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Arvanitaki A, Diller G, Giannakoulas G. The Right Heart in Congenital Heart Disease. Curr Heart Fail Rep 2023; 20:471-483. [PMID: 37773427 DOI: 10.1007/s11897-023-00629-7] [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] [Accepted: 09/17/2023] [Indexed: 10/01/2023]
Abstract
PURPOSE OF REVIEW To analyze the pathophysiologic importance of the right heart in different types of congenital heart disease (CHD), summarize current diagnostic modalities, and discuss treatment options. RECENT FINDINGS The right ventricle (RV) plays a key role in disease progression and prognosis, either as the subpulmonary or as the systemic ventricle. Volume and/or pressure overload as well as intrinsic myocardial disease are the main factors for RV remodeling. Echocardiography and cardiac magnetic resonance imaging are important noninvasive modalities for assessing anatomy, size, and function of the right heart. Timely repair of related lesions is essential for preventing RV dysfunction. Few inconclusive data exist on conventional pharmacotherapy in CHD-related RV dysfunction. Cardiac resynchronization therapy and ventricular assist devices are an option in patients with advanced systemic RV failure. Right heart disease is highly related with adverse clinical outcomes in CHD. Research should focus on early identification of patients at risk and development of medical and interventional treatments that improve RV function.
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Affiliation(s)
- Alexandra Arvanitaki
- 1st Department of Cardiology, AHEPA University Hospital, St. Kiriakidi 1, 54621, Thessaloniki, Greece
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Gerhard Diller
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton and Harefield NHS Foundation Trust, London, UK
- Department of Cardiology III-Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer-Campus 1, Muenster, Germany
- National Register for Congenital Heart Defects, Berlin, Germany
| | - George Giannakoulas
- Department of Cardiology, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, St. Kiriakidi 1, 54636, Thessaloniki, Greece.
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2
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Lippmann MR, Maron BA. The Right Ventricle: From Embryologic Development to RV Failure. Curr Heart Fail Rep 2022; 19:325-333. [PMID: 36149589 PMCID: PMC9818027 DOI: 10.1007/s11897-022-00572-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/01/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE OF REVIEW The right ventricle (RV) and left ventricle (LV) have different developmental origins, which likely plays a role in their chamber-specific response to physiological and pathological stress. RV dysfunction is encountered frequently in patients with congenital heart disease (CHD) and right heart abnormalities emerge from different causes than increased afterload alone as is observed in RV dysfunction due to pulmonary hypertension (PH). In this review, we describe the developmental, structural, and functional differences between ventricles while highlighting emerging therapies for RV dysfunction. RECENT FINDINGS There are new insights into the role of fibrosis, inflammation, myocyte contraction, and mitochondrial dynamics in the pathogenesis of RV dysfunction. We discuss the current state of therapies that may potentially improve RV function in both experimental and clinical trials. A clearer understanding of the differences in molecular alterations in the RV compared to the LV may allow for the development of better therapies that treat RV dysfunction.
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Affiliation(s)
- Matthew R. Lippmann
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, 77 Ave. Louis Pasteur, NRB 0630-N, Boston, MA 02115, USA
| | - Bradley A. Maron
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, 77 Ave. Louis Pasteur, NRB 0630-N, Boston, MA 02115, USA,Department of Cardiology, VA Boston Healthcare System, West Roxbury, MA, USA
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Goh E, Mohammed H, Salmasi MY, Ho S, Benedetto U, Caputo M, Angelini G, Vohra HA. Minimally invasive versus transcatheter closure of secundum atrial septal defects: a systematic review and meta-analysis. Perfusion 2022; 37:700-710. [PMID: 34109866 PMCID: PMC9500175 DOI: 10.1177/02676591211021935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Limited data exists demonstrating the efficacy of minimally invasive surgery (MIS) compared to transcatheter (TC) closure of atrial septal defects (ASD). This systematic review and meta-analysis aims to compare post-operative outcomes of MIS versus TC repair in ASD closure. METHODS PubMed, Medline and EMBASE were searched from inception until June 2018 for randomised and observational studies comparing post-operative outcomes for MIS and TC repair. The studies were reviewed for bias using the ROBINS-I Score and pooled in a meta-analysis using STATA (version 15). RESULTS Six observational studies, involving 1524 patients assessing three primary and five secondary outcomes were included. Evidence suggests TC repair yielded shorter hospital stay (MD = 3.32, 95% CI 1.04-5.60) and lower rates of transient atrial fibrillation (AF) (RR = 0.48, 95% CI 0.20-1.15). TC repair patients also had fewer pericardial effusions (RR = 0.27, 95% CI 0.05-1.54, I2 = 0.0%) and pneumothoraxes (RR = 0.18, 95% CI 0.04-0.80, I2 = 0.0%). However, TC repair results in more minor residual shunts (RR = 6.04, 95% CI 1.69-21.63 in favour of MIS, I2 = 39.0%). No differences were found for incidences of strokes (RR = 1.58, 95% CI 0.23-10.91, I2 = 19.3%), unexpected bleeding (RR = 0.44, 95% CI 0.19-1.04, I2 = 0.0%) and blood transfusion (RR = 0.39, 95% CI 0.09-1.59, I2 = 0.0%). CONCLUSIONS MIS closure for ASD has similar outcomes compared to TC repair. However, the lack of randomised literature related to MIS versus TC repair for ASD closure warrants further evidence in the form of RCTs to further support these findings.
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Affiliation(s)
- Esther Goh
- Department of Cardiovascular Sciences Surgery, Bristol Hearth Institute, Bristol, UK
| | - Haya Mohammed
- Department of Cardiovascular Sciences Surgery, Bristol Hearth Institute, Bristol, UK
| | | | - Samantha Ho
- Department of Cardiovascular Sciences Surgery, Bristol Hearth Institute, Bristol, UK
| | - Umberto Benedetto
- Department of Cardiovascular Sciences Surgery, Bristol Hearth Institute, Bristol, UK
| | - Massimo Caputo
- Department of Cardiovascular Sciences Surgery, Bristol Hearth Institute, Bristol, UK
| | - Gianni Angelini
- Department of Cardiovascular Sciences Surgery, Bristol Hearth Institute, Bristol, UK
| | - Hunaid A Vohra
- Department of Cardiovascular Sciences Surgery, Bristol Hearth Institute, Bristol, UK
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4
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Giordano M, Santoro G, Gaio G, Cappelli Bigazzi M, Esposito R, Marzullo R, Di Masi A, Palladino MT, Russo MG. Novel echocardiographic score to predict duct-dependency after percutaneous relief of critical pulmonary valve stenosis/atresia. Echocardiography 2022; 39:724-731. [PMID: 35466466 PMCID: PMC9322398 DOI: 10.1111/echo.15358] [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] [Received: 01/12/2022] [Revised: 02/07/2022] [Accepted: 04/10/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives This study aimed to identify clinical, hemodynamic, or echocardiographic predictive features of persistent duct‐dependency of pulmonary circulation (PDDPC) after effective percutaneous relief of pulmonary atresia with the intact ventricular septum (PA‐IVS) or critical pulmonary stenosis (CPS). Methods From 2010 to 2021, 55 neonates with PA‐IVS or CPS underwent percutaneous right ventricle (RV) decompression at our Institution. After successfully relief of critical obstruction, 27 patients (group I) showed PDDPC, whereas RV was able to support the pulmonary circulation in the remaining 28 patients (group II). Clinical, hemodynamic, and echocardiographic features of these two groups were compared. Results No significant difference in clinical and hemodynamic data was found between the groups, although the group I had a lower oxygen saturation at hospital admission. However, tricuspid valve (TV) diameter <8.8 mm, TV z‐score ←2.12, tricuspid/mitral valve annular ratio <.78, pulmonary valve diameter <6.7 mm, pulmonary valve z‐score ←1.17, end‐diastolic RV area <1.35 cm2, end‐systolic right atrium area >2.45 cm2, percentage amount of interatrial right‐to‐left shunt >69.5%, moderate/severe tricuspid regurgitation, RV systolic pressure >42.5 mmHg, tricuspid E/E′ ratio >6.6 showed each significant predictive value of PDDPC. These parameters were used to build a composite echocardiographic score (PDDPC‐score), assigning one point each above the respective cut‐off value. A score ≥4.00 showed high sensitivity (100%) and specificity (86%) in predicting PDDPC. Conclusion Clinical and hemodynamic features fail to predict the short‐term fate of the pulmonary circulation after successful treatment of PA‐IVS/CPS. However, a simple, composite echocardiographic score is useful to predict PDDPC and could be crucial in the management of this frail subset of patients.
