Septal Defect Of Secundum Type Research Articles

Arterial Switch Operation, Cor Triatriatum Repair, Patent Ductus Arteriosis Transection and Atrial Septal Defect Patching in a 1-Month-Old Male for D Transposition of the Great Arteries, Cor Triatriatum Sinister and Atrial Septal Defect Secundum Type With Dextrocardia

Arterial Switch Operation, Cor Triatriatum Repair, Patent Ductus Arteriosis Transection and Atrial Septal Defect Patching in a 1-Month-Old Male for D Transposition of the Great Arteries, Cor Triatriatum Sinister and Atrial Septal Defect Secundum Type With Dextrocardia

Total anomalous pulmonary venous connections

Aim: To asses the clinical presentation, follow-up of the rare type of total anomalous pulmonary venous connection (TAPVC) according to their anatomic subtype: supracardiac, cardiac, infracardiac or mixed drainage. Matherial and methods: In the last 3 years we diagnosed 5 cases of TAPVC, aged 1 week –5 years. All the cases were diagnosed through echocardiography, 1 case was confirmed also by MRI, other 2 during surgery. Results: Two cases had isolated TAPVC with atrial septal defect of secundum type, and 3 had complex cardiac diseases -complete cushion defect with imbalanced ventricles (1), double outlet right ventricle (2) with severe pulmonary stenosis/atresia, associating heterotaxia – asplenia (Ivemark syndrome). Concerning the anatomic type of the venous connections 3 had supracardiac drainage by a common venous collector, 1 mixed (cardiac through coronary sinus and supracardiac), 1 infracardiac. The isolated TAPVC were both operated in the moment of the diagnosis, with good results. One of them was diagnosed only at 8 month and still has a residual pulmonary hypertension. The other 3 cases were not possible to be operated because of complex malformations of the heart, 2 died shortly after diagnosis. Conclusion: Although a rare heart defect TAPVC is important to diagnose as early as possible. Echocardiography is a sure method for diagnosis. Although in all cases the cardiac malformation was obvious shortly after birth, a correct diagnosis was made late in 3 cases (8 month –5 years). Late diagnosis and surgery is associated with residual pulmonary hypertension. Isolated TAPVC has an excellent prognosis when operated in time. In Ivemark syndrome only paleative surgery techniques can be applied, and the mortality remains high even in experienced centers.

Non-immunologically-induced hydrops fetalis in complete atrioventricular block of the fetus. A summary of 11 prenatally diagnosed cases

In 11 of 21 fetuses with prenatally diagnosed complete heart block, congestive heart failure with signs of non-immune hydrops fetalis was seen. In all 11 fetuses, cardiac malformations were present: complete atrioventricular canal with levocardia, situs inversus viscerum, and polysplenia: 5 cases; tricuspid atresia with situs inversus viscerum, endocardial fibroelastosis, common atrium with aortic valve atresia, hypoplastic left heart, atrial septal defect of secundum type: one case each. All these cardiac malformations can also cause intrauterine heart failure without heart block except hypoplastic left heart and atrial septal defect. A review of the literature confirms, that only the association between complete heart block and cardiac malformation--in particular AV-canal and endocardial fibroelastosis--can cause an intrauterine congestive heart failure, whereas in the case of fetal complete heart block without cardiac malformation or with prenatally hemodynamically insignificant cardiac malformations--in particular "corrected" transposition of great arteries--a congestive heart failure is rare.

CONGENITAL HEART DISEASE IN MIDDLE-AGED AND ELDERLY PATIENTS

One hundred and four patients with congenital heart disease and over the age of 40 years have been visited the Second Department of Internal Medicine, Gunma University Hospital during the last 11 years. The most frequent lesion was the atrial septal defect of secundum type (72 cases) which was followed by ventricular septal defect (12 cases) and patent ductus arteriosus (7 cases). Forty eight of the above cases were first pointed out the cardiac abnormalities at the age of 40 years or later, while a correct diagnosis of congenital heart disease had been made only in 14 cases before.The numbers of the disabled patients increased with the advancing age. Three fourths of the elderly patients over the age of 60 years were classified as being NYHA function class III or IV. Significant positive correlations were demonstrated between the age and the cardio-thoracic ratio and between the age and the right ventricular systolic pressure in atrial septal defect.The clinical course of 68 cases followed for 2 years or longer were rather favorable under proper medical care. Only 3 died, while 9 cases without any medical supervisions were deteorirated. The course of 17 operated cases were good. Although an appropriate medical care is effective to relieve the symptoms, we thought that the surgical interventions should not be hesitated in middle-aged and even in elderly patients with congenital heart disease if indicated.

Effects of corrective surgery on natural history of atrial septal defect of secundum type.

