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Pasternack DM, Martinez MJ, McKinstry J, Singh R, Saharan S, Muise ED, Mosca R, Kumar T. Diastolic dysfunction manifesting as acute plastic bronchitis after Warden procedure. JTCVS Tech 2024; 25:153-156. [PMID: 38899069 PMCID: PMC11184659 DOI: 10.1016/j.xjtc.2024.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 02/19/2024] [Accepted: 03/13/2024] [Indexed: 06/21/2024] Open
Affiliation(s)
- Daniel M. Pasternack
- Division of Pediatric Cardiology, New York University Hassenfeld Children's Hospital, New York, NY
| | - Michael J. Martinez
- Division of Pediatric Cardiology, New York University Hassenfeld Children's Hospital, New York, NY
| | - Jacqueline McKinstry
- Division of Pediatric Cardiology, New York University Hassenfeld Children's Hospital, New York, NY
| | - Rakesh Singh
- Division of Pediatric Cardiology, New York University Hassenfeld Children's Hospital, New York, NY
| | - Sunil Saharan
- Division of Pediatric Cardiology, New York University Hassenfeld Children's Hospital, New York, NY
| | - Eleanor D. Muise
- Division of Pediatric Pulmonology, New York University Hassenfeld Children's Hospital, New York, NY
| | - Ralph Mosca
- Division of Pediatric Cardiology, New York University Hassenfeld Children's Hospital, New York, NY
- Division of Congenital Cardiothoracic Surgery, New York University Hassenfeld Children's Hospital, New York, NY
| | - T.K.Susheel Kumar
- Division of Pediatric Cardiology, New York University Hassenfeld Children's Hospital, New York, NY
- Division of Congenital Cardiothoracic Surgery, New York University Hassenfeld Children's Hospital, New York, NY
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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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Karunanithi Z, Andersen MJ, Mellemkjær S, Alstrup M, Waziri F, Clemmensen TS, Hjortdal VE, Poulsen SH. Impaired left and right systolic ventricular capacity in corrected atrial septal defect patients. Int J Cardiovasc Imaging 2022; 38:1221-1231. [PMID: 35129735 PMCID: PMC11142960 DOI: 10.1007/s10554-021-02506-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 12/24/2021] [Indexed: 12/01/2022]
Abstract
Resting right ventricular (RV) systolic function has in some studies been shown to be impaired after correction of an atrial septal defect (ASD) whereas impairment of left ventricular (LV) systolic function is uncertain. In the present study we examine the LV and RV systolic response to exercise in patients with a previously corrected ASD in order to investigate the myocardial capacity. Thirty-six adult ASD patients with a corrected isolated secundum ASD and eighteen adult age-matched controls underent a semi-supine exercise stress echocardiographic examination. At rest, LV parameters were comparable between groups, and RV global longitudinal strain (RV-GLS) was lower for the ASD group (-18.5%, 95% CI -20.0--17.0%) compared with controls (-24.5%, 95% CI -27.7--22.4%, p < 0.001). At peak exercise, LV ejection fraction (LVEF) was lower for ASD patients (61%, 95% CI 58-65%) compared with controls (68%, 95% CI 64-73% p = 0.01). Peak LV global longitudinal strain (LV-GLS) was borderline significantly lower (ASD: -18.4%, 95% CI -20.2--16.6%, controls: -21.3%, 95% CI -23.6--19.0%, p = 0.059). Both RVEF (ASD: 64%, 95% CI 60-68%, controls: 73%, 95% CI 65-80%, p = 0.05) and tricuspid annular plane systolic excursion (TAPSE) (ASD: 2.5 cm, 95% CI 2.3-2.7 cm, controls: 3.2 cm, 95% CI 2.9-3.6 cm, p < 0.001) at peak exercise were lower for ASD patients. Exercise assessed peak oxygen uptake was comparable between groups (ASD: 32.8 mL O2/kg/min, 95% CI 30.3-35.5 mL O2/kg/min, controls: 35.2 mL O2/kg/min, 95% CI 31.6-38.8 mL O2/kg/min, p = 0.3). Corrected ASD patients demonstrate a reduced LV and RV systolic exercise response decades after ASD correction whereas resting parameters of LV and RV systolic function were within normal range. The presence of subclinical systolic myocardial dysfunction during exercise might be associated with the long-term morbidities documented in this patient group.
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Affiliation(s)
- Zarmiga Karunanithi
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
- Department of Clinical Medicine, Aarhus University, Palle-Juul Jensens Boulevard 82, 8200, Aarhus N, Denmark.
| | - Mads Jønsson Andersen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Søren Mellemkjær
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Mathias Alstrup
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle-Juul Jensens Boulevard 82, 8200, Aarhus N, Denmark
| | - Farhad Waziri
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle-Juul Jensens Boulevard 82, 8200, Aarhus N, Denmark
| | - Tor Skibsted Clemmensen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Vibeke Elisabeth Hjortdal
- Department of Clinical Medicine, Aarhus University, Palle-Juul Jensens Boulevard 82, 8200, Aarhus N, Denmark
- Department of Cardiothoracic Surgery, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| | - Steen Hvitfeldt Poulsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle-Juul Jensens Boulevard 82, 8200, Aarhus N, Denmark
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Sahebjam M, Toofaninejad N, Ajam A, Hosseini K, Jalali A, Zoroufian A. Assessment of Left Ventricular Function and Mitral Regurgitation Severity Early After Percutaneous Device Closure of the Atrial Septal Defect. Crit Pathw Cardiol 2022; 21:30-35. [PMID: 34907937 DOI: 10.1097/hpc.0000000000000274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Atrial septal defect (ASD) is one the most prevalent forms of congenital heart disease in adults. Closure of ASDs eliminates left-to-right shunt and reduces right heart volumes, but the effects of ASD closure, on the left ventricle (LV) and mitral valve competence are somewhat inconsistent. Therefore, we designed this study to evaluate the early effect of percutaneous closure of ASD on LV function and mitral regurgitation (MR) severity. METHODS In this prospective study, we enrolled 32 patients with ASD secundum who underwent percutaneous device closure in Tehran Heart Center. We used transthoracic and transesophageal echocardiography (TEE) before the procedure and TTE 24 hours after the procedure, then compared obtained LV parameters before and after the procedure. RESULTS LV end-diastolic diameter (LVEDD) increased significantly from 44.8 ± 2.4 to 45.8 ± 2.8 (P < 0.001). LV end-systolic diameter (LVESD) also increased but was statistically insignificant (P = 0.063) and LV ejection fraction (LVEF) remained nearly unchanged. Highest alteration was in right ventricular systolic pressure (12.4% decrease; P < 0.001) and mitral early Doppler/tissue Doppler velocity ratio (E/E') (9.7% increase; P = 0.010). The change in MR severity was insignificant using Wilcoxon signed-rank test (P = 0.157). CONCLUSIONS We concluded that systolic functions do not change immediately. However, LVEDD and E/E' will increase immediately, resulting from the passage of all blood from the LA into the LV in the early diastole just after closure. We also observed the positive effect of device closure on reducing right ventricular systolic pressure, and at least it does not worsen MR early after the procedure.
