Surgery For Atrial Septal Defect Research Articles

Risk Analysis of the Long-Term Outcomes of the Surgical Closure of Secundum Atrial Septal Defects.

BackgroundClosure of a secundum atrial septal defect (ASD) is possible through surgical intervention or device placement. During surgical intervention, concomitant pathologies are corrected. The present study was conducted to investigate the outcomes of surgical ASD closure, to determine the risk factors of mortality, and establish the effects of concomitant disease correction.MethodsBetween October 1989 and October 2009, 693 adults underwent surgery for secundum ASD. Their mean age was 40.9±13.1 years, and 199 (28.7%) were male. Preoperatively, atrial fibrillation was noted in 39 patients (5.6%) and significant tricuspid regurgitation (TR) in 137 patients (19.8%). The mean follow-up duration was 12.4±4.7 years.ResultsThere was no 30-day mortality. The 1-, 5-, 10-, and 20-year survival rates were 99.4%, 96.8%, 94.5%, and 81.6%, respectively. In multivariate analysis, significant preoperative TR (hazard ratio [HR], 1.95; 95% confidence interval [CI], 1.09 to 3.16; p=0.023) and preoperative age (HR, 1.04; 95% CI, 1.01 to 1.06; p=0.001) were independent risk factors for late mortality. The TR grade significantly decreased after ASD closure with tricuspid repair. However, in patients with more than mild TR, repair was not associated with improved long-term survival (p=0.518).ConclusionSurgical ASD closure is safe. Significant preoperative TR and age showed a strong negative correlation with survival. Our data showed that tricuspid valve repair improved the TR grade effectively. However, no effect on long-term survival was found. Therefore, early surgery before the development of significant TR mat be beneficial for improving postoperative survival.

Hemolysis During Open-Heart Surgery With Vacuum-Assisted Venous Drainage at Different Negative Pressures in Pediatric Patients Weighing Less Than 10 kilograms.

This study examined the degree of hemolysis during vacuum-assisted venous drainage at different negative pressures to identify an adequate negative pressure that provides effective venous drainage without significant hemolysis in open-heart surgery in children weighing less than 10 kg. Patients weighing less than 10 kg who underwent surgery for ventricular septal defect or atrial septal defect from 2011 to 2014 were enrolled. We used one of four negative pressures (20, 30, 40, or 60 mm Hg) for each patient. We measured haptoglobin, plasma hemoglobin, aspartate aminotransferase, and lactate dehydrogenase levels in the patients' blood three times perioperatively and determined the potential correlation between the change in each parameter with the level of negative pressure. Forty-six patients were enrolled in this study (mean age: 7.1 ± 7.0 months, mean body weight: 6.1 ± 1.8 kg). There were no significant differences according to the degree of negative pressure with respect to patient age, body weight, cardiopulmonary bypass (CPB) time, aorta cross-clamping time, blood flow during CPB, or lowest body temperature. All parameters that we measured reflected progression of hemolysis during CPB; however, the degree of change in the parameters did not correlate with negative pressure. In pediatric patients weighing less than 10 kg, the change in the degree of hemolysis did not differ with the amount of negative pressure. We may apply negative pressures up to 60 mm Hg without increasing the risk of hemolysis, with almost same the level of hemolysis using negative pressures of 20, 30, and 40 mm Hg for effective venous drainage and an ideal operative field during open-heart surgery.

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.

Outcomes of Totally Endoscopic Atrial Septal Defect Closure Using a Glutaraldehyde-Treated Autologous Pericardial Patch.

