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Kaemmerer H, Diller GP, Achenbach S, Dähnert I, Eichstaedt CA, Eicken A, Freiberger A, Freilinger S, Geiger R, Gorenflo M, Grünig E, Hager A, Huntgeburth M, Kaemmerer-Suleiman AS, Kozlik-Feldmann R, Lammers AE, Nagdyman N, Michel S, Schmidt KH, Uebing A, von Scheidt F, Apitz C. [Pulmonary hypertension in adults with congenital heart disease in light of the 2022-ESC-PAH guidelines - Part II: Supportive therapy, special situations (pregnancy, contraception, non-cardiac surgery), targeted pharmacotherapy, organ transplantation, special management (shunt lesions, left ventricular disorders, univentricular hearts), interventions, intensive care, follow-up, future perspectives]. Pneumologie 2024; 78:566-577. [PMID: 38788761 DOI: 10.1055/a-2274-1025] [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: 05/26/2024]
Abstract
The number of adults with congenital heart defects (CHD) is steadily rising and amounts to approximately 360,000 in Germany. CHD is often associated with pulmonary hypertension (PH), which may develop early in untreated CHD. Despite timely treatment of CHD, PH not infrequently persists or recurs in older age and is associated with significant morbidity and mortality.The revised European Society of Cardiology/European Respiratory Society 2022 guidelines for the diagnosis and treatment of PH represent a significant contribution to the optimized care of those affected. However, the topic of "adults with congenital heart disease" is addressed only relatively superficial in these guidelines. Therefore, in the present article, this topic is commented in detail from the perspective of congenital cardiology.
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Affiliation(s)
- Harald Kaemmerer
- Internationales Zentrum für Erwachsene mit angeborenen Herzfehlern (EMAH), Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, Deutschland
| | - Gerhard Paul Diller
- Klinik für Kardiologie III: angeborene Herzfehler (EMAH) und Klappenerkrankungen, Universitätsklinikum Münster, Münster, Deutschland
| | - Stephan Achenbach
- Universitätsklinik Erlangen, Medizinische Klinik 2 - Kardiologie und Angiologie, Erlangen, Deutschland
| | - Ingo Dähnert
- Universitätsklinik für Kinderkardiologie, Herzzentrum Leipzig, Leipzig, Deutschland
| | - Christina A Eichstaedt
- Zentrum für Pulmonale Hypertonie, Thoraxklinik Heidelberg am Universitätsklinikum Heidelberg, Heidelberg, Deutschland; Institut für Humangenetik, Universität Heidelberg, INF 366, TLRC am DZL Heidelberg, Deutschland
| | - Andreas Eicken
- Internationales Zentrum für Erwachsene mit angeborenen Herzfehlern (EMAH), Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, Deutschland
| | - Annika Freiberger
- Internationales Zentrum für Erwachsene mit angeborenen Herzfehlern (EMAH), Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, Deutschland
| | - Sebastian Freilinger
- Internationales Zentrum für Erwachsene mit angeborenen Herzfehlern (EMAH), Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, Deutschland
| | - Ralf Geiger
- Univ.-Klinik für Pädiatrie III, Kardiologie, Pneumologie, Allergologie, Cystische Fibrose, Innsbruck, Österreich
| | - Matthias Gorenflo
- Klinik für Kinderkardiologie und angeborene Herzfehler, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Ekkehard Grünig
- Zentrum für Pulmonale Hypertonie, Thoraxklinik Heidelberg am Universitätsklinikum Heidelberg, Heidelberg, Deutschland; Institut für Humangenetik, Universität Heidelberg, INF 366, TLRC am DZL Heidelberg, Deutschland
| | - Alfred Hager
- Internationales Zentrum für Erwachsene mit angeborenen Herzfehlern (EMAH), Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, Deutschland
| | - Michael Huntgeburth
- Internationales Zentrum für Erwachsene mit angeborenen Herzfehlern (EMAH), Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, Deutschland
| | | | - Rainer Kozlik-Feldmann
- Klinik und Poliklinik für Kinderkardiologie, Universitäres Herz- und Gefäßzentrum Hamburg, Klinik und Poliklinik für Kinderherzmedizin und Erwachsene mit angeborenen Herzfehlern, Hamburg, Deutschland
| | - Astrid E Lammers
- Klinik für Pädiatrische Kardiologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Münster, Deutschland
| | - Nicole Nagdyman
- Internationales Zentrum für Erwachsene mit angeborenen Herzfehlern (EMAH), Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, Deutschland
| | - Sebastian Michel
- LMU Klinikum, Herzchirurgische Klinik und Poliklinik, Sektion für Chirurgie angeborener Herzfehler und Kinderherzchirurgie, Campus Großhadern, München, Deutschland
| | - Kai Helge Schmidt
- Universitätsmedizin Mainz, Zentrum für Kardiologie - Kardiologie I, Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - Anselm Uebing
- Universitätsklinikum Schleswig-Holstein, Klinik für angeborene Herzfehler und Kinderkardiologie, Kiel, Deutschland
| | - Fabian von Scheidt
- Internationales Zentrum für Erwachsene mit angeborenen Herzfehlern (EMAH), Klinik für angeborene Herzfehler und Kinderkardiologie, Deutsches Herzzentrum München, Deutschland
| | - Christian Apitz
- Sektion Pädiatrische Kardiologie, Universitätsklinik für Kinder- und Jugendmedizin Ulm, Ulm, Deutschland
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Li A, Aboulhosn JA. Update on Transcatheter Interventions in Adults with Congenital Heart Disease. J Clin Med 2024; 13:3685. [PMID: 38999250 PMCID: PMC11242816 DOI: 10.3390/jcm13133685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 06/13/2024] [Accepted: 06/17/2024] [Indexed: 07/14/2024] Open
Abstract
The field of adult congenital interventions is unique in the world of cardiac catheterization, combining the structural concepts commonly employed in pediatric heart disease and applying them to adult patients, who are more amenable to device intervention as they no longer experience somatic growth. Rapid advances in the field have been made to match the growing population of adult patients with congenital heart disease, which currently surpasses the number of pediatric patients born with congenital heart disease. Many congenital defects, which once required surgical intervention or reoperation, can now be addressed via the transcatheter approach, minimizing the morbidity and mortality often encountered within adult congenital surgeries. In this paper, we aim to provide a focused review of the more common procedures that are utilized for the treatment of adult congenital heart disease patients in the catheterization laboratory, as examples of current practices in the United States, as well as emerging concepts and devices awaiting approval in the future.