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Affiliation(s)
- Mohammad Sahebjam
- From the Department of Echocardiography, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Neda Toofaninejad
- From the Department of Echocardiography, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Ajam
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
- Research Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Kaveh Hosseini
- Research Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Jalali
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
- Research Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Arezou Zoroufian
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
- Research Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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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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Memic Sancar K, Isık A, Aydın U, Kalkan AK, Erturk M, Babur Guler G. A case of progressive dyspnea: Atrial septal device-related functional mitral regurgitation after myocardial infarction. J Cardiovasc Thorac Res 2022; 13:370-373. [PMID: 35047143 PMCID: PMC8749366 DOI: 10.34172/jcvtr.2021.04] [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: 05/30/2020] [Revised: 09/30/2020] [Accepted: 11/07/2020] [Indexed: 11/09/2022] Open
Abstract
Transcatheter device closure is a common treatment option of atrial septal defect. Mitral regurgitation has been reported with comorbid mitral valve prolapse and atrial septal defect. However there is no consensus regarding the pathogenesis of mitral regurgitation after closure. We are reporting a patient with functional mitral regurgitation associated with both an oversize closure device and wall motion abnormality after inferior myocardial infarction.
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Affiliation(s)
- Kadriye Memic Sancar
- Mehmet Akif Ersoy Thoracic and Cardiovascular Research and Education Hospital, Cardiology, Istanbul, Turkey
| | - Ayan Isık
- Mehmet Akif Ersoy Thoracic and Cardiovascular Research and Education Hospital, Cardiology, Istanbul, Turkey
| | - Unal Aydın
- Mehmet Akif Ersoy Thoracic and Cardiovascular Research and Education Hospital, Cardiovascular Surgery, Istanbul, Turkey
| | - Ali Kemal Kalkan
- Mehmet Akif Ersoy Thoracic and Cardiovascular Research and Education Hospital, Cardiology, Istanbul, Turkey
| | - Mehmet Erturk
- Mehmet Akif Ersoy Thoracic and Cardiovascular Research and Education Hospital, Cardiology, Istanbul, Turkey
| | - Gamze Babur Guler
- Mehmet Akif Ersoy Thoracic and Cardiovascular Research and Education Hospital, Cardiology, Istanbul, Turkey
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7
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Allen JW, Phipps KL, Llamas AA, Barrett KA. Left atrial decompression as a palliative minimally invasive treatment for congestive heart failure caused by myxomatous mitral valve disease in dogs: 17 cases (2018-2019). J Am Vet Med Assoc 2021; 258:638-647. [PMID: 33683957 DOI: 10.2460/javma.258.6.638] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine whether left atrial decompression (LAD) would reduce left atrial pressure (LAP) in dogs with advanced myxomatous mitral valve disease (MMVD) and left-sided congestive heart failure (CHF) and to describe the LAD procedure and hemodynamic alterations and complications. ANIMALS 17 dogs with advanced MMVD and left-sided CHF that underwent LAD. PROCEDURES The medical record database was retrospectively reviewed for all LAD procedures attempted in dogs with MMVD and left-sided CHF between October 2018 and June 2019. Data were collected regarding signalment (age, breed, weight, and sex), clinical signs, treatment, physical examination findings, and diagnostic testing before and after LAD. Procedural data were also collected including approach, technique, hemodynamic data, complications, and outcome. RESULTS 18 LAD procedures performed in 17 patients were identified. Dogs ranged in age from 7.5 to 16 years old (median, 11 years) and ranged in body weight from 2.9 to 11.6 kg (6.4 to 25.5 lb) with a median body weight of 7.0 kg (15.4 lb). Minimally invasive creation of an atrial septal defect for the purpose of LAD was successful in all dogs without any intraoperative deaths. Before LAD, mean LAP was elevated and ranged from 8 to 32 mm Hg with a median value of 14 mm Hg (reference value, < 10 mm Hg). Following LAD, there was a significant decrease in mean LAP (median decrease of 6 mm Hg [range, 1 to 15 mm Hg]). Survival time following LAD ranged from 0 to 478 days (median, 195 days). CONCLUSIONS AND CLINICAL RELEVANCE For dogs with advanced MMVD and left-sided CHF, LAD resulted in an immediate and substantial reduction in LAP.
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8
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Paitazoglou C, Bergmann MW. The atrial flow regulator: current overview on technique and first experience. Ther Adv Cardiovasc Dis 2021; 14:1753944720919577. [PMID: 32972299 PMCID: PMC7522821 DOI: 10.1177/1753944720919577] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
| | - Martin W Bergmann
- Interventional Cardiology, Cardiologicum Hamburg, Schloßgarten 3-7, Hamburg 22401, Germany
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9
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Jin X, Hummel YM, Tay WT, Nauta JF, Bamadhaj NSS, van Melle JP, Lam CSP, Voors AA, Hoendermis ES. Short- and long-term haemodynamic consequences of transcatheter closure of atrial septal defect and patent foramen ovale. Neth Heart J 2021; 29:402-408. [PMID: 33594591 PMCID: PMC8271075 DOI: 10.1007/s12471-021-01543-0] [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] [Accepted: 01/25/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Transcatheter atrial septal defect (ASD) and patent foramen ovale (PFO) closure might have opposite short- and long-term haemodynamic consequences compared with restricted interatrial shunt creation, which recently emerged as a potential treatment modality for patients with heart failure with preserved ejection fraction (HFpEF). Given the opposing approaches of ASD and PFO closure versus shunt creation, we investigated the early and sustained cardiac structural and functional changes following transcatheter ASD or PFO closure. METHODS In this retrospective study, adult secundum-type ASD and PFO patients with complete echocardiography examinations at baseline and at 1‑day and 1‑year follow-up who also underwent transcatheter closure between 2013 and 2017 at the University Medical Centre Groningen, the Netherlands were included. RESULTS Thirty-nine patients (mean age 48 ± standard deviation 16 years, 61.5% women) were included. Transcatheter ASD/PFO closure resulted in an early and persistent decrease in right ventricular systolic and diastolic function. Additionally, transcatheter ASD/PFO closure resulted in an early and sustained favourable response of left ventricular (LV) systolic function, but also in deterioration of LV diastolic function with an increase in LV filling pressure (LVFP), as assessed by echocardiography. Age (β = 0.31, p = 0.009) and atrial fibrillation (AF; β = 0.24, p = 0.03) were associated with a sustained increase in LVFP after transcatheter ASD/PFO closure estimated by mean E/e' ratio (i.e. ratio of mitral peak velocity of early filling to diastolic mitral annular velocity). In subgroup analysis, this was similar for ASD and PFO closure. CONCLUSION Older patients and patients with AF were predisposed to sustained increases in left-sided filling pressures resembling HFpEF following ASD or PFO closure. Consequently, these findings support the current concept that creating a restricted interatrial shunt might be beneficial, particularly in elderly HFpEF patients with AF.
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Affiliation(s)
- X Jin
- National Heart Centre Singapore, Singapore, Singapore.,Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Y M Hummel
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - W T Tay
- National Heart Centre Singapore, Singapore, Singapore
| | - J F Nauta
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | | | - J P van Melle
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - C S P Lam
- National Heart Centre Singapore, Singapore, Singapore.,Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.,Duke-NUS Medical School, Singapore, Singapore
| | - A A Voors
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - E S Hoendermis
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.
