Surgical Closure Of Atrial Septal Defect Research Articles

Cardiac arrest in pregnancy with successful stabilization and delivery on veno-arterial extracorporeal membrane oxygenation: a case report

Abstract Background Cardiac arrest in pregnancy is rare. Clinicians need to adapt management to the altered anatomy and physiology of pregnancy, and the well-being of two patients (mother and foetus) may come into consideration. The medical literature has limited reports on outcomes following extracorporeal membrane oxygenation (ECMO) in pregnancy. Case summary We report the evaluation, management, and outcome of a woman with cardiac arrest and severe left ventricle (LV) dysfunction in mid-trimester of pregnancy. The previously well woman had tolerated two prior term pregnancies without complication. At 25 weeks of gestation, she presented to the hospital with breathlessness and vomiting after a pre-syncopal episode at home. She then had in-hospital cardiac arrest, managed initially with cardiopulmonary resuscitation. The LV was dilated, thin walled, and severely impaired (LV ejection fraction 14%), and there was a secundum atrial septal defect (ASD). She was supported with veno-arterial ECMO. Planned birth occurred 5 days post-arrest for maternal indication. Coronary angiography demonstrated 99% proximal left anterior descending artery stenosis and aneurysm, raising the possibility of previous subclinical Kawasaki disease. She underwent surgical revascularization and ASD closure. Both mother and infant made a good recovery. Discussion We report a case of cardiac arrest in pregnancy as first presentation of severe LV dysfunction. The case highlights the role of ECMO for cardiac arrest in pregnancy and outlines specific interventions and management concepts in this setting.

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.

The Impact of Transcatheter or Surgical Defect Closure on Self-Reported Sleep Quality in Adults with Atrial Septal Defect.

Sleep quality in those with cardiovascular disease is significantly lower than in the general population. This study aimed to explore the effect of transcatheter or surgical closure of atrial septal defect (ASD) on sleep quality. One hundred nineteen adult patients with ASD who underwent transcatheter or surgical closure were included in the study. Sleep quality was investigated prospectively just before defect closure and six months after defect closure. Pittsburgh Sleep Quality Index (PSQI) was used to evaluate sleep quality of these patients. PSQI scores were similar in both groups before the procedure in patients who underwent both transcatheter and surgical closure. The PSQI scores six months after transcatheter closure was significantly improved compared to the PSQI score before transcatheter ASD closure (3.5 ± 2.0 vs. 6.9 ± 3.4, respectively; P<0.001). The PSQI scores six months after surgical ASD closure was significantly improved compared to the PSQI score before surgical closure (4.8 ± 2.1 vs. 7.1 ± 2.0, respectively; P<0.001). Total PSQI scores were also statistically different at six months after transcatheter and surgical closure (3.5 ± 2.0 vs. 4.8 ± 2.1, P=0.014). However, six months after both transcatheter and surgical closure, PSQI scores were significantly decreased in both groups which was more pronounced in patients who underwent transcatheter closure. Transcatheter or surgical closure of the defect may be beneficial in improving the sleep quality of adult patients with ASD. Delayed improvement of sleep quality after surgical closure may be an important advantage for transcatheter closure.

An overview of treatment for atrial septal defect with pulmonary hypertension

Background: Atrial Septal Defect (ASD) is a congenital heart defect which can be the cause of comorbidities in the form of Pulmonary Arterial Hypertension (PAH) and therapy cannot be done simply by correcting the ASD but requires further study and evaluation.Purpose: Describe the treatment given to patients with ASD and PAH and the correlation between the administration of interventional therapy and the patient's probability of PH.Method: This study is a descriptive quantitative using a cross-sectional research design. The sampling technique was total sampling method. The samples were 41 ASD patients with PAH at Prof. Ngoerah General Hospital in Denpasar in 2022. Patients under 18 years of age and those with other congenital heart disease will be excluded. The demographic characteristics assessed were the patient's age and gender. The therapy data included information on medical therapy and intervention therapy.Results: Focus of medical therapy was supportive therapy rather than specific PAH therapy. Percutaneous ASD closure was the most widely-used intervention therapy compared to surgical ASD closure. Based on statistical analysis, the p value &gt; 0.05 is 0.284, so there is no significant correlation between the probability of the patient's pH and the provision of intervention therapy.Conclusion: At Prof Ngoerah General Hospital Denpasar, the majority of ASD patients with complications of pulmonary hypertension were females aged between 21 to 30 years. The medical therapy given is adjusted based on the severity of PH as assessed through echocardiography examination. Majority of patients received supportive therapy compared to specific therapy for PAH. Medical therapy is prioritized for patients who have contraindication criteria for interventional therapy. Percutaneous ASD Closure was found to be the largest percentage in interventional therapy regardless of the severity, except for patients who were indicated to undergo surgical ASD closure. There is no significant relationship between the patient's PH probability level and the choice of intervention therapy.

