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Yadav R, Sharma A, Pathak S. A Case Series on Successful Surgical Management of Patients Presenting With Lutembacher's Syndrome to a Tertiary Healthcare Center in Northern India. Cureus 2023; 15:e44371. [PMID: 37779792 PMCID: PMC10540655 DOI: 10.7759/cureus.44371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2023] [Indexed: 10/03/2023] Open
Abstract
Atrial septal defect (ASD), whether congenital or iatrogenic, and mitral stenosis (MS), whether congenital or acquired, may all come together into a condition called Lutembacher's syndrome (LS). The ASD is typically larger than 15 mm in a normal LS case. However, congenital ASD is less frequent than residual iatrogenic ASD in the current era of percutaneous balloon mitral valvuloplasty for acquired MS. This is referred to as iatrogenic LS by cardiologists. Hereby, we report a case series of three patients who presented to us, were diagnosed with LS, a very rare entity, and were managed successfully.
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Affiliation(s)
- Rajeshwar Yadav
- Department of Cardiothoracic & Vascular Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Aditya Sharma
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Swati Pathak
- Department of Cardiothoracic & Vascular Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
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2
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Adu‐Boakye Y, Amponsah GM, Andoh HK, Gyan KF, Wiafe YA. Lutembacher syndrome in a middle-aged woman in Ghana with an extremely large atrial septal defect. Clin Case Rep 2023; 11:e6939. [PMID: 36789326 PMCID: PMC9913180 DOI: 10.1002/ccr3.6939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 01/10/2023] [Accepted: 01/13/2023] [Indexed: 02/12/2023] Open
Abstract
Lutembacher syndrome (LS) is a rare heart disorder characterized by a congenital or acquired combination of the atrial septal defect (ASD) and mitral stenosis. In LS, patients may be asymptomatic for years, but early detection and treatment result in a better prognosis. In contrast, the prognosis is usually poor, with conservative treatment if the diagnosis is late and the patient develops heart failure and pulmonary hypertension. Although rheumatic heart disease (RHD) and congenital heart disease are prevalent in Ghana, cases of LS are not reported. Here, we report the case of a 45-year-old woman with rheumatic mitral valve stenosis and an exceptionally large ASD with bidirectional flow who was diagnosed with LS and treated conservatively for heart failure at a cardiology clinic in Ghana.
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Affiliation(s)
- Yaw Adu‐Boakye
- Department of MedicineKwame Nkrumah University of Science and TechnologyKumasiGhana,Department of MedicineKomfo Anokye Teaching HospitalKumasiGhana
| | - Gordon Manu Amponsah
- Department of MedicineKomfo Anokye Teaching HospitalKumasiGhana,Department of PhysiologyKwame Nkrumah University of Science and TechnologyKumasiGhana
| | | | | | - Yaw Amo Wiafe
- Department of MedicineKomfo Anokye Teaching HospitalKumasiGhana,Department of Medical DiagnosticsKwame Nkrumah University of Science and TechnologyKumasiGhana
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3
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Fu L, Wang R, Zhao J, Ni Y, Chen Z, Li F. 'Two-step' percutaneous procedure for repairing the atrial septal defect with severe pulmonary hypertension: a case report. J Surg Case Rep 2023; 2023:rjac612. [PMID: 36636648 PMCID: PMC9831650 DOI: 10.1093/jscr/rjac612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 12/11/2022] [Indexed: 01/11/2023] Open
Abstract
Atrial septal defect is the most common type of congenital heart disease. Interventional closure is currently the best treatment for the atrial septal defect. However, the repair strategy for atrial septal defect accompanies by severe pulmonary hypertension remains controversial. We report a case of an atrial septal defect with severe pulmonary hypertension in which we applied a perforated occlude for atrial septal defect percutaneously at first. After 6 months, when the pulmonary pressure gradually went down, we completely blocked the reserved hole with a closure device percutaneously. We suggest that the stepwise procedure is an important treatment option for select patients with atrial septal defect accompanied by severe pulmonary hypertension.
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Affiliation(s)
| | | | - Jinlong Zhao
- Department of Cardiovascular Surgery, Shanghai Sixth People’s Hospital, Shanghai, People’s Republic of China
| | - Yinkai Ni
- Department of Cardiovascular Surgery, Shanghai Sixth People’s Hospital, Shanghai, People’s Republic of China
| | - Zonghui Chen
- Department of Cardiovascular Surgery, Shanghai Sixth People’s Hospital, Shanghai, People’s Republic of China
| | - Feng Li
- Correspondence address. Department of Cardiovascular Surgery, Shanghai Sixth People’s Hospital, 600 Yishan Rd, Shanghai 200233, People’s Republic of China. Tel: +86-137-0174-6812; E-mail:
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4
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Muacevic A, Adler JR, Tara N, Anwar M, Khan MU. A Rare Case of Severe Isolated Right Heart Failure with Secundum Type Atrial Septal Defect and Mitral Regurgitation Without Pulmonary Hypertension. Cureus 2023; 15:e34112. [PMID: 36843826 PMCID: PMC9946817 DOI: 10.7759/cureus.34112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2023] [Indexed: 01/25/2023] Open
Abstract
Typically, right heart failure (RHF) may occur following left heart failure (LHF) in chronic volume overload states such as chronic severe mitral regurgitation (MR) through chronically elevated pulmonary pressures. In Lutembacher syndrome (LS), the direct shunting through a secundum type atrial septal defect (ASD) results in congestive heart failure in the setting of severe mitral stenosis (MS) with or without elevated pulmonary arterial or venous pressures. We report a rare case of severe isolated RHF and bi-atrial enlargement resulting from the direct shunting through a secundum type ASD in the presence of a severe eccentric primary MR. There are no significant cases documented like this after a thorough search using PubMed, Medline, and Google Scholar. A review of the literature suggests that LS is also caused by a combination of mitral regurgitation and a secundum-type atrial septal defect without mitral stenosis, though rarely. Because this is a primary MR, we feel it is a case of LS with MR, ruling out a combination of secondary MR and secundum-type atrial septal defect.