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Affiliation(s)
- Mario Giordano
- Paediatric Cardiology Unit, University of Campania "Luigi Vanvitelli", A.O.R.N. "Ospedali dei Colli", Naples, Italy
| | - Giuseppe Santoro
- Paediatric Cardiology Unit, University of Campania "Luigi Vanvitelli", A.O.R.N. "Ospedali dei Colli", Naples, Italy.,Paediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Gianpiero Gaio
- Paediatric Cardiology Unit, University of Campania "Luigi Vanvitelli", A.O.R.N. "Ospedali dei Colli", Naples, Italy
| | - Maurizio Cappelli Bigazzi
- Paediatric Cardiology Unit, University of Campania "Luigi Vanvitelli", A.O.R.N. "Ospedali dei Colli", Naples, Italy.,Invasive Cardiology Unit, University of Campania "Luigi Vanvitelli", A.O.R.N. "Ospedali dei Colli", Naples, Italy
| | - Raffaella Esposito
- Paediatric Cardiology Unit, University of Campania "Luigi Vanvitelli", A.O.R.N. "Ospedali dei Colli", Naples, Italy
| | - Raffaella Marzullo
- Paediatric Cardiology Unit, University of Campania "Luigi Vanvitelli", A.O.R.N. "Ospedali dei Colli", Naples, Italy
| | - Antonio Di Masi
- Paediatric Cardiology Unit, University of Campania "Luigi Vanvitelli", A.O.R.N. "Ospedali dei Colli", Naples, Italy
| | - Maria Teresa Palladino
- Paediatric Cardiology Unit, University of Campania "Luigi Vanvitelli", A.O.R.N. "Ospedali dei Colli", Naples, Italy
| | - Maria Giovanna Russo
- Paediatric Cardiology Unit, University of Campania "Luigi Vanvitelli", A.O.R.N. "Ospedali dei Colli", Naples, Italy
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Effectiveness and Safety of Transcatheter Atrial Septal Defect Closure in Adults with Systemic Essential Hypertension. J Clin Med 2022; 11:jcm11040973. [PMID: 35207245 PMCID: PMC8879914 DOI: 10.3390/jcm11040973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/24/2022] [Accepted: 02/10/2022] [Indexed: 12/27/2022] Open
Abstract
Concomitant systemic essential hypertension (HTN) in adults with a secundum atrial septal defect (ASD) can unfavorably affect the hemodynamics and transcatheter ASD closure (ASDC) effects. This study aims to assess the effectiveness and safety of ASDC in adults with HTN in real-world clinical practice. Right ventricular (RV) reverse remodeling (RVR) and the lack of a left-to-right interatrial residual shunt (NoRS) in echocardiography 24 h and 6 months (6 M) post-ASDC, and ASDC-related complications within 6 M were evaluated in 184 adults: 79 with HTN (HTN+) and 105 without HTN (HTN−). Compared to HTN−, HTN+ patients were older and had a greater RV size and the prevalence of atrial arrhythmias, chronic heart failure, nonobstructive coronary artery disease, diabetes, hyperlipidemia, and left ventricular diastolic dysfunction. ASDC was successful and resulted in RVR, NoRS, and a lack of ASDC-related complications in the majority of HTN+ patients both at 24 h and 6 M. HTN+ and HTN− did not differ in ASD size, a successful implantation rate (98.7% vs. 99%), RVR 24 h (46.8% vs. 46.7%) and 6 M (59.4% vs. 67.9%) post-ASDC, NoRS 24 h (79% vs. 81.5%) and 6 M (76.6% vs. 86.9%) post-ASDC, and the composite of RVR and NoRS at 6 M (43.8% vs. 57.1%). Most ASDC-related complications in HTN+ occurred within 24 h and were minor; however, major complications such as device embolization within 24 h and mitral regurgitation within 6 M were observed. No differences between HTN+ and HTN− were observed in the total (12.7% vs. 9.5%) and major (5.1% vs. 4.8%) complications. Transcatheter ASDC is effective and safe in adults with secundum ASD and concomitant HTN in real-world clinical practice; however, proper preprocedural management and regular long-term follow-up post-ASDC are required.
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6
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Van Praagh R. Interatrial Communications. CONGENIT HEART DIS 2022. [DOI: 10.1016/b978-1-56053-368-9.00009-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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7
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Alkhateeb A, Roushdy A, Hasan-Ali H, Kishk YT, Hassan AK. Immediate and short-term biventricular function assessment post-atrial septal defect surgical versus device closure: A comparative two-dimensional speckle tracking study. PROGRESS IN PEDIATRIC CARDIOLOGY 2021. [DOI: 10.1016/j.ppedcard.2020.101309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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9
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Agha HM, Mohammed IS, Hassan HA, Abu Seif HS, Abu Farag IM. Left and right ventricular speckle tracking study before and after percutaneous atrial septal defect closure in children. J Saudi Heart Assoc 2020; 32:71-78. [PMID: 33154895 PMCID: PMC7640596 DOI: 10.37616/2212-5043.1012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 11/14/2019] [Accepted: 11/15/2019] [Indexed: 01/21/2023] Open
Abstract
Objectives To analyze the acute and short-term deformation changes of both right (RV) and left (LV) ventricular wall before and after transcatheter closure of atrial septal defect (ASD) secundum in children. Outcome measures To determine the feasibility of tissue Doppler and myocardial deformation imaging for evaluating RV and LV functions in children undergoing transcatheter ASD closure. Patients and methods A prospective study was performed for 32 children with hemodynamic significant ASD secundum before and 6 months after percutaneous ASD closure in the Pediatric Cardiology Division of Specialized Pediatric Hospital, Cairo University. Speckle tracking echocardiography (STE) of LV and RV global analysis (longitudinal and circumferential strain) before and after ASD transcatheter closure was performed. Results The mean age of the patients was 6.01 ± 3.19 (range: 3–9) years with a female to male ratio of 1.3:1. There was an improvement in the RV and LV myocardial performance index (MPI) 6 months post-ASD closure (RVMPI = 0.46 ± 0.069 vs. 0.38 ± 0.05, p < 0.0001; LVMPI = 0.49 ± 0.12 vs. 0.38 ± 0.08, p < 0.0001, respectively). By 2D STE, there was a significant improvement in the RV global longitudinal strain (GLS) 6 months post-ASD closure (−20.17 ± 3.14% vs. −25.86 ± 5.02%, p < 0.0001). There was a significant increase in the LV end-diastolic volume (EDV) and LV end-systolic volume (ESV) using 4D STE after device closure (LVEDV = 32.96 ± 10.99 mL vs. 44.024 ± 14.9017 mL, p < 0.0001; LVESV = 15.16 ± 6.08 mL vs. 21.76 ± 8.34 mL, p < 0.0001, respectively). Additionally, there was a significant improvement in the LV GLS after device occlusion (−19.17 ± 3.67% vs. −22.36 ± 4.72%, p = 0.009) using 4D TomTec software. There was a significant decrease in the RVEDV (54.65 ± 10.05 mL vs. 15.73 ± 8.67 mL) and RV stroke volume (25.15 ± 6.36 vs. 20.06 ± 7.2) after device occlusion using 4D TomTec software. Conclusion By using 4D STE, the LV GLS was significantly improved; in contrast, by 2D STE, the RV volume overload decreased and the RV GLS was improved on short term after transcatheter ASD secundum closure in children.
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Affiliation(s)
- Hala M Agha
- Department of Pediatrics, Pediatric Cardiology Division, Specialized Pediatric Hospital, Cairo University, Cairo, Egypt
| | - Islam S Mohammed
- Department of Pediatrics, Faculty of Medicine, Al-Azhar University, Egypt
| | - Hassan A Hassan
- Department of Pediatrics, Faculty of Medicine, Al-Azhar University, Egypt
| | - Hassan S Abu Seif
- Department of Pediatrics, Faculty of Medicine, Al-Azhar University, Egypt
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10
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Wang S, Pan J, Xiao B, Tang Y, Lan J, Zheng X, Yang C, Xu D, Zhang J. Immediate and short-term effects of transcatheter device closure of large atrial septal defect in senior people. CONGENIT HEART DIS 2019; 14:939-944. [PMID: 31513356 DOI: 10.1111/chd.12844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 07/29/2019] [Accepted: 08/29/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES We sought to evaluate the safety and efficacy in improving cardiac function and functional capacity with device closure of large atrial septal defects (ASD) in senior adults. BACKGROUND Atrial septal defect accounts for about 10% of all congenital heart disease. It still remains unclear whether large ASD closure in senior people should be performed or not. Hence we aim to prospectively assess the safety and clinical status of senior patients after transcatheter closure in large ASD. PATIENTS AND INTERVENTIONS This was a prospective study of all patients aged over 50 years who underwent device closure of a secundum large ASD between January 2013 and January 2018. Investigations including brain natriuretic peptide level, electrocardiography, chest X-ray, transthoracic echocardiogram, transesophageal echocardiogram, and 6-minute walk test were performed before and at 2 days and 4 weeks and 6 months after the procedure. RESULTS Twenty patients (median age 68 years, 10 women) had transcatheter device closure of large ASD successfully. Median ASD size was 32 mm (range 30-39 mm). Median pulmonary artery pressure was 58 mm Hg (range 47-67 mm Hg). At 6 months, there was a significant change in right atrium size (P < .001) and right ventricle size (P < .01) and left ventricle size (P < .001) and also pulmonary artery pressure (P < .0001), New York Heart Association functional class improved (P = .03) in 19 patients and also significant improvement in 6-minute walk test distance (P < .001). There were no major complications. CONCLUSIONS Our data showed that large ASD closure at senior people results in satisfactory cardiac remodeling and cardiac function improvement.