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Affiliation(s)
- Angela Li
- Division of Cardiology, UCLA Medical Center, Los Angeles, CA 90095, USA;
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Al-modhaffer SS, Mohammed AA, Ahmed OF, Kakamad FH, Saeed DHM, Rahim HM, Hama JI, Mohammed HS, Mohammed SH. Cardiac myxoma following transcatheter closure of an atrial septal defect. Proc AMIA Symp 2024; 37:862-865. [PMID: 39165818 PMCID: PMC11332617 DOI: 10.1080/08998280.2024.2345557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/27/2024] [Accepted: 03/22/2024] [Indexed: 08/22/2024] Open
Abstract
To date, no significant association has been reported between atrial septal defects (ASD) and cardiac myxomas. This study reports a 56-year-old woman with cardiac myxoma following transcatheter closure of ASD. She presented with a 3-month history of recurrent dizziness, vertigo, palpitations, and generalized weakness after undergoing ASD occlusion a year earlier. Echocardiography and cardiac computed tomography scans identified a large, mobile mass (7.2 cm × 2.8 cm) in the left atrium, protruding through the mitral valve. The patient underwent median sternotomy and pericardiotomy, and the histopathological examination confirmed the diagnosis of atrial myxoma. The current case illustrates the challenges in determining whether an atrial mass is a benign myxoma or a dangerous thrombus. While there is no definitive link between the implantation of an ASD closure device and the formation of a myxoma, the emergence of this tumor is a potential occurrence.
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Affiliation(s)
| | | | | | - Fahmi H. Kakamad
- College of Medicine, University of Sulaimani, Sulaimani, Kurdistan, Iraq
- Smart Health Tower, Sulaimani, Kurdistan, Iraq
- Kscien Organization for Scientific Research (Middle East office), Kurdistan, Iraq
| | - Dana H. Mohammed Saeed
- College of Medicine, University of Sulaimani, Sulaimani, Kurdistan, Iraq
- Smart Health Tower, Sulaimani, Kurdistan, Iraq
| | - Hawbash M. Rahim
- Smart Health Tower, Sulaimani, Kurdistan, Iraq
- Kscien Organization for Scientific Research (Middle East office), Kurdistan, Iraq
| | | | | | - Shvan H. Mohammed
- Kscien Organization for Scientific Research (Middle East office), Kurdistan, Iraq
- Xzmat Polyclinic, Sulaimani, Kurdistan, Iraq
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de Liyis BG, Kosasih AM, Jagannatha GNP, Dewangga MSY. Complications and Efficacies of Surgical Versus Transcatheter Closure for Pediatric Ostium Secundum Atrial Septal Defect: A Meta-Analysis. J Endovasc Ther 2024:15266028241245599. [PMID: 38597284 DOI: 10.1177/15266028241245599] [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: 04/11/2024]
Abstract
INTRODUCTION The optimal approach for pediatric ostium secundum atrial septal defect (ASD) closure remains uncertain. This study aims to assess complications and efficacies of surgical and transcatheter closures. METHODS Systematic search in Medline, Cochrane, and EMBASE databases identified cohort studies until July 2023. Complications, length of hospital stay, and efficacy outcomes were evaluated. Subgroup analyses considered ethnicity, ASD size, age, and rim deficiency involvement. RESULTS Fourteen cohort studies involving 9695 patients were comprehensively analyzed. Regarding complications, the pediatric patients in the surgery group exhibited higher occurrences of cardiac arrhythmia (odds ratio [OR]: 1.87, 95% confidence interval [CI]: 1.22-2.87, p=0.004), pericardial effusion (OR: 14.80, 95% CI: 6.97-31.43, p<0.00001), and pulmonary complications (OR: 2.58, 95% CI: 1.73-3.85, p<0.00001) compared with those in the transcatheter group. However, no significant difference in fever incidence was observed (OR: 2.57, 95% CI: 0.90-7.34, p=0.08). Furthermore, length of hospital stay was notably shorter in the pediatric transcatheter group (mean difference [MD]: 4.00, 95% CI: 1.71-6.29, p=0.0006). Regarding efficacies, both groups demonstrated similar rates of successful closure (OR: 1.97, 95% CI: 0.56-6.92, p=0.29) and residual shunting (OR: 0.55, 95% CI: 0.17-1.77, p=0.31) in the pediatric cohort. Subgroup analyses revealed that surgical residual shunting was notably lower in the European pediatric population (OR: 0.18, 95% CI: 0.07-0.45, p=0.0002), in cases with ASD size exceeding 15 mm (OR: 0.19, 95% CI: 0.08-0.49, p=0.0006), and in pediatric patients younger than 8 years (OR: 0.33, 95% CI: 0.12-0.92, p=0.03). Interestingly, residual shunting involving complex ASD with rim deficiency was more pronounced in the surgery group (OR: 2.66, 95% CI: 1.33-5.32, p=0.006). CONCLUSIONS Both surgical and transcatheter closures are equally effective, with transcatheter closure showing significantly fewer complications. CLINICAL IMPACT This meta-analysis offers pivotal insights for clinicians grappling with the optimal approach to pediatric ostium secundum ASD closure. The observed higher incidence of cardiac arrhythmias, pericardial effusions, and pulmonary complications in surgical closures underscores the challenges associated with this modality. In contrast, transcatheter closure, with its comparable efficacy and shorter hospital stays, emerges as an appealing and less invasive alternative. These findings equip clinicians with evidence to make informed decisions, optimizing patient outcomes. Subgroup analyses further refine recommendations, emphasizing tailored considerations for European pediatric patients, larger ASDs, and those under 8 years old, ultimately fostering personalized and improved care strategies.
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Affiliation(s)
- Bryan Gervais de Liyis
- Faculty of Medicine, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Universitas Udayana, Denpasar, Indonesia
| | - Anastasya Maria Kosasih
- Faculty of Medicine, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Universitas Udayana, Denpasar, Indonesia
| | | | - Made Satria Yudha Dewangga
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Universitas Udayana, Denpasar, Indonesia
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Zhixin L, Gang L, Zhixian J, Silin P. The development and validation of an artificial intelligence-based screening method for atrial septal defect in children's chest x-rays. Front Pediatr 2023; 11:1203933. [PMID: 37753193 PMCID: PMC10518390 DOI: 10.3389/fped.2023.1203933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 08/28/2023] [Indexed: 09/28/2023] Open
Abstract
Purpose For precise diagnosis and effective management of atrial septal defects, it is of utmost significance to conduct elementary screenings on children. The primary aim of this study is to develop and authenticate an objective methodology for detecting atrial septal defects by employing deep learning (DL) on chest x-ray (CXR) examinations. Methods This retrospective study encompassed echocardiographs and corresponding Chest x-rays that were consistently gathered at Qingdao Women's and Children's Hospital from 2018 to 2022. Based on a collaborative diagnosis report by two cardiologists with over 10 years of experience in echocardiography, these radiographs were classified as positive or negative for atrial septal defect, and then divided into training and validation datasets. An artificial intelligence model was formulated by utilizing the training dataset and fine-tuned using the validation dataset. To evaluate the efficacy of the model, an assessment of the area under the curve, sensitivity, specificity, accuracy, positive predictive value, and negative predictive value was conducted employing the validation dataset. Results This research encompassed a total of 420 images from individuals. The screening accuracy and recall rate of the model surpass 90%. Conclusions One of profound neural network models predicated on chest x-ray radiographs (a traditional, extensively employed, and economically viable examination) proves highly advantageous in the assessment for atrial septal defect.