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5
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Vishwanath V, Akseer S, Frankfurter C, Reza S, Farrell A, Horlick E, Abrahamyan L. Comparative effectiveness of devices for transcatheter closure of atrial septal defects: Systematic review and network meta-analysis. Arch Cardiovasc Dis 2022; 115:664-674. [PMID: 36336619 DOI: 10.1016/j.acvd.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/08/2022] [Accepted: 09/13/2022] [Indexed: 12/15/2022]
Abstract
Atrial septal defect is a common congenital heart disease, producing a left-to-right shunt in the atrial septum; the current preferred treatment is transcatheter device closure. The aim is to conduct a systematic review to synthesize information on the comparative effectiveness and safety of atrial septal defect closure devices. The methods used: a comprehensive search of Ovid MEDLINE®, Embase, and Cochrane Central databases was conducted. Studies comparing procedural and follow-up outcomes of atrial septal defect devices were included. Network meta-analyses were conducted to generate direct and indirect evidence for comparative effectiveness and safety outcomes between devices. The results are as follows: Twelve studies met our inclusion criteria and were compared in network meta-analyses. The meta-analyses evaluated contemporary devices: the AMPLATZER Septal Occluder; the GORE CARDIOFORM Septal Occluder; the Figulla Flexible II Occluder; the CeraFlex Septal Occluder; and the HELEX Septal Occluder. These studies represented 3998 patients. The primary safety and efficacy outcomes were device embolization and follow-up residual shunt, respectively. Secondary clinical outcomes included procedural success and major and minor complications. No differences were found between devices in terms of device embolization and secondary clinical outcomes. Follow-up residual shunt was higher with the HELEX Septal Occluder compared with the AMPLATZER Septal Occluder (odds ratio 2.92, 95% confidence interval 1.12-7.61). To conclude: although most outcomes were similar between devices, evidence was largely based on observational low-quality studies. There were inconsistencies in outcome reporting and definitions; this merits future studies, with head-to-head device comparisons and standardization of outcomes.
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Affiliation(s)
- Varnita Vishwanath
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre (PMCC), University Health Network, ON M5G 2N2 Toronto, Canada
| | - Selai Akseer
- Toronto General Hospital Research Institute, University Health Network, 10th Floor Eaton North, Room 237, 200, Elizabeth Street, ON M5G 2C4 Toronto, Canada; Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto ON M5T 3M6, Canada
| | - Claudia Frankfurter
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre (PMCC), University Health Network, ON M5G 2N2 Toronto, Canada
| | - Seleman Reza
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto ON M5T 3M6, Canada
| | - Ashley Farrell
- Library & Information Services, University Health Network, Toronto ON M5G 2C4, Canada
| | - Eric Horlick
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre (PMCC), University Health Network, ON M5G 2N2 Toronto, Canada
| | - Lusine Abrahamyan
- Toronto General Hospital Research Institute, University Health Network, 10th Floor Eaton North, Room 237, 200, Elizabeth Street, ON M5G 2C4 Toronto, Canada; Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto ON M5T 3M6, Canada.
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6
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Albalawi M, Ahmad S, Nasef MA, Alotay A, Rajaa NA, Alsahari A, Saleem I, Abudlhamed JM. Mid-Term Outcome of Left Ventricle Reverse Remodeling After Atrial Septal Defect Closure: A Comparison Between Surgical and Device Groups. Pediatr Cardiol 2022; 43:1530-1538. [PMID: 35325281 DOI: 10.1007/s00246-022-02879-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/15/2022] [Indexed: 10/18/2022]
Abstract
Right ventricular (RV) volume overload occurs in patients with significant atrial septal defect (ASD II) shunts, which can impair left ventricle (LV) filling, thus decreasing LV indices. However, after ASD II closure, the left ventricle regains near normal dimensions. The purpose of this study was to compare the long-term outcomes of LV reverse remodeling between device and surgical closure. We retrospectively reviewed the echocardiographic data of 222 patients with isolated ASD II who underwent surgical (95 patients) or device closure (127 patients) between January 2012 and December 2017. The ASD II was significantly larger in the surgical closure group (p < 0.001.) leading to a higher degree of paradoxical interventricular septal (IVS) movement. In contrast, the LV volume was larger in the device closure group (p < 0.001). After a median follow-up period of 19.5 months, the maximum LV systolic and diastolic volumes were reached at 1 year in the device closure group and 2 years in the surgical closure group. IVS motion normalized in 91% of the device closure group compared to 57% of the surgical closure group (p = < 0.001). There was significant improvement in left ventricular indices and IVS motion after ASD II closure in both groups but more favorable in patients after device closure.
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Affiliation(s)
- Muflih Albalawi
- Division of Pediatrics, Department of Cardiology, King Salman Armed Forces Hospital, Tabuk, Saudi Arabia.
| | - Salim Ahmad
- Department of Pediatric Cardiology, Prince Sultan Cardiac Center (PSCC), Riyadh, Saudi Arabia
| | - Mohamed Al Nasef
- Department of Pediatric Cardiology, Prince Sultan Cardiac Center (PSCC), Riyadh, Saudi Arabia
| | - Abdulmajeed Alotay
- Department of Pediatric Cardiology, Prince Sultan Cardiac Center (PSCC), Riyadh, Saudi Arabia
| | - Najlaa Al Rajaa
- Department of Pediatric Cardiology, Prince Sultan Cardiac Center (PSCC), Riyadh, Saudi Arabia
| | - Atif Alsahari
- Department of Pediatric Cardiology, Prince Sultan Cardiac Center (PSCC), Riyadh, Saudi Arabia
| | - Irfan Saleem
- Department of Pediatric Cardiology, Prince Sultan Cardiac Center (PSCC), Riyadh, Saudi Arabia
| | - Jassim Mohamed Abudlhamed
- The King Abdul-Aziz Cardiac Center (KACC), King Abdul-Aziz Medical City (KAMC), Riyadh, Saudi Arabia
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7
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Total Thoracoscopic versus Robotic Surgery for Repair of Atrial Septum Defect: A Propensity Matching Score Analysis. Emerg Med Int 2022; 2022:5371493. [PMID: 36193543 PMCID: PMC9525788 DOI: 10.1155/2022/5371493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/28/2022] [Accepted: 09/02/2022] [Indexed: 12/07/2022] Open
Abstract
Robotic surgery can provide less surgical trauma than conventional surgery, but differences between robotic and thoracoscopic surgery for atrial septal defect (ASD) repair are not well documented. To explore whether ASD can be repaired by thoracoscopic surgery or robotic surgery, which procedure is less invasive, and the difference in outcomes between these two procedures, this article studies 160 patients undergoing ASD repair at our institution. Sixty-five patients underwent total thoracoscopic surgery and 95 patients underwent total endoscopic robotic surgery. Propensity score matching yielded 64 well-matched patient pairs. Surgical data and early postoperative outcomes between the two matched groups were analyzed and compared. The results show that thoracoscopic and robotic surgery to repair ASD are both safe and reliable, and the early curative effect is good. However, regardless of similar complication rates, robotic surgery has a shorter time, less postoperative drainage, and faster recovery than thoracoscopic surgery.