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Affiliation(s)
- Shihai Wang
- Department of Cardiovascular Disease, Central Hospital of Panzhihua City, Panzhihua, China
| | - Jun'an Pan
- Department of Cardiovascular Disease, Central Hospital of Panzhihua City, Panzhihua, China
| | - Bei Xiao
- Department of Cardiovascular Disease, Central Hospital of Panzhihua City, Panzhihua, China
| | - Yongjiang Tang
- Department of Cardiovascular Disease, Central Hospital of Panzhihua City, Panzhihua, China
| | - Jianjun Lan
- Department of Cardiovascular Disease, Central Hospital of Panzhihua City, Panzhihua, China
| | - Xuezhong Zheng
- Department of Cardiovascular Disease, Central Hospital of Panzhihua City, Panzhihua, China
| | - Chao Yang
- Department of Cardiovascular Disease, Central Hospital of Panzhihua City, Panzhihua, China
| | - Dawen Xu
- Department of Cardiovascular Disease, Central Hospital of Panzhihua City, Panzhihua, China
| | - Jiyu Zhang
- Department of Cardiovascular Disease, Central Hospital of Panzhihua City, Panzhihua, China
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Kumar P, Sarkar A, Kar SK. Assessment of ventricular function in patients of atrial septal defect by strain imaging before and after correction. Ann Card Anaesth 2019; 22:41-46. [PMID: 30648678 PMCID: PMC6350442 DOI: 10.4103/aca.aca_153_17] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Atrial septal defect (ASD) is a common congenital heart disease associated with volume overload of Right ventricle (RV) with variable effect on Left ventricle (LV). Two-dimensional (2D) Strain analysis is a new tool for objective analysis of myocardial function. This prospective study evaluated the systolic function of right and left ventricle by conventional 2D echo and strain echo and measured changes in cardiac hemodynamics that occurred in patients of ASD before and after correction. Patients and Methods: 2D echo and strain analysis of each patient before and at 48 hrs, 3 months and 6 months after correction was performed. Routine 2D echo parameters and global longitudinal strain of both ventricles were measured. Result: Improvement in LV ejection fraction (P = 0.0001) and myocardial performance index (MPI) (P < 0.0001) occurred at the end of 6 months, whereas decrease in RV MPI (P < 0.0001) and tricuspid annular plane systolic excursion (P < 0.0001) became statistically significant after 3 months of ASD correction. In comparison to conventional 2D echo, global longitudinal strain of RV decreased significantly only after 48 hours of ASD correction while there was no improvement in left ventricular global longitudinal strain after 6 month of correction. Conclusion: There was improvement in RV function with subtle change in LV function by strain imaging and most of these changes were completed within 6 months of ASD correction and nearly correlated with conventional 2DEchocardiography.
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Affiliation(s)
- Prashant Kumar
- Department of Cardiology, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Achyut Sarkar
- Department of Cardiology, Institute of Post Graduation Medical Education and Research, Kolkata, India
| | - Sandeep Kumar Kar
- Department of Cardiac Anaesthesia, Institute of Post Graduation Medical Education and Research, Kolkata, India
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Le Gloan L, Legendre A, Iserin L, Ladouceur M. Pathophysiology and natural history of atrial septal defect. J Thorac Dis 2018; 10:S2854-S2863. [PMID: 30305945 DOI: 10.21037/jtd.2018.02.80] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Atrial septal defects are among the third most common types of congenital heart disease. This group of malformations includes several types of atrial communications allowing shunting of blood between the systemic and the pulmonary circulations. The nature of shunting across the defect in patients with atrial septal defect is of particular interest. Understanding the underlying mechanisms of interatrial shunts and their natural history will help selecting the best timing for closure, before irreversible cardiac and pulmonary injury occur. This review describes the different pathophysiologic mechanisms involved in the direction and magnitude of blood flow through atrial septal defects. The natural history of an individual born with an isolated atrial septal defect is then discussed, including the impact of a longstanding shunt on survival.
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Affiliation(s)
- Laurianne Le Gloan
- Department of Cardiology, Adult Congenital Heart Disease. Institut du thorax, CHU de Nantes, Université de Nantes, boulevard Jacques Monod, Saint-Herblain, France
| | - Antoine Legendre
- Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Cardiology, Adult Congenital Heart Disease Unit, Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, Paris, France
| | - Laurence Iserin
- Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Cardiology, Adult Congenital Heart Disease Unit, Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, Paris, France
| | - Magalie Ladouceur
- Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Cardiology, Adult Congenital Heart Disease Unit, Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, Paris, France.,INSERM U970, PARCC, Paris Descartes University, Sorbonne Paris Cité, Paris, France
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13
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Konstam MA, Kiernan MS, Bernstein D, Bozkurt B, Jacob M, Kapur NK, Kociol RD, Lewis EF, Mehra MR, Pagani FD, Raval AN, Ward C. Evaluation and Management of Right-Sided Heart Failure: A Scientific Statement From the American Heart Association. Circulation 2018; 137:e578-e622. [DOI: 10.1161/cir.0000000000000560] [Citation(s) in RCA: 335] [Impact Index Per Article: 55.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background and Purpose:
The diverse causes of right-sided heart failure (RHF) include, among others, primary cardiomyopathies with right ventricular (RV) involvement, RV ischemia and infarction, volume loading caused by cardiac lesions associated with congenital heart disease and valvular pathologies, and pressure loading resulting from pulmonic stenosis or pulmonary hypertension from a variety of causes, including left-sided heart disease. Progressive RV dysfunction in these disease states is associated with increased morbidity and mortality. The purpose of this scientific statement is to provide guidance on the assessment and management of RHF.
Methods:
The writing group used systematic literature reviews, published translational and clinical studies, clinical practice guidelines, and expert opinion/statements to summarize existing evidence and to identify areas of inadequacy requiring future research. The panel reviewed the most relevant adult medical literature excluding routine laboratory tests using MEDLINE, EMBASE, and Web of Science through September 2017. The document is organized and classified according to the American Heart Association to provide specific suggestions, considerations, or reference to contemporary clinical practice recommendations.
Results:
Chronic RHF is associated with decreased exercise tolerance, poor functional capacity, decreased cardiac output and progressive end-organ damage (caused by a combination of end-organ venous congestion and underperfusion), and cachexia resulting from poor absorption of nutrients, as well as a systemic proinflammatory state. It is the principal cause of death in patients with pulmonary arterial hypertension. Similarly, acute RHF is associated with hemodynamic instability and is the primary cause of death in patients presenting with massive pulmonary embolism, RV myocardial infarction, and postcardiotomy shock associated with cardiac surgery. Functional assessment of the right side of the heart can be hindered by its complex geometry. Multiple hemodynamic and biochemical markers are associated with worsening RHF and can serve to guide clinical assessment and therapeutic decision making. Pharmacological and mechanical interventions targeting isolated acute and chronic RHF have not been well investigated. Specific therapies promoting stabilization and recovery of RV function are lacking.
Conclusions:
RHF is a complex syndrome including diverse causes, pathways, and pathological processes. In this scientific statement, we review the causes and epidemiology of RV dysfunction and the pathophysiology of acute and chronic RHF and provide guidance for the management of the associated conditions leading to and caused by RHF.
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Ozturk O, Ozturk U, Ozturk S. Assessment of right atrial function with speckle tracking echocardiography after percutaneous closure of an atrial septal defect. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.repce.2017.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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15
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Ozturk O, Ozturk U, Ozturk S. Assessment of right atrial function with speckle tracking echocardiography after percutaneous closure of an atrial septal defect. Rev Port Cardiol 2017; 36:895-900. [PMID: 29191713 DOI: 10.1016/j.repc.2017.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 04/14/2017] [Accepted: 06/15/2017] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Speckle tracking echocardiography (STE) for two-dimensional (2D) strain analysis is a new tool to assess myocardial function. The aim of this study was to assess right atrial (RA) function using STE in patients with an atrial septal defect (ASD) before and one month after percutaneous closure. METHODS We prospectively examined 32 consecutive patients (nine male, 23 female) who underwent percutaneous transcatheter closure of a secundum ASD between June 2013 and December 2015. Echocardiography was performed on admission, prior to cardiac catheterization and then one month after ASD closure. Peak global RA longitudinal strain was analyzed by 2D-STE. RESULTS Patients' mean age was 34.6±8.2 years. The mean diameter of the occlusive devices was 18.5±7.5 mm. Right ventricular (RV) end-diastolic diameters were significantly increased but decreased significantly after ASD closure (43±5 vs. 38±4 mm, p<0.05). Left atrial (LA) diameters (40±8 vs. 37±6 mm, p<0.05) decreased significantly after the intervention, whereas left ventricular (LV) end-diastolic diameters (45±5 vs. 46±4 mm, NS) remained unchanged. Tricuspid annular plane systolic excursion increased significantly (17.6±5.4 vs. 22.3±8.1 mm, p<0.05). After closure of the defect, a significant increase was observed in longitudinal RA strain (26.5±9.6% vs. 35.3±10.5%, p<0.001). CONCLUSIONS After percutaneous transcatheter closure of a secundum ASD, there was an increase in RA longitudinal strain. 2D-STE strain analysis appears to be helpful for the assessment of RA function and of response to correction of volume overload after percutaneous transcatheter closure of a secundum ASD.