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Affiliation(s)
| | | | | | - Pan Silin
- Heart Center, Women and Children’s Hospital, Qingdao University, Qingdao, China
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Alexandre A, Luz A, de Frias AD, Santos RB, Brochado B, Oliveira F, Silveira J, Torres S. Temporary atrial septal defect balloon occlusion test as a must in the elderly. BMC Cardiovasc Disord 2023; 23:15. [PMID: 36635628 PMCID: PMC9836334 DOI: 10.1186/s12872-023-03046-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 01/05/2023] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Atrial septal defect (ASD) can often remain asymptomatic until adulthood. It still remains unclear whether large ASD closure in senior people should be performed or not. Temporary ASD balloon occlusion test has been suggested as a tool to assess the risk of acute left ventricular heart failure post-ASD closure, and it allows to better distinguish responders from non-responders. CASE PRESENTATION An 83-year-old man with a long-standing uncorrected secundum ASD was admitted for recently decompensated right-sided heart failure. During hospitalization, this patient was studied with trans-esophageal echocardiography, cardiac magnetic resonance imaging, and right heart catheterization, showing high Qp:Qs ratio and favorable anatomical conditions for percutaneous closure. Because of patient's increasing need for intravenous diuretics and worsening renal function, it was considered that transcatheter ASD closure could improve symptoms, hence it was performed an attempt of percutaneous closure of the ASD with a fenestrated device. Unfortunately, irrespective of ASD being hemodynamically significant, it was found a very significant increase in pulmonary capillary wedge pressure during the temporary balloon occlusion test, supporting the existence of concealed left ventricular diastolic dysfunction. As a result, it was decided to abandon the procedure and not to close the ASD. CONCLUSION This clinical case illustrates the value of temporary balloon occlusion test before permanent percutaneous closure of ASD in elderly patients, regardless of left ventricular (systolic or diastolic) dysfunction.
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Affiliation(s)
- André Alexandre
- grid.5808.50000 0001 1503 7226Department of Cardiology, Centro Hospitalar Universitário do Porto (CHUPorto), Largo do Prof. Abel Salazar, 4099-001 Porto, Portugal ,grid.5808.50000 0001 1503 7226ICBAS – School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
| | - André Luz
- grid.5808.50000 0001 1503 7226Department of Cardiology, Centro Hospitalar Universitário do Porto (CHUPorto), Largo do Prof. Abel Salazar, 4099-001 Porto, Portugal ,grid.5808.50000 0001 1503 7226ICBAS – School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal ,grid.5808.50000 0001 1503 7226Cardiovascular Research Group, UMIB – Unit for Multidisciplinary Research in Biomedicine, ICBAS – School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
| | - André Dias de Frias
- grid.5808.50000 0001 1503 7226Department of Cardiology, Centro Hospitalar Universitário do Porto (CHUPorto), Largo do Prof. Abel Salazar, 4099-001 Porto, Portugal
| | - Raquel Baggen Santos
- grid.5808.50000 0001 1503 7226Department of Cardiology, Centro Hospitalar Universitário do Porto (CHUPorto), Largo do Prof. Abel Salazar, 4099-001 Porto, Portugal ,grid.5808.50000 0001 1503 7226ICBAS – School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
| | - Bruno Brochado
- grid.5808.50000 0001 1503 7226Department of Cardiology, Centro Hospitalar Universitário do Porto (CHUPorto), Largo do Prof. Abel Salazar, 4099-001 Porto, Portugal ,grid.5808.50000 0001 1503 7226ICBAS – School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
| | - Filomena Oliveira
- grid.5808.50000 0001 1503 7226Department of Cardiology, Centro Hospitalar Universitário do Porto (CHUPorto), Largo do Prof. Abel Salazar, 4099-001 Porto, Portugal ,grid.5808.50000 0001 1503 7226ICBAS – School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
| | - João Silveira
- grid.5808.50000 0001 1503 7226Department of Cardiology, Centro Hospitalar Universitário do Porto (CHUPorto), Largo do Prof. Abel Salazar, 4099-001 Porto, Portugal ,grid.5808.50000 0001 1503 7226ICBAS – School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
| | - Severo Torres
- grid.5808.50000 0001 1503 7226Department of Cardiology, Centro Hospitalar Universitário do Porto (CHUPorto), Largo do Prof. Abel Salazar, 4099-001 Porto, Portugal ,grid.5808.50000 0001 1503 7226ICBAS – School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
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Sivakumar K, Jain G. Experience with the largest custom-made 48 mm fenestrated atrial septal occluder device and its 4-year follow-up. Ann Pediatr Cardiol 2023; 16:52-55. [PMID: 37287835 PMCID: PMC10243662 DOI: 10.4103/apc.apc_126_22] [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: 10/12/2022] [Revised: 11/13/2022] [Accepted: 01/10/2023] [Indexed: 06/09/2023] Open
Abstract
Atrial septal defects (ASDs) measuring <38 mm are referred for transcatheter closure. Availability of larger devices up to 46 mm extended the inclusion criteria. An elderly hypertensive male with a 44 mm secundum ASD and coexistent sick sinus syndrome and atrioventricular (AV) nodal block presented with syncope. Balloon interrogation unmasked restrictive left ventricular (LV) physiology. After AV synchronous pacing, balloon-assisted deployment of a custom fenestrated 48 mm Figulla septal occluder (Occlutech Inc., Schaffhausen, Switzerland) prevented a rise of LV end-diastolic pressures beyond 12 mmHg. Echocardiogram and computed tomography after 4 years confirmed a patent fenestration and favorable remodeling. This report of the clinical use of the largest ASD device demonstrated the feasibility of closure of extremely large defects despite a restrictive LV.
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Affiliation(s)
- Kothandam Sivakumar
- Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, Tamil Nadu, India
| | - Gaurav Jain
- Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, Tamil Nadu, India
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Bani Hani A, Salhiyyah K, Salameh M, Abu Abeeleh M, Al Smady M, Al Rawashdeh M, Abu Fares H, Al-Ammouri I. Atrial Septal Defect Repair in Adolescent and Adult Patients, a Cross Sectional Study at Jordan University Hospital, a Tertiary Hospital in a Developing Country. Int J Gen Med 2022; 15:3517-3524. [PMID: 35392029 PMCID: PMC8979831 DOI: 10.2147/ijgm.s356502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 03/08/2022] [Indexed: 11/27/2022] Open
Abstract
Objective We aim to report our heart team's experience in repair of Secundum atrial septal defect (ASD) in adolescent and adult patients at Jordan University Hospital (JUH). Methodology A retrospective observational study of 44 patients who underwent secundum ASD closure by transcatheter closure (TCC) or Minimally Invasive Cardiac Surgery (MICS) at JUH. Patients who were treated at an age of 14 years or older regardless of the age of diagnosis were included. SPSS and Microsoft Excel were used to analyze the data. Results A total of 44 patients with secundum ASD were treated during the period of (January 2015 and December 2019). The mean age was 34.1 (±14.3) years. Thirty-four patients underwent TCC, 9 underwent surgical closure and one had a hybrid procedure. We had no mortality and 2 minor morbidities. After a mean follow-up period of 13.2-/+13.6 months, most patients experienced improved symptoms, and there was a significant reduction of right ventricular dimension from 33.1 (±8.74) to 24 (±4.67) mm (p=0.0001). Conclusion ASD closure whether TCC or MICS is a safe procedure with very low morbidity. A heart team approach is a necessity in the era of advances in both MICS surgery and TCC approach. A heart team provides the patients with a variety of safe and cosmetic solutions that allow the patients to have a fast management and recovery phase in rapid time through providing the merits and avoiding the complications of each modality, the team allows low volume centers in developing countries to achieve an excellent outcome.