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10
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Rahmat B, Dwita NU, Arya Wardana PW, Lilyasari O. Preoperative Left Ventricle End Diastolic Volume Index as a Predictor for Low Cardiac Output Syndrome After Surgical Closure of Secundum Atrial Septal Defect With Small-Sized Left Ventricle. Front Pediatr 2021; 9:705257. [PMID: 35004531 PMCID: PMC8740283 DOI: 10.3389/fped.2021.705257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 11/22/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Low cardiac output syndrome is one of the postoperative complications that are associated with significant morbidity and mortality after surgical closure of atrial septal defect (ASD) with small-sized left ventricle (LV). This study investigated whether preoperative left ventricular end-diastolic volume index (LVEDVi) could accurately predict low cardiac output syndrome (LCOS) after surgical closure of ASD with small-sized LV. Method: This retrospective cohort study involved adult ASD patients with small-sized LV from January 2018 to December 2019 in National Cardiovascular Center Harapan Kita. Preoperative MRI data to assess the left and right ventricle volume were collected. A bivariate analysis using independent Student's t-test was done. Diagnostic test using receiver operating characteristic (ROC) curve was also done to obtain the area under the curve (AUC) value. The best cutoff point was determined by Youden's index. Result: Fifty-seven subjects were involved in this study [age (mean ± SD) 32.56 ± 13.15 years; weight (mean ± SD) 48.82 ± 12.15 kg]. Subjects who had post-operative LCOS (n = 30) have significantly lower LVEDVi (45.0 ± 7.42 ml/m2 vs. 64.15 ± 13.37 ml/m2; p < 0.001), LVEDV (64.6 ± 16.0 ml vs. 85.9 ± 20.7 ml; p < 0.001), LVSV (38.97 ± 11.5 ml vs. 53.13 ± 7.5 ml; p < 0.001), and LVSVi (27.28 ± 8.55 ml/m2 vs. 37.42 ± 5.35 ml/m2; p < 0.001) compared to subjects who did not have post-operative LCOS (n = 27). ROC analysis showed that the best AUC was found on LVEDVi (AUC 95.3%; 95% confidence interval: 90.6-100%). The best cutoff value for LVEDVi to predict the occurrence of LCOS after surgical closure of ASD was 53.3 ml/m2 with a sensitivity of 86.7% and a specificity of 85.2%. Conclusion: This study showed that preoperative LVEDVi could predict LCOS after surgical closure of ASD with small-sized LV with a well-defined cutoff. The best cutoff value of LVEDVi to predict the occurrence of LCOS after surgical ASD closure was 53.5 ml/m2.
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Affiliation(s)
- Budi Rahmat
- Pediatric and Congenital Heart Surgery Unit, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia.,Department of Thoracic, Cardiac and Vascular Surgery, Faculty of Medicine, Cipto Mangunkusumo Hospital, University of Indonesia, Jakarta, Indonesia
| | - Nurima Ulya Dwita
- Department of Thoracic, Cardiac and Vascular Surgery, Faculty of Medicine, Cipto Mangunkusumo Hospital, University of Indonesia, Jakarta, Indonesia
| | - Putu Wisnu Arya Wardana
- Department of Thoracic, Cardiac and Vascular Surgery, Faculty of Medicine, Cipto Mangunkusumo Hospital, University of Indonesia, Jakarta, Indonesia
| | - Oktavia Lilyasari
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Centre Harapan Kita, Jakarta, Indonesia
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11
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Eun LY, Park HK, Choi JY. Comparison of the Change in Diastolic Dysfunction after Transcatheter Atrial Septal Defect Closure between Asymptomatic Younger and Older Age Groups. J Clin Med 2020; 9:jcm9113637. [PMID: 33198239 PMCID: PMC7696672 DOI: 10.3390/jcm9113637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 11/16/2022] Open
Abstract
Transcatheter device closure of a secundum atrial septal defect (ASD) is followed by a noticeable change in the left atrium (LA) and left ventricle (LV) over a long-term follow-up. This study aimed to assess the remodeling of the atrial and ventricular myocardium with respect to diastolic function in adult ASD patients. Around 38 asymptomatic patients (age: 48.6 ± 17.1 years, range: 23–69 years) diagnosed with ASD during routine health check-up and who underwent ASD device closure with the Amplatzer septal occluder were included in this retrospective study, and their medical records (containing echocardiographic data) were reviewed. The defect size was 21.77 + 6.79 mm, while the balloon measurement of the defect was 24.29 ± 6.64 mm. The patients were divided into two groups, namely, Group I (with 18 patients aged <50 years [mean: 33.06 ± 9.43 years] and Group II (with 20 patients aged ≥50 years [mean: 62.55 ± 7.54 years]). Comparison of echocardiographic data collected before closure and at a follow-up 2 years later revealed significant differences between pre-closure and post-closure states in the left ventricular end-diastolic dimension (40.76 ± 3.28 vs. 43.39 ± 3.52), left ventricular mass (99.64 ± 28.81 vs. 116.57 ± 32.03), and right ventricular pressure (36.88 ± 12.20 vs. 31.81 ± 11.11). Tissue Doppler measurements were significantly decreased 2 years after closure, while the post-closure E/E’ was higher than the pre-closure E/E’ (11.58 ± 4.80 vs. 8.79 + 3.19, p < 0.005). In both groups, mitral A and tissue Doppler E’, A’, and S’ values decreased post-closure, while the E/E’ was higher in Group II than in Group I at both pre-closure and long-term follow-up measurements (pre-closure: 9.60 ± 5.15 vs. 7.41 ± 1.42, p < 0.003; post-closure: 13.03 + 4.05 vs. 10.49 ± 3.95, p < 0.02). The LA size and LV function exhibited recognizable remodeling after transcatheter ASD closure. Because the LV preload elevation (i.e., E/E’) after ASD closure can be pronounced in older patients, caution should be provided more in older patients than in younger patients. Hence, it may be beneficial to close the ASD at an earlier age in adults even after a late diagnosis; a relatively younger age may be more suited for adaptation to the remodeling process to protect the myocardial function. Careful consideration should be given to the previous underloaded left heart after long-term closure.
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Affiliation(s)
- Lucy Youngmin Eun
- Division of Pediatric Cardiology, Department of Pediatrics, Yonsei University College of Medicine, Seoul 03722, Korea;
| | - Han Ki Park
- Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul 03722, Korea
- Correspondence: (H.K.P.); (J.Y.C.)
| | - Jae Young Choi
- Division of Pediatric Cardiology, Department of Pediatrics, Yonsei University College of Medicine, Seoul 03722, Korea;
- Correspondence: (H.K.P.); (J.Y.C.)
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12
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Geenen LW, Uchoa de Assis L, Baggen VJM, Eindhoven JA, Cuypers JAAE, Boersma E, Roos-Hesselink JW, van den Bosch AE. Evolution of blood biomarker levels following percutaneous atrial septal defect closure in adults. IJC HEART & VASCULATURE 2020; 30:100582. [PMID: 32715081 PMCID: PMC7378682 DOI: 10.1016/j.ijcha.2020.100582] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/17/2020] [Accepted: 07/02/2020] [Indexed: 11/25/2022]
Abstract
A substantial number of adults with unrepaired ASD have elevated biomarker levels. Percutaneous ASD closure in adults leads to acute changes in most biomarker levels. TnT, CRP, RDW, GDF-15 increase immediate after ASD closure and galectin-3 decreases. Long-term reverse cardiac remodeling was not reflected by a decrease in biomarkers. Novel biomarkers can help to elucidate mechanisms of reverse cardiac remodeling.