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Affiliation(s)
- Onder Ozturk
- University of Health Sciences, Diyarbakır Gazi Yasargil Education and Research Hospital, Department of Cardiology, Diyarbakir, Turkey.
| | - Unal Ozturk
- University of Health Sciences, Diyarbakır Gazi Yasargil Education and Research Hospital, Department of Neurology, Diyarbaki, Turkey
| | - Sengul Ozturk
- University of Health Sciences, Diyarbakır Gazi Yasargil Education and Research Hospital, Department of Archives and Dicle University Agricultural Faculty, Department of Plant Protection,, Diyarbakir, Turkey
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Kopic S, Stephensen SS, Heiberg E, Arheden H, Bonhoeffer P, Ersbøll M, Vejlstrup N, Søndergaard L, Carlsson M. Isolated pulmonary regurgitation causes decreased right ventricular longitudinal function and compensatory increased septal pumping in a porcine model. Acta Physiol (Oxf) 2017; 221:163-173. [PMID: 28580611 PMCID: PMC5655773 DOI: 10.1111/apha.12904] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 05/16/2017] [Accepted: 05/31/2017] [Indexed: 01/18/2023]
Abstract
Aim Longitudinal ventricular contraction is a parameter of cardiac performance with predictive power. Right ventricular (RV) longitudinal function is impaired in patients with free pulmonary regurgitation (PR) following corrective surgery for Tetralogy of Fallot (TOF). It remains unclear whether this is a consequence of the surgical repair, or whether it is inherent to PR. The aim of this study was to assess the relationship between longitudinal, lateral and septal pumping in a porcine model of isolated PR. Methods Piglets were divided into a control (n = 8) group and a treatment (n = 12) group, which received a stent in the pulmonary valve orifice, inducing PR. After 2–3 months, animals were subjected to cardiac magnetic resonance imaging. A subset of animals (n = 6) then underwent percutaneous pulmonary valve replacement (PPVR) with follow‐up 1 month later. Longitudinal, lateral and septal contributions to stroke volume (SV) were quantified by measuring volumetric displacements from end‐diastole to end‐systole in the cardiac short axis and long axis. Results PR resulted in a lower longitudinal contribution to RV stroke volume, compared to controls (60.0 ± 2.6% vs. 73.6 ± 3.8%; P = 0.012). Furthermore, a compensatory increase in septal contribution to RVSV was observed (11.0 ± 1.6% vs. −3.1 ± 1.5%; P < 0.0001). The left ventricle (LV) showed counter‐regulation with an increased longitudinal LVSV. Changes in RV longitudinal function were reversed by PPVR. Conclusion These findings suggest that PR contributes to decreased RV longitudinal function in the absence of scarring from cardiac surgery. Measurement of longitudinal RVSV may aid risk stratification and timing for interventional correction of PR in TOF patients.
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Affiliation(s)
- S. Kopic
- Department of Clinical Sciences Lund; Clinical Physiology; Skåne University Hospital; Lund University; Lund Sweden
| | - S. S. Stephensen
- Department of Clinical Sciences Lund; Clinical Physiology; Skåne University Hospital; Lund University; Lund Sweden
| | - E. Heiberg
- Department of Clinical Sciences Lund; Clinical Physiology; Skåne University Hospital; Lund University; Lund Sweden
- Department of Biomedical Engineering; Faculty of Engineering; Lund University; Lund Sweden
| | - H. Arheden
- Department of Clinical Sciences Lund; Clinical Physiology; Skåne University Hospital; Lund University; Lund Sweden
| | | | - M. Ersbøll
- The Heart Centre; Rigshospitalet Copenhagen University Hospital; Copenhagen Denmark
| | - N. Vejlstrup
- The Heart Centre; Rigshospitalet Copenhagen University Hospital; Copenhagen Denmark
| | - L. Søndergaard
- The Heart Centre; Rigshospitalet Copenhagen University Hospital; Copenhagen Denmark
| | - M. Carlsson
- Department of Clinical Sciences Lund; Clinical Physiology; Skåne University Hospital; Lund University; Lund Sweden
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17
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Yoo BW, Kim JO, Eun LY, Choi JY, Kim DS. Time course of the changes in right and left ventricle function and associated factors after transcatheter closure of atrial septal defects. CONGENIT HEART DIS 2017; 13:131-139. [DOI: 10.1111/chd.12541] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 09/06/2017] [Accepted: 09/10/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Byung W. Yoo
- Department of Clinical Pharmacology, Clinical Trial Center, Severance Hospital; Yonsei University College of Medicine; Seoul Korea
| | - Jung O. Kim
- Division of Pediatric Cardiology, Department of Pediatrics; Yonsei University College of Medicine; Seoul Korea
| | - Lucy Y. Eun
- Division of Pediatric Cardiology, Department of Pediatrics; Yonsei University College of Medicine; Seoul Korea
| | - Jae Y. Choi
- Division of Pediatric Cardiology, Department of Pediatrics; Yonsei University College of Medicine; Seoul Korea
| | - Dong S. Kim
- Department of Pediatrics, Severance Children's Hospital; Yonsei University College of Medicine; Seoul Korea
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18
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Regional contribution to ventricular stroke volume is affected on the left side, but not on the right in patients with pulmonary hypertension. Int J Cardiovasc Imaging 2016; 32:1243-53. [PMID: 27142431 DOI: 10.1007/s10554-016-0898-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 04/16/2016] [Indexed: 10/21/2022]
Abstract
To develop more sensitive measures of impaired cardiac function in patients with pulmonary hypertension (PH), since detection of impaired right ventricular (RV) function is important in these patients. With the hypothesis that a change in septal function in patients with PH is associated with altered longitudinal and lateral function of both ventricles, as a compensatory mechanism, we quantified the contributions of these parameters to stroke volume (SV) in both ventricles using cardiac magnetic resonance (CMR). Seventeen patients (10 females) evaluated for PH underwent right heart catheterization (RHC) and CMR. CMR from 33 healthy adults (13 females) were used as controls. Left ventricular (LV) atrioventricular plane displacement (AVPD) and corresponding longitudinal contribution to LVSV was lower in patients (10.8 ± 3.2 mm and 51 ± 12 %) compared to controls (16.6 ± 1.9 mm and 59 ± 9 %, p < 0.0001 and p < 0.01, respectively). This decrease did not differ in patient with ejection fraction (EF) >50 % and <50 % (p = 0.5) and was compensated for by increased LV lateral contribution to LVSV in patients (49 ± 13 % vs. 37 ± 7 %, p = 0.001). Septal motion contributed less to LVSV in patients (5 ± 8 %) compared to controls (8 ± 4 %, p = 0.05). RV AVPD was lower in patients (12.0 ± 3.6 mm vs. 21.8 ± 2.2 mm, p < 0.0001) but longitudinal and lateral contribution to RVSV did not differ between patients (78 ± 17 % and 29 ± 16 %) and controls (79 ± 9 % and 31 ± 6 % p = 0.7 for both) explained by increased RV cross sectional area in patients. LV function is affected in patients with PH despite preserved global LV function. The decreased longitudinal contribution and increased lateral contribution to LVSV was not seen in the RV, contrary to previous findings in patients with volume loaded RVs.
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19
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Tadros VX, Asgar AW. Atrial septal defect closure with left ventricular dysfunction. EUROINTERVENTION 2016; 12 Suppl X:X13-X17. [DOI: 10.4244/eijv12sxa3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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20
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Stout KK, Broberg CS, Book WM, Cecchin F, Chen JM, Dimopoulos K, Everitt MD, Gatzoulis M, Harris L, Hsu DT, Kuvin JT, Law Y, Martin CM, Murphy AM, Ross HJ, Singh G, Spray TL. Chronic Heart Failure in Congenital Heart Disease. Circulation 2016; 133:770-801. [DOI: 10.1161/cir.0000000000000352] [Citation(s) in RCA: 219] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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21
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Ermis P, Franklin W, Mulukutla V, Parekh D, Ing F. Left Ventricular Hemodynamic Changes and Clinical Outcomes after Transcatheter Atrial Septal Defect Closure in Adults. CONGENIT HEART DIS 2014; 10:E48-53. [DOI: 10.1111/chd.12204] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/09/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Peter Ermis
- Department of Pediatric Cardiology; Texas Children's Hospital; Baylor College of Medicine; Houston Tex USA
| | - Wayne Franklin
- Department of Pediatric Cardiology; Texas Children's Hospital; Baylor College of Medicine; Houston Tex USA
| | - Venkatachalam Mulukutla
- Department of Pediatric Cardiology; Texas Children's Hospital; Baylor College of Medicine; Houston Tex USA
| | - Dhaval Parekh
- Department of Pediatric Cardiology; Texas Children's Hospital; Baylor College of Medicine; Houston Tex USA
| | - Frank Ing
- Department of Pediatric Cardiology; Children's Hospital of Los Angeles; Los Angeles Calif USA
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22
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Wilson D, Livesey S, Morgan J. Long-term follow-up of right ventricular disarticulation for treatment of Arrhythmogenic Right Ventricular Cardiomyopathy: a case series. Int J Cardiol 2014; 175:e21-4. [PMID: 24825028 DOI: 10.1016/j.ijcard.2014.04.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 04/22/2014] [Indexed: 11/26/2022]
Affiliation(s)
- David Wilson
- University Hospital of Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, United Kingdom.
| | - Steve Livesey
- University Hospital of Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, United Kingdom
| | - John Morgan
- University Hospital of Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, United Kingdom
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Abstract
Atrial septal defects are the third most common type of congenital heart disease. Included in this group of malformations are several types of atrial communications that allow shunting of blood between the systemic and the pulmonary circulations. Most children with isolated atrial septal defects are free of symptoms, but the rates of exercise intolerance, atrial tachyarrhythmias, right ventricular dysfunction, and pulmonary hypertension increase with advancing age and life expectancy is reduced in adults with untreated defects. The risk of development of pulmonary vascular disease, a potentially lethal complication, is higher in female patients and in older adults with untreated defects. Surgical closure is safe and effective and when done before age 25 years is associated with normal life expectancy. Transcatheter closure offers a less invasive alternative for patients with a secundum defect who fulfil anatomical and size criteria. In this Seminar we review the causes, anatomy, pathophysiology, treatment, and outcomes of atrial septal defects in children and adult patients in whom this defect is the primary cardiac anomaly.