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Affiliation(s)
- Amjad Bani Hani
- Department of General Surgery, Division of Cardiac Surgery, The University of Jordan, Amman, Jordan
| | - Kareem Salhiyyah
- Department of Cardiac Science, Middle East University, Amman, Jordan
| | - Mohammad Salameh
- Department of General Surgery, Division of Cardiac Surgery, The University of Jordan, Amman, Jordan
| | - Mahmoud Abu Abeeleh
- Department of General Surgery, Division of Cardiac Surgery, The University of Jordan, Amman, Jordan
| | - Moaath Al Smady
- Department of General Surgery, Division of Cardiac Surgery, The University of Jordan, Amman, Jordan
| | - Mohammad Al Rawashdeh
- Department of Pediatrics, Division of Pediatric Cardiology, The University of Jordan, Amman, Jordan
| | - Hala Abu Fares
- Department of Pediatrics, Division of Pediatric Cardiology, The University of Jordan, Amman, Jordan
| | - Iyad Al-Ammouri
- Department of Pediatrics, Division of Pediatric Cardiology, The University of Jordan, Amman, Jordan
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Maldonado Escalante J, Molina G, Rincón FM, Corso-Ramirez JM, Pérez Rivera CJ. Estenosis de vena pulmonar secundaria a corrección quirúrgica de insuficiencia mitral y tricúspide por comunicación interauricular residual: reporte de caso. CIRUGIA CARDIOVASCULAR 2022. [DOI: 10.1016/j.circv.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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10
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Holm MA, Emfield K, Iles TL, Iaizzo PA. High-resolution 3D reconstructions of human vasculatures: creation of educational tools and benchtop models for transcatheter devices. Cardiovasc Interv Ther 2021; 37:519-525. [PMID: 34468961 DOI: 10.1007/s12928-021-00804-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 08/11/2021] [Indexed: 11/28/2022]
Abstract
Transcatheter therapies are a common way to treat cardiovascular diseases. These therapies are complicated by significant anatomical patient-to-patient variations that exist in terms of transcatheter vascular pathways. Adding to the complexity of transcatheter procedures, the training tools used for physician education often overlook vast patient-to-patient variations and utilize idealized models of patient anatomy that may be unrealistic. In this study, anatomically accurate models were created from high-resolution images of real patient vasculatures. Using fourteen human cadavers donated for research, we collected high-resolution images to generate 3D computational renderings of various patient anatomies. These models make up the "Transcatheter Pathways Vasculature Database" that can be used for physician education and training, as well as improving transcatheter delivery system design. We performed multiple studies that emphasize the anatomical differences that exist in patient vasculatures. Using 3D printing and virtual reality, we developed educational materials and benchtop models to train physicians using true patient anatomies. These tools can also provide device designers with data to improve their products based on real patient vessels. The "Transcatheter Pathways Vasculature Database" highlights differences between patient vasculatures. By educating and training physicians with patient anatomies that accurately represent significant patient-to-patient variations, learning is more translatable to what is seen in the clinic.
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Affiliation(s)
- Mikayle A Holm
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA
| | - Kendall Emfield
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Tinen L Iles
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Paul A Iaizzo
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA. .,Department of Surgery, University of Minnesota, Minneapolis, MN, USA. .,Integrative Biology and Physiology, University of Minnesota, Minneapolis, MN, USA. .,Institute for Engineering in Medicine, University of Minnesota, Minneapolis, MN, USA.
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Bac NH, Dinh NH, Van Thuan P, Bich Ha TC, Khoi LM. Atrial Myxoma on Atrial Septal Defect Occlusion Device: A Rare but True Occurrence. ACTA ACUST UNITED AC 2021; 5:204-208. [PMID: 34430767 PMCID: PMC8370869 DOI: 10.1016/j.case.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Device occlusion is the method of choice to treat atrial septal defects. Atrial myxoma on an atrial septal defect occlusion device is rare but does occur. Echocardiography plays an essential role in confirming an atrial myxoma. Echocardiography helps to exclude a left atrial thrombus. Echocardiography contributes to surgical planning.
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Affiliation(s)
- Nguyen Hoang Bac
- Endoscopic Surgery Training Center, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, Viet Nam
| | - Nguyen Hoang Dinh
- Cardiovascular Center, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, Viet Nam
| | - Phan Van Thuan
- Cardiovascular Center, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, Viet Nam
| | - Tran Chau Bich Ha
- Cardiovascular Center, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, Viet Nam
| | - Le Minh Khoi
- Cardiovascular Center, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, Viet Nam
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Yamamoto H, Shinke T, Otake H, Terashita D, Nagasawa A, Tanimura K, Matsumoto K, Tanaka H, Hirata KI. Hemodynamic changes during transcatheter atrial septal defect closure predict midterm heart failure deterioration in adults. Catheter Cardiovasc Interv 2021; 98:E715-E723. [PMID: 34227726 DOI: 10.1002/ccd.29859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 06/20/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To investigate whether hemodynamic changes during balloon occlusion test (BOT) predict future heart failure (HF) deterioration after transcatheter atrial septal defect closure (tASD-closure). BACKGROUND Midterm HF deterioration can sometimes occur after tASD-closure in adults. Whether hemodynamic changes during tASD-closure can help identify patients at risk is unknown. METHODS This prospective observational study enrolled 86 consecutive adult patients who underwent tASD-closure. Hemodynamic parameters, including pulmonary capillary wedge pressure (PCWP), were measured at baseline, during BOT, and after tASD-closure. The changes in PCWP during BOT and after tASD-closure were defined as ΔPCWP (Occ-Pre) and ΔPCWP (Post-Pre), respectively. Clinical parameters were evaluated before tASD-closure and during the 3-month follow-up. We assessed the occurrence of HF deterioration (HF requiring hospitalization or additional diuretics) during a 2-year follow-up period and categorized patients into HF (+) and HF (-) groups accordingly. The aforementioned parameters were compared between groups. RESULTS Midterm HF deterioration occurred in 12 patients (13.9%). Compared to the HF (-) group, the HF (+) group presented a significantly higher ΔPCWP (Occ-Pre) (9.5 ± 4.4 mmHg vs. 3.0 ± 3.3 mmHg; p < 0.001) and ΔPCWP (Post-Pre) (4.0 ± 2.8 mmHg vs. 0.6 ± 1.8 mmHg; p = 0.004). Receiver operating characteristic curve analysis showed that the ΔPCWP (Occ-Pre) cutoff value of 5.5 mmHg had excellent ability to predict HF deterioration (Area under the curve 0.886 [0.779-0.993], p < 0.001; sensitivity 0.917, specificity 0.824). CONCLUSIONS Increases in PCWP during BOT predict midterm HF deterioration after tASD-closure. Close surveillance may be needed in patients with a ΔPCWP (Occ-Pre) >5 mmHg.
