Type Atrial Septal Defect Research Articles

Correlation between Left Ventricular Eccentricity Index and Mean Pulmonary Arterial Pressure in Secundum Type Atrial Septal Defect Adult Patients

Background: Secundum type atrial septal defect (ASD) is the most common adult congenital heart disease. Hemodynamically, ASD result in a left-to-right shunt that causes right heart volume overload. This condition affects interventricular septal position and shape. Left ventricular (LV) eccentricity index (EI) suggests right ventricle (RV) overload when this ratio is >1.0. The aim of this study was to assess correlation between LV EI and mean pulmonary arterial pressure (mPAP) in secundum type ASD patients. Methods: We conducted a cross sectional study from ASD patients registry data. We enrolled subjects with secundum type ASD from the complete registry data. The LV EI was calculated from transthoracal echocardiography. The mPAP was measured by right heart catheterization as a gold standart. The correlation was performed by Spearman correlation test. Results: There were 40 adult secundum type ASD patients participated. The mean LV EI in enddiastolic was 1.55±0.39 and LV EI in end-systolic was 1.75±0.58. The median value of mPAP was 29 (12-99) mmHg. There was a moderate strength, positive and significant correlation between LV EI in end-diastolic and mPAP (r=0.37, p=0.018). The correlation was more significant and stronger between LV EI in end-systolic and mPAP (r=0.52, p=0.001). Conclusion: There was sufficiently strong and significant correlation between LV EI in both end-diastolic and end-systolic phase with mPAP in adult secundum type ASD.

Associated Valvular Heart Diseases among ASD Patients Undergoing Surgical Repair

Background: Congenital heart diseases (CHD) are one of the most common developmental errors in humans.Objectives: The purpose of the present study was to see the frequencies of various types of atrial septal defect (ASD) and associated cardiovascular disorders in patients undergoing surgical repair.Methodology: This cross-sectional study was conducted on patients undergoing surgical repair at the National Institute of Cardiovascular Diseases (NICVD) or the National Heart Foundation and Research Institute (NHF & RI) in Dhaka, during the period of July, 2010 to June, 2011. Patients presented with ASD at any age of both sexes were selected as study population. Diagnoses were revealed with echocardiography and confirmed preoperatively by registered cardiac surgeons.Results: The morphological types of ASD were ostium secundum type in 96% cases and sinus venosus type in 4% cases. Atrial septal defects were either small or larger defects associated with pulmonary hypertension in 38 (76%) cases, varying degree of tricuspid regurgitation was seen in 33 (66%) patients and dilated pulmonary artery was noted in 24 (48%) cases. Ventricular septal defect in 4 (8%) cases, tricuspid atresia in 2 (4%) cases and mitral valve prolapse in 6 (12%) cases were also observed.Conclusions: Ostium secundum type of ASD is found to be the commonest type of ASDJournal of Current and Advance Medical Research 2018;5(2):60-63

Echocardiographic approach to catheter closure of atrial septal defects: patient selection, procedural guidance and post-procedural checks

Echocardiography is the imaging modality of choice to diagnose different types of atrial septal defect and to determine which defects are suitable for catheter occlusion. In addition to assessment of defect size and rims, transoesophageal echocardiography may be used to guide the procedure itself including device placement, procedural complications and post-procedural checks. This review covers a practical approach to this subject and is accompanied by online videos illustrating the technique.

Transcatheter closure of atrial septal defects type 2 in children under three years of age.

Atrial septal defect (ASD) type 2, according to current standards, is closed percutaneously usually after the child has reached the age of four to five years. There are limited data regarding such treatment in younger infants. We sought to evaluate the feasibility, safety, and efficacy of percutaneous ASD closure in children under three years of age. The research group consisted of 157 children less than three years old with haemodynamically significant ASD, who underwent effective transcatheter ASD closure in a single tertiary centre between 1999 and 2014. The mean procedural age of the treated children was 2.2 years and mean weight was 12.5 kg. In all cases nitinol wire mesh devices were applied (mostly Amplatzer Septal Occluders). ASD was closed using standard technique (except a few cases wherein the left disc of the implant was inserted initially into the right pulmonary vein to prevent oblique position of the device). Procedure-related complications were divided into major and minor ones. Atrial septal defect was closed in 149 children: 97 with a single ASD and 52 with double/multiple ASD. The procedure was abandoned in eight patients (three with single and five with double/multiple ASD). No death or implant embolisation occurred during the procedure or follow-up, and there was one case of major postprocedural complications. Normalisation of the right ventricular diameter occurred in all patients during one-year follow-up. In the majority of children acceleration of physical development and resolution of accompanying morbidity were observed in follow-up. Percutaneous ASD closure can be performed safely in children under three years of age with low risk of peri- or postprocedural complications.