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Affiliation(s)
- Tal Geva
- Department of Cardiology, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
| | - Jose D Martins
- Department of Pediatric Cardiology, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Rachel M Wald
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University of Toronto, Toronto, ON, Canada
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Chronic overcirculation-induced pulmonary arterial hypertension in aorto-caval shunt. Microvasc Res 2014; 94:73-9. [PMID: 24862700 DOI: 10.1016/j.mvr.2014.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Revised: 05/09/2014] [Accepted: 05/15/2014] [Indexed: 11/20/2022]
Abstract
Pulmonary arterial hypertension is a common complication of congenital heart defects with left-to-right shunts. Current preclinical models do not reproduce clinical characteristics of shunt-related pulmonary hypertension. Aorto-caval shunt was firstly described as a model of right ventricle volume overload. The pathophysiology and the possible determination of pulmonary arterial hypertension of different periods of shunt exposure are still undefined. A method to create standardized, reproducible aorto-caval shunt was developed in growing rats (260±40 g). Three groups of animals were considered: shunt exposure for 10 weeks, shunt exposure for 20 weeks and control (sham laparotomy). Echocardiography and magnetic resonance revealed increased right ventricular end diastolic area in shunt at 10 weeks compared to control. Hemodynamic analysis demonstrated increased right ventricular afterload and increased effective pulmonary arterial elastance (Ea) in shunt at 20 weeks compared to control (1.29±0.20 vs. 0.14±0.06 mmHg/μl, p=0.004). At the same time point, the maximal slope of end-systolic pressure-volume relationship (Ees) decreased (0.5±0.2 mmHg/ml vs. 1.2±0.3, p<0.001). Consequently, right ventricular-arterial coupling was markedly deteriorated with a ≈50% decrease in the ratio of end-systolic to pulmonary artery elastance (Ees/Ea). Finally, left ventricular preload diminished (≈30% decrease in left ventricular end-diastolic volume). Histology demonstrated medial hypertrophy and small artery luminal narrowing. Chronic exposure to aorto-caval shunt is a reliable model to produce right ventricular volume overload and secondary pulmonary arterial hypertension. This model could be an alternative with low mortality and high reproducibility for investigators on the underlying mechanisms of shunt-related pulmonary hypertension.
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25
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Ventricular and pulmonary vascular remodeling induced by pulmonary overflow in a chronic model of pretricuspid shunt. J Thorac Cardiovasc Surg 2014; 148:2609-17. [PMID: 24908349 DOI: 10.1016/j.jtcvs.2014.04.044] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 04/14/2014] [Accepted: 04/24/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Current preclinical models of pulmonary arterial hypertension do not reproduce the clinical characteristics of congenital heart anomalies. Aortocaval shunt is relevant to a variety of clinical conditions. The pathophysiology and possible determination of pulmonary hypertension in this model are still undefined. METHODS A method to create a standardized and reproducible aortocaval shunt was developed in rats. After creation of the shunt, the animals were followed up for 20 weeks and a sham laparotomy was used as a control. The chronic effects of volume overload on the right and left ventricles and pulmonary hemodynamic modifications were evaluated by biventricular catheterization, echocardiography, and magnetic resonance. Pulmonary vascular changes were defined by histology. RESULTS An increased right ventricular end-diastolic area was confirmed by echocardiography. Left ventricular overload and decreased biventricular ejection fraction were demonstrated by magnetic resonance after 20 weeks in the shunt group compared with the controls (left ventricle, 50% ± 5% vs 62% ± 3%, P = .029; right ventricle, 53% ± 2% vs 65% ± 2%, P = .036). Preload recruitable stroke work of left and right ventricles decreased after 20 weeks in shunt rats (left ventricle: 36 ± 7 vs 98 ± 5, P = .004; right ventricle: 19 ± 2 vs 32 ± 9, P = .047). At the same time point, catheterization showed that effective pulmonary arterial elastance was increased only in the shunt group (1.29 ± 0.20 vs 0.14 ± 0.06 mm Hg/μL; P = .004). Histology showed medial hypertrophy, small artery luminal narrowing, and occlusion. CONCLUSIONS The aortocaval shunt model reliably produces right ventricular volume overload and secondary pulmonary hypertension. Due to a combination of left ventricular dysfunction and pulmonary overflow, the pulmonary hypertension produced shows features similar to those found in patients with chronic atrial-level shunt.
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Sánchez-Lázaro IJ, Bonet LA, Muñoz BI, Rueda-Soriano J, Martínez-Dolz L, Zorio-Grima E, Arnau-Vives MÁ, Salvador-Sanz A. Phenotypic Patterns of Right Ventricular Dysfunction: Analysis by Cardiac Magnetic Imaging. Heart Int 2014. [DOI: 10.4081/hi.2013.e18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Ignacio J. Sánchez-Lázaro
- Heart Failure and Transplantation Unit, Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Luis Almenar Bonet
- Heart Failure and Transplantation Unit, Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Begoña Igual Muñoz
- Heart Failure and Transplantation Unit, Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Joaquín Rueda-Soriano
- Heart Failure and Transplantation Unit, Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Luis Martínez-Dolz
- Heart Failure and Transplantation Unit, Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Esther Zorio-Grima
- Heart Failure and Transplantation Unit, Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Miguel Ángel Arnau-Vives
- Heart Failure and Transplantation Unit, Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Antonio Salvador-Sanz
- Heart Failure and Transplantation Unit, Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
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27
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Milev I, Idrizi S, Zimbakov Z, Ampova-Sokolov V, Zafirovska P, Nikolov S, Angjuseva T, Mitrev Z. Percutaneous Interventional Treatment of Atrial Septal Defect Secundum in Macedonia. Open Access Maced J Med Sci 2014. [DOI: 10.3889/oamjms.2014.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Atrial septal defect (ASD) is a common congenital heart disorder (CHD). While conventional open surgical treatment is the standard procedure in our country, percutaneous device closure with implantation of an atrial septal defect occluder is a promising alternative with very few peri and post procedural complications.Aim: The aim of the study was to present the rate of success and complications in percutaneous ASD closure with the implantation of an atrial septal defect occluder.Material and Methods: We treated 153 patients (ages 2-76; 65% female) with ASD secundum with percutaneous trans catheter closure using a septal occluder. Follow up was on a 3 month interval and assessment included clinical, electrophysiological and echocardiographic status. Results: The mean diameter of ASD obtained via balloon sizing was 16 ± 16 mm. Multiple ASDs were found in 20 (13%) patients and deficitary aortic and anterior rim (< 5 mm) was present in 16 (10%) patients. Due to inadequate placement and/or sizing, the device was removed and replaced in seven patients (5%). During follow up, trivial shunt was present in 4 (2.6%) patients. The diameter of the right ventricle corrected for age was reduced by an average of 20% by the first month and in 130 (86%) of patients it had normalized by one year of follow up. During follow up, 16 (10%) patients reported transient headaches and 3 (1.9%) patients had transient atrial fibrillation (AF).Conclusion: In conclusion, the implantation of a septal occluder was found to be a safe procedure that resulted in improved hemodynamic parameters that result from right ventricular volume overload with favorable short- and mid-term results.
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28
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J Sánchez-Lázaro I, Almenar Bonet L, Igual Muñoz B, Rueda-Soriano J, Martínez-Dolz L, Zorio-Grima E, Angel Arnau-Vives M, Salvador-Sanz A. Phenotypic patterns of right ventricular dysfunction: analysis by cardiac magnetic imaging. Heart Int 2013; 8:e3. [PMID: 24179637 PMCID: PMC3805167 DOI: 10.4081/hi.2013.e3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 10/03/2012] [Accepted: 10/12/2012] [Indexed: 11/28/2022] Open
Abstract
The aim of this study was to use magnetic resonance imaging (MRI) to classify the morphological changes and remodeling of the right ventricle (RV) that occur in different clinical situations and that have an impact on RV function. Most literature has traditionally focused on the left ventricle (LV) and as a result, few studies analyze RV behavior and remodeling. The study evaluated all cardiac MRI performed at our center from 2008 to 2010. We retrospectively identified 159 patients who had some sign of right ventricular dysfunction (RVD) based on MRI findings. We classified patients according to a combination of criteria for RVD and the presence of left ventricle dysfunction (LVD). We considered RVD as any of the following abnormalities: i) depressed RV function; ii) RV dilatation; iii) RV hypertrophy. LVD was considered when there was atrial dilatation, LV hypertrophy, LV dilatation and/or depressed LV function. We obtained 6 pathophysiological patterns: RV pressure overload (1.9%), RV volume overload (15.7%), RV volume overload + LVD (32.7%), depressed RV function + LVD (42.1%), mixed RV overload + LVD (6.9%) and other (0.6%). The most frequent etiology was congenital heart disease (33.3%), followed by idiopathic dilated cardiomyopathy (18.2%), left valvular disease (17.6%), ischemic heart disease (15%), pulmonary disease (9.8%), and other (6.1%). This study helps to classify the different patterns that RV can adopt in different clinical situations and can, therefore, help us to understand the RV pathophysiology.
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Affiliation(s)
- Ignacio J Sánchez-Lázaro
- Heart Failure and Transplantation Unit, Cardiology Department, Hospital Universitari i Politècnic La Fe , Valencia, Spain
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29
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Monfredi O, Luckie M, Mirjafari H, Willard T, Buckley H, Griffiths L, Clarke B, Mahadevan VS. Percutaneous device closure of atrial septal defect results in very early and sustained changes of right and left heart function. Int J Cardiol 2013; 167:1578-84. [PMID: 22608895 DOI: 10.1016/j.ijcard.2012.04.081] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Accepted: 04/14/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Oliver Monfredi
- Cardiovascular Research Group, School of Biomedicine, The University of Manchester, Level 3 Core Technology Facility, Grafton Street, Manchester M13 9NT, United Kingdom.