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8
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Rais G, Vassallo P, Schorer R, Bollen Pinto B, Putzu A. Patent foramen ovale and perioperative stroke in noncardiac surgery: a systematic review and meta-analysis. Br J Anaesth 2022; 129:898-908. [PMID: 35987705 DOI: 10.1016/j.bja.2022.06.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 06/25/2022] [Accepted: 06/29/2022] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Patent foramen ovale (PFO) is associated with perioperative stroke in noncardiac surgery. The magnitude of this association was assessed in a systematic review and meta-analysis. METHODS Electronic databases were searched up to June 2022 for studies assessing the association between patent foramen ovale and perioperative stroke in adult patients undergoing noncardiac surgery. The primary analysis was limited to studies reporting effect estimates adjusted for significant clinical confounders. We calculated the adjusted odds ratio (aOR) and 95% confidence interval (CI). RESULTS We included nine retrospective and two prospective observational studies, including 21 257 082 patients. The presence of a patent foramen ovale was independently associated with stroke at 30 days after surgery (aOR=6.68 [95% CI: 3.51-12.73]; P<0.001) and at longest follow-up available (aOR=7.36 [95% CI: 3.56-15.21]; P<0.001). The odds of stroke at 30 days varied according to surgical specialty: neurosurgery (aOR=4.52 [95% CI: 3.17-6.43]), vascular surgery (aOR=7.15 [95% CI: 2.52-20.22]), thoracic surgery (aOR=10.64 [95% CI: 5.97-18.98]), orthopaedic surgery (aOR=11.85 [95% CI: 5.38-26.08]), general surgery (aOR=14.40 [95% CI: 10.88-19.06]), and genitourinary surgery (aOR=17.28 [95% CI: 10.36-28.84]). CONCLUSIONS The presence of a patent foramen ovale is associated with a large and consistent increase in odds of stroke across all explored surgical settings. Prospective trials should further explore this association by systematically assessing patent foramen ovale and stroke prevalence and identifying a specific population at risk. This is crucial for the elaboration of prevention plans and may improve perioperative outcomes.
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Affiliation(s)
- Gael Rais
- Department of Acute Medicine, Division of Anaesthesiology, Geneva University Hospitals, Geneva, Switzerland
| | - Paola Vassallo
- Department of Clinical Neuroscience, Lausanne University Hospital, Lausanne, Switzerland
| | - Raoul Schorer
- Department of Acute Medicine, Division of Anaesthesiology, Geneva University Hospitals, Geneva, Switzerland
| | - Bernardo Bollen Pinto
- Department of Acute Medicine, Division of Anaesthesiology, Geneva University Hospitals, Geneva, Switzerland
| | - Alessandro Putzu
- Department of Acute Medicine, Division of Anaesthesiology, Geneva University Hospitals, Geneva, Switzerland.
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9
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Vanreusel I, Maes S, De Wolf D, Van Berendoncks A. Percutaneous closure of a secundum atrial septum defect performed under hypnosis: a case report. Acta Cardiol 2021; 76:1078-1082. [PMID: 32964783 DOI: 10.1080/00015385.2020.1822491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Atrial septal defects (ASDs) are the third most common type of congenital heart diseases with ostium secundum defects (ASDsII) being responsible for approximately 75% of these defects. The treatment consists of either a transcatheter closure or a surgical intervention. The transcatheter approach offers a less invasive alternative for patients who fulfill anatomical and size criteria and is therefore increasingly used as the preferred primary intervention. As general anaesthesia is sometimes contra-indicated for some patients needing ASD or PFO closure and intracardiac echocardiography (ICE) is not always readily available, alternative "supportive" techniques as hypnosis could be of interest. In our case, a relative contra-indication for general anaesthesia was pronounced due to the severely impaired pulmonary function caused by severe deformative torsional scoliosis. Over the years several reviews have been published on hypnotic analgesia used together with usual care suggesting that hypnotic analgesia is a promising non-pharmacologic adjunct treatment for ameliorating pain and surgical distress. Also, various cardiological procedures under hypnosis have already been described in literature, but this is the first time that percutaneous ASD closure under virtual reality (VR) hypnosis is mentioned in literature.
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Affiliation(s)
| | - S. Maes
- Department of Anesthesiology, University Hospital of Antwerp, Edegem, Belgium
| | - D. De Wolf
- Department of Pediatric Cardiology, University Hospital of Ghent, Ghent, Belgium
| | - A. Van Berendoncks
- University of Antwerp, Antwerp, Belgium
- Department of Cardiology, University Hospital of Antwerp, Edegem, Belgium
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10
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Himelfarb JD, Shulman H, Olesovsky CJ, Rumman RK, Oliva L, Friedland J, Farrell A, Huszti E, Horlick E, Abrahamyan L. Atrial fibrillation following transcatheter atrial septal defect closure: a systematic review and meta-analysis. Heart 2021; 108:1216-1224. [PMID: 34675040 DOI: 10.1136/heartjnl-2021-319794] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/28/2021] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE The ostium secundum atrial septal defect (ASD) is among the most common congenital cardiac anomalies diagnosed in adulthood. A known complication of transcatheter ASD closure is the development of new-onset atrial fibrillation and flutter (AFi/AFl). These arrhythmias confer an increased risk of postoperative stroke, thrombus formation and systemic emboli. This systematic review examines the burden of de novo AFi/AFl in adults following transcatheter closure and seeks to identify risk factors for AFi/AFl development. METHODS Studies were identified by a search of MEDLINE, EMBASE and Cochrane databases from inception until 29 April 2020. A meta-analysis of AFi/AFl incidence was performed using a random-effects model. RESULTS A total of 31 studies met inclusion criteria, comprising 4788 adult patients without a history of AFi/AFl. Twenty-three studies were included in quantitative synthesis and demonstrated an overall incidence rate of 1.82 patients per 100 person-years of follow-up (I2=83%). In studies that enrolled only patients ≥60 years old, the incidence was 5.21 patients per 100 person-years (I2=0%). Studies with follow-up duration ≤2 years reported an incidence of 4.05 per 100 person-years (I2=55%) compared with a rate of 1.19 per 100 person-years (I2=85%) for studies with follow-up duration >2 years. CONCLUSIONS The incidence of new-onset AFi/AFl is relatively low following transcatheter closure of secundum ASDs. The rate of de novo AFi/AFl, however, was significantly higher in elderly patients. Shorter follow-up time was associated with a higher reported incidence of AFi/AFl.