Background We sought to assess the effects of percutaneous atrial septal defect (ASD) closure on blood biomarker levels that possibly reflect reverse cardiac remodeling. Therefore, this study investigated temporal changes in six blood biomarkers following percutaneous ASD closure in adults. Methods In this prospective observational cohort study, adults with ASD type II scheduled for percutaneous closure were included (2012–2016). NT-proBNP, high-sensitive troponin-T (hs-TnT), high-sensitive C-reactive protein (hs-CRP), red blood cell distribution width (RDW), growth differentiation factor-15 (GDF-15) and galectin-3 were measured one day prior to ASD closure and one day, three months and one year post ASD closure, and changes were evaluated using paired T-tests. Echocardiographic measurements were obtained. Results Fifty patients were included (median age 50 years, 62% women, 32% NYHA II). At baseline, biomarker levels were elevated in a substantial number of patients; NT-proBNP n = 22 (45%), hs-TnT n = 6 (13%) hs-CRP n = 19 (40%), galectin-3 n = 5 (11%) and GDF n = 10 (23%). One day after ASD closure, significant increases of hs-TnT (median change (Δ) = 12 ng/L), hs-CRP (Δ = 1.9 mg/L), GDF-15(Δ = 129 pg/mL) and RDW (Δ = 0.1%) were observed, and a decrease in galectin-3 (Δ = −1.0 ng/mL). Consequently, 92% had at least one abnormal biomarker directly after closure. At three months biomarker levels returned to baseline, and while echocardiographic measures 1 year post closure were indicative of reverse cardiac remodeling, biomarker levels did not further decrease. Conclusion Percutaneous ASD closure in adults leads to a direct increase in most blood biomarkers, in particular hs-CRP and hs-TnT. After three months, biomarkers returned to baseline levels and remained stable up to one year.
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Affiliation(s)
- Laurie W Geenen
- Department of Cardiology, Erasmus University Medical Center Rotterdam, the Netherlands
| | - Lucas Uchoa de Assis
- Department of Cardiology, Erasmus University Medical Center Rotterdam, the Netherlands
| | - Vivan J M Baggen
- Department of Cardiology, Erasmus University Medical Center Rotterdam, the Netherlands
| | - Jannet A Eindhoven
- Department of Cardiology, Erasmus University Medical Center Rotterdam, the Netherlands
| | - Judith A A E Cuypers
- Department of Cardiology, Erasmus University Medical Center Rotterdam, the Netherlands
| | - Eric Boersma
- Department of Cardiology, Erasmus University Medical Center Rotterdam, the Netherlands
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13
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Giordano M, Gaio G, D'Alto M, Santoro G, Scognamiglio G, Cappelli Bigazzi M, Palladino MT, Sarubbi B, Golino P, Russo MG. Transcatheter closure of atrial septal defect in the elderly: Early outcomes and mid-term follow-up. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2020. [DOI: 10.1016/j.ijcchd.2020.100058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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14
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Zeitler EP, Abraham WT. Novel Devices in Heart Failure. JACC-HEART FAILURE 2020; 8:251-264. [DOI: 10.1016/j.jchf.2019.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 10/28/2019] [Accepted: 11/04/2019] [Indexed: 12/22/2022]
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15
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Paitazoglou C, Özdemir R, Pfister R, Bergmann MW, Bartunek J, Kilic T, Lauten A, Schmeisser A, Zoghi M, Anker S, Sievert H, Mahfoud F. The AFR-PRELIEVE trial: a prospective, non-randomised, pilot study to assess the Atrial Flow Regulator (AFR) in heart failure patients with either preserved or reduced ejection fraction. EUROINTERVENTION 2019; 15:403-410. [DOI: 10.4244/eij-d-19-00342] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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16
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Transcatheter closure of atrial septal defect in adults: time-course of atrial and ventricular remodeling and effects on exercise capacity. Int J Cardiovasc Imaging 2019; 35:2077-2084. [PMID: 31203534 PMCID: PMC6805959 DOI: 10.1007/s10554-019-01647-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 06/07/2019] [Indexed: 11/01/2022]
Abstract
Investigate ventricular and atrial remodeling following atrial septal defect (ASD) closure and examine if pulmonary-to-systemic flow ratio (QP/QS) and right ventricular (RV) volume predict improvement, determined as percentage of predicted oxygen uptake (VO2%). Long-term cardiovascular magnetic resonance (CMR) data on atrial and ventricular remodeling after ASD-closure is limited and treatment effect on exercise capacity is debated. Sixteen patients undergoing transcatheter ASD closure and 16 age and sexmatched controls were studied. CMR was performed before treatment, the day after and 3 and 12 months later. Exercise test with gas analysis was performed before and 12 months after treatment. QP/QS decreased from 2.1 ± 0.5 to 1.4 ± 0.3 at day 1 and 1.1 ± 0.1 at 3 and 12 months. Left ventricular (LV) volumes increased and normalized on day 1 whereas left atrial volumes were unchanged. RV and right atrial volumes decreased the first 3 months. LV and RV volumes had not equalized at 12 months (RV/LV ratio 1.2 ± 0.1, P < 0.01) and RV ejection fraction remained decreased compared to controls. Improvement of VO2% after ASD closure (P < 0.01) was inversely related to QP/QS at rest (r = - 0.56, P < 0.05) but unrelated to RV end-diastolic volume (P = 0.16). Following transcatheter ASD closure, LV adaptation is rapid and RV adaptation is prolonged, with decreased systolic RV function. Patients with smaller shunts had larger improvement in VO2% suggesting patients with defects of borderline hemodynamic significance might benefit from closure. This may be due to impaired LV diastolic function influencing shunt size and exercise capacity following ASD closure.
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17
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Burlacu A, Simion P, Nistor I, Covic A, Tinica G. Novel percutaneous interventional therapies in heart failure with preserved ejection fraction: an integrative review. Heart Fail Rev 2019; 24:793-803. [DOI: 10.1007/s10741-019-09787-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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18
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Mohanty S, Solomon A. The left ventricle in atrial septal defect: Looking through 3D glasses. Echocardiography 2019; 36:577-584. [DOI: 10.1111/echo.14269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 12/25/2018] [Accepted: 01/04/2019] [Indexed: 11/27/2022] Open
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19
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Miranda WR, Hagler DJ, Reeder GS, Warnes CA, Connolly HM, Egbe AC, Taggart NW. Temporary balloon occlusion of atrial septal defects in suspected or documented left ventricular diastolic dysfunction: Hemodynamic and clinical findings. Catheter Cardiovasc Interv 2019; 93:1069-1075. [DOI: 10.1002/ccd.28150] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 01/29/2019] [Indexed: 11/09/2022]
Affiliation(s)
| | - Donald J. Hagler
- Department of Pediatric and Adolescent Medicine/Division of Pediatric CardiologyMayo Clinic Rochester Minnesota
| | - Guy S. Reeder
- Department of Cardiovascular MedicineMayo Clinic Rochester Minnesota
| | - Carole A. Warnes
- Department of Cardiovascular MedicineMayo Clinic Rochester Minnesota
| | - Heidi M. Connolly
- Department of Cardiovascular MedicineMayo Clinic Rochester Minnesota
| | - Alexander C. Egbe
- Department of Cardiovascular MedicineMayo Clinic Rochester Minnesota
| | - Nathaniel W. Taggart
- Department of Pediatric and Adolescent Medicine/Division of Pediatric CardiologyMayo Clinic Rochester Minnesota
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20
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Veeram Reddy SR, Nugent AW, Zellers TM, Dimas VV. Invasive Hemodynamics of Adult Congenital Heart Disease: From Shunts to Coarctation. Interv Cardiol Clin 2018; 6:345-358. [PMID: 28600089 DOI: 10.1016/j.iccl.2017.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Adults with congenital heart disease are a growing population with increasingly more complex disease, in large part due to improvements in delivery of care to the pediatric population. Cardiac catheterization is an integral component of diagnosis and management in these patients. Careful attention to detail and a thorough understanding of intracardiac hemodynamics are critical to performing complete diagnostic evaluations. This article outlines the most commonly encountered lesions with guidelines for invasive assessment to help guide further therapy.