Minimal-Access Atrial Septal Defect (ASD) Closure

Progress towards the development and adoption of minimally invasive techniques in cardiac surgery has been slower than that seen in other surgical specialties. Congenital heart disease (CHD) patients represent an important population within cardiac disease, of which atrial septal defect (ASD) is one of the most common diagnoses. Management of ASD encompasses a range of minimal-access and minimally invasive approaches, including transcatheter device closure, mini-sternotomy, thoracotomy, video-assisted, endoscopic, and robotic approaches. In this article, we will discuss the pathophysiology of ASD, along with diagnosis, management, and indications for intervention. We will review the current evidence supporting minimally invasive and minimal-access surgical ASD closure in the adult and paediatric patient, highlighting peri-operative considerations and areas for further research.

Fibronectin enhances attachment of human adipose-derived mesenchymal stem cells into polytetrafluoroethylene patch during surgical closure of the atrial and ventricular septal defect.

Polytetrafluoroethylene (PTFE) patch is commonly used during surgical closure for atrial septal defect (ASD) and ventricular septal defect (VSD). However, this patch has several limitations such as its inability to grow or remodel, especially in children and young adults. To tackle these limitations, we have tried to use fibronectin and human adipose-derived mesenchymal stem cells (hAMSCs) in the PTFE patch. To understand the impact of fibronectin to enhance hAMSCs cell-to-cell adherence and cell-to-patch surface attachment into PTFE patches used in the surgical closure of ASD or VSD. The hAMSCs were plated and fixated with 15 mL methanol and cluster of differentiation (CD) 90+, CD105+, and CD45 - antibodies were labeled with fluorescein isothiocyanate, rinsed with phosphate-buffered saline, and analyzed under a fluorescence microscope. Fibronectin solution (0.1%) was used to soak patch scaffolds for approximately 2-h duration and then dried for 20 min in the treatment group. The samples were examined with a scanning electron microscope (SEM). SEM examination showed incomplete attachment of the cells even after 10 days in the control group at 1.14 ± 1.13. In contrast, the treatment group showed more cells attached to the patch surface at 31.25 ± 13.28 (P ≤ 0.0001). The observation at 5 days was 17.67 ± 20.21, at 7 days was 12.11 ± 10.94, and at 10 days was 18.83 ± 23.25. There was no significant statistical difference in mean cell per view among each treatment group (P = 0.802). Our work demonstrates that fibronectin has a positive impact on hAMSC attachment seeded onto the PTFE patch. These properties, in combination with their developmental plasticity, have generated tremendous interest in regenerative medicine.

Characteristics of Patients with Surgical Closure of an Atrial Septal Defect during Infancy.

Surgical closure of an atrial septal defect (ASD) is infrequently indicated during infancy. We evaluated the clinical characteristics and outcomes of patients who underwent surgical ASD closure during infancy. A single-center retrospective review was performed for 39 patients (19 males) who underwent surgical ASD closure during infancy between 1993 and 2020. The median body weight percentile at the time of operation was 9.3. During a median follow-up of 60.9 months, 4 late deaths occurred due to chronic respiratory failure. A preoperative history of bronchopulmonary dysplasia (BPD) was the only risk factor for late mortality identified in Cox regression (hazard ratio, 3.54; 95% confidence interval [CI], 1.75-163.04; p=0.015). The 5-year survival rate was significantly lower in patients with preoperative history of BPD (97.0% vs. 50.0%, p<0.001) and preoperative ventilatory support (97.1% vs. 40.4%, p<0.001). There were significant postoperative increases in left ventricular end-diastolic (p=0.017), end-systolic (p=0.014), and stroke volume (p=0.013) indices. A generalized estimated equation model showed significantly better postoperative improvement in body weight percentiles in patients with lower weight percentiles at the time of operation (<10th percentile, p=0.01) and larger indexed ASD diameter (≥45 mm/m2, p=0.025). Patients with ASD necessitating surgical closure during infancy are extremely small preoperatively and remain small even after surgical closure. However, postoperative somatic growth was more prominent in smaller patients with larger defects, which may be attributable to an increase in postoperative cardiac output due to changes in ventricular septal configuration. The benefits of ASD closure in patients with BPD are undetermined.