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30
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Enlarged right ventricular size at 11 years' follow-up after closure of secundum-type atrial septal defect in children. Cardiol Young 2013; 23:7-13. [PMID: 22717259 DOI: 10.1017/s1047951112000480] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The fate of right ventricular dimensions after surgical closure of secundum-type atrial septal defects remains unclear. The objectives of this study were to assess ventricular dimensions, exercise capability, and arrhythmias of patients operated for secundum-type atrial septal defect and compare the results with those in healthy references. METHODS A total of 78 consecutive patients underwent surgical closure for a secundum-type atrial septal defect between 1990 and 1995. In all, 42 patients were included and underwent a cross-sectional evaluation including echocardiography, magnetic resonance imaging, exercise testing, and 24-hour ambulatory electrocardiography. Patients were matched with healthy controls for gender, body surface area, and age. RESULTS The mean age at surgery was 4.6 plus or minus 2.8 years, and the mean age at follow-up was 16 plus or minus 3 years. There were no residual intracardiac lesions. The mean right ventricular endsystolic volume was significantly larger in patients (142 ± 26 millilitres) than in references (137 ± 28 millilitres; p = 0.04). In 25% of the patients, right ventricular end-systolic volume was larger than the 95th percentile for references. No relevant arrhythmias were detected. Exercise testing did not reveal differences with healthy references: maximal power (169 ± 43 Watt patients versus 172 ± 53 controls; p = 0.8), maximal oxygen uptake (38 ± 8 versus 41 ± 13 millilitres per minute per kilogram; p = 0.1). COMMENT After surgical closure of secundum-type atrial septal defect, right ventricular end-systolic volume is increased. These findings have no impact on rhythm status or exercise capacity at this stage of follow-up, but may have implications for the timing of surgery or the technique of closure if confirmed in longer follow-up.
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31
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Takatsuki S, Nakayama T, Jone PN, Wagner BD, Naoi K, Ivy DD, Saji T. Tissue Doppler imaging predicts adverse outcome in children with idiopathic pulmonary arterial hypertension. J Pediatr 2012; 161:1126-31. [PMID: 22748515 PMCID: PMC3508005 DOI: 10.1016/j.jpeds.2012.05.050] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Revised: 04/24/2012] [Accepted: 05/22/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the clinical utility of tissue Doppler imaging (TDI) in assessment of disease severity and prognostic value in children with idiopathic pulmonary arterial hypertension (PAH). STUDY DESIGN A prospective study was performed to evaluate TDI velocities (systolic myocardial velocity, early diastolic myocardial relaxation velocity [Em], late diastolic myocardial velocity associated with atrial contraction), brain natriuretic peptide, New York Heart Association (NYHA) functional class, and hemodynamics in 51 children (mean age; 11.6 years) with idiopathic PAH. Fifty-one healthy children with comparable demographics served as controls. RESULTS Em, Em/late diastolic myocardial velocity associated with atrial contraction ratio, and systolic myocardial velocity at mitral annulus, septum, and tricuspid annulus in PAH were significantly reduced compared with controls. Tricuspid Em had significant inverse correlations with plasma brain natriuretic peptide levels (r = -0.60, P < .001), right ventricular end-diastolic pressure (r = -0.79, P < .001), and mean pulmonary arterial pressure (r = -0.67, P < .001). Statistically significant differences were observed in tricuspid Em between NYHA functional class II vs combined III and IV (mean and SD; 11.9 ± 4.2 cm/s vs 8.2 ± 3.6 cm/s, respectively, P = .002). Cumulative event-free survival rate was significantly lower when tricuspid Em was ≤8 cm/s (log-rank test, P < .001) CONCLUSIONS Tricuspid Em velocity correlated with NYHA functional class as disease severity and may serve as a useful prognostic marker in children with idiopathic PAH. The present study is the initial report to evaluate TDI velocities against midterm outcome variables in a relatively large pediatric PAH population.
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Affiliation(s)
- Shinichi Takatsuki
- Department of Pediatrics, University of Colorado School of Medicine, Children’s Hospital Colorado, CO, USA
,Department of Pediatrics, Toho University Omori Medical Center, Tokyo, Japan
| | - Tomotaka Nakayama
- Department of Pediatrics, Toho University Omori Medical Center, Tokyo, Japan
| | - Pei-Ni Jone
- Department of Pediatrics, University of Colorado School of Medicine, Children’s Hospital Colorado, CO, USA
| | - Brandie D Wagner
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver
| | - Kazuyuki Naoi
- Department of Pediatrics, Toho University Omori Medical Center, Tokyo, Japan
| | - David D Ivy
- Department of Pediatrics, University of Colorado School of Medicine, Children’s Hospital Colorado, CO, USA
| | - Tsutomu Saji
- Department of Pediatrics, Toho University Omori Medical Center, Tokyo, Japan
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Fernandes FP, Manlhiot C, Roche SL, Grosse-Wortmann L, Slorach C, McCrindle BW, Mertens L, Kantor PF, Friedberg MK. Impaired Left Ventricular Myocardial Mechanics and Their Relation to Pulmonary Regurgitation, Right Ventricular Enlargement and Exercise Capacity in Asymptomatic Children after Repair of Tetralogy of Fallot. J Am Soc Echocardiogr 2012; 25:494-503. [DOI: 10.1016/j.echo.2012.01.014] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Indexed: 11/26/2022]
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Valsangiacomo Buechel ER, Mertens LL. Imaging the right heart: the use of integrated multimodality imaging. Eur Heart J 2012; 33:949-60. [PMID: 22408035 DOI: 10.1093/eurheartj/ehr490] [Citation(s) in RCA: 133] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
During recent years, right ventricular (RV) structure and function have been found to be an important determinant of outcome in different cardiovascular and also pulmonary diseases. Currently, echocardiography and cardiac magnetic resonance (CMR) imaging are the two imaging modalities most commonly used to visualize the RV. Most structural abnormalities of the RV can be reliably described by echocardiography but due its complex geometrical shape, echocardiographic assessment of RV function is more challenging. Newer promising echocardiographic techniques are emerging but lack of validation and limited normal reference data influence their routine clinical application. Cardiac magnetic resonance is generally considered the clinical reference technique due to its unlimited imaging planes, superior image resolution, and three-dimensional volumetric rendering. The accuracy and reliability of CMR measurements make it the ideal tool for serial examinations of RV function. Multidetector computed tomography (MDCT) plays an important role in the diagnosis of pulmonary emboli but can also be used for assessing RV ischaemic disease or as an alternative for CMR if contra-indicated. Radionuclide techniques have become more obsolete in the current era. The different imaging modalities should be considered complimentary and each plays a role for different indications.
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Affiliation(s)
- Emanuela R Valsangiacomo Buechel
- Division of Paediatric Cardiology and Children's Research Centre, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland.
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Transcatheter Device Closure for Atrial Septal Defects: Safety, Efficacy, Complications, and Costs. Crit Care Nurs Clin North Am 2011; 23:339-48. [DOI: 10.1016/j.ccell.2011.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Effects of age on hemodynamic changes after transcatheter closure of atrial septal defect: importance of ventricular diastolic function. Heart Vessels 2011; 27:71-8. [DOI: 10.1007/s00380-011-0122-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Accepted: 02/04/2011] [Indexed: 10/18/2022]
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Geva T. Repaired tetralogy of Fallot: the roles of cardiovascular magnetic resonance in evaluating pathophysiology and for pulmonary valve replacement decision support. J Cardiovasc Magn Reson 2011; 13:9. [PMID: 21251297 PMCID: PMC3036629 DOI: 10.1186/1532-429x-13-9] [Citation(s) in RCA: 382] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Accepted: 01/20/2011] [Indexed: 11/10/2022] Open
Abstract
Surgical management of tetralogy of Fallot (TOF) results in anatomic and functional abnormalities in the majority of patients. Although right ventricular volume load due to severe pulmonary regurgitation can be tolerated for many years, there is now evidence that the compensatory mechanisms of the right ventricular myocardium ultimately fail and that if the volume load is not eliminated or reduced by pulmonary valve replacement the dysfunction might be irreversible. Cardiovascular magnetic resonance (CMR) has evolved during the last 2 decades as the reference standard imaging modality to assess the anatomic and functional sequelae in patients with repaired TOF. This article reviews the pathophysiology of chronic right ventricular volume load after TOF repair and the risks and benefits of pulmonary valve replacement. The CMR techniques used to comprehensively evaluate the patient with repaired TOF are reviewed and the role of CMR in supporting clinical decisions regarding pulmonary valve replacement is discussed.
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Affiliation(s)
- Tal Geva
- Department of Cardiology, Children's Hospital Boston, Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
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Gao CH, Zhang H, Chen XJ. The impacts of transcatheter occlusion for congenital atrial septal defect on left ventricular systolic synchronicity: a three-dimensional echocardiography study. Echocardiography 2010; 27:324-8. [PMID: 20486961 DOI: 10.1111/j.1540-8175.2009.01054.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES To investigate the impacts of transcatheter occlusion for congenital atrial septal defect (ASD) on left ventricular (LV) systolic synchronicity using a real time three-dimensional echocardiography (RT3DE). METHODS Thirty patients with ASD closure were recruited for the study. Realtime three-dimensional echocardiographic data sets were acquired for the measurement of LV volumes LV ejection fractions and LV three-dimensional systolic synchronicity before and at 6 months after transcatheter occlusion for ASD. M-mode echocardiography and RT3DE were performed to characterize interventricular septal (IVS) motion. RESULTS There were no differences in LV systolic synchronicity between before and after transcatheter closure of ASD (Tmsv-16SD%: 5.6%+/- 1.4% vs 5.8%+/- 1.8%, P > 0.05; Tmsv-12SD%: 5.2 +/- 1.1% vs 5.4 +/- 1.2%, P > 0.05). But the abnormal IVS motion was found before device closure and normalized after transcatheter occlusion for ASD using M-mode echocardiography and the excursion-time figure (bull's-eye derived from RT3DE); At the same time, LV ejection fraction (59.8 +/- 2.6 vs 66.7 +/- 5.9, P < 0.05) stroke volume (49 +/- 14 vs 63 +/- 11, P < 0.05) was improved significantly as well as normalization of IVS motion after transcatheter occlusion for ASD. The correlation between ASD diameter and change of LVEF is significant (r = 0.85, P < 0.001). CONCLUSION Although transcatheter occlusion did not significantly impact on intrinsic LV systolic synchronicity in patients with ASD, LV systolic function can be improved through normalization of IVS abnormal motion after transcatheter ASD occlusion.