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Affiliation(s)
- Surendranath R Veeram Reddy
- Division of Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Children's Health System of Texas, 1935 Medical District Drive, Dallas, TX 75235, USA
| | - Alan W Nugent
- Division of Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Children's Health System of Texas, 1935 Medical District Drive, Dallas, TX 75235, USA
| | - Thomas M Zellers
- Division of Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Children's Health System of Texas, 1935 Medical District Drive, Dallas, TX 75235, USA
| | - V Vivian Dimas
- Division of Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Children's Health System of Texas, 1935 Medical District Drive, Dallas, TX 75235, USA.
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21
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Kobayashi A, Kunii H, Yokokawa T, Sakuma Y, Oikawa M, Yoshihisa A, Yamaki T, Nakazato K, Ishida T, Takeishi Y. Safety and effectiveness of transcatheter closure of atrial septal defects: Initial results in Fukushima Prefecture. Fukushima J Med Sci 2018; 64:151-156. [PMID: 30404951 DOI: 10.5387/fms.2018-13] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Atrial septal defect is the third most common type of congenital heart disease. Surgical closure was the standard treatment for atrial septal defects before transcatheter closure was approved as minimally invasive treatment in Japan in 2006. In our hospital, this procedure has been performed since 2015. OBJECTIVE To evaluate the safety and effectiveness of transcatheter closure of atrial septal defects in our hospital. METHODS Thirty patients (mean age 57.0 ± 19.7 years, 11 males), who underwent transcatheter closure of atrial septal defect between September 2015 and February 2018 at the Fukushima Medical University Hospital, were enrolled. All procedures were performed under general anesthesia with angiographic and transesophageal echocardiographic guidance. Safety and effectiveness were evaluated by the procedural results and complications. RESULTS All 30 patients successfully underwent transcatheter closure of atrial septal defects and no patient developed complications. New York Heart Association functional class was improved, and the right ventricular area and right atrium area were decreased, postoperatively. CONCLUSION Transcatheter closure is a safe and effective treatment for atrial septal defects, and thus could be an alternative option to open heart surgery.
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Affiliation(s)
| | - Hiroyuki Kunii
- Department of Cardiovascular Medicine, Fukushima Medical University
| | - Tetsuro Yokokawa
- Department of Cardiovascular Medicine, Fukushima Medical University.,Department of Pulmonary Hypertension, Fukushima Medical University
| | - Yuya Sakuma
- Department of Cardiovascular Medicine, Fukushima Medical University
| | - Masayoshi Oikawa
- Department of Cardiovascular Medicine, Fukushima Medical University
| | - Akiomi Yoshihisa
- Department of Cardiovascular Medicine, Fukushima Medical University.,Department of Advanced Cardiac therapeutics, Fukushima Medical University
| | - Takayoshi Yamaki
- Department of Cardiovascular Medicine, Fukushima Medical University
| | | | - Takafumi Ishida
- Department of Cardiovascular Medicine, Fukushima Medical University
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22
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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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23
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Abstract
Atrial septal defect (ASD) is one of the most common congenital cardiac anomalies. ASD can present as an isolated lesion in an otherwise normal heart or in association with other congenital heart conditions. Regardless of the type of ASD, the direction and degree of shunting across the communication is mainly determined by the difference in compliance between the right and left ventricle. Hemodynamics in children is characterized by left-to-right shunting, dilated right heart structures and normal pulmonary artery pressures (PAP). Patients diagnosed at adult age often present with complications related to long-standing volume overload such as pulmonary artery hypertension and right and left ventricular dysfunction. Diagnostic catheterization is usually not indicated unless there is suggestion of pulmonary hypertension on echocardiography. In older patients and/or in those with ventricular dysfunction, measurement of left heart pressures during temporary balloon occlusion is recommended prior to device closure as it may not be tolerated. In ASD associated with other congenital malformations, shunting degree and direction will depend upon underlying condition. Restrictive ASD can result in significant hemodynamic compromise in neonates with conditions such as hypoplastic left heart syndrome (HLHS) and transposition of the great arteries (TGA). In most cases, hemodynamics can be estimated with echocardiography only.
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Affiliation(s)
- Alejandro Javier Torres
- Department of Pediatric Cardiology, Children's Hospital of New York-Presbyterian, Columbia University Medical Center, New York, NY, USA
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24
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Capotosto L, Massoni F, De Sio S, Ricci S, Vitarelli A. Early Diagnosis of Cardiovascular Diseases in Workers: Role of Standard and Advanced Echocardiography. BIOMED RESEARCH INTERNATIONAL 2018; 2018:7354691. [PMID: 29560362 PMCID: PMC5820578 DOI: 10.1155/2018/7354691] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 12/04/2017] [Indexed: 12/30/2022]
Abstract
Cardiovascular disease (CVD) still remains the main cause of morbidity and mortality and consequently early diagnosis is of paramount importance. Working conditions can be regarded as an additional risk factor for CVD. Since different aspects of the job may affect vascular health differently, it is important to consider occupation from multiple perspectives to better assess occupational impacts on health. Standard echocardiography has several targets in the cardiac population, as the assessment of myocardial performance, valvular and/or congenital heart disease, and hemodynamics. Three-dimensional echocardiography gained attention recently as a viable clinical tool in assessing left ventricular (LV) and right ventricular (RV) function, volume, and shape. Two-dimensional (2DSTE) and, more recently, three-dimensional speckle tracking echocardiography (3DSTE) have also emerged as methods for detection of global and regional myocardial dysfunction in various cardiovascular diseases and applied to the diagnosis of subtle LV and RV dysfunction. Although these novel echocardiographic imaging modalities have advanced our understanding of LV and RV mechanics, overlapping patterns often show challenges that limit their clinical utility. This review will describe the current state of standard and advanced echocardiography in early detection (secondary prevention) of CVD and address future directions for this potentially important diagnostic strategy.
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25
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Freed JK, Simon JA, Iqbal Z, Almassi GH, Pagel PS. An Unusual Cause of an Isolated Transient Ischemic Attack in an Otherwise Healthy Elderly Man. J Cardiothorac Vasc Anesth 2017; 32:1529-1532. [PMID: 28927695 DOI: 10.1053/j.jvca.2017.06.008] [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: 05/31/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Julie K Freed
- Anesthesia Services, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Jacqueline A Simon
- Anesthesia Services, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Zafar Iqbal
- Anesthesia Services, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - G Hossein Almassi
- Cardiothoracic Surgery Services, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Paul S Pagel
- Anesthesia Services, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI.
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26
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Cuthbert JJ, Pellicori P, Clark AL. Interatrial shunt devices for heart failure with normal ejection fraction: a technology update. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2017; 10:123-132. [PMID: 28652826 PMCID: PMC5476655 DOI: 10.2147/mder.s113105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Heart failure with normal ejection fraction (HeFNEF) accounts for ~50% of heart failure admissions. Its pathophysiology and diagnostic criteria are yet to be defined clearly which may hinder the search for effective treatments. The clinical hallmark of HeFNEF is exertional breathlessness, often due to an abnormal increase in left atrial pressure during exercise. Creation of an interatrial communication to offload the left atrium is a possible therapeutic approach. There are two percutaneously delivered devices currently under investigation which are discussed in this review.