Minimal Invasive Technique in Atrial Septal Defect Surgery.

BackgroundMedian sternotomy with minimal skin incision (MSWMSI) and modified anterior mini-thoracotomy (MAMT) approach that both are innovative techniques modified from previous documented techniques are important alternative to conventional median sternotomy in atrial septal defect (ASD) repair. Our aim is to explain the details of two performed techniques in our center and explain the results.MethodsTotally 54 children with ASD (20 female and 34 male) were operated with two different techniques i.e. MAMT and MSWMSI in Imam Ali heart surgery center between May 2010 and May 2013. Intra and postoperative variables such as cardiopulmonary bypass time and aortic cross-clamp time, intensive care unit stay time, length of incision, postoperative hematoma and seroma, dehiscence mortality, exploration for postoperative bleeding, neurologic complication, infection and amount of blood transfusion were recorded.ResultsMean cardiopulmonary bypass time was 30 ± 11 min, and mean aortic cross-clamp time was 7 ± 2 min. The mean amount of blood transfusion was 150 ± 39 mL, and the mean chest tube drainage after surgery was 140 ± 57 mL. Superficial skin infection occurred in three patients. Subcutaneous hematoma and seroma were founded in six patients. In 50 cases the defect was secundum type, in two patients it was sinus venosus type, and in two with associated perimembranous ventricular septal defect repair.ConclusionBoth approaches are safe and may be the surgical techniques of choice for secundum ASD repair in all age groups; and we can also utilize these techniques for more complicated kinds of surgery, for instance, sinus venosus type ASD with or without partial anomalous defect.

Transcatheter closure of large atrial septal defects: A single-center experience

Background: Despite the favorable history of surgical approach to repair secundum type atrial septal defects (ASDs), the transcatheter closure has increasingly become the preferred strategy because of its relatively high efficacy and lower morbidity compared to surgery in selected cases. However, there is some controversy around the preferred strategy and long-term complications of device closure of large ASDs. Here, we evaluated the early and midterm outcomes of adults with large ASDs who underwent transcatheter device closure with devices larger than 28 mm. Methods: A prospective single-center study was conducted encompassing all the patients who were 18 years of age or older and underwent device closure for secundum type ASD from 2006 to 2014 with device size of >28 mm, and early and midterm follow-up data were assessed. Results: The procedure was successful in 93.6% of the scheduled patients. Two and a half percent had nonsignificant residual shunt. Immediate device migration occurred in one patient (1.2%) who underwent surgical retrieval and defect closure. One case of device thrombosis (1.2%) was seen 1 month after the procedure who had successful medical treatment. There was a case of device erosion 1 month after the procedure referred for the surgery. Mild postintervention pericardial effusion was seen in 16.5% and reduced to 7.6% in the first outpatient visit. Conclusions: The study demonstrated that the vast majority of anatomically suitable large ASDs could be closed by using the transcatheter technique with a low complication rate. Therefore, the transcatheter closure could be recommended as the first-line strategy in adults with large ASDs. However, meticulous preprocedural imaging and evaluation by experts are necessary before scheduling patients with large ASDs for the percutaneous alternative.

Percutaneous closure of atrial septal defect type II - a few remarks on the basis of my own experience.

Percutaneous closure of atrial septal defect type II - a few remarks on the basis of my own experience.

Atrial Septal Defect (ASD) and Associated Cardiovascular Disorders in Patients Undergoing Surgical Repair

Background: Congenital heart diseases (CHD) are one of the most common developmental errors in humans.Objectives: The purpose of the present study was to see the frequencies of various types of atrial septal defect (ASD) and associated cardiovascular disorders in patients undergoing surgical repair.Methodology: This cross-sectional descriptive study was conducted on patients undergoing surgical repair at the National Institute of Cardiovascular Diseases (NICVD) and National Heart Foundation and Research Institute (NHF&RI) in Dhaka during the period of July, 2010 to June, 2011. Patients presented with ASD at any age of both sexes were selected as study population. Diagnoses were revealed with echocardiography and confirmed preoperatively by registered cardiac surgeons.Results: The morphological types of ASD were Ostium secundum type in 96% cases and sinus venosus type in 4% cases. Atrial septal defects were either small or larger defects associated with pulmonary hypertension in 38(76%) cases, varying degree of tricuspid regurgitation was seen in 33(66%) patients and dilated pulmonary artery was noted in 24(48%) cases. Ventricular septal defect in 4(8%) cases, tricuspid atresia in 2(4%) cases and mitral valve prolapse in 6(12%) cases were also observed.Conclusions: Ostium secundum type of ASD is found to be the commonest type of ASD.J Shaheed Suhrawardy Med Coll, 2015; 7(1):18-21