Two hundred and seventy-eight patients with atrial septal defect of secundum type were operated on surgical closure of the defect. The patients were divided into 5 groups according to age at surgery, and preoperative complaints and laboratory findings were analyzed to evaluate natural history. As year passed, incidence of complaints increased. Cardiothoracic ratio (CTR), systolic pressure of the right ventricle (PRVS), end-diastolic pressure of the right ventricle (RVEDP), mean pressure of the right atrium (PRAm), ratio of pulmonary to systemic systolic pressure (PPA/PS), right ventricular dimension (RVD) and left atrial dimension (LAD) increased significantly, while frontal axis of the QRS complex, RV1, SV1 +RV5 and LVD decreased. No chronological changes were seen in ratio of pulmonary to systemic blood flow (QPA/QS) and ratio of pulmonary to systemic vascular resistance (RPA/RS). The first and second decades of life were considered to be stable stages of the disease. Postoperatively, changes in the above-mentioned parameters were compared in each age group, and effects of surgical repair on natural history were evaluated. Of 265 survivors, 168 were followed-up for more than one year, the longest period being 22 years. CTR, frontal axis, RV1, PRVS, RVEDP, PPA/PS and RVD decreased significantly, while SV1 + RV5, RPA/RS and LVD increased. No changes were seen in LAD. Surgical effects appeared most significantly in the first decade and least in the fifth or more. From these findings it would be concluded that corrective surgery should be best carried out in the first decade, at latest in the second, though not to be contraindicated by age alone. Otherwise, postoperative improvement of parameters delays or hemodynamical abnormalities may persist regardless of considerable clinical improvement.

The Surgical Repair of Atrial Septal Defect of Secundum Type in the Old Age (Sixty Years of Age)

The Surgical Repair of Atrial Septal Defect of Secundum Type in the Old Age (Sixty Years of Age)

ATRIAL SEPTAL DEFECT AND PULMONARY VALVULAR STENOSIS IN A TRIPLE X FEMALE

A 29 year old female admitted with the neurological disorders consistent with acute myelitis was diagnosed as 45, XO/47, XXX mosaicism associated with atrial septal defect of secundum type and mild pulmonary valvular stenosis. Although the association of congenital heart disease with the chromosome aberration in the present patient might be coincidental, this case was reported because only few similar associations have been described before.

Surgical management of atrial septal defect of secundum type with a special reference to th e hemodynamic changes with aging

Surgical management of atrial septal defect of secundum type with a special reference to th e hemodynamic changes with aging

Circumclusion of atrial septal defect in elderly patients.

The results of surgical closure of atrial septal defect of secundum type (ASD) in 28 patients over 40 years of age with a closed method, circumclusion ad modum Søndergaard, are presented. One death occurred in the postoperative period caused by cerebral embolism in a patient with increased pressure in the pulmonary artery and atrial fibrillation. The most frequent postoperative complications were transient atrial arrhythmias and the post-pericardiotomy syndrome. The pressures in the pulmonary artery decreased in all patients, who had increased pressures pre-operatively. In two patients with pulmonary vascular resistance of 6 mmHg/l/min before operation the resistance was significantly reduced postoperatively. Residual shunts of less than 30% of the systemic flow were present in 4 cases. The ASD recurred years after the operation in two patients. At follow-up examinations on an average 44 months after operation, 75% had improved. In 20 cases the heart was reduced in size. In the remaining 6 the heart size was unchanged or larger, in spite of eliminated shunts in 5 of the 6 patients. Of 8 patients with atrial fibrillation before operation, two gained stable sinus rhythm postoperatively. It is concluded that circumclusion is also an effective method in the elderly patient with ASD and that such patients should undergo surgical repair of the defect.

An unusual form of mitral insufficiency accompanying atrial septal defect

An unusual case of atrial septal defect secundum type, associated with intermittent severe mitral insufficiency due to billowing anterior mitral leaflet, in a 56-year old female is described. The degree of mitral insufficiency ranged from severe to none. This phenomenon manifested itself by an intermittent systolic apical thrill and intermittent mitral regurgitation on angiocardiography. Pulling the anterior mitral leaflet at operation through the atrial septal defect demonstrated that this leaflet could be caught in the left atrium, thus causing intermittent mitral insufficiency. Closure of the atrial septal defect and replacement of the mitral valve was performed.

主題II-2-16 合併心奇形を有するASDの外科治療

主題II-2-16 合併心奇形を有するASDの外科治療

Atrial septal defect of secundum type in patients under 40 years of age. A review of 481 operated cases. Symptoms, signs, treatment and early results.

