Secundum Type Research Articles

Clinical and diagnostic value of the novel algorithm for categorisation of neonatal interatrial communication; findings at follow-up in preschool children

Abstract Background and aim Differentiation between a patent foramen ovale (PFO) and an atrial septal defect (ASD) of the secundum type is challenging, particularly in newborns. A PFO is considered normal, often undergoes spontaneous closure and is rarely associated with complications. An ASDs on the other hand tend to remain patent and may lead to right sided volumen overload, atrial fibrillation, and stroke, often necessitating surgical repair. To determine the need for follow-up in newborns with interatrial communications (IACs), a clear diagnostic differentiation between ASD and PFO is essential. We recently developed an algorithm to facilitate differentation between ASD and PFO in newborns. In this study, we reassessed preschool children diagnosed according to this algorithm with an ASD or a PFO neonatally, to investigate potential differences in patentcy between the two IAC subtypes. Methods Children participating in a large, multicenter, prospective population study were enrolled for a follow-up echocardiogram if they had a PFO or an ASD detected at the neonatal echocardiogram. The recently developed algorithm classifies IACs into three subtypes of PFO and three subtypes of ASD. According to the algorithm an ASD was defined as a defect with a diameter ≥4 mm, a location in the inferior part of the septum, or if multiple communications were present. Children with neonatal IACs were included until reaching n=200 in each of the six groups of IAC subtypes, or all children in a group (n<200) were invited. A single operator, blinded to the neonatal IAC subtype, assessed the follow-up echocardiograms for patency of an IAC. Patent IACs were reclassified as ASD or PFO using the same algorithm. Results We included 904 children with IAC (median age 5.2 years [interquartile range 4.5-5.5], 54% female). Neonatally, ASDs were present in 292 newborns and PFOs in 612 newborns. The follow-up echocardiograms showed patency of the IAC in 62 of the children with a neonatal ASD (18.5%) and in 54 of the children with a neonatal PFO (10.1%), (OR 2.0 [95% CI 1.3;3.0], p-value<0.001). Overall, patency was sligtly more frequent in girls (15.1%) compared to boys (10.1%), (OR 1.6 [95% CI 1.0;2.4], p-value<0.05). The risk of having a patent IAC, that classified as an ASD at follow-up, was 7.5% in the group of children with a neonatal ASD, compared to 1.1% in the group with a neonatal PFO, (OR 7.0 [95% CI 2.9;19.7], p-value<0.0001), figure. Conclusions Newborns diagnosed according to the new IAC algorithm with an ASD were twice as likely to have a patent IAC at follow-up at five years of age compared to children diagnosed with a neonatal PFO. At follow-up, the risk of having a patent IAC, that was classified as an ASD, was very low for children with a neonatal PFO. These findings support the diagnostic and clinical value of the new IAC diagnostic algorithm to differentiate between neonates with IACs that may need follow-up.

Long-Term Outcomes of Percutaneous Trans-catheter Device Closure of Atrial Septal Defects During Teenage Life versus Adulthood

