age 29 (6.78) years and 17 ASD with a mean (SD) age 35.25 (15.90). Twenty followed obstetric trauma (6RVF, 14 ASD), 1 prior rectocoele repair (ASD), 2 rape (1RVF + 1 ASD) and 1 was idiopathic (RVF). All patients had 1 or more prior repairs except for idiopathic RVF. Operative technique entailed transvaginal complete excision of the fibrous scar and accurate anatomical reconstruction of healthy tissue layers. A colostomy was not routinely used. There were three significant postoperative complications: ASD breakdown from an infected haematoma; perianal abscess, later a sinus after drainage; and RVF repair dehiscence during early coitus. All patients had full continence after 8 months minimum follow-up. Complete excision of the fibrous scar and accurate anatomical tissue layers reconstruction of the obstetric RVF or ASD, aided by prior ultrasonography, yielded good results.

Use of Selective Pulmonary Vasodilators to Treat Pulmonary Arterial Hypertension Prior to Successful Surgical Closure of Atrial-Level Shunts

Background: Significant pulmonary hypertension [PH] is often considered a contraindication for closure of atrial septal defects [ASD]. Treatment of pulmonary arterial hypertension [PAH] with selective pulmonary vasodilators can allow for surgical repair of ASD otherwise considered prohibitive. We describe our experience in the assessment and treatment of adults with ASD and PAH with pulmonary vasodilator therapy who underwent successful surgical repair.

Percutaneous repair of sinus venosus ASD: the end of congenital cardiac surgery?

Percutaneous repair of sinus venosus ASD: the end of congenital cardiac surgery?

Cryoballoon pulmonary vein isolation prior to percutaneous atrial septal defect closure: a case report

We report the case of a 61-year-old female who was admitted to our department with progressive dyspnea and palpitation. Transthoracic echocardiography and transesophageal echocardiography showed a small atrial septal defect (ASD, 8x7 mm). Paroxysmal atrial fibrillation (AF) was detected in Holter monitoring. As repair of ASD does not significantly reduce the risk of arrhythmias, cryoablation of AF was performed prior to ASD closure. On cardiac examination at one year, this combined intervention improved right ventricular function and prevented AF episodes.

Impact of Warden's Procedure on the Sinus Rhythm: Our Experience

Our experience with the use of Warden's procedure for the repair of sinus venosus ASD with anomalous right upper pulmonary venous connection. Fifty-eight patients had Warden's procedure from September 2008 to May 2011. The demographic data, preoperative and postoperative ECG, aortic cross-clamp time, cardiopulmonary bypass time, Holter monitoring, complications length of ICU and hospital stay were analysed. The male to female ratio was 1:1. The median age was 10.9 years (range 2-48 years). Preoperatively all patients were in sinus rhythm. Twenty-six patients had associated left superior vena cava and two patients had also Tucker's procedure at the same time. The mean follow up was 1.2 years (range 1 months-2.8 years). Postoperative Holter monitoring showed sinus rhythm in all the patients. The mean CPB time was 83.6 min (range 54-163 min), mean aortic cross-clamp time was 48.0 min (range 22-112 min), mean ICU stay was 1.26 days (range 1-4 days) and length of hospital was 8.3 days (range 5-13 days) Postoperative echocardiography showed less than 1 mm Hg gradient across the SVC-RA appendage anastomotic site in all the patients. No mortality was recorded. This is the largest reported series of Warden's procedure in the literature till date. It is known from other studies that sinus node dysfunction and conversion to junctional nodal rhythm were quite a concern with the conventional techniques and Warden's procedure specifically avoids these problems.

Left atrial approach to close the atrial septal defect type II in case of right lung agenesis with extreme dextroversion

This paper presents a case of a rare combination of right lung agenesis and atrial septal defect type II (ASD II). Successful surgical repair of ASD II was performed at the age of six years with total circulatory arrest (TCA) and deep hypothermia, because of difficult approach. Computed tomography and intraoperative findings are described. From patho-embryological consideration, defects in the primitive respiratory apparatus in embryo stages were presumably responsible for agenesis of the lung. The patient was found to have a very short stump of the right pulmonary artery, but this malformation seems to be secondary.

Echocardiographic analysis of ventricular geometry and function during repair of congenital septal defects

Background This study investigated changes in left ventricular (LV) geometry and systolic function after corrective surgery for atrial (ASD) and ventricular septal defects (VSD). Methods Transesophageal LV short-axis echocardiograms were recorded before and after operative repair of ASD (n = 11) and VSD (n = 7). Preload was measured using LV end-diastolic area indexed for body surface area. Measurements of septal-freewall (D1) and anterior-posterior (D2) endocardial diameters were used to assess LV symmetry from D1/D2. Systolic indices included stroke area, area ejection fraction, and fractional shortening. Results Preload, stroke area, area ejection fraction, and fractional shortening of D1 increased after ASD repair but decreased after VSD repair ( p < 0.05). End-diastolic symmetry increased after ASD closure and decreased after VSD closure ( p < 0.05). Increases in stroke area and ejection fraction after ASD correction primarily reflected increased shortening of D1. A positive correlation was found overall between percent change in end-diastolic area (EDA) and percent change in area ejection fraction (r 2 = 0.80, p < 0.0001, n = 18). Conclusions Preload was the primary determinant of changes in LV function in this series of ASD and VSD repairs. Intraoperative changes in position of the interventricular septum affected systolic and diastolic LV symmetry and septal free wall shortening. Additional studies are needed to define changes in afterload and contractility as well as diastolic compliance and systolic mechanics.