Cyanosis in a calf with a double outlet right ventricle

A 4-day-old female Holstein Friesian calf was presented for evaluation of cyanosis and dyspnea. On auscultation, severe bronchovesicular sounds and a systolic heart murmur of grade IV/VI above the tricuspid valve were found. On echocardiography, a marked dextroposition of the aorta (>50% originating from the right ventricle), leading to both great arteries arising from the right ventricle - a so-called double-outlet right ventricle - was detected. Two ventricular septal defects were present, one in the perimembranous, subpulmonary region, the other non-committed in the muscular region. The subpulmonary ventricular septal defect was responsible for the shunting of unoxygenated blood into the aorta. Additionally, an aneurysma-like atrial septal defect (type secundum) and a large patent ductus arteriosus were visualized. The main pulmonary artery was severely enlarged without the presence of a stenotic defect. The findings could be verified by angiography. Additionally, a diffuse hypoplastic ascending aorta was visualized. Necropsy confirmed the echocardiographic and angiographic findings.

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.

Intermediate Outcome of Transcatheter Closure of Secundum Atrial Septal Defect on Cardiac Remodeling in Egyptian Children and Adults

Background: Atrial septal defects (ASDs) are the second most common congenital lesion in adults. ASD closure is followed by symptomatic improvement and regression of pulmonary artery pressure (PAP), reduction in right heart volume overload and hence the prevalence of arrhythmias, thus quantification of the RV function is an important prognostic factor. Tissue Doppler and strain imaging are helpful tools for the assessment of RV systolic and diastolic function. Purpose: To evaluate the intermediate-term outcome of transcatheter closure of ASD by Atrial Septal Occluder (ASO) on the cardiac remodeling especially RV using 2D Echocardiography and Tissue Doppler Methods: From April 2011 to January 2012, 30 patients with secundum type ASD were treated by transcatheter closure of their defects. One year after the procedure Patients included in the study were subjected to thorough history taking, physical examination and 12 leads surface electrocardiogram. Full 2D and color Doppler echocardiographic study was performed in addition to Tissue Doppler Assessment of right ventricular function via measurement of Tricuspid annular Tissue Doppler velocities, strain and strain rate from the RV free-wall and the interventricular septum and RV Tei index. Results: At the 1 year follow up of transcatheter ASD closure, the RVEDD had decreased from 22.93±5.889 mm to 18±4.06 mm(P=0.000), and the LVEDD had increased from 33.23±5.393 mm to 36.27±6.75 mm(P=0.001). Mean PAP decreased from 18.37±4.796 mmHg to 14.77±4.75 mmHg (P=0.022). RVSP decreased from 28.9±4.425 mmHg to 15.83±4.17 mmHg (P=0.000). Regarding electrocardiography, the P wave duration decreased from 107.13±19.62 ms to 77±14.18 ms (P=0.000) and the PR interval decreased from 177.97±21.932 ms to 160.33±26.06 ms (P=0.000).The QRS duration decreased from 134.40± 4.97 ms to a mean of 119.87±4.12 ms (P=0.000). All the patients had normal sinus rhythm before closure and no one developed arrhythmia until 1 year after closure. 50 % of the patients had normal RV size at the 1-year follow up. Tricuspid annular velocities, longitudinal strain, and strain rate measurement showed no significant difference as compared to normal values, which suggest improvement of the RV systolic and diastolic function after transcatheter closure. Conclusion: Transcatheter ASD closure leads to a significant improvement in heart cavity dimensions and RV function and reversal of electrical and mechanical changes. Novel parameters for assessment of RV function are promising and appear to be helpful for the assessment of RV function and its response to correction of volume

Altered Pulmonary Venous Flow Pattern in Young Adults with Atrial Septal Defect

Introduction: Atrial septal defect (ASD) is a common congenital heart disease and causes left-to-right shunting and significant right ventricular (RV) volume overload. The goal of this study was to evaluate the influence of these hemodynamic changes on pulmonary venous flow pattern in young adults. Methods: Complete echocardiographic examination was performed in a group of 40 young adults (aged < 40 years) who had secundum type ASD and was compared to 40 age-matched individuals in control group who had no cardiac abnormality. Systolic and diastolic flow velocities in pulmonary veins (PV), superior vena cava (SVC), inferior vena cava (IVC) and RV functional parameters were recorded and evaluated. Results: As opposed to healthy young individuals who showed distinct S and D waves with diastolic predominance in pulmonary vein Doppler, in patients with ASD a continuous flow with increased systolic peak that began in systole and continued to the late diastole was observed. The RV systolic function increased compared to the control group. Conclusions: In patients with ASD, the pattern of pulmonary veins flow transforms into a single continuous antegrade wave with systolic dominance due to persistent shunting of left atrial blood in to right heart chambers as well as increased RV pump function on pulmonary vein (by means of ASD), SVC and IVC, and could be used as a screening method for the presence of secundum type ASDs in young adults.