Cosmetic and shoulder functional outcomes in posterolateral minithoracotomy atrial septal defect closure: A retrospective study.

Transcatheter device closure has become the first treatment option for atrial septal defects (ASD). Surgical ASD closure, although still implemented, is cosmetically inferior to transcatheter closure. This study aimed to evaluate the feasibility as well as short- and long-term clinical outcomes of the right posterolateral minithoracotomy approach for surgical ASD closure. In total, 102 consecutive patients underwent posterolateral minithoracotomy for ASD between January 2014 and December 2021 at our center. Early surgical outcomes, cosmetic findings, and skin perception were evaluated over 1 year of postoperative follow-up using a self-satisfaction survey (1: very good, 2: good, 3: normal, 4: not good, 5: bad), Cavendish score, and shoulder joint function (angles of flexion, extension, and abduction). No patient required conversion to median sternotomy. Only one patient required reoperation due to bleeding. Postoperative echocardiography revealed no residual shunt at discharge in all patients. The mean follow-up period was 3.7 years (range: 0.3-7.1 years), during which the questionnaire was answered by 69 of 98 patients who were evaluated after more than 1 year. The mean self-satisfaction survey scores for cosmetic findings and skin perception were 1.3 ± 0.6 and 1.2 ± 0.5, respectively. The Cavendish score was under Grade 1 in all patients. Shoulder flexion and abduction were normal at 180° in all patients, except one, while extension was normal at 50° in all patients, except three. Our procedure achieved not only good early surgical outcomes but also excellent long-term cosmetic and shoulder function results.

Pulmonary Hypertension Crisis Management in Adult Atrial Septal Defect Surgical Closure

Atrial Septal Defect (ASD) is the most common congenital disorder found in adulthood, accounting for 35% of Adult Congenital Heart Disease (ACHD). In ASD, there is a defect in the septum/wall between right and left atria, resulting in left-to-right shunt which lead to an increase of the right heart volume and pulmonary circulation. If left untreated, increased pulmonary resistance develop to pulmonary hypertension (PH) which results in a progressive decrease in right ventricular function, causing right heart failure and death. Although ASD surgical closure is not a complicated procedure, patients with complication of PH and right heart failure have a high mortality rate if not managed properly. Increase in mortality was mainly due to perioperative pulmonary hypertensive crisis (PH crisis), condition of an acute increase in mean pulmonary arterial pressure (mPAP) exceeding mean systemic arterial pressure (MAP). In this case report, we will discuss the management of postoperative adult patients with ASD closure complicated by intraoperative pulmonary hypertensive crisis who are treated in the intensive care unit (ICU).

Pleuropericardial Window Prevents Pericardial Effusion Following Surgical Atrial Septal Defect Closure

Background:Pericardial effusion occurs frequently after surgical atrial septal defect closure. This complication carries the risk of development of cardiac tamponade and death. It is also the responsibility of the hospital for readmissions. Any measure in preventing the development of pericardial effusion is of paramount importance. In this report, our objective was to demonstrate the protective effect of creating a pleuropericardial window against the development of postsurgical pericardial effusion.Methods:Hospital records of all patients who underwent surgical atrial septal defect closure between January 2015 and December 2020 were reviewed. Patients were divided into 2 groups according to the creation of right/left pleuropericardial window during surgical ASD closure. There were 45 patients in group I in which a right pleuropericardial window was done, and 85 patients constituted group II in which pericardium was left intact.Results:None of the 45 patients in group I developed pericardial effusion, while 15 of 85 patients in group II developed pericardial effusion (P = .001). Ten patients developed more than mild pericardial effusion which required medical treatment, while 5 patients had to be re-hospitalized because of massive pericardial effusion and effusions were managed by percutaneous drainage.Conclusions:The creation of a right pleuropericardial window resulted in a safe postoperative recovery after surgical atrial septal defect closure in all patients with the development of no pericardial effusion. No adverse effect of the creation of a pleural communication was noted.

Functional Echocardiographic and Serum Biomarker Changes Following Surgical and Percutaneous Atrial Septal Defect Closure in Children.