We evaluated the outcomes of totally endoscopic minimally invasive surgery for atrial septal defect (ASD) using a glutaraldehyde-treated autologous pericardial patch in the transcatheter interventional era.Methods and Results:We retrospectively reviewed 37 consecutive patients who underwent totally endoscopic ASD closure with a glutaraldehyde-treated autologous pericardial patch between June 2011 and April 2015. All patients had been deferred from catheter-based intervention for clinical or anatomical reasons. We analyzed operative outcomes and postoperative echocardiographic data. The mean age was 45.7±16.5 years, and 25 patients (67.6%) were women. The mean ratio of pulmonary to systemic flow was 2.4±0.7. Six patients (16.2%) underwent concomitant tricuspid valve repair, and 3 patients (8.1%) underwent concomitant atrial fibrillation surgery. There were no operative deaths, and the median length of hospital stay was 5 days. Postoperative echocardiography revealed trivial residual shunt in 1 patient. During the follow-up period, there were no re-interventions for ASD or readmission for heart failure. Follow-up echocardiography revealed no recurrent shunt or calcification of the autologous pericardial patch. Totally endoscopic ASD closure with a glutaraldehyde-treated autologous pericardial patch demonstrated excellent outcomes. It is a useful option for patients with unfavorable anatomy or other reasons excluding transcatheter intervention.

Transfusion-related acute lung injury (TRALI) after pediatric cardiac surgery: A case report

Transfusion-related acute lung injury (TRALI), acute respiratory distress with noncardiogenic pulmonary edema that occurs within six hours of transfusion, is the leading cause of transfusion-related deaths. However, there is no reliable literature regarding the incidence of TRALI in the pediatric population. We report a case study of a 3-year-old boy presenting with TRALI syndrome four hours after heart surgery for atrial septal defect (ASD) closure for which he received the transfusion of red blood cells and fresh frozen plasma. We report this case with the aim that doctors become aware of the signs of TRALI to enable early intervention and the development of preventive measures.

Right Atrial Tamponade Post Atrial Septal Defect Surgery in a Child

This report describes a rare and life threatening occurrence of right atrial tamponade secondary to massive intrapericardial clot compressing the right atrium, in a three year old child post atrial septal defect surgery.

Prevalence and Risk Factors for Pericardial Effusions Requiring Readmission After Pediatric Cardiac Surgery.

Pericardial effusion (PE) may require readmission after cardiac surgery and has been associated with postoperative morbidity and mortality. We sought to identify the prevalence and risk factors for postoperative PE requiring readmission in children. A retrospective analysis of the Pediatric Health Information System database was performed between January 1, 2003, and September 30, 2014. All patients ≤18years old who underwent cardiac surgery were identified by ICD-9 codes. Those readmitted within 1year with an ICD-9 code for PE were identified. Logistic regression analysis was performed to determine risk factors for PE readmissions. Of the 142,633 surgical admissions, 1535 (1.1%) were readmitted with PE. In multivariable analysis, older age at the initial surgical admission [odds ratio (OR) 1.17, p<0.001], trisomy 21 (OR 1.24, p=0.015), geographic region (OR 1.33-1.48, p≤0.001), and specific surgical procedures [heart transplant (OR 1.82, p<0.001), systemic-pulmonary artery shunt (OR 2.23, p<0.001), and atrial septal defect surgical repair (OR 1.34, p<0.001)] were independent risk factors for readmission with PE. Of readmitted patients, 44.2% underwent an interventional PE procedure. Factors associated with interventions included shorter length of stay (LOS) for the initial surgical admission (OR 0.85, p=0.008), longer LOS for the readmission (OR 1.37, p<0.001), and atrial septal defect surgery (OR 1.40, p=0.005). In this administrative database of children undergoing cardiac surgery, readmissions for PE occurred after 1.1% of cardiac surgery admissions. The risk factors identified for readmissions and interventions may allow for improved risk stratification, family counseling, and earlier recognition of PE for children undergoing cardiac surgery.