A rare case of Abmormal Connection of Right Inferior Pulmonary Vein to Right atrium with Intact Intera trial Septum

Isolated Partial Anomalous Pulmonary Venous Connection is a rare congenital defect that may not clinically manifest until adulthood. It can be misdiagnosed as a secundum type atrial septal defect by an echo cardiographer too. We present a 9 year-old girl who presented to us with complaints of occasional exertional fatigue. An ejection systolic murmur was heard in the 2 rd inter-costal space at left parasternal area. The cardiothoracic ratio was normal in routine chest X-ray with an anomalous vessel adjacent to the left pulmonary hilum. Echocardiography revealed an ostium secondum type of atrial septal defect of 18x10 mm in size with absence of inferior limb. She was taken up for surgery for closure of atrial septal defect. Intraoperatively, it was found that the atrial septum was intact but the right inferior pulmonary vein was draining to the right atrium. Surgically the defect was corrected by resecting part of atrial septum and tunneling the right inferior pulmonary vein to left atrium with a Dacron patch. The postoperative outcome was

A case of asymptomatic patient with right ventricular dilatation

Sinus venous defect is an uncommon type of atrial septal defect (ASD), often associated with anomalous pulmonary vein drainage and left to right shunting. If undetected, it leads to right atrial and ventricular volume overload. The current case describes an asymptomatic athlete with missed large sinus venosus defect since birth, and the different types of cardiac imaging modalities that lead to the detection of the defect and guiding the appropriate surgical intervention.

Giant intracardiac blood cyst: assessing the relationship between its formation and previous cardiac surgery.

This case report discusses a 23-year-old male patient who presented with shortness of breath during exercise. Echocardiography revealed an intracardiac mass located on the mitral valve. His medical history included surgical closure of an atrial septal defect type 2 at the age of 2 years. After being discussed within a multidisciplinary heart team, the intracardiac mass was surgically removed. Histopathological examination revealed a blood cyst. This case report emphasises that the presence of an acquired intracardiac cyst is a rare entity and that a pathophysiological association between the formation of a blood cyst and previous cardiac surgery has not been proven yet.Electronic supplementary materialThe online version of this article (doi:10.1007/s12471-015-0707-4) contains supplementary material, which is available to authorized users.

English

CONTEXT/BACKGROUND: Congenital malformations have been known and recognized for centuries. It is a stimulating problem for research because of the high frequency of their occurrence and the influence of consanguinity on these defects is even more devastating problem. AIM AND OBJECTIVES: To determine the effect of consanguinity in occurrence of congenital defects and occurrence of more common types of congenital defects. MATERIALS AND METHODS: The study was done retrospectively in Government medical college and civil hospitals between 1 st Oct. 2011 till 31 st May 2012. A total of 182 congenitally defective live births and still births admitted in above hospitals in same period were studied against total deliveries taken place. Information was collected by using questionnaires and pedegree charts were formed. Information about consanguinity, degree of consanguinity, type and subtype of anomaly etc. was obtained. Data obtained was statistically analysed and compared with previous studies. RESULTS: Incidence of congenital anomalies was 1.16%. Cardiovascular defects were the most common type of anomaly and atrial septal defect was most common subtype. Third degree / first cousins was the most common type of degree of consanguinity found amongst all. Male pre-ponderence was found amongst the anomalous births. Frequency of consanguineous marriages was found more in muslims than hindus. DISCUSSION AND CONCLUSIONS: 1. Births with congenital defects were commonly occurring among normal births and the incidence calculated was 1.79 % in the present study. 2. Cardiovascular defects were most common type of defects. 3. In the present study, it was found that third degree consanguinity cases were most common, about 56.25 % out of all 48 consanguineous cases. 4. In the present study congenital defects were found to occur more commonly in consanguineous unions than

Percutaneous management of coronary sinus atrial septal defect: two cases representing the spectrum for device closure and a review of the literature

Coronary sinus atrial septal defects are the rarest defects of the atrial septum comprising <1% of the five different types of atrial septal defects. Despite the widespread adoption of percutaneous device closure of secundum atrial septal defects, the published experience with percutaneous device closure of coronary sinus atrial septal defects is limited to only a few isolated case reports because of uncertainty regarding safety and efficacy. Open-heart surgical repair remains the treatment of choice for coronary sinus atrial septal defects, although this may not be the only treatment option in selected cases. Herein we describe our own experience with two patients with different clinical presentations and our method of successful percutaneous coronary sinus atrial septal defect closure in each. We then present a review of the anatomic spectrum of coronary sinus atrial septal defects along with a review of contemporary surgical and percutaneous device treatment.