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Affiliation(s)
| | - Healey Shulman
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Rawan K Rumman
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Laura Oliva
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
| | - Joshua Friedland
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ashley Farrell
- Library and Information Services, University Health Network, Toronto, Ontario, Canada
| | - Ella Huszti
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada.,Biostatistics Research Unit, University Health Network, Toronto, Ontario
| | - Eric Horlick
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre (PMCC), University Health Network, Toronto, Ontario, Canada
| | - Lusine Abrahamyan
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada.,Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
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11
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Bac NH, Dinh NH, Van Thuan P, Bich Ha TC, Khoi LM. Atrial Myxoma on Atrial Septal Defect Occlusion Device: A Rare but True Occurrence. ACTA ACUST UNITED AC 2021; 5:204-208. [PMID: 34430767 PMCID: PMC8370869 DOI: 10.1016/j.case.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Device occlusion is the method of choice to treat atrial septal defects. Atrial myxoma on an atrial septal defect occlusion device is rare but does occur. Echocardiography plays an essential role in confirming an atrial myxoma. Echocardiography helps to exclude a left atrial thrombus. Echocardiography contributes to surgical planning.
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Affiliation(s)
- Nguyen Hoang Bac
- Endoscopic Surgery Training Center, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, Viet Nam
| | - Nguyen Hoang Dinh
- Cardiovascular Center, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, Viet Nam
| | - Phan Van Thuan
- Cardiovascular Center, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, Viet Nam
| | - Tran Chau Bich Ha
- Cardiovascular Center, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, Viet Nam
| | - Le Minh Khoi
- Cardiovascular Center, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, Viet Nam
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12
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Lapeña-Reguero M, Rueda-Nuñez F, Álvarez-García N. Long-term outcomes after percutaneous atrial septal deffects closure. Med Clin (Barc) 2020; 154:519-520. [PMID: 30857799 DOI: 10.1016/j.medcli.2019.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 01/28/2019] [Accepted: 01/31/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Miguel Lapeña-Reguero
- Servicio de Cardiología, Complejo Hospitalario Universitario A Coruña, A Coruña, España.
| | - Fernando Rueda-Nuñez
- Servicio de Cardiología, Complejo Hospitalario Universitario A Coruña, A Coruña, España
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13
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Ghaderian M, Shahsanaei F, Behdad S, Shirvani E. Long-Term Outcome After Transcatheter Atrial Septal Defect Closure in Adults: A Systematic Review and Meta-Analysis. Curr Probl Cardiol 2020; 46:100595. [PMID: 32684350 DOI: 10.1016/j.cpcardiol.2020.100595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 04/06/2020] [Indexed: 11/30/2022]
Abstract
AIMS We performed a systematic review and meta-analysis of published studies to characterize the current literature and help determine the long-term outcomes after transcatheter ASD closure in adults. METHODS AND RESULTS Two investigators searched the manuscript databases for all eligible studies in accordance with the considered keywords. The pooled prevalence of each event according to the meta-analysis and considering the weight calculated for each study included 10.1% (for arrhythmia), 1.8% (for emboli), 2.3% (for stroke), 12.5% (for residual shunt), 1.8% (for erosion), and 2.5% (for death). CONCLUSION The present meta-analysis show high long-term successfulness of transcatheter ASD closure in adults.
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14
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Ting CT, Chen JW, Chang MS, Yin FC. Pulmonary hemodynamics and wave reflections in adults with atrial septal defects. Am J Physiol Heart Circ Physiol 2020; 318:H925-H936. [DOI: 10.1152/ajpheart.00534.2019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Using high-fidelity micromanometers and flow velocity sensors at right heart catheterization, we compared pulmonary hemodynamics and wave reflections in age-matched normal adults and those with atrial septal defects, separated into three subgroups based on levels of mean pulmonary artery pressure: low (<17 mmHg), intermediate (17–26 mmHg), high (>26 mmHg). We made baseline measurements in all groups and after intravenous sodium nitroprusside in the subgroups. All of the subgroups had higher than normal baseline pulmonary flows and corresponding power that did not differ among the subgroups. The pulmonary vascular resistance, input resistance, and characteristic impedance in the subgroups did not differ from normal. Aside from the elevated flow and power, the hemodynamics in the low subgroup did not differ from normal. The intermediate subgroup had significantly higher than normal right ventricular and pulmonary artery pressures, wave reflections, and shorter wave reflection time, which all reverted to normal after nitroprusside. The high subgroup had similar changes as the intermediate subgroup. Unlike that subgroup, however, the pressures, wave reflections, and reflection return time did not revert to normal after nitroprusside. Hence, elevated wave reflections, but not resistance or characteristic impedance, are the hallmark of pulmonary hypertension in adults with atrial septal defects. Our results demonstrate that detailed measurements of hemodynamics and assessment of responsiveness to vasodilators provide important information about the pulmonary circulation in atrial septal defect. Coupled with studies after defect closure, those results may be a better foundation than current ones for clinical decisions.
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Affiliation(s)
- Chih-Tai Ting
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jaw-Wen Chen
- Department of Medical Research, Veterans General Hospital, Taipei, Taiwan
- Department of Medicine and Cardiovascular Research Center, National Yang Ming University School of Medicine, Taipei, Taiwan
- Cardiology Division, Department of Medicine, Veterans General Hospital, Taipei, Taiwan
| | - Mau-Song Chang
- Cardiology Division, Department of Medicine, Veterans General Hospital, Taipei, Taiwan
| | - Frank C.P. Yin
- Department of Biomedical Engineering, Washington University, St. Louis, Missouri
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15
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Ghaemian A, Nabati M, Shokri M. Undiagnosed inferior vena cava type of sinus venosus atrial septal defect in a middle-aged woman: A rare case report. JOURNAL OF CLINICAL ULTRASOUND : JCU 2020; 48:56-58. [PMID: 31364173 DOI: 10.1002/jcu.22767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 06/15/2019] [Accepted: 07/20/2019] [Indexed: 06/10/2023]
Abstract
Sinus venosus atrial septal defect (ASD) accounts for 5% to 10% of ASDs. In contrast with the more common superior vena cava (SVC) type, the inferior vena cava (IVC) type of sinus venosus ASD with overriding IVC is extremely rare. The sinus venosus defect occur posterior to the fossa ovalis and is not regarded as true ASD. Transesophageal echocardiography (TEE) is a diagnostic procedure of choice due to close proximity of atrial septum to TEE transducer. However; it may not constantly yield detailed anatomical and functional characterization, and other imaging modalities such as cardiac magnetic resonance imaging (MRI) may be needed. We report the case of a 45-year-old woman with an undiagnosed hemodynamically significant IVC-type ASD without any anomalous drainage of pulmonary veins, who presented with progressive dyspnea.