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Affiliation(s)
- Joseph J Cuthbert
- Department of Cardiology, Hull York Medical School, Hull and East Yorkshire Medical Research and Teaching Centre, Castle Hill Hospital, Cottingham, Kingston upon Hull, UK
| | - Pierpaolo Pellicori
- Department of Cardiology, Hull York Medical School, Hull and East Yorkshire Medical Research and Teaching Centre, Castle Hill Hospital, Cottingham, Kingston upon Hull, UK
| | - Andrew L Clark
- Department of Cardiology, Hull York Medical School, Hull and East Yorkshire Medical Research and Teaching Centre, Castle Hill Hospital, Cottingham, Kingston upon Hull, UK
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27
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Sorajja P, Borlaug BA, Dimas VV, Fang JC, Forfia PR, Givertz MM, Kapur NK, Kern MJ, Naidu SS. SCAI/HFSA clinical expert consensus document on the use of invasive hemodynamics for the diagnosis and management of cardiovascular disease. Catheter Cardiovasc Interv 2017; 89:E233-E247. [PMID: 28489331 DOI: 10.1002/ccd.26888] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 11/20/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Paul Sorajja
- Center for Valve and Structural Heart Disease, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Barry A Borlaug
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Vasiliki V Dimas
- Childrens Health Dallas, University of Texas Southwestern Medical Center, Dallas, Texas
| | - James C Fang
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Paul R Forfia
- Section of Cardiology, Temple University, Philadelphia, Pennsylvania
| | - Michael M Givertz
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Navin K Kapur
- Division of Cardiology, Tufts University School of Medicine, Boston, Massachusetts
| | - Morton J Kern
- Cardiology Services, University of California Irvine, Irvine, California
| | - Srihari S Naidu
- Division of Cardiology, Westchester Medical Center, Valhalla, New York
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28
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Di Nora C, Negri F, Sinagra G, Antonini-Canterin F. A Large Ostium Secundum Atrial Septal Defect in an 88-Year-Old Asymptomatic Woman. J Am Geriatr Soc 2016; 64:e113-e115. [DOI: 10.1111/jgs.14406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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29
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Li T, Cheng HJ, Ohte N, Hasegawa H, Morimoto A, Herrington DM, Little WC, Li W, Cheng CP. C-Type Natriuretic Peptide Improves Left Ventricular Functional Performance at Rest and Restores Normal Exercise Responses after Heart Failure. J Pharmacol Exp Ther 2016; 357:545-53. [PMID: 27026682 PMCID: PMC4885509 DOI: 10.1124/jpet.115.231696] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 03/28/2016] [Indexed: 01/20/2023] Open
Abstract
In heart failure (HF), the impaired left ventricular (LV) arterial coupling and diastolic dysfunction present at rest are exacerbated during exercise. C-type natriuretic peptide (CNP) is elevated in HF; however, its functional effects are unclear. We tested the hypotheses that CNP with vasodilating, natriuretic, and positive inotropic and lusitropic actions may prevent this abnormal exercise response after HF. We determined the effects of CNP (2 μg/kg plus 0.4 μg/kg per minute, i.v., 20 minutes) on plasma levels of cGMP before and after HF and assessed LV dynamics during exercise in 10 chronically instrumented dogs with pacing-induced HF. Compared with the levels before HF, CNP infusion caused significantly greater increases in cGMP levels after HF. After HF, at rest, CNP administration significantly reduced LV end-systolic pressure (PES), arterial elastance (EA), and end-diastolic pressure. The peak mitral flow (dV/dtmax) was also increased owing to decreased minimum LVP (LVPmin) and the time constant of LV relaxation (τ) (P < 0.05). In addition, LV contractility (EES) was increased. The LV-arterial coupling (EES/EA) was improved. The beneficial effects persisted during exercise. Compared with exercise in HF preparation, treatment with CNP caused significantly less important increases in PES but significantly decreased τ (34.2 vs. 42.6 ms) and minimum left ventricular pressure with further augmented dV/dtmax Both EES, EES/EA (0.87 vs. 0.32) were increased. LV mechanical efficiency improved from 0.38 to 0.57 (P < 0.05). After HF, exogenous CNP produces arterial vasodilatation and augments LV contraction, relaxation, diastolic filling, and LV arterial coupling, thus improving LV performance at rest and restoring normal exercise responses after HF.
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Affiliation(s)
- Tiankai Li
- Wake Forest School of Medicine, Winston-Salem, North Carolina (H.J.C., N.O., H.H., A.M., D.M.H., W.C.L., C.P.C.), and the First Affiliated Hospital of Harbin Medical University, Harbin, China (T.L., H.J.C, W.L., C.P.C)
| | - Heng-Jie Cheng
- Wake Forest School of Medicine, Winston-Salem, North Carolina (H.J.C., N.O., H.H., A.M., D.M.H., W.C.L., C.P.C.), and the First Affiliated Hospital of Harbin Medical University, Harbin, China (T.L., H.J.C, W.L., C.P.C)
| | - Nobuyuki Ohte
- Wake Forest School of Medicine, Winston-Salem, North Carolina (H.J.C., N.O., H.H., A.M., D.M.H., W.C.L., C.P.C.), and the First Affiliated Hospital of Harbin Medical University, Harbin, China (T.L., H.J.C, W.L., C.P.C)
| | - Hiroshi Hasegawa
- Wake Forest School of Medicine, Winston-Salem, North Carolina (H.J.C., N.O., H.H., A.M., D.M.H., W.C.L., C.P.C.), and the First Affiliated Hospital of Harbin Medical University, Harbin, China (T.L., H.J.C, W.L., C.P.C)
| | - Atsushi Morimoto
- Wake Forest School of Medicine, Winston-Salem, North Carolina (H.J.C., N.O., H.H., A.M., D.M.H., W.C.L., C.P.C.), and the First Affiliated Hospital of Harbin Medical University, Harbin, China (T.L., H.J.C, W.L., C.P.C)
| | - David M Herrington
- Wake Forest School of Medicine, Winston-Salem, North Carolina (H.J.C., N.O., H.H., A.M., D.M.H., W.C.L., C.P.C.), and the First Affiliated Hospital of Harbin Medical University, Harbin, China (T.L., H.J.C, W.L., C.P.C)
| | - William C Little
- Wake Forest School of Medicine, Winston-Salem, North Carolina (H.J.C., N.O., H.H., A.M., D.M.H., W.C.L., C.P.C.), and the First Affiliated Hospital of Harbin Medical University, Harbin, China (T.L., H.J.C, W.L., C.P.C)
| | - Weimin Li
- Wake Forest School of Medicine, Winston-Salem, North Carolina (H.J.C., N.O., H.H., A.M., D.M.H., W.C.L., C.P.C.), and the First Affiliated Hospital of Harbin Medical University, Harbin, China (T.L., H.J.C, W.L., C.P.C)
| | - Che Ping Cheng
- Wake Forest School of Medicine, Winston-Salem, North Carolina (H.J.C., N.O., H.H., A.M., D.M.H., W.C.L., C.P.C.), and the First Affiliated Hospital of Harbin Medical University, Harbin, China (T.L., H.J.C, W.L., C.P.C)
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30
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Silvestry FE, Cohen MS, Armsby LB, Burkule NJ, Fleishman CE, Hijazi ZM, Lang RM, Rome JJ, Wang Y. Guidelines for the Echocardiographic Assessment of Atrial Septal Defect and Patent Foramen Ovale: From the American Society of Echocardiography and Society for Cardiac Angiography and Interventions. J Am Soc Echocardiogr 2016; 28:910-58. [PMID: 26239900 DOI: 10.1016/j.echo.2015.05.015] [Citation(s) in RCA: 298] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Frank E Silvestry
- Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Meryl S Cohen
- Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Laurie B Armsby
- Doernbecher Children's Hospital, Oregon Health and Sciences University, Portland, Oregon
| | | | - Craig E Fleishman
- Arnold Palmer Hospital for Children, University of Central Florida College of Medicine, Orlando, Florida
| | | | - Roberto M Lang
- University of Chicago Hospital, University of Chicago School of Medicine, Chicago, Illinois
| | - Jonathan J Rome
- Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Yan Wang
- Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, Pennsylvania
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31
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Chigurupati K, Reshmi LJ, Gadhinglajkar S, Venkateshwaran S, Sreedhar R. Pulmonary edema following transcatheter closure of atrial septal defect. Ann Card Anaesth 2016; 18:441-4. [PMID: 26139760 PMCID: PMC4881711 DOI: 10.4103/0971-9784.159827] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We describe an incident of development of acute pulmonary edema after the device closure of a secundum atrial septal defect in a 52-year-old lady, which was treated with inotropes, diuretics and artificial ventilation. Possibility of acute left ventricular dysfunction should be considered after the defect closure in the middle-aged patients as the left ventricular compliance may be reduced due to increased elastic stiffness and diastolic dysfunction. Baseline left atrial pressure may be > 10 mmHg in these patients. Associated risk factors for the left ventricular dysfunction are a large Qp:Qs ratio, systemic hypertension, severe pulmonary hypertension and paroxysmal atrial fibrillation.
