Septal Defect In Adults Research Articles

Transcatheter closure of atrial septal defect in adults: time-course of atrial and ventricular remodeling and effects on exercise capacity

Investigate ventricular and atrial remodeling following atrial septal defect (ASD) closure and examine if pulmonary-to-systemic flow ratio (QP/QS) and right ventricular (RV) volume predict improvement, determined as percentage of predicted oxygen uptake (VO2%). Long-term cardiovascular magnetic resonance (CMR) data on atrial and ventricular remodeling after ASD-closure is limited and treatment effect on exercise capacity is debated. Sixteen patients undergoing transcatheter ASD closure and 16 age and sexmatched controls were studied. CMR was performed before treatment, the day after and 3 and 12 months later. Exercise test with gas analysis was performed before and 12 months after treatment. QP/QS decreased from 2.1 ± 0.5 to 1.4 ± 0.3 at day 1 and 1.1 ± 0.1 at 3 and 12 months. Left ventricular (LV) volumes increased and normalized on day 1 whereas left atrial volumes were unchanged. RV and right atrial volumes decreased the first 3 months. LV and RV volumes had not equalized at 12 months (RV/LV ratio 1.2 ± 0.1, P < 0.01) and RV ejection fraction remained decreased compared to controls. Improvement of VO2% after ASD closure (P < 0.01) was inversely related to QP/QS at rest (r = − 0.56, P < 0.05) but unrelated to RV end-diastolic volume (P = 0.16). Following transcatheter ASD closure, LV adaptation is rapid and RV adaptation is prolonged, with decreased systolic RV function. Patients with smaller shunts had larger improvement in VO2% suggesting patients with defects of borderline hemodynamic significance might benefit from closure. This may be due to impaired LV diastolic function influencing shunt size and exercise capacity following ASD closure.

P144Transcatheter closure of atrial septal defect in adults - time-course of atrial and ventricular remodeling and effects on exercise capacity

P144Transcatheter closure of atrial septal defect in adults - time-course of atrial and ventricular remodeling and effects on exercise capacity

TCTAP C-220 Management of Partial Anomalous Pulmonary Venous Connection in Atrial Septal Defect in Adults

### Patient Initials or Identifier Number SHC00033971 ### Relevant Clinical History and Physical Exam A 41-year-old gentleman who is a former smoker presented with vertigo for one year. He has no known medical illness. The vertigo was sudden in onset and intermittent, occurring on average once

Ostium Secundum Atrial Septal Defect in Adults

Ostium Secundum Atrial Septal Defect in Adults

Simultaneous Percutaneous Coronary Intervention and Endovascular Closure of Atrial Septal Defect in Adults

to assess clinical efficacy and expediency (appropriateness) of simultaneous single stage combined coronary stenting and closure of atrial septal defect. Of total number of patients who underwent endovascular correction of atrial septal defect (ASD) (n=91), in 6 (6.6 %) the procedure of endovascular repair of secondary ASD was combined with performed at same session oronary stenting. Mean age of these patients was 63±6.4 years. Mean diameter of ASD according to transesophageal echocardiography was 13.7±3.1 мм (from 10 to 17 mm). Two patients had dysplasia of atrial septum with pronounced aneurysmal protrusion in the right atrial cavity. Estimate of coronary arteries (CA) involvement SYNTAX score was 14.5±4.9. At initial stage we performed coronary stenting, then ASD closure with occluder. Technical success of combined endovascular procedures was 100 %. Six ASD occluders were implanted in 6 patients. Mean occluder diameter was 21±7,3 mm. Immediately after occluder implantation complete defect closure was achieved in 5 cases, in one case small residual shunt was observed. CA stenting procedure, in one patient after successful recanalization of chronic CA occlusion, in all cases was fulfilled without complications. At control examination after 13.5±1.5 months complete closure of defects was preserved. In all cases significant reduction of right heart chambers occurred. According to echocardiography right atrial volume decreased from 48.6±5.6 to 32.6±3.3 cm3, right ventricular volume - from 45.2±5.1 to 33.4±3.8 cm3, systolic pulmonary pressure fell from 49.7±8.6 to 32.6±6.9 mm Hg. According to control coronary angiography good effect of endovascular procedures was preserved. Tolerance to exercise rose from 68.5±11.8 до 85.3±12.4 W. Same time CA stenting and endovascular ASD closure appears to be safe and effective procedure. The strategy used was not associated with additive risk for a patient and shortened duration of hospital stay.