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Affiliation(s)
- Ali Ghaemian
- Fellowship of Interventional Cardiology, Department of Cardiology, Faculty of Medicine, Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Maryam Nabati
- Fellowship of Echocardiography, Department of Cardiology, Faculty of Medicine, Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mojtaba Shokri
- Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, Iran
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Trends in the Prevalence of Atrial Septal Defect and Its Associated Factors among Congenital Heart Disease Patients in Vietnam. J Cardiovasc Dev Dis 2019; 7:jcdd7010002. [PMID: 31892227 PMCID: PMC7151091 DOI: 10.3390/jcdd7010002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 12/20/2019] [Accepted: 12/24/2019] [Indexed: 02/06/2023] Open
Abstract
Atrial septal defect (ASD) is a non-physiologic communication between the two atria, allowing the shunt between systemic and pulmonary circulation. Data about ASD prevalence among congenital heart disease patients (CHD) in Vietnam are still scarce. We aim to assess the trends in the prevalence of ASD patients and associated factors among CHD patients. This was a cross-sectional study, with data collected from medical records from 1220 CHD patients in Da Nang hospital from 1 January 2010 to 31 December 2015. Descriptive statistics were used to estimate the prevalence of ASD among CHD patients. Comparative statistical methods were used to compare groups and logistic regression to access associated factors with ASD. The overall prevalence of ASD among CHD patients was 18.5% between 2010 and 2015. The prevalence varied between periods, ranging between 15% and 31.9% during the period. The prevalence of ASD women among CHD (25.9%) was significantly higher than for men (16.0%). The prevalence of ASD increased gradually when the age group increased. The factors associated with increased ASD prevalence were being a female and being in an older age group. The findings suggest that targeted policy should provide more-specific health-care services of ASD for women and older patients.
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Vodusek Z, Khaliqdina S, Borz-Baba C, Scandrett R. Sinus Venosus Atrial Septal Defect: A Challenging Diagnosis. Cureus 2019; 11:e5936. [PMID: 31788393 PMCID: PMC6858266 DOI: 10.7759/cureus.5936] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Sinus venosus atrial septal defect (SVASD) is a rare adult congenital heart disease which permits shunting of blood from the systemic to the pulmonary circulation and is commonly associated with anomalous pulmonary venous return. We report a case of a 27-year-old man with a history of premature birth and unilateral cryptorchidism who was admitted for syncope. Electrocardiogram (ECG) demonstrated atrial fibrillation (AF)and S1Q3T3 pattern along with an incomplete right bundle branch block. Transthoracic echocardiography (TTE) suggested the presence of right ventricular pressure and volume overload and severe right ventricular and right atrial enlargement. The agitated saline study was negative suggesting no inter-atrial communication. Transesophageal echocardiography (TEE) demonstrated a superior SVASD and raised the possibility of an anomalous pulmonary venous connection. Chest computed tomography identified the right superior pulmonary vein connection to the superior vena cava. The diagnosis of SVASD poses multiple challenges from the variety of symptoms to the selection of appropriate imaging and the complexity of surgical treatment.
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Affiliation(s)
- Ziga Vodusek
- Internal Medicine, Frank H. Netter M.D. School of Medicine at Quinnipiac University, North Haven, USA
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18
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Smilowitz NR, Subashchandran V, Berger JS. Atrial Septal Defect and the Risk of Ischemic Stroke in the Perioperative Period of Noncardiac Surgery. Am J Cardiol 2019; 124:1120-1124. [PMID: 31375244 DOI: 10.1016/j.amjcard.2019.06.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 06/09/2019] [Accepted: 06/13/2019] [Indexed: 12/16/2022]
Abstract
Stroke is a serious complication of noncardiac surgery. Congenital defects of the interatrial septum may be a potent risk factor for perioperative stroke. The aim of the present study was to determine the association between atrial septal defect (ASD) or patent foramen ovale (PFO) and in-hospital perioperative ischemic stroke after non-cardiac surgery in a large nationwide cohort of patients hospitalized in the United States. Patients undergoing noncardiac surgery between 2004 and 2014 were identified using the Healthcare Cost and Utilization Project's National Inpatient Sample. Patients without an in-hospital echocardiogram were excluded. The presence of an ostium secundum-type ASD or PFO was identified by ICD-9 diagnosis code 745.5. The primary study outcome was perioperative acute ischemic stroke. Between 2004 and 2014, there were 639,985 admissions for noncardiac surgery with an in-hospital echocardiogram. An ASD or PFO was documented in 9,041 (1.4%) hospitalizations. Perioperative ischemic stroke occurred more frequently in patients with an ASD or PFO compared with those without an ASD or PFO (35.1% vs 6.0%, p <0.001). The association between ASD or PFO and ischemic stroke persisted after adjustment for demographics and clinical covariates (adjusted odds ratio 6.30, 95% confidence interval, 5.59 to 7.10) and in all non-cardiac surgery subtypes. In conclusion, in a large, nationwide analysis of patients undergoing noncardiac surgery, a diagnosis of ASD or PFO was associated with an increased risk of acute ischemic stroke overall and in all surgical subtypes. Additional measures are necessary to mitigate stroke risk in patients with septal defects who are planned for non-cardiac surgery.
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Affiliation(s)
- Nathaniel R Smilowitz
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York.
| | - Varun Subashchandran
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York
| | - Jeffrey S Berger
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York; Department of Surgery, New York University School of Medicine, New York, New York
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Serinelli S, Gitto L, Stoppacher R. A Case of Sudden Death Due to Persistent Severe Pulmonary Arterial Hypertension After Late Atrial Septal Defect Closure. J Forensic Sci 2019; 64:1916-1920. [PMID: 31150105 DOI: 10.1111/1556-4029.14076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/10/2019] [Accepted: 04/23/2019] [Indexed: 11/29/2022]
Abstract
Atrial septal defects (ASDs) are one of the most prevalent congenital cardiac anomalies in adults. These interatrial communications can produce changes in the right heart (remodeling and failure) and the lungs (pulmonary hypertension). Most adults with ASDs are surgically treated with excellent results. However, a small fraction of patients is at risk for postoperative complications, particularly the persistence of pulmonary hypertension. A case of a 47-year-old woman who was found unresponsive in the bathroom of her house and died despite resuscitative efforts is described. According to medical records, the woman underwent a surgical repair of an atrial septal defect at the age of 37. At the autopsy, macroscopic and microscopic signs of advanced pulmonary hypertension were detected, highlighting the importance for the forensic pathologists to recognize pulmonary hypertension as a cause of sudden death in adults with a history of late surgical closure of an atrial septal defect.