Abstract Aim and Objectives To evaluate the long-term follow up outcome of patients who underwent percutaneous trans-catheter closure of atrial septal defects during teenage life versus adulthood. Patients and Methods The study included 100 patients with secundum type ASD were treated by transcatheter closure of their defects. Two year after the procedure patients included in the study were subjected to thorough history taking, physical examination,12 leads surface electrocardiogram and Holter. Full 2D and Doppler echocardiographic study was performed in addition to Tissue Doppler Assessment of left ventricular function. Results At the 2 years follow up of transcatheter ASD closure, the RVEDD had decreased from 22.93±5.889 mm to 18±4.06 mm(P = 0.000). By comparing 2D echocardiographic parameters between teenagers and adults there was a highly significant difference in RV basal diameter (P = 0.004), RV systolic function (P = 0.000), RA area (P = 0.030). Mean PAP decreased from 18.37±4.796 mmHg to 14.77±4.75 mmHg (P = 0.022). RVSP decreased from 28.9±4.425 mmHg to 15.83±4.17 mmHg (P = 0.000). There was statistically significant difference regarding defect size (P = 0.037), device size (P = 0.038) and Holter findings (P = 0.042) while there was no statistically significant difference between both groups regarding mPAP, device type and ECG. Defect size was larger in adult group ranged from 9 to 33 mm with mean ± SD 15.57 ± 6.57 mm than teenagers ranged from 6 to 22 mm with mean ± SD 13.06 ± 5.18 mm. Also, incidence of arrhythmia in adults was higher than teenagers as follows: PACs was in 7 patients (14 %) in adult group while 3 patients (6 %) had PACs in teenagers group and paroxsymal AF was found in 4 patients (8 %) in adult group while no patients in teenagers develop AF. All the patients had normal sinus rhythm before closure and no one developed arrhythmia until 1 year after closure. 50 % of the patients had normal RV size at the 2-year follow up. Regarding Doppler parameters, mitral E/A ratio (P = 0.000) and lateral E/e' ratio (P = 0.041) had significant difference between adults and teenagers as shown in table (8) mostly related to age. Mitral E/A ratio in adults ranged from 0.7 to 1.5 with mean ± SD 1.06 ± 0.20 while in teenagers ranged from 1.1 to 1.8 with mean ± SD 1.45 ± 0.17. Lateral E/e’ ratio in adults ranged from 3 to 7.9 with mean ± SD 5.43 ± 1.24 while in teenagers ranged from 3 to 7 with mean ± SD 4.94 ± 1.13. Conclusion Transcatheter ASD closure leads to a significant improvement in heart cavity dimensions and RV function and reversal of electrical and mechanical changes. Novel parameters for assessment of RV function are promising and appear to be helpful for the assessment of RV function and its response to correction of volume. Key words: Atrial septal defect, arrhythmia, transcatheter closure, adults, teenagers. Abbreviations and Acronyms 2D: Two-Dimensional 3D:Three-dimensional ASD(s): Atrial septal defect(s) BSA: Body surface area CHDs: Congenital heart defects ECG: Electrocardiogram EF: Ejection fraction FAC: Fractional Area Change LA: Left Atrium mPAP: mean Pulmonary Artery Pressure RA: Right Atrium RAA: Right atrial area RBBB: Right Bundle Branch Block RV : Right Ventricle TEE : TransEsophgyeal Echocardiography TTE : TransThoracic Echocardiography

Metastatic right atrial mass in the presence of atrial septal defect: A rare clinical coincidence

Key Clinical MessageThe key takeaway from this clinical scenario is to choose the most appropriate and reasonable treatment plan when dealing with a patient who has atrial septal defect (ASD) and concurrent atrial and mediastinal masses. In such cases, a heart‐oncology team should make the therapeutic decision.AbstractRight atrial masses are not pretty rare and might be a diagnostic challenge. Thrombosis, tumors, and vegetations are primary differential diagnoses. Workup for these masses usually includes multimodality imaging and biopsy in selected cases. We report a case of a 37‐year‐old lady who presented with cough, dyspnea, and head and neck swelling after a cesarean section. Echocardiography revealed a right atrial mass accompanied by a secundum type atrial septal defect (ASD). Pulmonary CT Angiography was performed, in which a lobulated mass in the anterior mediastinum was detected, and a heart‐oncology team made the therapeutic decision. The patient was scheduled for surgical ASD closure and concomitant tissue biopsy. The pathology results were in favor of poorly differentiated germ cell tumors, and chemotherapy was started following the surgery. After two sessions of chemotherapy, the tumor did not respond to the primary regimen. Thus, an updated regimen was initiated. Compliance with the updated regimen was acceptable, and the patient is currently under treatment and follow‐up.

Three‐dimensional transesophageal echocardiography measurements of ASD sizing parameters in comparison to balloon sizing method in percutaneous ASD closure

AbstractBackgroundBalloon sizing (BS) has been used for device size selection in percutaneous atrial septal defect (ASD) closure. Due to its limitations, alternative imaging techniques like three‐dimensional transesophageal echocardiography (3D‐TEE) are valuable for guiding ASD device size selection during ASD closure procedures. The purpose of this study was to compare ASD sizing using measurements obtained from 3D–TEE to those utilizing the standard balloon sizing method.MethodsWe identified 53 patients with single secundum type ASD without PFO who underwent percutaneous closure at the Tehran Heart Center between 2019 and 2022. Balloon sizing was performed in all patients with the stop‐flow technique, and the choice of device size was determined based on the sizing derived from BS. 3D‐TEE imaging was performed before the intervention, and the ASD shape and quality of ASD rims were assessed.ResultsAmong the 53 patients who underwent single ASD device closure, multiple 3D TEE measurements significantly correlated with balloon sizing results. This included defect area, perimeter, and diameter obtained from 3D‐TEE images multi‐planar reconstruction. ASD perimeter detected by 3D TEE had the best correlation with BS results. When divided by the shape of ASD, there was no significant difference between our 3D‐images data and BS in round or oval‐shaped ASDs.ConclusionThe 3D‐TEE study is reliable for assessing ASD configurational characteristics in percutaneous device closure candidates. 3D‐TEE has the potential to accurately determine the appropriate device size and reduce complications, costs, and procedural duration. Further research is needed to validate these findings and establish the role of 3D‐TEE measurements in guiding the best treatment decisions for ASD closure.