BackgroundVentricular performance is temporarily reduced following surgical atrial septal defect closure. Cardiopulmonary bypass and changes in loading conditions are considered important factors, but this phenomenon is incompletely understood. We aim to characterize biventricular performance following surgical and percutaneous atrial septal defect closure and to relate biomarkers to ventricular performance following intervention.Methods and ResultsIn this multicenter prospective study, children scheduled for surgical or percutaneous atrial septal defect closure were included. Subjects were assessed preoperatively, in the second week postintervention (at 2‐weeks follow‐up), and 1‐year postintervention (1‐year follow‐up). At each time point, an echocardiographic study and a panel of biomarkers were obtained. Sixty‐three patients (median age, 4.1 [interquartile range, 3.1–6.1] years) were included. Forty‐three patients underwent surgery. At 2‐weeks follow‐up, right ventricular global longitudinal strain was decreased for the surgical, but not the percutaneous, group (−17.6±4.1 versus −27.1±3.4; P<0.001). A smaller decrease was noted for left ventricular global longitudinal strain at 2‐weeks follow‐up for the surgical group (surgical versus percutaneous, −18.6±3.2 versus −20.2±2.4; P=0.040). At 1‐year follow‐up, left ventricular performance returned to baseline, whereas right ventricular performance improved, but did not reach preintervention levels. Eight biomarkers relating to cardiovascular and immunological processes differed across study time points. Of these biomarkers, only NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) correlated with less favorable left ventricular global longitudinal strain at 2‐weeks follow‐up.ConclusionsRight, and to a lesser degree left, ventricular performance was reduced early after surgical atrial septal defect closure. Right ventricular performance at 1‐year follow‐up remained below baseline levels. Several biomarkers showed a pattern over time similar to ventricular performance. These biomarkers may provide insight into the processes that affect ventricular function.RegistrationURL: https://www.trialregister.nl/; Unique identifier: NL5129

Transcatheter versus surgical closure of atrial septal defect in adult patients with tricuspid regurgitation

ObjectivesTranscatheter closure using a device has been established as an effective atrial septal defect (ASD) treatment, but its value in treating patients with concomitant functional tricuspid regurgitation (TR) is relatively...

Functional echocardiographic and serum biomarker changes following surgical and percutaneous atrial septal defect closure in children

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Dutch Heart Foundation Background Ventricular performance is temporarily reduced following surgical atrial septal defect (ASD) closure. Cardiopulmonary bypass and changes in loading conditions are considered important factors, but this phenomenon is incompletely understood. We aim to characterize biventricular performance following surgical and percutaneous ASD closure and to relate biomarkers to ventricular performance following intervention. Methods In this multicenter prospective study, children scheduled for surgical or percutaneous ASD closure were included. Subjects were assessed pre-operatively (T1); in the 2nd week post-intervention (T2) and 1 year post-intervention (T3). At each time point an echocardiographic study and a panel of biomarkers was obtained. Results Sixty-three patients (age 4.1 [3.1–6.1] years) were included. Forty-three patients underwent surgery. At T2 right ventricular (RV) global longitudinal strain (GLS) was decreased for the surgical, but not the percutaneous, group (-17.6 ± 4.1 versus -27.1 ± 3.4, p&amp;lt;.001). A smaller decrease was noted for left ventricular (LV) GLS at T2 for the surgical group (surgical -18.6 ± 3.2 versus percutaneous -20.2 ± 2.4, p=.040). At T3 LV performance returned to baseline, while RV performance improved, but did not reach pre-intervention levels. Cadherin-5, chitotriosidase-1, integrin-beta-2 and urokinase differed across time points and related to favorable RV GLS at T2. Conclusions Right, and to a lesser degree left, ventricular performance was reduced early after surgical ASD closure, possibly related to cardiopulmonary bypass. RV performance at T3 remained below baseline levels, probably related to changed loading conditions. Several biomarkers showed a pattern over time similar to ventricular performance and related to cardiac function at early follow-up. These markers may provide insight into the processes that affect ventricular function.