Objawy pooperacyjnego zespołu Hornera po korekcji wrodzonej wady serca prowadzące ostatecznie do rozpoznania zespołu Axenfelda-Riegera

Axenfeld-Rieger syndrome (ARS) is an uncommon, autosomal dominant disorder characterized by anomalies of the anterior segment of the eye, face, teeth, and abdominal region. The coincidence of congenital heart defects and eye anomalies have been recently reported, as well as the genetic origin of these disorders. Clinical manifestation of the both the Horner’s and ARS resemble very similar therefore they could be easily misdiagnosed. The ARS is induced by spontaneous mutations in PITX2 and FOXC1 genes though. As in 50% cases of ARS the glaucoma develops, permanent ophthalmological care is necessary. 14-years-old patient in an early postoperative course after successful ostium secundum atrial septal defect surgery was observed with mild, iatrogenic Horner’s syndrome which coexisted with increased pericardial fluid. The ophthalmological examination revealed the iridial dysgenesis suggesting the ARS diagnosis. There were no recent abnormalities found in the optical coherent tomography (OCT) of the optic nerve. Thus, further OCT repeats and intraocular pressure measures under ophtalmological supervision were deputed. This case report confirms the coexistence of ARS and congenital heart defects, and emphasize the need of meticulous examination of any possible postoperative complications, and additional genetic defects.

Late Causes of Death After Pediatric Cardiac Surgery: A 60-Year Population-Based Study

BackgroundComprehensive information regarding causes of late post-operative death following pediatric congenital cardiac surgery is lacking. ObjectivesThe study sought to analyze late causes of death after congenital cardiac surgery by era and defect severity. MethodsWe obtained data from a nationwide pediatric cardiac surgery database and Finnish population registry regarding patients who underwent cardiac surgery at <15 years of age at 1 of 5 universities or 1 district hospital in Finland from 1953 to 2009. Noncyanotic and cyanotic defects were classified as simple and severe, respectively. Causes of death were determined using International Classification of Diseases diagnostic codes. Deaths among the study population were compared to a matched control population. ResultsOverall, 10,964 patients underwent 14,079 operations, with 98% follow-up. Early mortality (<30 days) was 5.6% (n = 613). Late mortality was 10.4% (n = 1,129). Congenital heart defect (CHD)–related death rates correlated with defect severity. Heart failure was the most common mode of CHD-related death, but decreased after surgeries performed between 1990 and 2009. Sudden death after surgery for atrial septal defect, ventricular septal defect, tetralogy of Fallot, and transposition of the great arteries decreased to zero following operations from 1990 to 2009. Deaths from neoplasms, respiratory, neurological, and infectious disease were significantly more common among study patients than controls. Pneumonia caused the majority of non–CHD-related deaths among the study population. ConclusionsCHD-related deaths have decreased markedly but remain a challenge after surgery for severe cardiac defects. Premature deaths are generally more common among patients than the control population, warranting long-term follow-up after congenital cardiac surgery.

Gallbladder agenesis and atrial septal defect: A case report.

Congenital absence of gallbladder and atrial septal defect (ASD) are clinically rare congenital organ malformations, and the simultaneous occurrence of the two is even more rare. The present study reported a case of gallbladder agenesis combined with congenital ASD. A 38-year-old male patient presented with a 3-year history of recurring upper right abdominal pain. The pain had no evident cause and was accompanied by dyspepsia and gasteremphraxis with indigestion. Several color Doppler ultrasonography scans revealed cholecystitis and gallbladder stones. A physical examination revealed cardiac murmur. A color Doppler ultrasonography of the heart was indicative of congenital heart disease. A corrective surgery for ASD was performed. Subsequently, a mini-incision cholecystectomy was performed as explorative surgery. A magnetic resonance cholangiopancreatography scan of the abdomen was performed in order to confirm the diagnosis of gallbladder disorder and cystic duct hypoplasia. A final definite diagnosis of gallbladder agenesis was confirmed. In conclusion, atrophy and gallbladder full of stones are frequently misdiagnosed, and establishing a definitive preoperative diagnosis is difficult. Awareness of this congenital malformation may assist physicians in distinguishing cases with unclear manifestation and avoiding unnecessary surgical interventions.

Changes in Plasma Atrial and Brain Natriuretic Peptide Levels in Children Undergoing Surgical Isolated Atrial Septal Defect Closure.