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Affiliation(s)
- Hiroyuki Yamamoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Toshiro Shinke
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.,Division of Cardiology, Department of Medicine, Showa University School of Medicine, Japan
| | - Hiromasa Otake
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Daisuke Terashita
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Akira Nagasawa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kousuke Tanimura
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kensuke Matsumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hidekazu Tanaka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ken-Ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
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13
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Yoshiba S, Kojima T, Oyanagi T, Toda K, Osada Y, Muraji S, Imamura T, Nakano S, Makita S, Kobayashi T, Sumitomo N. Late recovery of the cardiopulmonary exercise capacity after transcatheter amplatzer device closures for atrial septal defects in adults. Heart Vessels 2021; 36:710-716. [PMID: 33386922 DOI: 10.1007/s00380-020-01741-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 11/27/2020] [Indexed: 10/22/2022]
Abstract
Transcatheter atrial septal defect (ASD) closures using an Amplatzer Septal Occluder (ASO) have been widely performed. Compared to children, we sometimes experience late recovery of exercise performance in adult patients. Our study aimed to evaluate the change in the cardiopulmonary exercise capacity in asymptomatic or mildly symptomatic adult patients after a transcatheter ASD closure using an ASO. The subjects consisted of 29 patients (age 39.5 ± 13.6 years) that underwent cardiopulmonary exercise testing (CPX) before, 3, 6, and 12 months after a transcatheter secundum ASD closure using an ASO. The peak oxygen consumption (peak VO2), anaerobic threshold (AT), and slope of the correlation between the ventilation and carbon dioxide production (VE/VCO2 slope) were evaluated. We also evaluated the left-ventricular end-diastolic diameter (LVEDD), right-ventricular end-diastolic dimension (RVEDD) by echocardiography, and hemodynamic values by cardiac catheterization before the ASO procedure. The peak VO2 did not show any improvement 3 months after the ASO procedure; however, a significant improvement was displayed 6 and 12 months (baseline: 23.4 ± 6.3, 3 months: 23.6 ± 6.4, 6 months: 25.1 ± 5.6, 12 months: 26.4 ± 5.3 mL/kg/min; p < 0.001) after the ASO. The LVEDD (before: 38.1 ± 3.6, 3 months: 43.4 ± 3.4 mm; p < 0.001) and RVEDD (before: 33.6 ± 5.3, 3 months: 26.3 ± 2.6 mm; p < 0.001) on echocardiography quickly improved 3 months after the ASO. Although the LVEDD and RVEDD normalized 3 months after the ASO, the peak VO2 still decreased; however, the peak VO2 improved to almost a normal range 6 months after the ASO.
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Affiliation(s)
- Shigeki Yoshiba
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Takuro Kojima
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Takayuki Oyanagi
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Koichi Toda
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Yousuke Osada
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Shota Muraji
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Tomohiko Imamura
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Shintaro Nakano
- Department of Cardiology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Shigeru Makita
- Department of Cardiac Rehabilitation, Saitama Medical University International Medical Center, Saitama, Japan
| | - Toshiki Kobayashi
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan.
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14
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Nakayama R, Takaya Y, Akagi T, Watanabe N, Miki T, Nakagawa K, Toh N, Ito H. Efficacy and safety of atrial septal defect closure using Occlutech Figulla Flex II compared with Amplatzer Septal Occluder. Heart Vessels 2021; 36:704-709. [PMID: 33386412 DOI: 10.1007/s00380-020-01739-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/20/2020] [Indexed: 11/25/2022]
Abstract
Few studies have reported the efficacy of Occlutech Figulla Flex II (FFII) device compared with Amplatzer Septal Occluder (ASO) device. The aim of this study was to examine the efficacy and safety of FFII compared with ASO for transcatheter atrial septal defect (ASD) closure. We retrospectively evaluated 190 patients using FFII and 190 patients using ASO who underwent transcatheter ASD closure. ASD characteristics were evaluated by transesophageal echocardiography. The prevalence of procedural complications, including erosion, device embolization, stroke, and new-onset atrial arrhythmia, and the presence of a residual shunt were evaluated between the two groups during 12-month follow-up. FFII was used more frequently than ASO in patients with a deficient aortic rim or septal malalignment (P = 0.02, P < 0.01, respectively). The procedural complications of erosion, device embolization, and stroke did not occur in any patients. New-onset atrial arrhythmia occurred in 3 patients of the FFII group and 4 patients of the ASO group, and the difference between the two groups was not significant (P = 0.70). A large residual shunt (≥ 3 mm) was observed in 6 patients of the FFII group and 5 patients of the ASO group, and the difference between the two groups was not significant (P = 0.76). FFII was used frequently in patients with high-risk ASD morphology; however, there was no difference in the prevalence of procedural complications or efficacy between patients using FFII and those using ASO.
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Affiliation(s)
- Rie Nakayama
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Yoichi Takaya
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
| | - Teiji Akagi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Nobuhisa Watanabe
- Division of Medical Support, Okayama University Hospital, Okayama, Japan
| | - Takashi Miki
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Koji Nakagawa
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Norihisa Toh
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
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15
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Miki T, Yamano T, Yamano M, Nakamura T, Takamatsu K, Ma C, Wakana N, Nakanishi N, Zen K, Shiraishi H, Shirayama T, Matoba S. Favorable changes of left ventricular function in the circumferential direction following transcatheter atrial septal defect closure: a strain imaging study. Int J Cardiovasc Imaging 2020; 37:903-912. [PMID: 33047179 DOI: 10.1007/s10554-020-02064-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 10/05/2020] [Indexed: 11/26/2022]
Abstract
To clarify the impact on left ventricular (LV) function of percutaneous atrial septal defect (ASD) closure in adult patients. Echocardiograms of 46 patients (52 ± 18 years) who underwent ASD closure with a significant left-to-right shunt obtained before and 1 month after the procedure were retrospectively analyzed. Functional parameters were obtained by 2-dimensional speckle-tracking imaging. Global longitudinal strain and strain rate at early diastole (SRe) was calculated from the three standard apical views, while circumferential and radial parameters were calculated from basal, middle, and apical LV short-axis views. Along with a diminished right ventricular (RV) volume, the LV volume and ejection fraction increased (end-diastolic volume: 61 ± 12 to 76 ± 15 mL, p < 0.001; and 63% ± 4 to 64% ± 4% p = 0.03; respectively). Both global strain and SRe was augmented only in the circumferential direction (- 16.2% ± 2.9% to - 19.8% ± 2.8%; and 1.07 ± 0.29 to 1.34 ± 0.28 s-1, both p < 0.001). Augmentation of circumferential SRe correlated with both the changes in and the pre-procedural value of diastolic LV eccentricity index (r = - 0.57, p < 0.001; and r = 0.37, p = 0.01; respectively), a morphological parameter of RV volume overload. Following ASD closure in adults, both LV systolic and diastolic function could favorably change in the circumferential direction, and the degree of diastolic functional change is associated with RV volume overload, i.e., severity of ventricular interdependence.