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Affiliation(s)
- Keerthi Chigurupati
- Department of Cardiothoracic and Vascular Anaesthesia; Department of Cardiovascular and Thoracic Anaesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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32
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Alkhouli M, Sarraf M, Holmes DR. Iatrogenic Atrial Septal Defect. Circ Cardiovasc Interv 2016; 9:e003545. [DOI: 10.1161/circinterventions.116.003545] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 02/22/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Mohamad Alkhouli
- From the Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN
| | - Mohammad Sarraf
- From the Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN
| | - David R. Holmes
- From the Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN
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33
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Żebrowska A, Hryniewiecki T, Stokłosa P, Duchnowski P, Orłowska-Baranowska E, Szymański P. Atrial Septal Defect in a Nonagenarian. J Am Geriatr Soc 2016; 64:224-6. [DOI: 10.1111/jgs.13893] [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]
Affiliation(s)
- Agnieszka Żebrowska
- Department of Acquired Cardiac Defects; Institute of Cardiology; Warsaw Poland
| | - Tomasz Hryniewiecki
- Department of Acquired Cardiac Defects; Institute of Cardiology; Warsaw Poland
| | - Patrycjusz Stokłosa
- Department of Acquired Cardiac Defects; Institute of Cardiology; Warsaw Poland
| | - Piotr Duchnowski
- Department of Acquired Cardiac Defects; Institute of Cardiology; Warsaw Poland
| | | | - Piotr Szymański
- Department of Acquired Cardiac Defects; Institute of Cardiology; Warsaw Poland
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34
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Amat-Santos IJ, Bergeron S, Bernier M, Allende R, Barbosa Ribeiro H, Urena M, Pibarot P, Verheye S, Keren G, Yaacoby M, Nitzan Y, Abraham WT, Rodés-Cabau J. Left atrial decompression through unidirectional left-to-right interatrial shunt for the treatment of left heart failure: first-in-man experience with the V-Wave device. EUROINTERVENTION 2015; 10:1127-31. [PMID: 24832489 DOI: 10.4244/eijy14m05_07] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
AIMS Elevated filling pressures of the left atrium (LA) are associated with poorer outcomes in patients with chronic heart failure. The V-Wave is a new percutaneously implanted device intended to decrease the LA pressure by the shunting of blood from the LA to the right atrium. This report describes the first-in-man experience with the V-Wave device. METHODS AND RESULTS A 70-year-old man with a history of heart failure of ischaemic origin, left ventricular dysfunction (LVEF: 35%, pulmonary wedge: 19 mmHg), no right heart dysfunction, NYHA Class III and orthopnoea despite optimal treatment, was accepted for V-Wave device implantation. The device consists of an ePTFE encapsulated nitinol frame that is implanted at the level of the interatrial septum and contains a trileaflet pericardium tissue valve sutured inside which allows a unidirectional LA to right atrium shunt. The procedure was performed through a transfemoral venous approach under fluoroscopic and TEE guidance. The device was successfully implanted and the patient was discharged 24 hours after the procedure with no complications. At three-month follow-up a left-to-right shunt through the device was confirmed by TEE. The patient was in NYHA Class II, without orthopnoea, the Kansas City Cardiomyopathy index was 77.6 (from 39.1 at baseline) and NT-proBNP was 322 ng/mL (from 502 ng/mL at baseline). The QP/QS was 1.17 and the pulmonary wedge was 8 mmHg, with no changes in pulmonary pressure or right ventricular function. CONCLUSIONS Left atrial decompression through a unidirectional left-to-right interatrial shunt represents a new concept for the treatment of patients with left ventricular failure. The present report shows the feasibility of applying this new therapy with the successful and uneventful implantation of the V-Wave device, which was associated with significant improvement in functional, quality of life and haemodynamic parameters at 90 days.
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Affiliation(s)
- Ignacio J Amat-Santos
- Department of Cardiology, Quebec Heart & Lung Institute, Quebec City, Quebec, Canada
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35
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Krieger EV, Leary PJ, Opotowsky AR. Pulmonary Hypertension in Congenital Heart Disease: Beyond Eisenmenger Syndrome. Cardiol Clin 2015; 33:599-609, ix. [PMID: 26471823 DOI: 10.1016/j.ccl.2015.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Patients with adult congenital heart disease have an increased risk of developing pulmonary hypertension. There are several mechanisms of pulmonary hypertension in patients with adult congenital heart disease, and understanding them requires a systematic approach to define the patient's hemodynamics and physiology. This article reviews the updated classification of pulmonary hypertension in patients with adult congenital heart disease with a focus on pathophysiology, diagnostics, and the evaluation of pulmonary hypertension in special adult congenital heart disease populations.
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Affiliation(s)
- Eric V Krieger
- Seattle Adult Congenital Heart Service, Division of Cardiology, Department of Medicine, University of Washington School of Medicine, 1959 Northeast Pacific Street, Seattle, WA 98195, USA.
| | - Peter J Leary
- Pulmonary Vascular Disease Program, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington School of Medicine, 1959 Northeast Pacific Street, Seattle, WA 98195, USA
| | - Alexander R Opotowsky
- Boston Adult Congenital Heart and Pulmonary Hypertension Service, Department of Cardiology, Boston Children's Hospital and Brigham and Women's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
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36
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Kurishima C, Inuzuka R, Kuwata S, Iwamoto Y, Sugimoto M, Saiki H, Ishido H, Masutani S, Senzaki H. Influence of Left Ventricular Stiffness on Hemodynamics in Patients With Untreated Atrial Septal Defects. Circ J 2015; 79:1823-7. [PMID: 25993903 DOI: 10.1253/circj.cj-14-1351] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although left ventricular (LV) stiffening with age is believed to increase left-to-right shunting in patients with atrial septal defects (ASD), clinical data have not confirmed this. We sought determinants of the pulmonary-to-systemic flow ratio (Qp/Qs) in patients with untreated ASD. METHODS AND RESULTS We retrospectively studied 180 patients with ASD who underwent percutaneous ASD closure between 2007 and 2011. Qp/Qs and LV stiffness were measured before ASD closure.The median age of the subjects was 18 years, and 117 (65.0%) were female. The mean ASD size adjusted for square root of body surface area (BSA) was 14.4±4.2 mm/m, and the Qp/Qs was 2.28±0.74. Adjusted ASD size most strongly related to Qp/Qs (r=0.74, P<0.0001). Multivariate analysis revealed that LV stiffness was a significant predictor of Qp/Qs, independently of adjusted ASD size and vascular resistance (P=0.0015). Based on the multivariate model that accounts for the effects of LV stiffness and vascular resistance, the minimal adjusted diameter that can cause a Qp/Qs of 2.0 was predicted to be 7.3 mm/m. CONCLUSIONS Qp/Qs in ASD can change significantly depending on LV stiffness, suggesting that it would increase with age. An ASD >7.3 mm/m in diameter has the potential to cause significant left-to-right shunting, and may require closure regardless of hemodynamic status at the time of assessment.