Plasma atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) levels increase after cardiopulmonary bypass (CPB) in pediatric patients. However, the exact reason for the postoperative increase remains unclear. This study elucidated the perioperative changes in plasma natriuretic peptide levels in children undergoing surgical isolated atrial septal defect (ASD) closure. Between 2010 and 2012, 24 pediatric patients (median 7.1, range 2.7-15.7 years) underwent surgery for simple ASD using CPB under ventricular fibrillation (Group A, 16 patients) or under cardiac arrest (Group B, 8 patients). Natriuretic peptide levels were measured before surgery, on postoperative day 0, 1, 3, and at the first outpatient visit. The pulmonary to systemic blood flow ratio (Qp/Qs) was estimated by echocardiography using an index of right ventricle end-diastolic area. Preoperative natriuretic peptide levels positively correlated with the Qp/Qs. Plasma ANP levels peaked on postoperative day 0, and its values were higher in Group A than in Group B patients (p < 0.001). Plasma BNP levels increased significantly in both Groups on postoperative day 1, and its values were significantly greater in Group A than in Group B patients (p = 0.007). There was a weak negative correlation between the amount of postoperative increase in natriuretic peptide levels and the Qp/Qs. There was no appreciable difference in the acute postoperative clinical course and echocardiographic parameter on postoperative day 3 between Group A and B patients. In conclusion, acute postoperative natriuretic peptide levels after isolated ASD closure were multifactorial, and they might be unreliable for predicting clinical outcomes.

Sports participation in adults with congenital heart disease

BackgroundIt is unclear whether sports participation in adults with repaired congenital heart disease is safe and has benefits. MethodsCongenital heart disease (ConHD) patients who underwent corrective surgery for Atrial Septal Defect, Ventricular Septal Defect, Pulmonary Stenosis, Tetralogy of Fallot or Transposition of the Great Arteries in our center between 1968 and 1980 were included, and participated in our longitudinal follow-up study with serial evaluations in 2001 and 2011. At both time points patients filled in questionnaires on sports participation, subjective physical functioning and quality of life. Exercise testing, echocardiogram and 24-hour continuous ambulatory ECG-monitoring were performed in both 2001 and 2011. All clinical events (re-intervention, arrhythmia, heart failure) were prospectively recorded. ResultsNo relationship was found between practicing sports and the occurrence of sudden death, PVCs or SVTs. Patients with moderate/complex forms of ConHD practiced fewer hours of sports compared with the general Dutch normative population. Patients with both simple and moderate/complex ConHD who practiced sports showed a higher exercise capacity. More favorable subjective physical functioning was found for moderate/complex patients who practiced sports. ConclusionsAdults with repaired ConHD are less often involved in sports than the Dutch general population. The patients that were engaged in sports show a higher exercise capacity than those who did not. Sports participation in patients with ConHD was not associated with an increased incidence of adverse cardiac events.

Minimally Invasive Surgery for Congenital Atrial Septal Defects vs. Catheter Based Device-Occlusion in Adults

Minimally Invasive Surgery for Congenital Atrial Septal Defects vs. Catheter Based Device-Occlusion in Adults

Life threatening iatrogenic abnormal venous return following atrial septal defect surgery

A 16-year-old woman was referred for surgery because of a secundum atrial septal defect (ASD) causing exercise dyspnea. The pulmonary/systemic output ratio was estimated at 2.3 and the defect was measured at 40mm by transesophageal echocardiography (TEE). Systemic and pulmonary venous return was normal. A pericardial patch was sutured through a minimally-invasive approach by right thoracotomy. Immediately after surgical closure, the patient developed severe hypoxemia without hemodynamic instability or pulmonary failure.