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Affiliation(s)
- Tomonori Miki
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Tetsuhiro Yamano
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Michiyo Yamano
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Takeshi Nakamura
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Kazuaki Takamatsu
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Chao Ma
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Noriyuki Wakana
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Naohiko Nakanishi
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Kan Zen
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Hirokazu Shiraishi
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Takeshi Shirayama
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Satoaki Matoba
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
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16
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Leong MC, Kandavello G, Husin A, Perumal D, Kaur Khelae S. Left atrial appendage and atrial septal occlusion in elderly patients with atrial septal defect and atrial fibrillation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:1252-1257. [PMID: 32845014 DOI: 10.1111/pace.14049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 08/16/2020] [Accepted: 08/23/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Elderly patients with atrial septal defect (ASD) often present with chronic atrial fibrillation and large left to right shunt. This study reports the experience of left atrial appendage (LAA) and ASD closure in patients with significant ASD and chronic atrial fibrillation. METHODS We report six consecutive elderly patients with chronic atrial fibrillation and significant ASD who underwent LAA and fenestrated ASD closure from January 1, 2014 until December 31, 2019. All periprocedural and long-term (>1 year) outcomes were reported. RESULTS Six patients (male: 33.3%; mean age: 66.8 ± 3.3 years) were included. Mean CHADS2 , CHA2 DS2 -VASc , and HAS-BLED scores were 2.33 ± 0.82, 3.83 ± 0.75, and 1.83 ± 0.75. Four patients underwent simultaneous procedure, while two patients underwent a staged procedure. Procedural success was achieved in all patients. Total occlusion was achieved during LAA occlusion without device embolization prior to ASD closure. Patients who underwent simultaneous procedure had a shorter total hospital stay and lower total hospital stay. During a follow-up period of 32.8 ± 19.4 months, both the devices were well seated. No device-related thrombosis or erosion reported. All patients remained in atrial fibrillation. No patients experienced any thromboembolic stroke or transient ischemic attack. CONCLUSIONS LAA and ASD closure is feasible and can be safely performed in the same seating in elderly patients with a significant ASD.
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Affiliation(s)
- Ming Chern Leong
- Paediatric & Congenital Heart Centre, Institut Jantung Negara (National Heart Institute), Kuala Lumpur, Malaysia
| | - Geetha Kandavello
- Paediatric & Congenital Heart Centre, Institut Jantung Negara (National Heart Institute), Kuala Lumpur, Malaysia
| | - Azlan Husin
- Electrophysiology Unit, Department of Cardiology, Institut Jantung Negara (National Heart Institute), Kuala Lumpur, Malaysia
| | - Deventhiren Perumal
- Department of Imaging, Institut Jantung Negara (National Heart Institute), Kuala Lumpur, Malaysia
| | - Surinder Kaur Khelae
- Electrophysiology Unit, Department of Cardiology, Institut Jantung Negara (National Heart Institute), Kuala Lumpur, Malaysia
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17
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Sun KP, Xu N, Huang ST, Chen LW, Cao H, Chen Q. Comparison of Short-Term Quality of Life between Percutaneous Device Closure and Surgical Repair via Median Sternotomy for Atrial Septal Defect in Adult Patients. J INVEST SURG 2020; 34:1223-1230. [PMID: 32654541 DOI: 10.1080/08941939.2020.1793037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To compare the quality of life and psychological state of patients after receiving different closure treatments for atrial septal defect (ASD) and to explore some factors affecting the quality of life of patients after ASD closure. METHODS Fifty-five patients who underwent percutaneous device closure of ASD (group A) and fifty-five patients who underwent surgical repair via median sternotomy of ASD (group B) were followed up from before to one year after surgery to assess their quality of life. We used the Medical Outcomes Study 36-Item Short-Form (SF-36) and the Hospital Anxiety and Depression Scale (HADS) to evaluate the quality of life of patients. RESULTS Both groups had improved HADS scores after operation. In the comparison of the postoperative quality of life between the two groups, group A was superior to group B on some dimensions of the SF-36, and there was a significant difference in HADS scores. Age was negatively correlated with quality of life. CONCLUSIONS In adults over 18 years of age, the quality of life after surgical repair or percutaneous device closure of ASD improved significantly. Compared with surgical repair via median sternotomy, percutaneous device closure has a more significant effect on the improvement in some aspects of people's quality of life.
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Affiliation(s)
- Kai-Peng Sun
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University Fuzhou, China.,Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Ning Xu
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University Fuzhou, China.,Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Shu-Ting Huang
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University Fuzhou, China.,Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Liang-Wan Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Hua Cao
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University Fuzhou, China
| | - Qiang Chen
- Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University Fuzhou, China.,Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
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ProT-α gene transfer attenuates cardiopulmonary remedying and mortality in a flow-induced pulmonary hypertension rat model. J Heart Lung Transplant 2020; 39:1126-1135. [PMID: 32593559 DOI: 10.1016/j.healun.2020.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/13/2020] [Accepted: 05/31/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND ProT is a cell survival gene, which modulates oxidative stress and transforming growth factor (TGF)-β signaling. We hypothesized that the delivery of the ProT cDNA gene in rats could protect against right heart dysfunction secondary to pulmonary hypertension (PH) induced by left-to-right shunt. METHODS A 2-hit rat model of flow-induced PH was used, and a single intravenous injection of adenoviral vectors (2 billion plaque-forming unit) carrying ProT or Luc gene was administered. The animals were euthanized 21 days after gene delivery to assess cardiopulmonary function, serum biochemistry, pulmonary artery (PA), and vasomotor reactivity. Immunohistology and immunoblotting of PA tissues were also performed. RESULTS ProT transduction significantly reduced PA pressure, right ventricle muscle mass, and wall stress, thereby improving the overall survival of the treated rat. Increased production of ProT through gene therapy preserved both the smooth muscle myosin heavy chain-II and α-smooth muscle actin while counteracting the abundance of TGF-β in PA. Protein abundances of phosphorylated p47-phox, heme oxygenase-1, caspase-3, inducible nitric oxide synthase, cyclo-oxygenase 2, and monocyte chemoattractant protein-1 in PA tissues were reduced. ProT also preserved microRNA-223, thereby suppressing the abundance of PARP-1, which is independent of hypoxia-inducible factor-1α signaling. CONCLUSIONS ProT gene transduction improved PA function by reducing oxidative stress, attenuating inflammation, and preserving the contractile phenotype of vascular smooth muscle cells. The modification of microRNA-223-associated downstream signaling through ProT transduction may play an important role in mitigating cardiopulmonary remodeling in flow-induced PH.