Role of speckle tracking echocardiography in assessing right ventricle function after percutaneous closure of atrial septal defect

Background; Atrial septal defect (ASD) is one of the most common congenital heart diseases. Right ventricular (RV) dysfunction is closely related to patient outcome in open and closed ASD closure. Aim of work; to quantify RV function in patients with chronic RV volume overload due to an ASD before and after its percutaneous closure. Subjects & methods; In this prospective study which included 40 patients with secundum type ASD and normal sinus rhythm who underwent successful percutaneous ASD closure procedure at Cardiology Department, Faculty of Medicine, Benha University; and Cardiology Department, national-heart-institute. All patients underwent full history taking, clinical examination, ecg & echocardiography including assessment of LA, LV, RA & RV functions & dimensions with special emphasis on TAPSE, RV MPI & 2D speckle tracking. Result: LA diameters (mm) were decreased significantly after ASD closure; Antero-posterior, Medio-lateral, and Apico-basal. RA diameters (mm) were decreased significantly after ASD closure; PASP was decreased significantly after ASD closure. LVEF% was increased significantly after ASD closure. TAPSE was increased significantly after ASD closure. RV end diastolic diameters were decreased significantly after ASD closure. Pulsed Doppler RV MPI was decreased significantly after ASD closure. RV longitudinal strain (%) was increased significantly after ASD closure. there was a positive correlation among delta RVSTE and delta LVEF and TAPSE. Also, there was a negative correlation among delta RVSTE and delta RV MPI, RV end diastolic diameter, RA diameters, and PASP. Conclusion; Our study demonstrated significant improvements in multiple echocardiographic measures of cardiac structure and function including reduced LA/RA diameters, decreased PASP, increased LVEF, higher TAPSE, reduced RVEDD, lower RV MPI, and increased RV longitudinal strain at one month post-procedure. These changes indicate reversal of the chronic volume and pressure overload on the right heart caused by the left-to-right shunt, resulting in measurable reverse remodeling and improved mechanics of the right ventricle.

Pulmonary Hypertension in Pregnancy: A Cardiological Approach to Maternal Outcomes as well as Neonatal and Therapeutic Management

Highlights: 1. Pulmonary hypertension is threatening to both the mother and the infant in the womb. 2. This report discusses the complexity of physiological changes in pregnant women with pulmonary hypertension. - Abstract Background: Maternal morbidity and mortality with pulmonary hypertension in pregnancy usually occur during labor until early postpartum. Historical reports have shown mortality rates as high as 30–56%. We report a 32-year-old female patient pregnant with her second child, with complaints of bleeding from the birth canal since 1 hour before admission to the hospital and a history of atrial septal defect type secundum. Case presentation: The patient was diagnosed with G2P1A0, 16–17 weeks pregnant, with death conception, thrombocytopenia, and ASD secundum with pulmonary hypertension. The patient was planned for dilation and curettage by the obstetrics and gynecology departments. As a result of consultation with the cardiology department, medication management was given, and the decision to tolerate CRI IV very high-risk surgery was given. Conclusion: Despite progress, pregnancy remains poorly tolerated in cases of pulmonary hypertension. Management should remain focused on contraceptive counseling and offering early termination when pregnancy does occur

Adults knowledge and perception of their congenital heart disease: a single center cross-sectional study