In the period 1957--1976 481 patients under 40 years of age were operated on. Dyspnoea and increased fatigue were dominating symptoms in more than half of the series. In 202 cases the anomaly was discovered at routine examination in the absence of relevant symptoms. Almost half of the patients were operated under hypothermia, in the others extracorporeal perfusion was used. Four hospital deaths occurred, two of which were related to cardiopulmonary bypass.

Natural history of atrial septal defect of secundum type in the middle-aged. Medical versus surgical therapy.

10 middle-aged patients with atrial septal defect of the secundum type (ASD II) were referred to surgery, but for several noncardiological reasons the operation was not performed. 5 patients were reexamined after an interval from 6 1/2 to 15 years. During the follow-up period only relatively minor changes in pulmonary arteriolar resistance had occurred and all patients were still acceptable candidates for surgical treatment. The other 5 patients died after a period of time ranging from 2 weeks to 16 1/2 years from conditions directly or indirectly related to the cardiac malformation. During the same period of time, 84 ASD II patients underwent surgery with a mortality rate of 8.3% after 74 months, including 2 hospital deaths. These results suggest that middle-aged patients with ASD II without obstructive pulmonary hypertension should be operated on without delay, but that in a significant number of cases, long-term conservative treatment is not associated with an increase in pulmonary arteriolar resistance.

Atrial septal defect of secundum type in the middle-aged: Clinical results of surgery and correlations between symptoms and hemodynamics

Summary This study comprised 98 of 100 patients above 40 years of age who underwent surgery in Norway for atrial septal defect of secundum type (ASD II) up to 1972. A follow-up study was performed on average 74 months (range 22 to 174) after surgery. Pulmonary hypertension was found in 30 per cent. The pulmonary arteriolar resistance (PAR) was increased in only one patient. Increasing degrees of arrhythmias, Dyspnea, edema, and functional class (NYHA) before surgery were significantly correlated to increasing pressures in the right atrium, right ventricle, pulmonary artery (PA), left atrium (pulmonary capillary venous pressure), and to increasing PAR. No significant correlations between the shunt ratio and different degrees of the symptoms were found. The hospital mortality rate was 3 per cent, and was not related to high age or increased PA pressure. There were no deaths among the last 65 patients. Before surgery, 13 per cent of the patients were in functional Class I, and 22.6 per cent in Class II or IV. The corresponding figures after surgery were 58.1 per cent and 0 per cent. The frequency of arrhythmias was high, and this was the symptom which showed the least improvement. Cerebral embolism occurred in six patients who also had arrhythmias, and five of the embolisms occurred after surgery. All patients with ASD II complicated with arrhythmias should be given anticoagulant therapy, whether they are operated on or not. In middle-aged patients disabled by ASD II, a marked improvement after surgery can be expected.

Diagnosis of endocardial cushion defect with cross-sectional and M-mode scanning echocardiography. Differentiation from secundum atrial septal defect.

Twelve cases of endocardial cushion defect were studied before and after operation with ultrasono-cardiotomography (tomography) cross-sectional echocardiography, two-dimensional echocardiography, B-scan echocardiography) and M-mode scan along a horizontal section of the heart. For comparison, 20 healthy subjects, 18 cases of mitral valvular disease, 4 cases of congestive cardiomyopathy, 1 case of partial anomalous pulmonary venous drainage, and 25 cases of atrial septal defect of secundum type were also examined with the same technique. In cases without cardiac malformation, the echo of the anterior mitral valve was usually continuous medially with that of the interatrial septum in the horizontal plane at the level of the membranous septum. This feature was clearly recorded in all cases with right heart enlargement. In ostium secundum atrial septal defect the echo of the anterior mitral valve continued into that of the interatrial septum. An echo interruption was shown, indicating the defect itself to be in the middle part of the interatrial septum. In all the cases of endocardial cushion defect which we examined discontinuity was shown between the echo of the anterior mitral valve and that of the interatrial septum. This discontinuity was interpreted as indicating the defect itself. The mitral valve ring echo was close to the basal end of that of the interventricular septum, possibly reflecting an abnormal attachment of the mitral valve. In all cases, after operation, the echo of the artificial interatrial septum was recorded, continuous with that of the anterior mitral valve. The features of the echocardiographic sweep from the anterior mitral valve to the interatrial septum were thus different in the three groups. These echocardiographic differences are thought to correspond to the anatomical differences between the normal, atrial septal defect of secundum type, and endocardial cushion defect, and are essential features differentiating them from each other.