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Affiliation(s)
- Serenella Serinelli
- Department of Pathology, State University of New York, Upstate Medical University, Syracuse, NY
| | - Lorenzo Gitto
- Department of Pathology, State University of New York, Upstate Medical University, Syracuse, NY
| | - Robert Stoppacher
- Department of Pathology, State University of New York, Upstate Medical University, Syracuse, NY
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Tang Y, Wu Y, Zhu J, Liu X, Zhou J, Huang H, Li M, Dai Y, Han X. Total endoscopic repair of atrial septal defect under on-pump beating heart. J Thorac Dis 2019; 10:6557-6562. [PMID: 30746200 DOI: 10.21037/jtd.2018.10.89] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background We previously reported the techniques for total endoscopic atrial septal defect (ASD) repair on hearts arrested with cardioplegia through three small incisions in the chest wall without aid of a surgical robotic system. The optimal results motivated us to use total thoracoscopic technology for ASD on perfused beating hearts. Methods From 2010 to 2017, 161 patients with a mean age of 28.31±12.34 years who underwent non-robotically assisted total thoracoscopic closure for ASD were included in this study, and those patients were also divided into two groups, including group A and group B. In group A, 115 patients underwent the procedure on beating hearts without aorta cross-clamped; in group B, 46 patients underwent the procedure on hearts arrested with cardioplegia with aorta cross-clamped. Cardiopulmonary bypass (CPB) was peripherally achieved as well. Results Total thoracoscopic ASD closures were successfully performed without in-hospital mortality or other serious complications in all patients of both groups. Dacron or bovine patches were used in 81 and 32 patients in the two groups, respectively. Duration of operation, duration of CPB, aorta cross-clamped time, duration of mechanical ventilation, the length of intensive care unit (ICU) and post-operative hospital stay in group A, were all shorter than those in group B (P<0.05). There was no statistically significant difference in blood transfusion during operation or post-operation thoracic drainage. During follow-up, echocardiograms at 3, 30, 90 and 365, showed no residual shunt or tricuspid regurgitation. Conclusions Total thoracoscopic closure of ASD without assistance of a surgical robotic system on beating heart is safe and feasible and can be used as a therapeutic option for ASD, and by using the mentioned technique, less injuries are applied to patients.
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Affiliation(s)
- Yihu Tang
- Department of Cardiovascular Surgery, First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China
| | - Yanhu Wu
- Department of Cardiovascular Surgery, First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China
| | - Jinfu Zhu
- Department of Cardiovascular Surgery, First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China
| | - Xiang Liu
- Department of Cardiovascular Surgery, First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China
| | - Jinxin Zhou
- Department of Cardiovascular Surgery, First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China
| | - Haobing Huang
- Department of Cardiovascular Surgery, First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China
| | - Mingke Li
- Department of Cardiovascular Surgery, First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China
| | - Yawei Dai
- Department of Cardiovascular Surgery, First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China
| | - Xu Han
- Department of Cardiovascular Surgery, First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China
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21
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Truong QB, Dao AQ, Do NT, Le MK. Percutaneous atrial septal defect closure through femoral and transjugular approaches in patients with interrupted inferior vena cava. J Cardiol Cases 2018; 18:106-109. [PMID: 30279924 PMCID: PMC6149646 DOI: 10.1016/j.jccase.2018.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 05/16/2018] [Accepted: 05/21/2018] [Indexed: 11/27/2022] Open
Abstract
Femoral venous approach is the classic route of percutaneous atrial septal defect (ASD) closure. But in patients with interrupted inferior vena cava (IVC) with azygos continuation the normal connection is lost rendering transcatheter intervention more complicated and innovative approaches should be sought. Transhepatic approach has been used with success but this approach is technically demanding and could lead to major complications. We report successful percutaneous secundum ASD closure in 2 patients with interrupted IVC. Transjugular route was used to close the secundum ASD in a 15-month-old girl. Percutaneous ASD closure through femoral venous route was performed in a 49-year-old woman. We found that both these approaches of percutaneous ASD device occlusion can be performed with success and safety. <Learning objective: Interrupted inferior vena cava with azygos or hemiazygos continuation is a rare congenital anomaly but potentially complicates the usual percutaneous atrial septal defect (ASD) closure and therefore merits an accurate diagnosis before the procedure. Percutaneous ASD device closure can be performed with success and safety through femoral and transjugular approaches in patients with ostium secundum ASD who present with interrupted inferior vena cava.>
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Affiliation(s)
- Quang Binh Truong
- Cardiovascular Center, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | - Anh Quoc Dao
- Cardiovascular Center, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | - Nguyen Tin Do
- Department of Cardiology, Children Hospital 1, Ho Chi Minh City, Vietnam
| | - Minh Khoi Le
- Cardiovascular Center, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
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22
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Sabouni MA, Benedict D, Alom MS, Petty S, Patel K. Atrial septal defect can be easily missed in chromosome 18q deletion syndrome. Oxf Med Case Reports 2018; 2018:omy076. [PMID: 30263129 PMCID: PMC6151314 DOI: 10.1093/omcr/omy076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/16/2018] [Accepted: 07/19/2018] [Indexed: 11/14/2022] Open
Abstract
The frequency of 18q− is estimated to be approximately 1/40 000 live births and is more commonly associated with certain clinical features including short stature, intellectual disability and malformations of many major organ systems. Congenital cardiac abnormalities are present in 24–36% of cases and screening can prove difficult. A 28-year-old Caucasian female with a history of long arm chromosome 18q deletion was evaluated for persistent dyspnea and decreased activity level. Multiple hospitalizations failed to identify the etiology of her symptoms. Initial transthoracic echocardiogram failed to show any underlying cardiac etiology of her symptoms. Multiple recurrent hospitalizations with the same chief complaint. A transesophageal echo (TEE) showed large secundum atrial septal defect (ASD). Successful surgical closure of her large secundum ASD provided significant symptoms relief. The threshold of obtaining TEE should be low in patients with 18q− which permits early recognition and treatment of underlying structural heart disease.
