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Adhikari CM, Bogati A, Prajapati D, Dhungel S, Najmy S, Acharya K, Shahi R, Subedi C, Adhikari J, Sharma D. Atrial Septal Defect Size and Rims on Transesophageal Echocardiogram. MÆDICA 2019; 14:81-85. [PMID: 31523285 DOI: 10.26574/maedica.2019.14.2.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background and aims:Rims and size of atrial septal defect (ASD) are crucial for the success of transcatheter ASD closure. The maximal diameter and dimensions of various rims of the ASD are essential for sizing and optimal placement of the device. We aimed to study the size and rims of ASD in our patients. Methods:This was a prospective study that was done at Shahid Gangalal National Heart Centre. All patients aged over 18 and referred to a unit IV in the Department of Cardiology for ASD device closure were included in the study. The study duration was six months, from April to September 2018. The size and rims of ASD were evaluated by transesophageal echocardiogram. Results:During the study, 173 patients underwent transesophageal echocardiogram. Most of them [122 (70.1%)] were women. Age ranged from 18 to 68 (mean, 35 years). The most common symptom was shortness of breath. Twenty-one (12.1%) patients were incidentally detected with ASDs. Sinus rhythm with right bundle branch block was present in 148 (85.5%) subjects. Right atrium and right ventricle were dilated in 162 (93.6%) patients. One patient had dextrocardia with situs inversus. More than half of all patients (54.9%) had mild tricuspid regurgitation. Mean tricuspid regurgitation pressure gradient was 39.5±16.8 mm Hg. More than one ASD was present in 11 (6.3%) patients. ASD size ranged from 2 mm to 43 mm in 4-chamber view, 2 mm to 44 mm in short axis view, and 2 mm to 47 mm in bicaval view. The mean ASD size was 18.6±7.7 mm in 4-chamber view, 19.6±8.5 mm in short axis view, and 18.7±8.0 mm in bicaval view. In only 11 (6.4%) patients, all rims were present and not floppy, while in other 11 (6.4%) subjects all rims were present, but floppy. With the exception of aortic rim, all other rims were present and good in 55 (33.9%) patients, while in 45 (27.7%) patients, other rims were present but floppy. Conclusion:Many ASD have absent, inadequate and floppy rims.
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Affiliation(s)
| | - Amrit Bogati
- Department of Cardiology, Shahid Gangalal National Heart Centre, Kathmandu, Nepal
| | - Dipanker Prajapati
- Department of Cardiology, Shahid Gangalal National Heart Centre, Kathmandu, Nepal
| | - Sachin Dhungel
- Department of Cardiology, Shahid Gangalal National Heart Centre, Kathmandu, Nepal
| | - Shaneez Najmy
- Department of Cardiology, National Academy of Medical Sciences, Kathmandu, Nepal
| | - Kiran Acharya
- Department of Cardiology, Shahid Gangalal National Heart Centre, Kathmandu, Nepal
| | - Roshani Shahi
- Department of Cardiology, Shahid Gangalal National Heart Centre, Kathmandu, Nepal
| | - Chirag Subedi
- Department of Cardiology, Shahid Gangalal National Heart Centre, Kathmandu, Nepal
| | - Jagat Adhikari
- Department of Cardiology, Shahid Gangalal National Heart Centre, Kathmandu, Nepal
| | - Deewakar Sharma
- Department of Cardiology, Shahid Gangalal National Heart Centre, Kathmandu, Nepal
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Baruteau AE, Petit J, Lambert V, Gouton M, Piot D, Brenot P, Angel CY, Houyel L, Le Bret E, Roussin R, Ly M, Capderou A, Belli E. Transcatheter Closure of Large Atrial Septal Defects. Circ Cardiovasc Interv 2014; 7:837-43. [DOI: 10.1161/circinterventions.113.001254] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Data are needed on the safety and efficacy of device closure of large atrial septal defects.