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Elaborate evaluation of serial changes in electrocardiograms of atrial septal defects after transcatheter closure for a better understanding of the recovery process. Heart Vessels 2020; 35:1594-1604. [PMID: 32468142 DOI: 10.1007/s00380-020-01632-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 05/22/2020] [Indexed: 10/24/2022]
Abstract
Serial changes of electrocardiograms (ECG) could be used to assess their clinical features in atrial septal defects (ASD) after transcatheter closure together with other clinical parameters. We retrospectively studied 100 ASD patients who underwent transcatheter closure. Complications of persistent atrial fibrillation occurred in five ASD patients, and they were excluded. We divided the other 95 patients according to PQ intervals before closure (normal: < 200 ms, n = 51; prolonged: ≥ 200 ms, n = 44) to evaluate their clinical characteristics and parameters such as echocardiography, chest X-rays, and brain natriuretic protein (BNP) levels. Individuals in the prolonged PQ group were significantly older, had higher incidences of paroxysmal atrial fibrillation (PAF) and heart failure (HF) treated with more β-blockers and diuretics, and with a higher tendency of NYHA functional classification and BNP levels than the normal PQ group. The prolonged PQ group also had a significantly higher incidence of complete right bundle branch block, wider QRS intervals, and larger cardiothoracic ratios in chest X-rays accompanied by larger right atrial-areas and larger left atrial dimensions in echocardiograms. Furthermore, the prolonged PQ intervals with less PQ interval shortening after transcatheter closure revealed that the patients were the oldest at the time of closures and showed less structural normalization of the right heart and left atrium after ASD closure. PAF and HF also occurred more frequently in this subgroup. These results suggested that the ASD patients with prolonged PQ intervals with less PQ shortening were accompanied by more advanced clinical conditions. Together with other clinical parameters, detailed analyses of ECG and their changes after closure could elucidate the clinical characteristics and status of ASD patients with transcatheter closure and were useful for predicting structural normalization after transcatheter closure.
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20
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Impact of Right Ventricular Dilatation in Patients with Atrial Septal Defect. J Interv Cardiol 2020; 2020:9509105. [PMID: 32410917 PMCID: PMC7204162 DOI: 10.1155/2020/9509105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 02/25/2020] [Indexed: 11/17/2022] Open
Abstract
Objective The aim of this study was to examine the relationship between right ventricular (RV) volume and exercise capacity in adult patients with atrial septal defect (ASD) and to determine the degree of RV dilatation for transcatheter ASD closure. Background RV dilatation is an indication of transcatheter ASD closure; however, few studies have reported the clinical significance of RV dilatation. Methods We enrolled 82 consecutive patients (mean age, 49 ± 18 years; female, 68%) who underwent cardiac magnetic resonance imaging and symptom-limited cardiopulmonary exercise test before ASD closure. The relationship between RV volume and peak oxygen uptake (VO2) was evaluated. Results The mean RV end-diastolic volume index was 108 ± 27 ml/m2 (range, 46 to 180 ml/m2). The mean peak VO2 was 24 ± 7 ml/min/kg (range, 14 to 48 ml/min/kg), and the mean predicted peak VO2 was 90 ± 23%. There were significant negative relationships of RV end-diastolic volume index with peak VO2 (r = -0.28, p < 0.01) and predicted peak VO2 (r = -0.29, p < 0.01). The cutoff value of RV end-diastolic volume index <80% of predicted peak VO2 was 120 ml/m2, with the sensitivity of 49% and the specificity of 89%. Conclusions There was a relationship between RV dilatation and exercise capacity in adult patients with ASD. RV end-diastolic volume index ≥120 ml/m2 was related to the reduction in peak VO2. This criterion of RV dilatation may be valuable for the indication of transcatheter ASD closure.
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21
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Shi D, Kang Y, Zhang G, Gao C, Lu W, Zou H, Jiang H. Biodegradable atrial septal defect occluders: A current review. Acta Biomater 2019; 96:68-80. [PMID: 31158496 DOI: 10.1016/j.actbio.2019.05.073] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 05/21/2019] [Accepted: 05/29/2019] [Indexed: 01/11/2023]
Abstract
Atrial septal defect (ASD) is a common structural congenital heart disease. With the development of interventional closure devices and transcatheter techniques, interventional closure therapy has become the most well-accepted therapeutic alternative worldwide, as it offers a number of advantages over conventional therapies such as improved safety, easier operation, lower complication rates and invasiveness, and shorter anesthetic time and hospitalizations. During the past decades, various types of occluders based on nondegradable shape memory alloys have been used in clinical applications. Considering that the permanent existence of foreign nondegradable materials in vivo can cause many potential complications in the long term, the research and development of biodegradable occluders has emerged as a crucial issue for interventional treatment of ASD. This review aims to summarize partially or fully biodegradable occlusion devices currently reported in the literature from the aspects of design, construction, and evaluation of animal experiments. Furthermore, a comparison is made on the advantages and disadvantages of the materials used in biodegradable ASD occlusion devices, followed by an analysis of the problems and limitations of the occlusion devices. Finally, several strategies are proposed for future development of biodegradable cardiac septal defect occlusion devices. STATEMENT OF SIGNIFICANCE: Although occlusion devices based on nondegradable alloys have been widely used in clinical applications and saved numerouspatients, biodegradable occlusion devices may offer some advantages such as fewer complications, acceptable biocompatibility, and particularly temporary existence, thereby leaving "native" tissue behind, which will certainly become the development trend in the long term. This review summarizes almost all partially or fully biodegradable occlusion devices currently reported in the literature from the aspects of design, construction, and evaluation of animal experiments. Furthermore, a comparison is made on the advantages and disadvantages of the materials used in biodegradable ASD occlusion devices, followed by an analysis of the problems and limitations of the occlusion devices. Finally, several strategies are proposed for future development of biodegradable cardiac septal defect occlusion devices.
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Jafari Fesharaki M, Alizadehasl A, Khajali Z, Farashi M. Dislodged Interatrial Septum Occluder was Found in an Incredible Place: A Case Report. INTERNATIONAL JOURNAL OF CARDIOVASCULAR PRACTICE 2019. [DOI: 10.29252/ijcp-26405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Larsson L, Rinnström D, Sandberg C, Högström G, Thilén U, Nordström P, Johansson B. Aerobic capacity in adolescence is associated with time to intervention in adult men with atrial septal defects. Int J Cardiol 2019; 280:57-60. [PMID: 30651192 DOI: 10.1016/j.ijcard.2018.12.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 12/05/2018] [Accepted: 12/27/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Atrial septal defect (ASD) is a congenital heart lesion that often remains undiagnosed until adulthood. The reasons for this may be multifactorial. It is, however, known that closure of a hemodynamically significant ASD improves exercise capacity. This study aimed to explore whether the aerobic capacity in late adolescence is associated with time to diagnosis and intervention in adult men with late diagnosis of an atrial shunt. METHODS The Swedish Military Conscription Service Register contains data on exercise tests performed in late adolescence. By linking these data with the National Patient Register, 254 men with a later intervention for an ASD were identified. RESULTS Interventions were performed at a mean of 26.5 ± 7.9 years after the initial exercise tests. The mean absolute workload among those with a later diagnosed ASD was similar to those without a later diagnosed ASD (274 ± 51 W vs. 276 ± 52 W, p = 0.49). Men with a higher exercise capacity (≥1 SD) had their intervention earlier (21.9 ± 8.6 years vs. 27.5 ± 7.4 years, p < 0.001). CONCLUSIONS The aerobic exercise capacity was similar in adolescent men with later interventions for ASD compared to the reference population. Furthermore, those with high exercise capacity appeared to be diagnosed earlier. Thus, low exercise capacity may not be a feature of ASD during adolescence, but rather develop later in life as a natural progression of the disease.