Assessment of right ventricular function by isovolumic contraction acceleration before and after percutaneous closure of atrial septal defects: a preliminary study.

The main purpose of present study was to investigate the impact of percutaneous closure of atrial septal defect (ASD) on right ventricular (RV) systolic function assessed by tricuspid annular isovolumic myocardial acceleration (IVA) that is independent of preload and afterload changes. A prospective cohort study was designed involving twenty five patients with secundum type ASD whom were successfully closed percutaneously between 2009 and 2011. Standard transthoracic echocardiography and tissue Doppler imaging were performed in all patients 12 to 24 hours before and one month after closure. Paired t test was performed to determine the statistical significance of variables before and after closure. Significant decreases were observed in RV end-diastolic diameter, RV/left ventricular (LV) end-diastolic diameter ratio, right ventricular systolic myocardial velocity (Sm), right ventricular early myocardial velocity (Em) and right ventricular late myocardial velocity (Am) in the control echocardiography in the first month when compared with pre-procedure values. While significant increase was observed after procedure in right ventricular IVA (3.4 ± 1.3 m/sec2 vs. 4.2 ± 1.8 m/sec2, p=0.001), no significant change was observed in right ventricular global performance index, in right ventricular Em/Am ratio and left ventricular ejection fraction. Percutaneous closure of ASD resulted in recovery of right ventricular function as early as 1 month after closure.

Double Intervention in Single Sitting: Percutaneous Device Closure and Permanent Pacemaker Implantation in a Patient with Atrial Septal Defect

Context: Atrial septal defect may rarely be associated with other cardiac diseases such as arrhythmia, and may require additional intervention. Case report: A 16-year-old boy presented with effort dyspnea, tiredness, and fatigue. The electrocardiograph revealed right bundle branch block, atrioventricular block, and left axis deviation. Ostium secundum type of atrial septal defect was detected by transthoracic echocardiography and was confirmed by transesophageal echocardiography. The patient was advised to undergo percutaneous device closure. Permanent pacemaker implantation was also suggested considering the risk of fatal arrhythmias associated with atrioventricular block. Consequently, patient underwent percutaneous atrial septal defect closure and implantation of pacemaker in a single sitting. Both the procedures were successful, after which the patient showed remarkable symptomatic improvement. Conclusion: In atrial septal defect patients with unexplained atrioventricular block, closure of atrial septal defect and implantation of pacemaker in single sitting appear to be an attractive modality.

Experiences in surgical closure of atrial septal defect with anterior mini-thoracotomy approach.

Introduction: Anterior mini-thoracotomy approach is a good alternative to median sternotomy in Atrial Septal Defect (ASD) repair. Our purpose is to explain the details of our technique and peresent the results. Methods: Seventy five patients with ASD (52 female and 23 male) were operated with anterior mini-thoracotomy approach in our tertiary center between March 2012 and March 2014. The mean age was 14±10 ranged from 2 to 42 years. Outcomes were defined according to cardiopulmonary and aortic cross-clump time, intensive care unit stay time, morbidity, mortality, the size of incision, the amount of post-operative bleeding, need for blood transfusion and reoperation. Results: Mean Cardiopulmonary bypass time was 49.62 minutes (26 to 105 minutes) and mean aortic cross clamp time was 22.29±6.77 minutes (11 to 47 minutes). The mean amount of blood transfusion was 47.49± 62.22 mm (0 to 200 cc) and the mean chest tube drainage after surgery was 80.17 ±121.06 mm (0 to 600 cc). One patient re-operated for dehiscence of ASD surgical sutures and there was no reoperation for surgical bleeding or tamponade drainage in these patients. In 74 cases the defect was secundum type, in 2 patients it was sinus venosus type and in one with associated partial Anomalous repair. Conclusion: Anterior thoracotomy approach is safe and may be the surgical technique of choice for secundum ASD repair in all age groups and we can utilize this technique also for more complicated kinds of surgery for instance, sinus venosus type ASD with or without Partial Anomalous Defect.