Abstract Background A great proportion of patients with congenital heart disease (CHD) reach adulthood and face daily challenges living with a chronic illness. Healthcare management of these patients is complex requiring a multidisciplinary approach. To date, few studies have focused on adult patients’ understanding of their CHD. Aim To assess adults’ knowledge of their CHD on 4 domains: (1) disease and treatment, (2) preventive measures, (3) physical activity, (4) reproductive issues. Methods One single center cross-sectional study. Patients were opportunistically recruited to participate in the study at their CHD medical visit, between October 2022 and December 2022. The authors translated Leuven Knowledge Questionnaire for CHD to Portuguese language. Patients that were willing to participate filled the survey before entering the physician’s room. Demographic and clinical variable were gathered during patients’ interview and from clinical records. After run-in period, data were analyzed in SPSS ® for the descriptive analysis. Categorical values were reported as counts and percentages. Results From a total of 344 patients observed during recruitment period, 97 accepted to participate in the study. Demographic and clinical characteristics of the study population are described in Table 1 and 2. Mean age was 41 years, 60% were female, 34% have an education level above 12th grade and 74% are employed. The 3 most prevalent CHD were Tetralogy of Fallot (16%) and atrial septal defect type secundum (13%) and ventricular septal defect (10%). Approximately half of the patients knew the name of their CHD and 41% could describe or locate the lesion on the pictured diagram. 38% could identify at least two symptoms of clinical deterioration. Three-fourths of patients did not know what endocarditis is and only 14% could tell fever was the main symptom of the disease. The majority of patients did not know the risk factors for endocarditis. 73% of patients are aware that they should choose an occupation adequate to their physical status and 75% knew that they are allowed to engage in sexual intercourse if capable of doing so. Only 20% had adequate knowledge about the hereditary nature of their condition. 43% of women knew the risk of clinical deterioration during pregnancy. Conclusion This study showed our patients have high levels of education and employment. Still, large proportions of adults have lack of knowledge about important issues in vary domains. These findings reinforce the need to improve patients’ education about their disease. In addition, it highlights the importance of guideline recommendations on multidisciplinary teams to achieve high quality of care in adults with CHD.

Who Falls Through the Gap? Revisiting the Pulmonary Hypertension Nomenclature in Atrial Septal Defect Closure

Background: The incidence of atrial septal defect is 1.6 per 1,000 live births accounting for 8-10% of all congenital heart defects. For the majority of patients the clinical course is often benign. However, pulmonary arterial hypertension is known to complicate 9 to 35% of patients with a secundum type atrial septal defect. The purpose of the study is to apply the new definition of pulmonary hypertension to our cohort of atrial septal defect interventional closures. Objectives: We aim to see whether children with atrial septal defect who have a mean pulmonary artery pressure of <20 mmHg have differences in body habitus and outcomes compared with the children with mean pulmonary artery pressure of 21-25mmHg and children with mean pulmonary arterial pressure of >25 mmHg. Methods: The data collection took place from January to March 2022. A retrospective search was carried out at the archives of the hemodynamic laboratory of a large pediatric hospital in Athens, Greece, carrying out a large number of catheterizations for congenital heart disease. Results: In total, we retrieved 78 children, 30 boys and 48 girls with a diagnosis of atrial septal defect. In 17 cases the mean PAP was not documented so the remaining 61 children were stratified according to their mean PAP as mean PAP <20 mmHg, mean PAP >20mmHg but less than 25 mmHg and more than 25 mmHg. Conclusions: There was no difference in height, weight, BMI, BMI centile, sex age, hospital stay between the groups of no pulmonary hypertension, pulmonary hypertension and pulmonary pressures between 20-25 mmHg.

Echocardiographic right ventricular remodeling after percutaneous atrial septal defect closure

BackgroundIn order to prevent right ventricular (RV) dysfunction, closure of secundum type atrial septal defects (ASD) is often indicated and percutaneous closure is the preferred treatment modality to do so. The magnitude and time course of RV remodeling is still incompletely understood. MethodsThis retrospective cohort study included consecutive patients who underwent percutaneous secundum ASD closure in two tertiary referral centers in The Netherlands. Main study parameters were RV and right atrial dimensions measured with transthoracic echocardiography before and after percutaneous ASD closure. Secondary outcome was change in New York Heart Association (NYHA) functional class at follow-up. ResultsFrom the 454 patients who underwent secundum ASD closure, 88 patients (median age 46 [range 17–84]) were included. The majority of RV and right atrial dimensional improvement occurred within 24 h. After a median follow-up of 569 days (IQR: 280–772) a further decrease in dimensions was observed. Comparing baseline and latest follow-up, end-diastolic RV basal diameter decreased from 4.5 SEM 0.1 to 3.9 SEM 0.1 cm (p < 0.001) and end-systolic right atrial area from 22.9 SEM 1.0 to 17.9 SEM 0.7 cm2 (p < 0.001). No significant changes in RV function were observed. NYHA functional class improved from 1.5 at baseline (IQR: 1.0–2.0) to 1.0 (IQR: 1.0–1.5) at latest follow-up (p < 0.001). ConclusionRemodeling of the RV heart dimensions commences within 24 h after percutaneous secundum ASD closure for the majority of patients, followed by a further gradual recovery. A concurrent improvement of NYHA functional class was observed during follow-up.

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.

The relationship between echocardiographic parameters and albumin bilirubin (ALBI) score in patients with isolated secundum type atrial septal defect.