Methods and Results—
Between 1998 and 2013, 336 patients (161 children <15 years) with large, isolated, secundum atrial septal defects (balloon-stretched diameter ≥34 mm in adults or echocardiographic diameter >15 mm/m
2
in children) were managed using the Amplatzer device, at the Marie Lannelongue Hospital. Transthoracic echocardiographic guidance was used starting in 2005 (n=219; 65.2%). Balloon-stretched diameter was >40 mm in 36 adults; mean values were 37.6±3.3 mm in other adults and 26.3±6.3 mm/m
2
in children. Amplatzer closure was successful in 311 (92.6%; 95% confidence interval, 89%–95%) patients. Superior and posterior rim deficiencies were more common in failed than in successful procedures (superior, 24.0% versus 4.8%;
P
=0.002; and posterior, 32.0% versus 4.2%;
P
<0.001). Device migration occurred in 4 adults (2 cases each of surgical and transcatheter retrieval); in the 21 remaining failures, the device was unreleased and withdrawn. After a median follow-up of 10.0 years (2.5–17 years), all patients were alive with no history of late complications.
Conclusions—
Closure of large atrial septal defects using the Amplatzer device is safe and effective in both adults and children. Superior and posterior rim deficiencies are associated with procedural failure. Closure can be performed under transthoracic echocardiographic guidance in experienced centers. Early device migration is rare and can be safely managed by device extraction. Long-term follow-up showed no deaths or major late complications in our population of 311 patients.
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Affiliation(s)
- Alban-Elouen Baruteau
- From the Marie Lannelongue Hospital-M3C, Department of Pediatric Cardiac Surgery, Paris, France (A.-E.B., J.P., V.L., M.G., D.P., P.B., C.-Y.A., L.H., E.L.B., R.R., M.L., E.B.); Université Paris Sud, Le Kremlin Bicêtre, Paris, France (A.-E.B., A.C.); l’Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM) 1087, Centre National de la Recherche Scientifique (CNRS) 6291, Université de Nantes, Nantes, France (A.-E.B.); and Institut National de la Santé et de la Recherche
| | - Jérôme Petit
- From the Marie Lannelongue Hospital-M3C, Department of Pediatric Cardiac Surgery, Paris, France (A.-E.B., J.P., V.L., M.G., D.P., P.B., C.-Y.A., L.H., E.L.B., R.R., M.L., E.B.); Université Paris Sud, Le Kremlin Bicêtre, Paris, France (A.-E.B., A.C.); l’Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM) 1087, Centre National de la Recherche Scientifique (CNRS) 6291, Université de Nantes, Nantes, France (A.-E.B.); and Institut National de la Santé et de la Recherche
| | - Virginie Lambert
- From the Marie Lannelongue Hospital-M3C, Department of Pediatric Cardiac Surgery, Paris, France (A.-E.B., J.P., V.L., M.G., D.P., P.B., C.-Y.A., L.H., E.L.B., R.R., M.L., E.B.); Université Paris Sud, Le Kremlin Bicêtre, Paris, France (A.-E.B., A.C.); l’Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM) 1087, Centre National de la Recherche Scientifique (CNRS) 6291, Université de Nantes, Nantes, France (A.-E.B.); and Institut National de la Santé et de la Recherche
| | - Marielle Gouton
- From the Marie Lannelongue Hospital-M3C, Department of Pediatric Cardiac Surgery, Paris, France (A.-E.B., J.P., V.L., M.G., D.P., P.B., C.-Y.A., L.H., E.L.B., R.R., M.L., E.B.); Université Paris Sud, Le Kremlin Bicêtre, Paris, France (A.-E.B., A.C.); l’Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM) 1087, Centre National de la Recherche Scientifique (CNRS) 6291, Université de Nantes, Nantes, France (A.-E.B.); and Institut National de la Santé et de la Recherche
| | - Dominique Piot
- From the Marie Lannelongue Hospital-M3C, Department of Pediatric Cardiac Surgery, Paris, France (A.-E.B., J.P., V.L., M.G., D.P., P.B., C.-Y.A., L.H., E.L.B., R.R., M.L., E.B.); Université Paris Sud, Le Kremlin Bicêtre, Paris, France (A.-E.B., A.C.); l’Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM) 1087, Centre National de la Recherche Scientifique (CNRS) 6291, Université de Nantes, Nantes, France (A.-E.B.); and Institut National de la Santé et de la Recherche