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Affiliation(s)
- Mouhamed Amr Sabouni
- UHS Heart and Vascular Institute, UHS Wilson Medical Center, Johnson City, NY, USA
| | - David Benedict
- UHS Heart and Vascular Institute, UHS Wilson Medical Center, Johnson City, NY, USA
| | - Md Saiful Alom
- UHS Internal Medicine, UHS Wilson Medical Center, Johnson City, NY, USA
| | - Stephen Petty
- Lake Erie College of Osteopathic Medicine, Erie, PA, USA
| | - Keyoor Patel
- UHS Heart and Vascular Institute, UHS Wilson Medical Center, Johnson City, NY, USA
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23
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Shen L, Liu J, Li JK, Xu M, Yuan L, Zhang GQ, Wang JY, Huang YJ. The Significance of Crochetage on the R wave of an Electrocardiogram for the Early Diagnosis of Pediatric Secundum Atrial Septal Defect. Pediatr Cardiol 2018; 39:1031-1035. [PMID: 29564520 DOI: 10.1007/s00246-018-1857-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 03/03/2018] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to test the hypothesis that the incidence of crochetage on the R wave in inferior limb leads can be used for the diagnosis of pediatric secundum atrial septal defect (ASD). Two hundred fifty-six children with secundum ASD (case cohort) and 256 age- and gender-matched children without heart disease (control cohort) were included in the study. Statistical analyses were performed to test the relationship between the ASD and the crochetage on the R wave with a single lead and three leads, respectively. The impact of incomplete right bundle branch block (IRBBB) and ASD diameter (≥ 5 and < 5 mm) on ASD diagnosis were also explored. Crochetage on the R wave was observed in all three inferior limb leads on 28.13% (72/256, 28 with IRBBB) of subjects with secundum ASD, while it was seen in only 2.73% (7/256, one with IRBBB) of control subjects (P < 0.001). Subgroup analysis showed that the incidence of R wave crochetage correlated with ASD size in both the single inferior limb lead (26.14%, 23/88 on ASD ≥ 5 mm vs. 10.71%, 18/168 on ASD < 5 mm; P = 0.001) and all three inferior limb leads (44.32%, 39/88 on ASD ≥ 5 mm vs. 19.64%, 33/168 on ASD < 5 mm; P < 0.001). Our findings suggest that crochetage on the R wave in inferior limb leads can serve as an independent marker for ASD diagnosis.
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Affiliation(s)
- Lei Shen
- Department of Cardiology, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200040, China
| | - Jian Liu
- Department of Emergency, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200040, China
| | - Jin-Kang Li
- Department of Emergency, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200040, China
| | - Meng Xu
- Department of Cardiology, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200040, China
| | - Lang Yuan
- Department of Emergency, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200040, China
| | - Guo-Qin Zhang
- Department of Emergency, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200040, China
| | - Jian-Yi Wang
- Department of Cardiology, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200040, China
| | - Yu-Juan Huang
- Department of Emergency, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200040, China.
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24
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Supomo S, Darmawan H, Arjana AZ. Role of pulmonary hemodynamics in determining 6-minute walk test result in atrial septal defect: an observational study. J Cardiothorac Surg 2018; 13:51. [PMID: 29788983 PMCID: PMC5964729 DOI: 10.1186/s13019-018-0725-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 05/09/2018] [Indexed: 11/24/2022] Open
Abstract
Background The presence of altered pulmonary hemodynamics in adult patients with atrial septal defect (ASD) is common. However, there are no observational studies which evaluate the impact of altered pulmonary hemodynamics on the 6-min walk test (6MWT) result. This study aimed to investigate the role of pulmonary hemodynamics in determining 6MWT result of patients with ASD. Method Forty-six consecutive adult patients with ASD were included in this study. Right heart catheterization was performed to obtain the pulmonary hemodynamics profile. Meanwhile, 6MWT was presented as high or low with cut-off point 350 m. Receiver operating characteristic (ROC) was used for analytical methods. Result Abnormal functional capacity was indicated by ROC result of mPAP cut-off value of > 24 mmHg (p = 0.0243; AUC = 0.681). The value of PVR > 3.42 woods unit (WU) showed high specificity in determining abnormal functional capacity (p = 0.0069; AUC = 0.713). Flow ratio with cut-off point ≤4.89 had the highest sensitivity (100%) (p = 0.8300; AUC = 0.520). Conclusion Pulmonary hemodynamics can serve as an indicator of 6MWT result in adult ASD patients with values of mPAP> 24 mmHg and PVR > 3.42 WU.
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Affiliation(s)
- Supomo Supomo
- Department of Thoracic and Cardiovascular Surgery, Dr. Sardjito General Hospital, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Kesehatan St. Number 1, Sleman, Yogyakarta, 55281, Indonesia.
| | - Handy Darmawan
- Faculty of Medicine, Universitas Islam Indonesia, Yogyakarta, Indonesia
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Yamasaki Y, Kawanami S, Kamitani T, Sagiyama K, Sakamoto I, Hiasa KI, Yabuuchi H, Nagao M, Honda H. Noninvasive quantification of left-to-right shunt by phase contrast magnetic resonance imaging in secundum atrial septal defect: the effects of breath holding and comparison with invasive oximetry. Int J Cardiovasc Imaging 2018; 34:931-937. [DOI: 10.1007/s10554-018-1297-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 01/04/2018] [Indexed: 11/27/2022]
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Electrocardiographic RR and QT Interval Variability in Patients with Atrial Septal Defect and Healthy Children. Pediatr Cardiol 2017; 38:582-587. [PMID: 28058479 DOI: 10.1007/s00246-016-1551-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 12/21/2016] [Indexed: 01/19/2023]
Abstract
Atrial septal defect is a common congenital heart disease. In patients with atrial septal defect, left-to-right shunting increases the right atrial and right ventricular preload. This pathological change affects sinus node automaticity and myocardial depolarization and repolarization, and has the potential to evoke arrhythmogenic substrates. We examined the effect of atrial septal defect on sinus node automaticity and myocardial repolarization by investigating the variability in the repolarization interval, namely the QT variability index (QTVI) and variability ratio (VR). This retrospective study included 38 patients (mean age, 2.2 ± 1.9 years; mean left-to-right shunt ratio, 2.1 ± 0.70) and 40 age-matched healthy control subjects evaluated from 2008 to 2015. QTVI was calculated using the ratio of the repolarization parameter variance to heart rate variance, and VR was calculated as the ratio of the standard deviation (SD) of QT intervals to the SD of RR intervals on electrocardiography. There was a significant difference in the SD of all normal RR intervals, heart rate variance, VR, and QTVI of control subjects or patients with low shunt ratio compared with patients with high shunt ratio (all P < 0.05). Linear regression analysis revealed strong positive correlations between the left-to-right shunt ratio and VR (r = 0.662, P < 0.0001) or QTVI (r = 0.808, P < 0.0001). These repolarization indices provide information on alteration of sinus node autonomic control and the pathophysiology of myocardial repolarization, and could be used as a noninvasive indicator of the shunt ratio in children with atrial septal defect.