It has been shown that the increase in volume and pressure in the right heart chambers increases liver stiffness. The Albumin-Bilirubin (ALBI) score is a useful and easy-to-use score for objectively assessing liver function. There is no information in the literature about changes in ALBI score in patients with atrial septal defect (ASD). The aim of our study is to investigate the changes in ALBI score and its clinical impact in patients with ASD. Of the 206 analyzed patients, 77 were excluded. The remaining 129 patients with secundum type ASD with left to right shunt were divided into three groups; Group I (16 patients with Qp/Qs<1.5 and defect diameter<10mm), Group II (52 patients with Qp/Qs>1.5 and defect diameter 10-20mm) and Group III (61 patients with Qp/Qs>1.5 and defect diameter>20mm). The ALBI score was calculated based on serum albumin and total bilirubin levels using the following formula: ALBI=(log10 bilirubin [umol/L] * .66) + (albumin [g/L] * -.085). ALBI scores as well as total bilirubin levels, transaminases, and functional-structural heart abnormalities (increase in RA and RV dimensions, sPAP, ASD size and decrease in LVEF and TAPSE) showed a significant increasing trend from Group I to Group III (p<.001 for all comparisons). The mean ALBI scores for Group I, Group II, and Group III were -3.71±.37, -3.51±.25, and -3.27±.34, respectively. In multivariate linear regression analysis, ASD size, sPAP, RV-RA diameter were found to be significantly associated with increased ALBI score. The ALBI score offers a simple, evidence-based, objective, and discriminatory method of assessing liver function in patients with ASD. ASD size, sPAP, RV and RA diameters were significantly associated with ALBI score.

Percutaneous Treatment of Pulmonary Valvular Stenosis and Secundum Type Atrial Septal Defect in a Young Adult

Pulmonary valve stenosis (PS) and secundum type atrial septal defect (ASD) are common forms of congenital heart disease. While traditional treatment for PS and ASD is open surgery, percutaneous treatment of both diseases are widely used with high rates of success and lower complication. However, the combination of PS with ASD in the same patient is relatively rare, and the optimal strategy is debated. We performed consecutive percutaneous balloon pulmonary valvuloplasty and ASD occlusion in a young adult patient with severe congenital PS associated with a secundum ASD.

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.

Mid-Right Atrial Obstruction by an Aneurysmal Interatrial Septum Simulating an Additional Secundum Type Atrial Septal Defect.

Mid-Right Atrial Obstruction by an Aneurysmal Interatrial Septum Simulating an Additional Secundum Type Atrial Septal Defect.

Does every ASD closure device stay in the atrial septum?

Atrial septal defect (ASD) is one of the most common congenital heart defects and the most common type is secundum type ASD. There are 2 approaches to its treatment: open surgical repair and percutaneous intervention. In this article, we describe the complication and intervention performed on a patient whose ASD was repaired percutaneously. In our opinion, what made this case interesting was that a complex case was handled by cardiology without a Cardiology-Cardiovascular Surgery council.

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.

Early and Mid-Term Follow-Up Results After Transcatheter Closure of Secundum Atrial Septal Defect.

Transcatheter secundum type atrial septal defect closure is an alternative to surgical closure in many cases when conditions are appropriate. In this study, the demographic data and follow-up results of patients with secundum atrial septal defect undergoing transcatheter closure were discussed. Data of patients who underwent transcatheter closure of secundum atrial septal defect between 2004 and 2017 were investigated retrospectively. Gender, age at intervention, defect size, procedure duration, fluoroscopy time, periprocedural complications, residual shunt existence, and early and mid-term follow-up results were collected. A total of 179 patients [41% males; 10% adults, median age: 8.1 years (1.3-58.6); weight: 28 kg (11-90)] were admitted to catheterization for atrial septal defect closure and their median atrial septal defect size was 13 mm (6-30); 74 (41%) patients had a large atrial septal defect (≥12 mm). Suitable defects for closure were observed in 165 of 179 patients. The procedural success rate was 95.7%. No death was observed; however, minor complications occurred in 3 patients during the procedure (1.6%). The rate of residual shunt after 1 year was 1.3%, and all shunts were mild. After a median follow-up of 2.8 years (range, 6 months to 13.6 years), delayed major complications such as death, cardiac erosion, and infective endocarditis were not experienced. The delayed minor complication was supraventricular extrasystole in 1 patient. Transcatheter atrial septal defect closure is safe in children and adults with a minimal rate of periprocedural and delayed complications. It has a favorable early and mid-term outcome in our study, especially with no death or major complications.