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Affiliation(s)
- Chun-Heng Gao
- Department of Ultrasonography, Jiangyin People's Hospital, South-East University, Jiangyin, Jiangsu, People's Republic of China.
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Serum Levels of Natriuretic Peptides in Children before and after Treatment for an Atrial Septal Defect, a Patent Ductus Arteriosus, and a Coarctation of the Aorta-A Prospective Study. Int J Pediatr 2010; 2010:674575. [PMID: 20445736 PMCID: PMC2859410 DOI: 10.1155/2010/674575] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2009] [Revised: 12/13/2009] [Accepted: 02/08/2010] [Indexed: 11/18/2022] Open
Abstract
Background and Objectives. We evaluated and compared the influence of treatment for atrial septal defect (ASD), patent ductus arteriosus (PDA), and coarctation of the aorta (CoA) on serum levels of N-terminal proatriopeptide and N-terminal probrain natriuretic peptide. Correlations between peptide levels and echocardiographic measurements were calculated. Patients and Methods. Peptide levels were measured and echocardiography performed before and 6-12 months after treatment in 21 children with ASD, 25 with PDA, 15 with CoA, and 76 control children. Results. ANPN levels were higher than in controls at baseline in all patient groups, and NT-proBNP in patients with ASD and PDA. Both peptide levels were elevated 6 months after treatment and decreased thereafter. Peptide levels were higher in patients with volume than pressure overload. They correlated with echocardiographic measurements. At the 6-month follow-up, dimensions of the originally overloaded ventricle had normalized only in patients with PDA. Conclusions. After intervention, peptide levels decrease but normalization takes over 6 months. The type of correlation between peptide levels and echocardiography varies according to the loading condition. Measurement of peptide levels can be used for monitoring the course of a patient's heart disease.
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Khan AA, Tan JL, Li W, Dimopoulos K, Spence MS, Chow P, Mullen MJ. The Impact of Transcatheter Atrial Septal Defect Closure in the Older Population. JACC Cardiovasc Interv 2010; 3:276-81. [DOI: 10.1016/j.jcin.2009.12.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Accepted: 12/13/2009] [Indexed: 11/27/2022]
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40
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Luermans JGLM, Bos WJW, Post MC, ten Berg JM, Thijs Plokker HW, Suttorp MJ. Haemodynamic effects of patent foramen ovale and atrial septal defect closure: a comparison during percutaneous shunt closure. Clin Physiol Funct Imaging 2009; 30:64-8. [PMID: 19804419 DOI: 10.1111/j.1475-097x.2009.00905.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
SUMMARY OBJECTIVES We investigated the haemodynamic effect of percutaneous closure of an intra-atrial shunt, using non-invasive finger pressure measurements. BACKGROUND Percutaneous closure of both patent foramen ovale (PFO) and atrial septal defect (ASD) is widely practised. Currently no data are available on short-term haemodynamic changes induced by closure. METHODS Twenty-five consecutive patients (mean age 49 +/- 17 years, 10 men) who underwent a percutaneous closure of a PFO (n = 15) or ASD (n = 10) were included in this study. During the procedure blood pressure and heart rate (HR) were monitored continuously with a Finometer. Changes in systolic, mean, and diastolic pressure, stroke volume (SV), cardiac output (CO) and total peripheral resistance (TPR) were computed from the pressure registrations using Modelflow methodology. RESULTS Baseline characteristics were similar for the PFO and ASD patients. After PFO closure none of the haemodynamic parameters changed significantly. After ASD closure the systolic, mean, and diastolic pressures increased 7.1 +/- 5.4 (P = 0.003), 3.8 +/- 3.5 (P = 0.007) and 2.0 +/- 3.0 mmHg (P = ns) respectively. HR decreased 5.1 +/- 5.3 beats per minute (P = 0.01). SV, CO and TPR increased 8.5 +/- 6.4 ml (13.5%; P = 0.002), 0.21 +/- 0.45 l min(-1) (5.6%; P = ns) and 0.02 +/- 0.14 dynes (4.1%; P = ns) respectively. The changes in SV differ between the PFO and ASD patients (P = 0.009). CONCLUSIONS Using non-invasive finger pressure measurements, we found that SV, mean and systolic blood pressure increased immediately after percutaneous closure of an ASD in adults, whereas the percutaneous PFO closure had no effect on haemodynamic characteristics.
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Lin JL. Atrial fibrillation in atrial septal defects: A problem of right atrium or left atrium? Heart Rhythm 2009; 6:1007-8. [DOI: 10.1016/j.hrthm.2009.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2009] [Indexed: 10/20/2022]
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Dong L, Zhang F, Shu X, Zhou D, Guan L, Pan C, Chen H. Left ventricular torsional deformation in patients undergoing transcatheter closure of secundum atrial septal defect. Int J Cardiovasc Imaging 2009; 25:479-86. [DOI: 10.1007/s10554-009-9458-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2008] [Accepted: 03/25/2009] [Indexed: 10/20/2022]
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Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA, Del Nido P, Fasules JW, Graham TP, Hijazi ZM, Hunt SA, King ME, Landzberg MJ, Miner PD, Radford MJ, Walsh EP, Webb GD. ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2009; 52:e143-e263. [PMID: 19038677 DOI: 10.1016/j.jacc.2008.10.001] [Citation(s) in RCA: 977] [Impact Index Per Article: 65.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Dong L, Zhang F, Shu X, Guan L, Chen H. Left Ventricular Torsion in Patients With Secundum Atrial Septal Defect. Circ J 2009; 73:1308-14. [DOI: 10.1253/circj.cj-08-1034] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Lili Dong
- Department of Echocardiography, Zhongshan Hospital, Fudan University
- Shanghai Institute of Cardiovascular Diseases
| | - Feng Zhang
- Department of Cardiology, Zhongshan Hospital, Fudan University
- Shanghai Institute of Cardiovascular Diseases
| | - Xianhong Shu
- Department of Echocardiography, Zhongshan Hospital, Fudan University
- Department of Cardiology, Zhongshan Hospital, Fudan University
- Shanghai Institute of Cardiovascular Diseases
| | - Lihua Guan
- Department of Cardiology, Zhongshan Hospital, Fudan University
- Shanghai Institute of Cardiovascular Diseases
| | - Haozhu Chen
- Department of Cardiology, Zhongshan Hospital, Fudan University
- Shanghai Institute of Cardiovascular Diseases
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45
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Liang XC, Cheung EWY, Wong SJ, Cheung YF. Impact of right ventricular volume overload on three-dimensional global left ventricular mechanical dyssynchrony after surgical repair of tetralogy of Fallot. Am J Cardiol 2008; 102:1731-6. [PMID: 19064033 DOI: 10.1016/j.amjcard.2008.07.062] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Revised: 07/25/2008] [Accepted: 07/25/2008] [Indexed: 11/28/2022]
Abstract
This study aimed to test the hypothesis that right ventricular (RV) volume overload may result in left ventricular (LV) systolic dysfunction through induction of LV systolic dyssynchrony after tetralogy of Fallot (TOF) repair. Sixty patients with TOF repair were studied at 14.3 +/- 7.2 years after TOF repair. Real-time 3-dimensional echocardiographic data sets were acquired for measurement of LV and RV volumes and derivation of ejection fractions and pulmonary regurgitant volume. The LV systolic dyssynchrony index (SDI) was derived from the dispersion of time to minimum regional volume using a 16-segment model. The results were compared with those of 29 healthy controls. LV SDI was significantly higher in patients than controls (7.4% +/- 2.0% vs 3.0% +/- 0.9%, p <0.001). The prevalence of LV mechanical dyssynchrony (SDI >4.7%) in patients was 93% (95% confidence interval 87% to 100%). The time to minimum regional volume was significantly longer in all of the 6 basal segments and the midposterior segment (all p <0.05) in patients than controls. Multivariate analysis identified RV end-diastolic volume (beta = 0.58, p <0.001), LV ejection fraction (beta = -0.38, p <0.001), and LV end-diastolic volume (beta = 0.26, p = 0.002) as significant correlates of LV SDI. In conclusion, in patients after TOF repair, RV volume overload has a negative effect on LV systolic function through induction of global LV mechanical dyssynchrony.