Intraoperative tranexamic acid in pediatric bloodless cardiac surgery

The aim of this study was to evaluate the clinical effects of intraoperative tranexamic acid administration in cardiac surgery without blood transfusion (bloodless cardiac surgery) in children. Seventy-one consecutive patients weighing less than 20 kg, who underwent bloodless cardiac surgery for simple atrial or ventricular septal defects at Kobe Children's Hospital from January 2011 to June 2013, were enrolled in this retrospective study. Tranexamic acid was administered during surgery from January 2012 (TXA group; n = 31), whereas it was not administered before January 2012 (control group; n = 40). Perioperative variables were compared between the TXA and control groups. There were no significant differences in patient characteristics or preoperative data between the 2 groups. Serial changes in perioperative hemoglobin and hematocrit levels, mixed venous oxygen saturation, and regional cerebral oxygenation during cardiopulmonary bypass were significantly higher in the TXA group compared to the control group. There were significant reductions in operative time, dopamine dose, peak serum lactate level, intubation time, chest tube drainage and duration, and hospital stay in the TXA group. Intraoperative tranexamic acid administration was effective for blood conservation, and improved postoperative clinical outcomes in pediatric bloodless cardiac surgery.

Coronary artery vasospasm after atrial septal defect surgery

Coronary vasospasm is one of the fatal complications that may occur in patients undergoing open heart surgery. To date, however, there are not many cases in this series and no definite pathophysiology has been documented. We experienced a case of coronary artery vasospasm after atrial septal defect (ASD) surgery and then successfully treated it with both transbrachial intra-aortic balloon pump and percutaneous cardiopulmonary support. Only several hours after ASD surgery, the patient exhibited the cardiovascular col- lapse, the ST-segment elevation, followed by ventricular fibrillation and normal coronary angiography findings. It is important to make a differential diagnosis of coronary artery vasospasm in patients presenting with ST-segment elevation who had no notable coronary artery diseases. This case indicates that clinicians should be aware of the possibility that the coronary artery vasospasm may also occur in patients undergoing ASD surgery.

Generalized Cutaneous Lesions Due to Mycobacterium abscessus: A Case Report

Introduction: Generalized cutaneous lesions caused by Mycobacterium abscessus have not been reported in immuno competent individuals. Case presentation: We describe here a case of 13-year old male child who developed a non-healing sternal wound after being operated upon for atrial septal defect surgery. Routine pyogenic and fungal cultures were negative. The wound did not clear with repeated courses of antibiotics. The continued serosanguinous discharge from the wound site ultimately progressed to generalized pustular non-healing lesions possibly through secondary bacteremia. Pustular pus showed acid-fast bacilli in Ziehl-Neelsen staining and grew Nontuberculous Mycobacteria on conventional LJ Medium and rapid MGIT medium. The NTM isolated was identified as M. abscessus through culture characters, biochemical testing, PCR and DNA fingerprinting technique. Treatment with multiple drugs helped in clearing of the skin pustular lesions. Conclusion: This case of generalized lesions by abscessus infection appears to be the first ever reported finding.

Postoperative Atrial Fibrillation following Open Cardiac Surgery: Predisposing Factors and Complications.

New-onset postoperative atrial fibrillation (POAF) is a common complication of cardiac surgery that has substantial effects on outcomes. The aim of this study is to analyze the risk factors in the pre, intra, and postoperative periods, and evaluate its impact on patients' outcome. In this prospective study, between March 2007 and February 2011, a total of 1254 patients with preoperative sinus rhythm who underwent open cardiac surgery were included of which 177 (13.6%) had developed POAF. Many clinical variables that are associated with the development of POAF, were evaluated. The study population consisted of 1254 patients that 864 (68.9%) were male and 390 (31.1%) female, and average age was 55.1±15.7 years. POAF occurred in 171 (13.6%) of patients and most of them (68.4%) developed within the first two days after surgery. Multivariate logistic regression analysis was used to identify the following risk factors of POAF: Preoperative risk factors: age>50, smoking, Left ventricular hypertrophy, renal dysfunction, intraoperative risk factors: intraoperative inotrope use, valve surgery, atrial septal defect (ASD) surgery, bicaval cannulation, concomitant cardiac venting of pulmonary and aorta, longer cardiopulmonary time, longer cross-clamp time, postoperative use of inotropic agent after termination of cardiopulmonary bypass. POAF is the most common arrhythmia after cardiac surgery and not only concerted effort should be performed to identify and to reduce the risk factors, but also effective treatment is necessary to prevent mortality and morbidity.