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Ntiloudi D, Giannakoulas G, Parcharidou D, Panagiotidis T, Gatzoulis MA, Karvounis H. Adult congenital heart disease: A paradigm of epidemiological change. Int J Cardiol 2016; 218:269-274. [DOI: 10.1016/j.ijcard.2016.05.046] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 05/12/2016] [Indexed: 11/25/2022]
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28
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Nassif M, Heuschen CBBC, Lu H, Bouma BJ, van Steenwijk RP, Sterk PJ, Mulder BJM, de Winter RJ. Relationship between atrial septal defects and asthma-like dyspnoea: the impact of transcatheter closure. Neth Heart J 2016; 24:640-646. [PMID: 27561281 PMCID: PMC5065534 DOI: 10.1007/s12471-016-0879-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Patients with atrial septal defects (ASD) are often misdiagnosed as asthma patients and accordingly receive erroneous bronchodilator treatment. In order to characterise their symptoms of dyspnoea to explain this clinical observation, we investigated the prevalence of asthma-like symptoms in patients with secundum ASD who then underwent successful percutaneous closure. METHODS A total of 80 ASD patients (74 % female, mean age 46.7 ± 16.8 years, median follow-up 3.0 [2.0-5.0] years) retrospectively completed dyspnoea questionnaires determining the presence and extent of cough, wheezing, chest tightness, effort dyspnoea and bronchodilator use on a 7-point scale (0 = none, 6 = maximum) before and after ASD closure. The Mini Asthma Quality of Life (Mini-AQLQ) and Asthma Control Questionnaire with bronchodilator use (ACQ6) were administered. RESULTS A total of 48 (60 %) patients reported cough, 27 (34 %) wheezing, 26 (33 %) chest tightness and 62 (78 %) effort dyspnoea. Symptom resolution or reduction was found in 64 (80 %) patients after ASD closure. Asthma symptom scores decreased significantly on the Mini-AQLQ and ACQ6 (both p < 0.001). The number of patients using bronchodilators decreased from 16 (20 %) to 8 (10 %) patients after ASD closure (p = 0.039) with less frequent use of bronchodilators (p = 0.015). CONCLUSIONS A high prevalence of asthma-like symptoms and bronchodilator use is present in ASD patients, which exceeds the low prevalence of bronchial asthma in this study population. Future prospective research is required to confirm this phenomenon. The presence of an ASD should be considered in the differential diagnosis of patients with asthma-like symptoms, after which significant symptom relief can be achieved by ASD closure.
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Affiliation(s)
- M Nassif
- Department of Cardiology, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands
| | - C B B C Heuschen
- Department of Cardiology, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands
| | - H Lu
- Department of Cardiology, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands
| | - B J Bouma
- Department of Cardiology, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands
| | - R P van Steenwijk
- Department of Pulmonary Medicine, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands
| | - P J Sterk
- Department of Pulmonary Medicine, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands
| | - B J M Mulder
- Department of Cardiology, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands.,Interuniversity Cardiology Institute of the Netherlands (ICIN), Utrecht, The Netherlands
| | - R J de Winter
- Department of Cardiology, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands.
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29
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Anderson RD, Wilson W, Morton J, Aggarwal A. Normalisation of hypoxaemia following successful percutaneous closure of a bidirectional shunting secundum atrial septal defect without pulmonary hypertension in a patient with severe non-ischaemic cardiomyopathy and refractory ventricular tachycardia. Intern Med J 2016; 46:969-72. [PMID: 27553997 DOI: 10.1111/imj.13074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 11/17/2015] [Accepted: 11/17/2015] [Indexed: 11/30/2022]
Abstract
Atrial septal defects (ASD) are an uncommon cause of dyspnoea. A high index of suspicion is required, and further investigation should be prompted in patients with unexplained hypoxaemia, particularly those with pulmonary hypertension. Hypoxic ASD without pulmonary hypertension are rare, and only a handful of cases have been published. We present a middle-aged man with progressive dyspnoea with a successfully closed ASD without pulmonary hypertension caused by elevated right ventricular pressures secondary to an idiopathic cardiomyopathy.
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Affiliation(s)
- R D Anderson
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - W Wilson
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - J Morton
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - A Aggarwal
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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Couperus LE, Henkens IR, Jongbloed MRM, Hazekamp MG, Schalij MJ, Vliegen HW. Tailored circulatory intervention in adults with pulmonary hypertension due to congenital heart disease. Neth Heart J 2016; 24:400-409. [PMID: 27098530 DOI: 10.1007/s12471-016-0833-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 03/08/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Adults with pulmonary hypertension associated with congenital heart disease (PH-CHD) often have residual shunts. Invasive interventions aim to optimise pulmonary flow and prevent right ventricular failure. However, eligibility for procedures strongly depends on the adaptation potential of the pulmonary vasculature and right ventricle to resultant circulatory changes. Current guidelines are not sufficiently applicable to individual patients, who exhibit great diversity and complexity in cardiac anomalies. METHODS AND RESULTS We present four complex adult PH-CHD patients with impaired pulmonary flow, including detailed graphics of the cardiopulmonary circulation. All these patients had an ambiguous indication for shunt intervention. Our local multidisciplinary Grown-Ups with Congenital Heart Disease team reached consensus regarding a patient-tailored invasive treatment strategy, adjacent to relevant guidelines. Interventions improved pulmonary haemodynamics and short-term clinical functioning in all cases. CONCLUSIONS Individual evaluation of disease characteristics is mandatory for tailored interventional treatment in PH-CHD patients, adjacent to relevant guidelines. Both strict registration of cases and multidisciplinary and multicentre collaboration are essential in the quest for optimal therapy in this patient population.
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Affiliation(s)
- L E Couperus
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands.
| | - I R Henkens
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - M R M Jongbloed
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
- Department of Anatomy, Leiden University Medical Center, Leiden, Netherlands
| | - M G Hazekamp
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - M J Schalij
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - H W Vliegen
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
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