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Affiliation(s)
- Xue-cun Liang
- Division of Paediatric Cardiology, Department of Paediatrics and Adolescent Medicine, Grantham Hospital, University of Hong Kong, Hong Kong, China
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46
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Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA, del Nido P, Fasules JW, Graham TP, Hijazi ZM, Hunt SA, King ME, Landzberg MJ, Miner PD, Radford MJ, Walsh EP, Webb GD. ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease. Circulation 2008; 118:e714-833. [PMID: 18997169 DOI: 10.1161/circulationaha.108.190690] [Citation(s) in RCA: 628] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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47
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Teo KSL, Dundon BK, Molaee P, Williams KF, Carbone A, Brown MA, Worthley MI, Disney PJ, Sanders P, Worthley SG. Percutaneous closure of atrial septal defects leads to normalisation of atrial and ventricular volumes. J Cardiovasc Magn Reson 2008; 10:55. [PMID: 19040763 PMCID: PMC2633333 DOI: 10.1186/1532-429x-10-55] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2008] [Accepted: 12/01/2008] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Percutaneous closure of atrial septal defects (ASDs) should potentially reduce right heart volumes by removing left-to-right shunting. Due to ventricular interdependence, this may be associated with impaired left ventricular filling and potentially function. Furthermore, atrial changes post-ASD closure have been poorly understood and may be important for understanding risk of atrial arrhythmia post-ASD closure. Cardiovascular magnetic resonance (CMR) is an accurate and reproducible imaging modality for the assessment of cardiac function and volumes. We assessed cardiac volumes pre- and post-percutaneous ASD closure using CMR. METHODS Consecutive patients (n = 23) underwent CMR pre- and 6 months post-ASD closure. Steady state free precession cine CMR was performed using contiguous slices in both short and long axis views through the ASD. Data was collected for assessment of left and right atrial, ventricular end diastolic volumes (EDV) and end systolic volumes (ESV). Data is presented as mean +/- SD, volumes as mL, and paired t-testing performed between groups. Statistical significance was taken as p < 0.05. RESULTS There was a significant reduction in right ventricular volumes at 6 months post-ASD closure (RVEDV: 208.7 +/- 76.7 vs. 140.6 +/- 60.4 mL, p < 0.0001) and RVEF was significantly increased (RVEF 35.5 +/- 15.5 vs. 42.0 +/- 15.2%, p = 0.025). There was a significant increase in the left ventricular volumes (LVEDV 84.8 +/- 32.3 vs. 106.3 +/- 38.1 mL, p = 0.003 and LVESV 37.4 +/- 20.9 vs. 46.8 +/- 18.5 mL, p = 0.016). However, there was no significant difference in LVEF and LV mass post-ASD closure. There was a significant reduction in right atrial volumes at 6 months post-ASD closure (pre-closure 110.5 +/- 55.7 vs. post-closure 90.7 +/- 69.3 mL, p = 0.019). Although there was a trend to a decrease in left atrial volumes post-ASD closure, this was not statistically significant (84.5 +/- 34.8 mL to 81.8 +/- 44.2 mL, p = NS). CONCLUSION ASD closure leads to normalisation of ventricular volumes and also a reduction in right atrial volume. Further follow-up is required to assess how this predicts outcomes such as risk of atrial arrhythmias after such procedures.
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Affiliation(s)
- Karen SL Teo
- Cardiovascular Research Centre, Royal Adelaide Hospital and The University of Adelaide, Adelaide, South Australia, Australia
- The University of Adelaide, Adelaide, South Australia, Australia
| | - Benjamin K Dundon
- Cardiovascular Research Centre, Royal Adelaide Hospital and The University of Adelaide, Adelaide, South Australia, Australia
- The University of Adelaide, Adelaide, South Australia, Australia
| | - Payman Molaee
- Cardiovascular Research Centre, Royal Adelaide Hospital and The University of Adelaide, Adelaide, South Australia, Australia
- The University of Adelaide, Adelaide, South Australia, Australia
| | - Kerry F Williams
- Cardiovascular Research Centre, Royal Adelaide Hospital and The University of Adelaide, Adelaide, South Australia, Australia
| | - Angelo Carbone
- Cardiovascular Research Centre, Royal Adelaide Hospital and The University of Adelaide, Adelaide, South Australia, Australia
| | - Michael A Brown
- Cardiovascular Research Centre, Royal Adelaide Hospital and The University of Adelaide, Adelaide, South Australia, Australia
| | - Matthew I Worthley
- Cardiovascular Research Centre, Royal Adelaide Hospital and The University of Adelaide, Adelaide, South Australia, Australia
- The University of Adelaide, Adelaide, South Australia, Australia
| | - Patrick J Disney
- Cardiovascular Research Centre, Royal Adelaide Hospital and The University of Adelaide, Adelaide, South Australia, Australia
| | - Prashanthan Sanders
- Cardiovascular Research Centre, Royal Adelaide Hospital and The University of Adelaide, Adelaide, South Australia, Australia
- The University of Adelaide, Adelaide, South Australia, Australia
| | - Stephen G Worthley
- Cardiovascular Research Centre, Royal Adelaide Hospital and The University of Adelaide, Adelaide, South Australia, Australia
- The University of Adelaide, Adelaide, South Australia, Australia
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Cardiac complications associated with the treatment of patients with congenital cardiac disease: consensus definitions from the Multi-Societal Database Committee for Pediatric and Congenital Heart Disease. Cardiol Young 2008; 18 Suppl 2:196-201. [PMID: 19063791 DOI: 10.1017/s1047951108002928] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
A complication is an event or occurrence that is associated with a disease or a healthcare intervention, is a departure from the desired course of events, and may cause, or be associated with, suboptimal outcome. A complication does not necessarily represent a breech in the standard of care that constitutes medical negligence or medical malpractice. An operative or procedural complication is any complication, regardless of cause, occurring (1) within 30 days after surgery or intervention in or out of the hospital, or (2) after 30 days during the same hospitalization subsequent to the operation or intervention. Operative and procedural complications include both intraoperative/intraprocedural complications and postoperative/postprocedural complications in this time interval. The MultiSocietal Database Committee for Pediatric and Congenital Heart Disease has set forth a comprehensive list of complications associated with the treatment of patients with congenital cardiac disease, related to cardiac, pulmonary, renal, haematological, infectious, neurological, gastrointestinal, and endocrinal systems, as well as those related to the management of anaesthesia and perfusion, and the transplantation of thoracic organs. The objective of this manuscript is to examine the definitions of operative morbidity as they relate specifically to the cardiac system. These specific definitions and terms will be used to track morbidity associated with surgical and transcatheter interventions and other forms of therapy in a common language across many separate databases.The MultiSocietal Database Committee for Pediatric and Congenital Heart Disease has prepared and defined a near-exhaustive list of cardiac complications, including intraoperative complications and cardiopulmonary bypass-related complications. These cardiac complications are presented in the following subgroups: 1) Cardiac (general), 2) Cardiac--Metabolic, 3) Cardiac--Residual and Recurrent cardiac lesions, 4) Arrhythmia, 5) Cardiopulmonary bypass and mechanical circulatory support, and 6) Operative/Procedural. Within each subgroup, complications are presented in alphabetical order. Clinicians caring for patients with congenital cardiac disease will be able to use this list for databases, quality improvement initiatives, reporting of complications, and comparing strategies for treatment.
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Blake GE, Lakkireddy D. Atrial Septal Defect and Atrial Fibrillation: The Known and Unknown. J Atr Fibrillation 2008; 1:45. [PMID: 28496588 DOI: 10.4022/jafib.45] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2008] [Revised: 05/19/2008] [Accepted: 08/25/2008] [Indexed: 11/10/2022]
Abstract
Atrial fibrillation (AF) is a common complication in patients with atrial septal defects (ASDs). The link between AF and ASD is fairly complex and entails modifications in electrophysiologic, contractile and structural properties, at the cellular and tissue level, of both atria, mainly due to chronic atrial stretch and dilation. Surgical repair or percutaneous closure of ASDs are equally effective in reducing mortality and symptoms but limited in preventing or curbing AF, unless combined with an arrhythmia-specific procedure. Transesophageal echocardiography (TEE) and intracardiac echocardiography (ICE) have improved the safety and success of the above procedures. Finally, clearer understanding of the pathophysiology of AF in patients with ASD (and CHF, in general) has led to target-specific advances in medical management.
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Affiliation(s)
- George E Blake
- Mid America Cardiology @ University of Kansas Hospital, Kansas City, KS
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50
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Toyono M, Pettersson GB, Matsumura Y, Wada N, Fukuda S, Yamano T, Takasaki K, Shiota T. Preoperative and postoperative mitral valve prolapse and regurgitation in adult patients with secundum atrial septal defects. Echocardiography 2008; 25:1086-93. [PMID: 18771547 DOI: 10.1111/j.1540-8175.2008.00726.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Little attention is given to development of mitral regurgitation (MR) in adults with atrial septal defect (ASD). The aim of the study was to determine the associated factors of MR in ASD adults before surgical repair and the fate of moderate to severe MR after surgery. METHODS We examined 71 consecutive patients with secundum ASD (47 +/- 16 years) who underwent surgical repair. Clinical and echocardiographic variables including size of left and right heart systems and severity of MR and tricuspid regurgitation (TR) were investigated before and early after surgery. RESULTS Before ASD closure, 14 patients (20%) had moderate to severe MR and 25 patients (35%) showed mitral valve (MV) prolapse. The ASD patients with moderate to severe MR showed worse cardiovascular symptoms, increased occurrence of atrial fibrillation and MV prolapse, and greater left ventricular (LV) end-diastolic volume, left atrial area, and TR severity than those with none to mild MR (all P < 0.05). Among preoperative variables, TR severity, left atrial area, LV end-diastolic volume, and MV prolapse were associated with preoperative MR severity in all the patients (all P < 0.03). Isolated ASD closure (n=46) decreased MV prolapse (P=0.008). Preoperative moderate to severe MR decreased after ASD closure with and without MV surgery (n=9 and 5, respectively; both P < 0.05). CONCLUSIONS Preoperative MR severity was associated with TR severity, dilated left heart chambers, and MV prolapse. MR decreased after ASD closure with and even without MV surgery.
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Affiliation(s)
- Manatomo Toyono
- Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH 44195, USA
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