Abstract 16669: Left Atrial Function After Closure of Atrial Septal Defect in Adults: Comparison Between Transcatheter Closure and Surgical Closure

Introduction: Transcatheter closure is offered as an alternative to surgery for the majority of patients with secundum atrial septal defect (ASD). However, little is known about the effect of a mechanical device on left atrial (LA) function. Hypothesis: Transcatheter closure of secundum ASD preferably preserves LA function compared with surgical closure in adult patients. Methods: We examined adult patients who underwent transcatheter (n = 58) and surgical ASD closure (n = 17) and controls (n = 20). Patients with greater than mild mitral or tricuspid regurgitation and those with a history of atrial fibrillation were not included. All the devices employed were the Amplatzer TM Septal Occluders. LA volumes were measured by the biplane area-length method using 2-dimensional transthoracic echocardiography at the onset of mitral opening (Vmax), the beginning of LA systole (Va) and the onset of mitral closure (Vmin) before and 15 ± 11 months after ASD closure. LA reservoir, conduit and booster pump functions were assessed by (Vmax-Vmin)/Vmax, (Vmax-Va)/Vmax and (Va-Vmin)/Va, respectively. Left ventricular (LV) ejection fraction was obtained to estimate LV systolic function. For the estimation of LV diastolic function, the ratio of transmitral early to late flow velocity (E/A), deceleration time of early mitral flow velocity (DT) and the ratio of systolic to diastolic pulmonary venous flow velocity (S/D) were obtained by conventional Doppler echocardiography. Results: In transcatheter closure, employed device size indexed to body surface area was 12 ± 3 mm/m 2 . Before ASD closure, there was no significant difference in all the LA parameters between the 2 groups, whereas LV ejection fraction was significantly decreased in the surgical group as compared with the transcatheter group. After ASD closure, Vmax index was significantly increased in the surgical group. LV end-diastolic volume index were significantly increased both after transcatheter and surgical ASD closure. After ASD closure, the surgery group showed significantly decreased LA reservoir and conduit functions as compared with the transcatheter group and controls. Conclusions: The transcatheter group, not surgical group, showed preserved LA function at mid-term follow-up after ASD closure.

Atrial septal defect in adults is associated with airway hyperresponsiveness.

The association between secundum atrial septal defects (ASD) and asthma-like dyspnea with consequent long-term pulmonary inhalant use, is poorly understood in adult ASD patients. Airway hyperresponsiveness is suggested to be the underlying mechanism of cardiac asthma from mitral valve disease and ischemic cardiomyopathy. We hypothesized that airway hyperresponsiveness may also be found in adult ASD patients. Our aim was to study airway responsiveness in adult ASD patients before percutaneous closure and at short-and long-term postprocedural follow-up. This prospective study included 31 ASD patients (65% female, mean age 49±15y) who underwent spirometry and bronchoprovocation testing pre-and six-month postprocedurally, with additional bronchoprovocation at 2-year follow-up. Airway hyperresponsiveness was defined as ≥20% fall of forced expiratory volume in 1-second (FEV1 ) following <8.0mg/mL of inhaled methacholine. Airway hyperresponsiveness was found in 19/30 patients (63%[95%CI 45%-81%]; post hoc statistical power = 89%). Asthma-like symptoms wheezing, chest tightness, and cough were more frequently reported in airway hyperresponsive patients. Airway responsiveness was not influenced by successful percutaneous ASD closure, corresponding to persistence of asthma-like symptoms postclosure. Regardless of airway responsiveness, postprocedural right-sided reverse remodeling significantly improved dyspnea and pulmonary function. This study is the first to report a high prevalence of airway hyperresponsiveness in a cohort of unrepaired adult ASD patients, and confirms the association between asthma-like symptoms and ASD in adults. Attention to symptoms and pulmonary function should be given during clinical follow-up of adult ASD patients, both before and long after repair.