Early changes in myocardial repolarization and coronary perfusion after cardiopulmonary bypass surgery for ASD repair in children

BackgroundIn adults, impaired myocardial repolarization and increased risk of arrhythmia are known consequences of open heart surgery. Little is known, however, about post-operative consequences of cardiopulmonary bypass surgery in children. The aim of this study was to assess ventricular repolarization and coronary perfusion after bypass surgery for atrial septal defect (ASD) repair in children.MethodsTwelve patients with ASD were assessed one day before and 5–6 days after ASD repair. Myocardial repolarization (corrected QT interval, QTc, QT dispersion, QTd, and PQ interval) was determined on 12-lead electrocardiograms. Coronary flow in proximal left anterior descending artery (peak flow velocity in diastole, PFVd) was assessed by transthoracic Doppler echocardiography.ResultsTen of the 12 (83%) children had normal myocardial repolarization before and after surgery. After surgery, QTc increased 1-9% in 5 (42%) patients, decreased 2-11% in 5 (42%) patients and did not change in 2 (16%) patients. Post-op QTc positively correlated with bypass time (R=0.686, p=0.014) and changes in PFVd (R=0.741, p=0.006). After surgery, QTd increased 33-67% in 4 (33%) patients, decreased 25-50% in 6 patients (50%) and did not change in 2 (16%) patients. After surgery, PQ interval increased 5-30% in 4 (33%) patients, decreased 4-29% in 6 (50%) patients and did not change in 1 (8%) patient. Post-op PQ positively correlated with bypass time (R=0.636, p=0.027). As previously reported, PFVd significantly increased after surgery (p<0.001).ConclusionsChanges in QTc, PQ and PFVd are common in young children undergoing surgery for ASD repair. Post-op QTc significantly correlates with bypass time, suggesting prolonged cardiopulmonary bypass may impair ventricular repolarization. Post-op QTc significantly correlates with PFVd changes, suggesting increased coronary flow may also impair ventricular repolarization. The clinical significance and reversibility of these alternations require further investigations.

Association of quadricuspid aortic valve and ventricular septal defect in a patient who had undergone atrial septal defect surgery

Quadricuspid aortic valve (QAV) is a rare congenital cardiac anomaly. QAV can be associated with other congenital cardiac abnormalities, such as ventricular or atrial septal defect, aneurysm of Valsalva sinus, and patent ductus arteriosus. A 20 year-old man was referred to our outpatient unit for evaluation of a systolic heart murmur. The patient had undergone atrial septal defect surgery 10 years previously. Electrocardiography showed a normal sinus rhythm with a right bundle branch block. Two-dimensional (2D) transthoracic echocardiography (TTE) showed moderate right ventricular dilatation and the calculated Qp/Qs was 2.2. For further evaluation, we applied 2D and 3D transoesophageal echocardiography (2D and 3D TEE), which revealed the aortic valve consisted of 4 leaflets of differing sizes (Fig. 1A). 2D colour Doppler TEE displayed a mild aortic regurgitation and a ventricular septal defect (Fig. 1B). 3D TEE full volume view also revealed QAV (Fig. 1C). Left ventriculography demonstrated a membraneous ventricular septal defect (Fig. 1D). We decided to close this defect because he was symptomatic and Qp/Qs was higher than normal values. Hurwitz and Roberts (Am J Cardiol, 1973; 31: 623–626) classified the quadricuspid semilunar valve into 7 types (A–G). According to this classification, our patient had the commonest variant — type G, with 4 different cusps. Severe regurgitation due to cusp malcoaptation is common in type G, but our patient had mild aortic regurgitation. QAV may be found as an isolated lesion, or an association with other congenital anomalies, including ventricular septal defect, hypoplasia of anterior mitral leaflet, subaortic fibromuscular stenosis, patent ductus arteriosus, pulmonary artery stenosis, supraventricular arrhythmias, complete atrioventricular block, and anomalies of coronary arteries. For this reason, although TTE is the method of choice in the diagnosis of QAV, TEE should be performed to investigate whether other congenital anomalies are associated with QAV.