“Cardiac Remodeling after Surgical Patch Closure of Adult Congenital Atrial Septal Defects: Perspective of Bangladesh”

Introduction: Atrial septal defect is one of the congenital heart diseases. An atrial septal defect (ASD) represents a communication between the left and right atrium leading to left to right shunt. It makes up about 10% of all congenital heart diseases after delivery and up to 30—40% of heart defects diagnosed in patients aged over 40 years. Objectives: To identify the status of cardiac remodeling after surgical patch closure of adult congenital atrial septal defects. Methodology: The descriptive and observation study was carried out atDepartment of Cardiac Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January 2013 to April 2015. The patients both male and female undergoing surgical closure of atrial septal defect, Department of Cardiac Surgery, BSMMU, Dhaka, Bangladesh. Total sixty (60) patients were studied, thirty (30) in each group. Group A: Thirty (30) patients of surgical closure of ASD at or before age of 25 years. Group B: Thirty (30) patients of surgical closure of ASD at or after age of 25 years. A purposive sampling technique was used for sample selection. The sample size was determined by using the standard formula for comparison between two proportions. To make it more convenient and reduce the error sample size of this study was fixed at 60 (30 in each group). Careful history regarding the complaints of Exerttional dyspnoea, Palpitation, Fatigability, General weakness, Electrocardiography (ECG), Chest X ray, Echocardiography (Echo), Left atrial diameter (LA), -Left ventricular internal diameter at the end of diaslole (LVIDd), -Left ventricular internal diameter at the end of systole (LVIDs), Interventricular septal thickness (IVST), Posterior wall thickness (PWT), Fractional shortening (FS), Ejection fraction (EF) were measured. Results: From the result it was found that exertional dyspnoea in 60.0%, palpitation in 70.0%, fatigue in 66.6% and general weakness in 53.33% in group A and in group B exertional dyspnoea in 80.0%, palpitation in 73.33%, fatigability in 63.33% and general weakness in 80.0%. There was no significant difference in presenting complaints distribution in between two groups. From the ECG findings between two study groups it was found that arrhythmia in 13.33%, left axis deviation in 10.0%, right axis deviation 23.330% and in group B arrhythmia in 16.67%, left axis deviation in 13.33%, right axis deviation 36.67%. There were differences between two groups regarding ECG findings. In early age group there was few complains but complains are more in late age group. From the types of ASD between two study groups it was revealed that septum secundum defect is 66.67%, Septum primum 20 % and sinous venosus defect in 13.33 % in group A. In group B septum secundum defect is 76.67%, Septum primum 13.33 % and sinous venosus defect in 10 %. There was no significant difference in type of ASD in between two groups. Conclusion: This study concluded that cardiac remodeling occurs after surgical closure of atrial septal defect in all age group and degree of cardiac remodeling was better in early age group (up to 25 years) compared with late age group (&gt;25 years).

Cardiac remodeling and factors determining occurrence of atrial arrhythmia after surgical closure of atrial septal defect in adults

The purpose of this study was to assess cardiac remodeling and to determine factors predicting the occurrence of atrial arrhythmia after surgical closure of atrial septal defect (ASD) in adults. Retrospective study including 33 adult patients (> 20 years old, mean age: 34 ± 11 years, 26 women) who underwent surgical closure of secundum or sinus venosus ASD. Before operation, all patients had dyspnea and 15% were in NYHA III-IV. Sinus rythm was present in 85% of patients. The ratio of pulmonary to systemic blood flow was calculated, yielding a mean of 2,8 ± 1 and pulmonary artery hypertension (PAH) was observed in 80% of patients with a mean value of 41,3 ± 10 mmHg. The ASD were closed by pericardial or Dacron patch in 97% of cases. Operative death was observed in 2 cases. In survival patient, with a follow-up of 97 ± 57 months, regression of right ventricular dilatation and PAH occurred in the first post-operative month and was maintained at late follow-up. Atrial arrhythmia occurred in 5 patients and were determined by older operative age (P = 0.003) and the absence of cardiac remodeling after surgery. Surgical correction of ASD in adults is safe and efficacious. Cardiac remodeling after ASD closure in the adult is a common and an early event and prevents late morbidity which is in most cases due to arrhythmias. The mode of closure does not seem to significantly impact remodeling.

Preoperative Left Ventricle End Diastolic Volume Index as a Predictor for Low Cardiac Output Syndrome After Surgical Closure of Secundum Atrial Septal Defect With Small-Sized Left Ventricle.