P2602Airway hyperresponsiveness is associated with secundum atrial septal defects in adults

P2602Airway hyperresponsiveness is associated with secundum atrial septal defects in adults

The Short and Midterm Follow-Up of Transthoracic Device Closure of Perimembranous Ventricular Septal Defect in Adults.

The purpose of this study was to assess the short- and mid-term follow-up results of transthoracic device closure of perimembranous ventricular septal defect (pmVSD) in adults. Sixty-one adults underwent transthoracic device closure of pmVSD at our institution from Jan. 2012 to Jan. 2016. All relevant clinical data were recorded and analyzed. All patients were invited to undergo contrast transthoracic echocardiography (TTE) for 12 months to 60 months after VSD closure. Phone interviews were conducted to further evaluate the cardiac function status. All patients were successfully occluded using this procedure. The most frequent complication was transient cardiac arrhythmia, which was easily treated during the perioperative period. During the follow-up period, we found no recurrence, malignant arrhythmia, thrombosis, device embolization, valve damage, device failure, or cases of death. The total occlusion rate was 100 percent in the 12 months of follow-up, and most of patients showed significant improvement in their clinical status. From the TTE data, the intracardiac structure and cardiac function were improved in the follow-up. Transthoracic device closure of perimembranous ventricular septal defect in adults is a safe and feasible technique. The short- and mid-term follow-up results were satisfactory, but long-term follow-up is required to better assess the safety and feasibility of this method in adults.

Transcatheter Vs. Surgical Closure of Atrial Septal Defects in Adults

Abstract Percutaneous transcatheter device closure of secundum atrial septal defects (ASD) has now largely replaced surgical closure in most centres. The aim of this study was to compare results of transcatheter and surgical ASD closure in adults in Latvia during the years 2002–2014 and to analyse long-term outcomes of transcatheter closure. We analysed data from 334 patients with secundum ASD who underwent ASD closure in Pauls Stradiņš Clinical University Hospital. Patients were included into device or surgical closure groups. In the device group, three follow-ups were made 1, 6, and 12 months after the procedure. No follow-up data were available for surgical arm patients beyond their hospitalisation period. The mean age of patients was 45.3 ± 19.9 years for the device group and 40.0 ± 16.9 years for the surgical group (p = 0.023). The mean secundum ASD size in the device and surgical groups was 14.2 ± 5.6 mm and 28.7 ± 10.0 mm, respectively (p &lt; 0.001). No differences were observed regarding procedure success rates: 99.2% in the device group and 100% in the surgical group (p = 0.451). Periprocedural complications generally were more common in the surgical closure group. The study results show a successful introduction of the percutaneous ASD closure method in Latvia with good early and late outcomes and without significant differences in procedure success rate compared to surgical closure.

Surgical closure of ventricular septal defect in adults: A multicenter study

Although ventricular septal defect (VSD) is one of the most common congenital heart disease, this defect is not so frequent in adults because of early surgery and spontaneous closure. Complications such as aortic insufficiency, infectious endocarditis or supraventricular arrhythmia are classically described. The main objective of this study was to determine the outcome of adult patients who were operated for VSD after childhood. We conducted an observational, retrospective and multicenter study including patients operated for VSD from the age of 18 years, over a 15-year period (2000–2015). Overall survival and occurrence of adverse events were analyzed. Seventy-three patients were included. Mean age was 37.47 ± 2.1 years with a male predominance (62%). Type 2 VSDs were the most common type encountered. After surgery, overall survival was 92% with a mean follow-up of 6 years. Excluding events occurring during the early postoperative period, overall survival was significantly better in patients operated for isolated VSD than in patients operated for VSD associated with other cardiac injuries (95% versus 92%, P = 0.02). Early postoperative complications were found in 14% of patients (principally atrioventricular block requiring early postoperative permanent pacing). Aortic cross clamp and cardiopulmonary bypass time were significantly lower in patients operated for isolated VSD than in patients with associated lesion. As morbi-mortality is low, surgical closure of VSD in adults is not a high-risk intervention. Survival of patients with isolated VSD is better than that of patients with associated cardiac lesions. This last finding advocates for early surgery before the apparition of complications.