| | - Philippe Brenot
- From the Marie Lannelongue Hospital-M3C, Department of Pediatric Cardiac Surgery, Paris, France (A.-E.B., J.P., V.L., M.G., D.P., P.B., C.-Y.A., L.H., E.L.B., R.R., M.L., E.B.); Université Paris Sud, Le Kremlin Bicêtre, Paris, France (A.-E.B., A.C.); l’Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM) 1087, Centre National de la Recherche Scientifique (CNRS) 6291, Université de Nantes, Nantes, France (A.-E.B.); and Institut National de la Santé et de la Recherche
| | - Claude-Yves Angel
- From the Marie Lannelongue Hospital-M3C, Department of Pediatric Cardiac Surgery, Paris, France (A.-E.B., J.P., V.L., M.G., D.P., P.B., C.-Y.A., L.H., E.L.B., R.R., M.L., E.B.); Université Paris Sud, Le Kremlin Bicêtre, Paris, France (A.-E.B., A.C.); l’Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM) 1087, Centre National de la Recherche Scientifique (CNRS) 6291, Université de Nantes, Nantes, France (A.-E.B.); and Institut National de la Santé et de la Recherche
| | - Lucile Houyel
- From the Marie Lannelongue Hospital-M3C, Department of Pediatric Cardiac Surgery, Paris, France (A.-E.B., J.P., V.L., M.G., D.P., P.B., C.-Y.A., L.H., E.L.B., R.R., M.L., E.B.); Université Paris Sud, Le Kremlin Bicêtre, Paris, France (A.-E.B., A.C.); l’Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM) 1087, Centre National de la Recherche Scientifique (CNRS) 6291, Université de Nantes, Nantes, France (A.-E.B.); and Institut National de la Santé et de la Recherche
| | - Emmanuel Le Bret
- From the Marie Lannelongue Hospital-M3C, Department of Pediatric Cardiac Surgery, Paris, France (A.-E.B., J.P., V.L., M.G., D.P., P.B., C.-Y.A., L.H., E.L.B., R.R., M.L., E.B.); Université Paris Sud, Le Kremlin Bicêtre, Paris, France (A.-E.B., A.C.); l’Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM) 1087, Centre National de la Recherche Scientifique (CNRS) 6291, Université de Nantes, Nantes, France (A.-E.B.); and Institut National de la Santé et de la Recherche
| | - Régine Roussin
- From the Marie Lannelongue Hospital-M3C, Department of Pediatric Cardiac Surgery, Paris, France (A.-E.B., J.P., V.L., M.G., D.P., P.B., C.-Y.A., L.H., E.L.B., R.R., M.L., E.B.); Université Paris Sud, Le Kremlin Bicêtre, Paris, France (A.-E.B., A.C.); l’Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM) 1087, Centre National de la Recherche Scientifique (CNRS) 6291, Université de Nantes, Nantes, France (A.-E.B.); and Institut National de la Santé et de la Recherche
| | - Mohamedou Ly
- From the Marie Lannelongue Hospital-M3C, Department of Pediatric Cardiac Surgery, Paris, France (A.-E.B., J.P., V.L., M.G., D.P., P.B., C.-Y.A., L.H., E.L.B., R.R., M.L., E.B.); Université Paris Sud, Le Kremlin Bicêtre, Paris, France (A.-E.B., A.C.); l’Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM) 1087, Centre National de la Recherche Scientifique (CNRS) 6291, Université de Nantes, Nantes, France (A.-E.B.); and Institut National de la Santé et de la Recherche
| | - André Capderou
- From the Marie Lannelongue Hospital-M3C, Department of Pediatric Cardiac Surgery, Paris, France (A.-E.B., J.P., V.L., M.G., D.P., P.B., C.-Y.A., L.H., E.L.B., R.R., M.L., E.B.); Université Paris Sud, Le Kremlin Bicêtre, Paris, France (A.-E.B., A.C.); l’Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM) 1087, Centre National de la Recherche Scientifique (CNRS) 6291, Université de Nantes, Nantes, France (A.-E.B.); and Institut National de la Santé et de la Recherche
| | - Emre Belli
- From the Marie Lannelongue Hospital-M3C, Department of Pediatric Cardiac Surgery, Paris, France (A.-E.B., J.P., V.L., M.G., D.P., P.B., C.-Y.A., L.H., E.L.B., R.R., M.L., E.B.); Université Paris Sud, Le Kremlin Bicêtre, Paris, France (A.-E.B., A.C.); l’Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM) 1087, Centre National de la Recherche Scientifique (CNRS) 6291, Université de Nantes, Nantes, France (A.-E.B.); and Institut National de la Santé et de la Recherche
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