Introduction: Low cardiac output syndrome is one of the postoperative complications that are associated with significant morbidity and mortality after surgical closure of atrial septal defect (ASD) with small-sized left ventricle (LV). This study investigated whether preoperative left ventricular end-diastolic volume index (LVEDVi) could accurately predict low cardiac output syndrome (LCOS) after surgical closure of ASD with small-sized LV.Method: This retrospective cohort study involved adult ASD patients with small-sized LV from January 2018 to December 2019 in National Cardiovascular Center Harapan Kita. Preoperative MRI data to assess the left and right ventricle volume were collected. A bivariate analysis using independent Student's t-test was done. Diagnostic test using receiver operating characteristic (ROC) curve was also done to obtain the area under the curve (AUC) value. The best cutoff point was determined by Youden's index.Result: Fifty-seven subjects were involved in this study [age (mean ± SD) 32.56 ± 13.15 years; weight (mean ± SD) 48.82 ± 12.15 kg]. Subjects who had post-operative LCOS (n = 30) have significantly lower LVEDVi (45.0 ± 7.42 ml/m2 vs. 64.15 ± 13.37 ml/m2; p < 0.001), LVEDV (64.6 ± 16.0 ml vs. 85.9 ± 20.7 ml; p < 0.001), LVSV (38.97 ± 11.5 ml vs. 53.13 ± 7.5 ml; p < 0.001), and LVSVi (27.28 ± 8.55 ml/m2 vs. 37.42 ± 5.35 ml/m2; p < 0.001) compared to subjects who did not have post-operative LCOS (n = 27). ROC analysis showed that the best AUC was found on LVEDVi (AUC 95.3%; 95% confidence interval: 90.6–100%). The best cutoff value for LVEDVi to predict the occurrence of LCOS after surgical closure of ASD was 53.3 ml/m2 with a sensitivity of 86.7% and a specificity of 85.2%.Conclusion: This study showed that preoperative LVEDVi could predict LCOS after surgical closure of ASD with small-sized LV with a well-defined cutoff. The best cutoff value of LVEDVi to predict the occurrence of LCOS after surgical ASD closure was 53.5 ml/m2.

Comparison of Short-Term Results between Minimally Invasive Cardiac Surgery and Conventional Median Sternotomy for Atrial Septal Defect Closure

Background: Median sternotomy (MS) is the standard approach for atrial septal defect (ASD) closure. Recently, minimally invasive cardiac surgery (MICS) for ASD closure via right mini-thoracotomy has been proposed as a promising alternative approach. Objective: To compare short-term results of standard median sternotomy with minimally invasive cardiac surgery for ASD closure in Ramathibodi Hospital. Materials and Methods: The authors retrospectively analyzed 59 patients who underwent surgical ASD closure between January 2014 and July 2020. There were 32 patients in MICS group and 27 patients in MS group. Patient demographic datas, intraoperative parameters and postoperative results were collected and compared between the two groups. Results: There were no statistically significant difference in age, gender, body mass index, mean pulmonary artery pressure and left ventricular ejection fraction between the two groups. Intraoperative parameters were not difference in ASD size, concomitant procedures and aortic cross-clamp time. Complete atrial septal defect closure were achieved in all patients of both groups without residual defect. Median cardiopulmonary bypass time was significantly longer in MICS group (91 (77, 140) min vs. 76 (51, 98) min p=0.006). The success rate of MICS approach was 96.9% (31 of 32 patients) and conversion rate was 3.1% (1 of 32 patients). Postoperative median drainage volume and incidence of patients required PRC transfusion were significantly lower in MICS group (270 (145, 480) ml vs. 460 (300, 660) ml p=0.002) and (43% vs. 85% p=0.001) respectively. Postoperative ventilation time, pain score, analgesic drug usage, neurological complications, renal complications, wound infection, ICU stay and hospital stay were similar. Conclusion: MICS for ASD closure is a reliable alternative approach that has lower post-operative drainage volume and incidence of PRC transfusion when compared to standard median sternotomy. However, MICS has longer cardiopulmonary bypass time but no difference in post-operative complications and hospital stay. Keywords: Cardiac surgical procedures; Atrial septal defect; Minimally invasive cardiac surgery; Median sternotomy; Comparison; Short-term results; Minimally invasive ASD closure

Abstract 13987: Efficacy and Safety of Surgical Repair of Atrial Septal Defect in Asymptomatic Children Less Than 3 Years of Age