CO2-58 - Surgical closure of ventricular septal defect in adults: a multicenter study

Background Although ventricular septal defect (VSD) is one of the most common congenital heart disease, this defect is not so frequent in adults because of early surgery and spontaneous closure. Complications such as aortic insufficiency, infectious endocarditis or supraventricular arrhythmia are classically described. Purpose The main objective of this study was to determine the outcome of adult patients who were operated for VSD after childhood. Methods We conducted an observational, retrospective and multicenter study including patients operated for VSD from the age of 18 years, over a 15-year period (2000–2015). Overall survival and occurrence of adverse events were analyzed. Results Seventy-three patients were included. Mean age was 37.47 ± 2.1 years with a male predominance (62%). Type 2 VSDs were the most common type encountered. After surgery, overall survival was 92% with a mean follow-up of 6 years. Excluding events occurring during the early postoperative period, overall survival was significantly better in patients operated for isolated VSD than in patients operated for VSD associated with other cardiac injuries (95% versus 92%, P = 0.02). Early postoperative complications were found in 14% of patients (principally atrioventricular block requiring early postoperative permanent pacing). Aortic cross clamp and cardiopulmonary bypass time were significantly lower in patients operated for isolated VSD than in patients with associated lesion. Conclusion As morbi-mortality is low, surgical closure of VSD in adults is not a high-risk intervention. Survival of patients with isolated VSD is better than that of patients with associated cardiac lesions. This last finding advocates for early surgery before the apparition of complications.

Feasibility of percutaneous closure of atrial septal defects in adults under transthoracic echocardiography guidance using the Figulla atrial septal defect occluder device

BackgroundClosure of atrial septal defect (ASD) among adults under transthoracic echocardiography (TTE) guidance using devices other than the Amplatzer Septal Occluder has not been extensively tested. Aim of workAssessment of the safety and efficiency of secundum ASD closure using the Occlutech Figulla ASD Occluder under TTE guidance in adult patients with hemodynamically significant secundum ASD. MethodsTwenty patients (mean age, 32.9±9.7, 75% of them females) were enrolled in the study. All patients underwent TTE and transoesophageal echocardiography (TEE) to assess the characteristics of the ASD prior to percutaneous closure. Procedures were performed using the Figulla Occluder device under both fluoroscopic and TTE guidance. Follow-up clinical and TTE examinations were done at 1, 3, and 6 months following the procedure. ResultsTTE estimated mean ASD size was 21.7±7.3 mm with adequate rims except for the aortic rim (deficient in one third of cases). Mean device size was 28.1±8.6 mm with mean procedure and fluoroscopic times of 46.2±16.4 and 15.7±5.4minutes respectively. ASD was successfully closed in all patients. Two patients showed a small residual shunt immediately after the device placement that disappeared by the end of the 2nd followup TTE examination. Transient complications were detected in 2 patients. All patients were asymptomatic during the follow-up period. ConclusionTranscatheter closure of secundum ASD in adults under TTE guidance using the Occlutech Figulla ASD occluder device is safe and effective when performed in a tertiary center and by expert echocardiographers and interventional cardiologists.

Coronary sinus atrial septal defect in adult (RCD code: IV-2B.1)

We present a case report of a 45‑year old man, who was admitted to medical center due to dyspnea and cough. Right bundle branch block was detected on electrocardiography. Transthoracic echocardiography demonstrated coronary sinus dilatation, enlargement of right‑side chambers, moderate to severe pulmonary hypertension and atrial septal defect with left‑to‑right shunt. Coronary sinus atrial septal defect was diagnosed by transesophageal echocardiography and computed tomography. Surgical repair of the defect was performed. Atrial flutter occurred in early postoperative period and was successfully treated by electrostimulation. Coronary sinus atrial septal defect in adults is a rare congenital heart disease. Transesophageal echocardiography and computed tomography are imaging modalities of choice in such cases. Surgical treatment is needed to prevent further complications. JRCD 2017; 3 (3): 86–88