Prediction of hemodynamic data in atrial septal defects of secundum type from simple and combined vectorcardiographic data

A search for simple and combined VCG data which could optimally predict right ventricular systolic pressure (RVSP) or shunt size was made in 50 patients with atrial septal defects of the secundum type. VCG was recorded by means of the axial lead system and a multiple regression computer program was applied. Fifty-four VCG data, age, sex, and systolic blood pressure were tested as independent predictors. Seventeen VCG data were significantly correlated with RVSP and six with flow. The best individual variable was the simple maximal negative deflection in Lead X (r = 0.64, p < 0.001). The correlations with flow were poorer, but of theoretical interest. Distinctive differences in the VCG-RVSP relationships were found in atrial septal defects compared with those in pulmonary stenosis, indicating that the increased flow sensitizes the right ventricle to the effect of pressure. Through multiple regression analysis, an equation based on four vectorcardiographic variables was derived. This equation improved the RVSP-VCG correlations significantly (p < 0.05, r = 0.80). The study confirms that vectorcardiogram is a reasonably reliable method for estimating RVSP in patients with atrial septal defects and that the use of combined VCG data may improve the method considerably.

Serial hemodynamic observations in secundum atrial septal defect with special reference to spontaneous closure

Forty patients with atrial septal defect of secundum type diagnosed by cardiac catheterization underwent repeat study 1 ½ to 14 years later to document the frequency of spontaneous closure. These 40 patients were classified in two groups of 20 each according to age. Group 1 comprised 20 patients who were less than 1 year of age on the initial study and Group 2 comprised 20 patients who were older than 1 year on the initial study. Eleven of the 20 patients in Group 1 were noted to have spontaneous closure of the atrial septal defect on repeat study. The incidence of spontaneous closure was not necessarily related to the size of the defect. In contrast, none of the 20 patients in Group 2 had spontaneous closure on repeat study. Our data indicate that atrial septal defect of secundum type diagnosed in the first year of life frequently closes spontaneously. If the defect is diagnosed after the first year, it is unlikely to close spontaneously.

Non-invasive Diagnosis in Clinically Suspected ASD Secundum

Background: The non-invasive tests like X-ray, ECG and Echocardiography are viewed as an extension of clinical art in cardiology and have become an integral part of history taking, physical examination and other diagnostic method. Atrial Septal Defect (ASD) of secundum type is defined as a through and through communication at atrial level. Previously the diagnosis and decision of surgery for ASD, mandatorily advocate cardiac catherization. Now cardiologist and cardiac surgeon very hardly asked for cardiac catheterization. Non-invasive diagnosis with the help of ECG, X-ray and Echo is sufficient for its diagnosis and treatment for surgery. In Bangladesh there is no study upon it. Considering this ground the study is perform on Bangladeshi patients.Methods: Forty six consecutive patients with clinical (auscultatory and electrocardiographic) signs of uncomplicated atrial septal defect of secundum type were examined by chest x-ray, ECG and echocardiography, before right heart catheterisation.Result: Thirty four (74%) had ASD, four patients (9%) had insignificant pulmonary stenosis, and eight subjects (17%) were normal. No false positive diagnosis of atrial septal defect was made by chest x-ray examination, whereas increased vascular markings were incorrectly interpreted as pulmonary congestion in one case. Eight patients had x-ray films showing questionable signs of left-to-right shunt. Twelve of 30 patients with a large left-to-right shunt were correctly selected for surgery based on radiological findings. Conclusion: Analysis of non invasive diagnosis and management of ASD secundum conform the usually described pattern in western literature. Keywords: Atrial Septal Defect; Cardiac Imaging DOI: 10.3329/cardio.v2i2.6645Cardiovasc. j. 2010; 2(2) : 223-226

A Forty Year Old Lady with Undiagnosed Lutembacher Syndrome - A Case Report

A forty years widow having four children presented with palpitation, shortness of breath on exertion and chest pain. Her sufferings progressively increase in course of time. Her ECG shows complete Right Bundle Branch Block. Transthoracic echocardiography showed atrial septal defect of secundum type. Both the leaflets of the mitral valve were thickened with mild degree of diastolic doming. Key Words: Lutembacher Syndrome; Mitral Stenosis. DOI: 10.3329/uhj.v6i1.7198University Heart Journal Vol.6(1) 2010 pp.51-54

Usefulness of vectorcardiography for assessment of severity of right ventricular overloading in congenital heart disease. II. Atrial septal defect of secundum type.

The Frank lead vectorcardiograms of 31 catheterized cases of atrial septal defect of secundum type were reviewed and the results were correlated with the hemodynamic observations. Although no definite relationship was demonstrated between the vectorcardiographic measurements and the hemodynamic data, there was a significant correlation between the QRS patterns in the frontal plane and the right/left ventricular work ratios. The vectorcardiograms were thought to be of some value for assessment of the severity of right ventricular overloading in atrial septal defect.