Background: Elective surgical closure of atrial septal defect (ASD) in asymptomatic children is commonly performed at 3 to 6 years of age when catheter-guided closure is not feasible. However, a recommended timing of surgical closure is not based on recent evidence. Hypothesis: Surgical ASD closure can be done safely in any age group. Methods: Asymptomatic patients with surgically closed isolated ASDs who were not indicated for catheter-guided closure in our cardiac center from 2002 to 2019 were studied. The patients were divided into 4 groups based on the age at surgery (&lt;3 years, ≥3 to &lt;6 years, ≥ 6 to &gt;10 years, and ≥ 10 years). Demographic data, type of ASD, cardiopulmonary bypass time (CPBT), intensive care unit (ICU) stay, total hospitalization days, post-operative adverse events, and readmission rate were studied. Effects of creation of pericardial window (PW) was also examined. Data are shown as mean ± standard deviation. Results: Total 163 patients were studied (Table). There was no statistically significant difference in CPBT, ICU stay, or total hospitalization days among the 4 groups. There were no mortalities. Incidence of adverse events during hospitalization was low in &lt; 6 years (1.9 to 4.2%) but higher in older ages (10.8 to 13.5%). Readmission rate was higher in younger groups: 18.6% in &lt; 3 years old, 13.2% in ≥ 3 and &lt; 6 years old, 8.0% in ≥ 6 and &lt; 10 years, and 10.8% in ≥ 10 years, which was mainly due to pericardial effusion (PE). Total 18 patients developed PE postoperatively, 14 of whom were readmitted for treatment. With the creation of PW at the time of initial surgery, the incidence of PE and readmission rate were significantly reduced compared with without PW, especially in younger children. There was no complication due to PW. Conclusion: Surgical ASD closure can be performed safely even in younger children with ages &lt;3 years, especially with creation of PW. Routine application of PW markedly reduced postoperative adverse events in surgical ASD closure.

Atrial Septal Defect Closure via Ministernotomy in Children

Atrial septal defect (ASD) closure is usually performed in children via a conventional sternotomy. In striving to improve the cosmetic result, we have adopted a lower ministernotomy approach with a very small skin incision. We present a single surgeon experience of 110 consecutive patients undergoing surgical closure of ASD, comparing conventional (n=55) and mini-sternotomy (n=55) approaches. Our ministernotomy technique avoids direct superior vena cava cannulation, allowing for a smaller incision, while providing adequate exposure. The ministernotomy approach is safe and provides an excellent cosmetic result.

Right ventricle reverse remodelling following transcatheter and surgical secundum: Atrial septal defect closure in adults by cardiac magnetic resonance imaging

Background: Securely closed Atrial Septal Defect (ASD) leads to reduction in right cardiac dimensions and improvement of symptoms. Device has become an accepted alternative to surgical closure. CMR is an accurate imaging modality for the assessment of cardiac function and volumes. Objective: We aimed at studying electrical and mechanical remodeling in RV preclosure and 3 months after transcatheter and surgical closure. Results: Our prospective study included 30 consecutive adult patients with isolated secundum ASD referred to either transcatheter or surgical ASD closure. There was significant reduction in the QT dispersion among the same group as compared with the baseline values (QTc dispersion was 70.33 ± 24.04 to 60.26 ± 28.56 in device group vs. 80.73 ± 30.38 to 60.27 ± 28.57 in surgical group). There was no significant difference between two groups indicating that transcatheter and surgical closure had led to equivalent value of electrical remodelling (P-value >0.05). In CMR study we measured Right Ventricle End Diastolic Volume (RVEDV), Right Ventricle End Systolic Volume (RVESV), Right ventricle function and Right ventricle mass index. RVEDV and RVESV decreased significantly in both groups as compared to the baseline values (P-value <0.001). Transcatheter closure resulted in more significant reduction in the RVEDV and RVESV than the surgical closure (P-value=0.03 and 0.02 respectively), (Figures 1 and 2). In device closure; RV-function after closure was significantly higher in comparison to surgical closure (60.67 ± 5.12 vs. 52.73 ± 8.62 (%); P<0.001). The RV mass decreased significantly in each group as absolute value from the baseline (P-value (0.001) but it was statistically insignificant different between the two groups (P-value 0.31) while percentage of change was higher in device group (-) 20.38 ± 10.80 versus (-) 16.63 ± 14.91 in surgical group. Conclusion: Our study showed significant changes from baseline measurements with significant RV mechanical reverse remodeling in the device group but there were no significant changes in electrical remodeling between the two groups.