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Affiliation(s)
- Clara Kurishima
- Division of Pediatric Cardiology, Saitama Medical University
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37
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Assessment of Ventricular Function Using the Pressure-Volume Relationship. CONGENIT HEART DIS 2015. [DOI: 10.1007/978-4-431-54355-8_5] [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: 10/24/2022]
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38
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Hiraishi M, Tanaka H, Motoji Y, Sawa T, Tsuji T, Miyoshi T, Imanishi J, Kaneko A, Matsumoto K, Shinke T, Hirata KI. Impact of Right Ventricular Geometry on Mitral Regurgitation After Transcatheter Closure of Atrial Septal Defect. Int Heart J 2015; 56:516-21. [DOI: 10.1536/ihj.15-073] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Mana Hiraishi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Hidekazu Tanaka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Yoshiki Motoji
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Takuma Sawa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Takayuki Tsuji
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Tatsuya Miyoshi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Junichi Imanishi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Akihiro Kaneko
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Kensuke Matsumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Toshiro Shinke
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Ken-ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
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Left ventricular rotation and right-left ventricular interaction in congenital heart disease: the acute effects of interventional closure of patent arterial ducts and atrial septal defects. Cardiol Young 2014; 24:661-74. [PMID: 23895866 DOI: 10.1017/s1047951113000978] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Left ventricular rotation is physiologically affected by acute changes in preload. We investigated the acute effect of preload changes in chronically underloaded and overloaded left ventricles in children with shunt lesions. METHODS A total of 15 patients with atrial septal defects (Group A: 7.4 ± 4.7 years, 11 females) and 14 patients with patent arterial ducts (Group B: 2.7 ± 3.1 years, 10 females) were investigated using 2D speckle-tracking echocardiography before and after interventional catheterisation. The rotational parameters of the patient group were compared with those of 29 matched healthy children (Group C). RESULTS Maximal torsion (A: 2.45 ± 0.9°/cm versus C: 1.8 ± 0.8°/cm, p < 0.05), apical peak systolic rotation (A: 12.6 ± 5.7° versus C: 8.7 ± 3.5°, p < 0.05), and the peak diastolic torsion rate (A: -147 ± 48°/second versus C: -110 ± 31°/second, p < 0.05) were elevated in Group A and dropped immediately to normal values after intervention (maximal torsion 1.5 ± 1.1°/cm, p < 0.05, apical peak systolic rotation 7.2 ± 4.1°, p < 0.05, and peak diastolic torsion rate -106 ± 35°/second, p < 0.05). Patients in Group B had decreased maximal torsion (B: 1.8 ± 1.1°/cm versus C: 3.8 ± 1.4°/cm, p < 0.05) and apical peak systolic rotation (B: 8.3 ± 6.1° versus C: 13.9 ± 4.3°, p < 0.05). Defect closure was followed by an increase in maximal torsion (B: 2.7 ± 1.4°/cm, p < 0.05) and the peak diastolic torsion rate (B: -133 ± 66°/second versus -176 ± 84°/second, p < 0.05). CONCLUSIONS Patients with chronically underloaded left ventricles compensate with an enhanced apical peak systolic rotation, maximal torsion, and quicker diastolic untwisting to facilitate diastolic filling. In patients with left ventricular dilatation by volume overload, the peak systolic apical rotation and the maximal torsion are decreased. After normalisation of the preload, they immediately return to normal and diastolic untwisting rebounds. These mechanisms are important for understanding the remodelling processes.
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40
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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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41
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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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42
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Aslan M, Erturk M, Turen S, Uzun F, Surgit O, Ozbay Ozyilmaz S, Rifat Yildirim M, Faruk Baycan O, Uygur B, Yildirim A, Eksik A. Effects of percutaneous closure of atrial septal defect on left atrial mechanical and conduction functions. Eur Heart J Cardiovasc Imaging 2014; 15:1117-24. [DOI: 10.1093/ehjci/jeu089] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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43
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Shimpo H, Hojo R, Ryo M, Konuma T, Tempaku H. Transcatheter closure of secundum atrial septal defect. Gen Thorac Cardiovasc Surg 2013; 61:614-8. [DOI: 10.1007/s11748-013-0268-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Indexed: 10/26/2022]
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Abstract
Ostium secundum-type atrial septal defect closure has evolved from a surgical procedure requiring cardiopulmonary bypass to a percutaneous, catheter-based procedure usually requiring only an overnight hospital stay. The overall safety and effectiveness has compared favorably with surgical repair. Although rare, complications have been described, including erosion, device embolization, or malfunction and arrhythmias. The overall long-term clinical outcomes have been excellent: good quality of life, functional class improvement, and ventricular remodeling have been the rule after the procedure. It is mandatory to recommend indefinite follow-up of patients undergoing this procedure for potential long-term complications.
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Affiliation(s)
- Alejandro Román Peirone
- Pediatric Cardiology Section, Hospital Privado de Córdoba, Naciones Unidas 346, Córdoba 5016, Argentina.
| | - Simone Fontes Pedra
- Echocardiography Laboratory for Congenital Heart Disease, Instituto Dante Pazzanese de Cardiología, Av Dr Dante Pazzanese 500 CEP 04012-180, Sao Paulo, Brazil
| | - Carlos Augusto Cardoso Pedra
- Catheterization Laboratory for Congenital Heart Disease, Instituto Dante Pazzanese de Cardiología, Avenida Doutor Dante Pazzanese 500 CEP 04012-180, Sao Paulo, Brazil; Catheterization Laboratory for Congenital Heart Disease, Hospital do Coração, Sao Paulo, Brazil
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45
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Stuart AG. Changing lesion demographics of the adult with congenital heart disease: an emerging population with complex needs. Future Cardiol 2012; 8:305-13. [DOI: 10.2217/fca.12.8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The demography of congenital heart disease is changing. Largely as a consequence of successful cardiac surgery in childhood, there are an increasing number of adults with congenital heart disease with a prevalence of more than four per 100 adults. The type of disease in adults is also changing with an increasing number of survivors with complex disease. These patients have a significantly increased healthcare requirement in comparison to healthy adults and this includes noncardiac, multisystem morbidity. The adult congenital heart disease population are now developing problems associated with aging and there is a new population of geriatrics with congenital heart disease. As survival continues to improve, increased healthcare resources need to be directed towards the management of the adult with congenital heart disease.
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Affiliation(s)
- Alan Graham Stuart
- Congenital Heart Unit, Bristol Royal Hospital for Children/Bristol Heart Institute, Upper Maudlin St, Bristol, BS2 8XW, UK
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