Improvement after Surgical Closure of Secundum Atrial Septal Defects in Adults

Background: Atrial septal defect (ASD) is the most common congenital heart disease (CHD) in adults after bicuspid aortic valve. Although the defect is often asymptomatic until adulthood, undetected ASDs could lead to potential irreversible complications like arrhythmias, stroke, pulmonary hypertension and its squeal. The purpose of our study was to determine the value of surgical closure of atrial septal defects in adults and the effect of age on the prognosis of these patients. Methods and patients: Retrospective study was carried out on 489 patients with age 18 to 65 years old who underwent surgical repair of isolated Secundum type ASD. There were 318 women and 171 men (mean age was25.21 ± 10.106 years). The patients were divided into two groups, group I: from 18-40 years old. Group II: 40-65 years old. Preoperative, operative, and postoperative data were reviewed. Statistical analysis was performed. Results: A statistically significant improvement of NYHA Functional class, tricuspid valve regurgitation and pulmonary artery pressure in most of the patients after operation. No residual intra-cardiac shunt was identified on echocardiographic follow up. Postoperative morbidity and mortality were higher in the older patients with high pulmonary pressure. Conclusion: Surgery for ASD in the adult age is a safe, beneficial, and a low-risk option that modifies the patient’s natural history by improving their clinical status. The operation must be performed without major delay, better to be in established GUCH centers by well trained staff. Despite the use of sildenafil is still need more research. It seems to have good result post-operative.

Acute Changes in Left Ventricular End Diastolic Pressure following the Transcatheter Closure of an Atrial Septal Defect in Adults.

Acute changes in left ventricular diastolic function shortly after ASD closure in elderly patients have not been well known. We aimed to investigate acute changes in left ventricular end diastolic pressure (LVEDP) in elderly patients following transcatheter closure of atrial septal defect (ASD). All 19 adults with ASDs who underwent transcatheter closure between June 2013 and December 2014 were enrolled. LVEDP was measured prior to device closure and compared with that immediately following device closure and 15 minutes after device closure. The median age of the patients was 48 years old. The baseline E/e' and LVEDP values were 8.3 ± 2.8 and 13 ± 3 mmHg. The LVEDP value immediately following closure was 19 ± 4 mmHg, and 15 minutes after closure was 16 ± 4 mmHg. The median increase in the LVEDP value immediately following closure was 6 mmHg, which significantly differed from that prior to closure. The LVEDP 15 minutes after closure decreased but remained significantly higher than the value observed immediately after closure. No significant changes were observed with regard to E/e' at either 1 day or 3 months following closure. The LVEDP value 15 minutes after device closure was significantly correlated with those observed before closure and immediately following closure; however, no significant correlations were observed with regard to patient age, Qp/Qs, E/e' before closure, or E/e' 3 months after device closure. LVEDP in adults with ASDs significantly increases following device closure. LVEDP before closure predicts LVEDP following device closure.

PT300 Outcomes of Tricuspid Regurgitation After Closure of Atrial Septal Defect in Adults

PT300 Outcomes of Tricuspid Regurgitation After Closure of Atrial Septal Defect in Adults

Effectiveness and Safety of Transcatheter Closure of Perimembranous Ventricular Septal Defects in Adults

This study was designed to determine the long-term safety and efficacy of using modified double-disk occluders for perimembranous ventricular septal defect (pmVSD) closure in adults. From January 2004 to December 2014, 337 adults with pmVSDs were treated through transcatheter intervention using 2 types of double-disk occluders; 302 patients received a symmetrical concentric pmVSD occluder, and 35 patients received an asymmetrical concentric pmVSD occluder. All patients were followed up through electrocardiography and transthoracic echocardiography until June 2015. The success rate was 100% for both procedures. During the median 71-month follow-up period, no cases of infective endocarditis, cerebrovascular accidents, heart failure, or death occurred. Two major adverse events (0.6%) were recorded: complete atrioventricular block requiring surgical treatment in one patient and severe tricuspid valvular regurgitation requiring surgical repair in another patient. Cardiac conduction block was the most common minor adverse event. The mean left ventricular (LV) end-diastolic volume decreased from 96.6 ± 23.2ml before intervention to 86.0 ± 22.0ml (p <0.05) at the 6-month follow-up visit. Previously enlarged LV chambers decreased to normal sizes during the follow-up period. In conclusion, transcatheter closure of pmVSDs using modified double-disk occluders was both safe and effective and yielded excellent long-term results in adults. The potential benefits of this intervention included remodeling of the heart, a reduced incidence of infective endocarditis and prevention of LV volume overload.