Ecodopplercardiografia transesofágica intra-operatória: utilidade na cirurgia da valva mitral

A ecodopplercardiografia ocupa posição de destaque no diagnóstico das valvopatias, pois fornece dados sobre a anatomia valvar, a área estenótica, os gradientes pressóricos e o grau da regurgitação. Seu uso na cirurgia cardíaca, com a abordagem epicárdica, é bastante conhecido. O advento da abordagem transesofágica, por não interferir no campo operatório, facilitou a sua utilização. O objetivo deste trabalho foi estudar a utilidade da ETE nacirurgiada valva mitral. De julho de 1991 a janeiro de 1992, aecodopplercardiografia transesofágica (ETE) monitorizou 198 cirurgias, das quais 65 foram sobre a valva mitral (VM). A idade variou de 8 a 62 anos e 42 pacientes eram do sexo feminino. A comissurotomia e papilarotomia (CP) foi o procedimento mais freqüente em 28 pacientes (pts), seguido do implante de bioprótese (BP) em 24 e da plastia (PL) em 19. A ETE pré-operatória confirmou o diagnóstico da lesão mitral em todos os pts, tendo acrescentado informações quanto ao grau e direção da insuficiência mitral (IM) em 8 dos 28 pts submetidos a CP. Modificou a orientação da abordagem da valva tricúspide em 9 oportunidades (3 por diagnosticar lesões não detectadas e 6 por evitar a abordagem desnecessária por melhor avaliação da lesão. Quanto aos pts submetidos a implante de BP, 6 já tinham próteses disfuncionantes, em 12 pts a BP foi implantada de imediato por decisão do cirurgião e, em 6 pts, a BP foi implantada após a detecção da presença de IM importante pós-correção. Quanto ao pts submetidos a PL, 12 tinham prolapso, 6 tinham insuficiência coronária e 1 era pós-operatório tardio de correção de defeito do septo atrioventricular. Em apenas 1 pt foi necessária nova CEC para nova plastia. A avaliação da tM pós CEC evidenciou 7 pts (10%) com IM importante, sendo necessária nova CEC, e mostrou IM leve em 15 pts, moderada em 8 e importante em 1 onde não foi realizada nova CEC. A ETE é um método de grande valor no auxílio do planejamento cirúrgico nas doenças da VM, bem como na avaliação imediaata dos resultados operatórios possibilitando ao cirurgião uma adequada análise anatômica e funcional da estrutura abordada.

Percutaneous mitral valvuloplasty following surgical repair of sinus venosus atrial septal defect

Mitral valvuloplasty performed 5 y after repair of a sinus venosus ASD was difficult because of a thickened septum, but resulted in improved mitral valve opening and did not lead to ASD. Thus, prior repair of a sinus venosus ASD may not be an absolute contraindication to mitral valvuloplasty.

Embolic complications following repair of atrial septal defects.

Postoperative embolism occurred in 35 of 546 patients traced for 2 to 15 years after surgical repair of uncomplicated ASD. A total of 58 embolic episodes occurred, resulting in the death of 11 of these 35 patients. The incidence of embolism was not significantly related to the technique used for surgical repair. Six of the nine patients who had had a preoperative embolism also had an embolism in the postoperative period. The most significant factors associated with an increased risk of postoperative embolism were increased age of the patient, atrial fibrillation, and pulmonary hypertension, all of which are interrelated: seventy-seven per cent (27/35) of patients having a postoperative embolism had either atrial fibrillation or pulmonary hypertension, and 77% (27/35) of patients with postoperative embolism were more than 40 years old at the time of the first embolism. Because actuarial analysis suggests that 30% of patients more than 40 years of age who have atrial fibrillation after repair of ASD may have an embolism within 10 years postoperatively, continuation of anticoagulation therapy indefinitely in these patients is suggested. The highest risk of embolism occurs in the early postoperative period, suggesting the advisability of anticoagulation therapy for all adult patients during convalescence.

Galvanic crystallization

Our experience with the use of Warden's procedure for the repair of sinus venosus ASD with anomalous right upper pulmonary venous connection.Fifty-eight patients had Warden's procedure from September 2008 to May 2011. The demographic data, preoperative and postoperative ECG, aortic cross-clamp time, cardiopulmonary bypass time, Holter monitoring, complications length of ICU and hospital stay were analysed.The male to female ratio was 1:1. The median age was 10.9 years (range 2–48 years). Preoperatively all patients were in sinus rhythm. Twenty-six patients had associated left superior vena cava and two patients had also Tuckers procedure at the same time. The mean follow up was 1.2 years (range 1 months–2.8 years). Postoperative Holter monitoring showed sinus rhythm in all the patients. The mean CPB time was 83.6 min (range 54–163 min), mean aortic cross-clamp time was 48.0 min (range 22–112 min), mean ICU stay was 1.26 days (range 1–4 days) and length of hospital was 8.3 days (range 5–13 days) Postoperative echocardiography showed less than 1 mmHg gradient across the SVC-RA appendage anastomotic site in all the patients. No mortality was recorded.This is the largest reported series of Warden's procedure in the literature till date. It is known from other studies that sinus node dysfunction and conversion to junctional nodal rhythm were quite a concern with the conventional techniques and Warden's procedure specifically avoids these problems.