Both Systemic and Pulmonary Artery Stiffness Predict Ventricular Functional Recovery after Successful Percutaneous Closure of Atrial Septal Defects in Adults.

Percutaneous closure of atrial septal defect (ASD) has become the preferred method in treatment of the majority of cases. The aim of this study was to evaluate the echocardiographic effects of percutaneous closure of secundum ASD in adults and assess which parameters predict good response to closure. We prospectively included 42 patients with secundum ASD treated successfully with percutaneous device closure. All patients underwent transthoracic echocardiography examination with tissue Doppler imaging before, 24 hours after and within 3 months of intervention. Measurements of arterial stiffness were carried out using a Mobil-O-Graph arteriography system. Remodeling of heart chambers occurred immediately and persisted at 3 months after ASD closure. Significant decreases were observed in right ventricle (RV) end-diastolic diameter, right atrium volume index, and tricuspid annular plane systolic excursion both after the procedure and at 3 months (P < .01 for all). The RV and left ventricle (LV) tissue Doppler-myocardial performance index demonstrated to decline during follow up (P = .0001). Significant correlations were found between pulse-wave velocity, augmentation index, pulmonary artery stiffness, and LV-RV tissue Doppler-myocardial performance index at third month. Linear regression analyses showed that pulse-wave velocity is the most effective parameter of LV and pulmonary artery stiffness is the most effective parameter of RV functional recovery, respectively, assessed by tissue Doppler-myocardial performance index. Percutaneous closure of secundum ASD in adults has various sustained benefits on multiple echocardiographic parameters within 3 months. The changes in RV and LV function after device closure were significantly correlated with the degree of pulmonary artery stiffness and pulse-wave velocity, respectively.

Efficacy and Safety of Transthoracic Echocardiography Alone in Transcatheter Closure of Secundum-Type Atrial Septal Defects in Adults.

On-site transthoracic echocardiography (TTE) to guide the transcutaneous closure of secundum-type atrial septal defects (ASDs) in the catheterization laboratory remains unclear, especially in adults. Between 2005 and 2012, a total of 82 adults underwent transcutaneous closure of ASDs. The initial 15 cases underwent the procedure with both on-site transesophageal echocardiography (TEE) and TTE monitoring. Since January 2008, a total of 67 patients underwent on-site TTE alone to guide the procedure. Among the 82 adult patients who underwent a transcutaneous closure of the secundum-type ASD procedure, all had successful closure of the defects, and no periprocedural adverse complications occurred. No statistical significance was observed in the successful complete shunt closure rate between the TEE plus TTE and TTE groups during sequential follow-up (postprocedure 24 hour [87% vs. 92%],1 month [93% vs. 95%], 3 month [93% vs. 97%], and 12 month [93% vs. 97%], P > 0.05, respectively) nor was a significant difference observed between the two groups, including decreased right ventricular dimension (29.5 ± 3.3 vs. 32.0 ± 4.9 mm, 26.5 ± 3.0 vs. 28.7 ± 4.6 mm, 26.2 ± 3.1 vs. 28.2 ± 4.8 mm, and 25.6 ± 2.8 vs. 27.7 ± 4.7 mm, P > 0.05, respectively) or increased left ventricular end-diastolic dimension (41.1 ± 2.0 vs. 42.6 ± 3.0 mm, 44.3 ± 2.7 vs. 45.5 ± 3.1 mm, 44.2 ± 2.8 vs. 45.4 ± 3.1 mm, 44.9 ± 2.7 vs. 45.8 ± 2.6 mm, P > 0.05, respectively) before the procedure, and at the 3-, 6-, and 12-month follow-up evaluations. This study showed that TTE guidance alone may be considered efficacious and safe as TEE during a transcutaneous ASD occlusion procedure in select adults.