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Affiliation(s)
- Lena Larsson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Daniel Rinnström
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Camilla Sandberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Gabriel Högström
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Ulf Thilén
- Department of Cardiology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Peter Nordström
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Bengt Johansson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
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Krueger M, Cronin P, Sayyouh M, Kelly AM. Significant incidental cardiac disease on thoracic CT: what the general radiologist needs to know. Insights Imaging 2019; 10:10. [PMID: 30725202 PMCID: PMC6365314 DOI: 10.1186/s13244-019-0693-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 01/10/2019] [Indexed: 12/20/2022] Open
Abstract
Objective Incidental cardiac findings are often found on chest CT studies, some of which may be clinically significant. The objective of this pictorial review is to illustrate and describe the appearances and management of the most frequently encountered significant cardiac findings on non-electrocardiographically gated thoracic CT. Most radiologists will interpret multidetector chest CT and should be aware of the imaging appearances, significance, and the appropriate next management steps, when incidental significant cardiac disease is encountered on thoracic CT. Conclusion This article reviews significant incidental cardiac findings which may be encountered on chest CT studies. After completing this review, the reader should not only be familiar with recognizing clinically significant cardiac findings seen on thoracic CT examinations but also have the confidence to direct their further management.
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Affiliation(s)
- Maren Krueger
- Fulford Radiology, Base Hospital, Private Bag 2016, New Plymouth, Taranaki, 4342, New Zealand
| | - Paul Cronin
- Department of Radiology, Division of Cardiothoracic Radiology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Mohamed Sayyouh
- Department of Radiology, Division of Cardiothoracic Radiology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Aine Marie Kelly
- Department of Radiology, Division of Cardiothoracic Radiology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA.
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Ananthakrishna Pillai A, Sinouvassalou S, Jagadessan KS, Munuswamy H. Spectrum of morphological abnormalities and treatment outcomes in ostium secundum type of atrial septal defects: Single center experience in >500 cases. J Saudi Heart Assoc 2019; 31:12-23. [PMID: 30364462 PMCID: PMC6197373 DOI: 10.1016/j.jsha.2018.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 08/26/2018] [Accepted: 09/23/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Transcatheter closure (TCC) has emerged as the first line treatment option for secundum type of atrial septal defects (ASD). Outcomes of TCC depend upon proper delineation of defect anatomy by transesophageal echocardiography (TEE). Stability and proper placement of the device mandates adequate rims and proper alignment to the septum. Failed or unfavorable morphology for TCC requires referral for surgical repair. METHODS We prospectively analyzed the ASD patients who were referred for treatment. The morphological features of the defect were evaluated and the outcomes of TCC studied. Patients who undergo TCC and surgical repair were followed for immediate and long-term outcome comparison. RESULTS Of the 512 patients who underwent treatment, TCC was attempted in 430/512 (83.2%) patients. It was successful in 393/430 (91.3%) patients. The remaining 119 patients underwent surgical patch closure. Twenty patients had failure of device alignment and device embolization occurred in 17 patients. Very large defect size ≥35 mm, absent or deficient posterior rim, absent/deficient inferior naval rim showed high chances for failure and formed major reasons for surgical referral. The surgical group had higher success (100%) across all anatomic variables. However, they had longer intensive care unit (ICU) and hospital stay (p < 0.001). CONCLUSION TCC offered a success rate of 91% in complex defects after TEE selection. Very large size and deficient inferior, posterior rims predicted failure of TCC. Surgery offered 100% success and it involved a longer hospital and ICU stay. The long-term clinical results were identical with both treatment modalities.
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Affiliation(s)
- Ajith Ananthakrishna Pillai
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, IndiaIndia
| | - Shabnasri Sinouvassalou
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, IndiaIndia
| | - Kabilan S Jagadessan
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, IndiaIndia
| | - Hemachandren Munuswamy
- Department of Cardiothoracic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, IndiaIndia
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Impact of modified techniques of transcatheter closure in large atrial septal defects (⩾30 mm) with anatomic complexities. Cardiol Young 2018; 28:1122-1133. [PMID: 30033909 DOI: 10.1017/s1047951118001099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The outcome of transcatheter closure in ostium secundum atrial septal defects is determined by the morphology of the defects. Modified techniques such as balloon assistance, pulmonary vein deployment, left atrial roof technique, and so on are used for circumventing the anatomic complexities and increasing the success rates. METHODS We planned a prospective study looking at the outcomes of transcatheter closure in secundum atrial septal defects with modified techniques in different anatomic complexities identified in transoesophageal echocardiography and their association with outcome of transcatheter closure. RESULTS Transcatheter closure was successful in 295 out of 346 (82%) patients with modified techniques. Balloon-assisted technique offered a success rate of 87%. The mean defect size was 34.7±2.78 mm (95% confidence interval (CI) 30.67-43.1 mm) with success and 40.16±4.5 mm (95% CI 32.16-44.7) with failure (p = 0.02). The mean total septal length was 38.11±0.63 (95% CI 35.21-40.56 mm) with success and 42.54±0.34 (95% CI 38.79-43.21 mm) with failure. The defect to septal ratios were 0.82 and 0.94 in success and failure groups, respectively (p=0.02). However, the absence of a retro-aortic margin, septal aneurysm, and multiple defects did not affect the success rate. Deficient inferior vena caval margin, deficient posterior margin, and size⩾40 mm had a high risk of failure with transcatheter closure. The odds ratio for procedural failure was 25.3 (4.3-143.8) in patients with malaligned septum, 8.3(1.4-48.5) with deficient inferior vena caval margin, and 4.1(2.5-19) for size⩾40 mm. CONCLUSIONS The modified techniques for device deployment offer substantial chances of success in transcatheter closure of secundum atrial septal defects with anatomical complexity (82%). Variants such as defect size of⩾40 mm and deficient inferior and posterior margins have high failure rates with a modified technique.
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Rigatelli G, Zuin M, Nghia NT. Interatrial shunts: technical approaches to percutaneous closure. Expert Rev Med Devices 2018; 15:707-716. [DOI: 10.1080/17434440.2018.1526674] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Gianluca Rigatelli
- Section of Congenital and Structural Heart Disease Interventions, Cardiovascular Diagnosis and Endoluminal Interventions Unit, Rovigo General Hospital, Rovigo, Italy
| | - Marco Zuin
- Section of Internal and Cardiopulmonary Medicine, Department of Medical Science, University of Ferrara, Ferrara, Italy
- Department of Cardiology, Rovigo General Hospital, Rovigo, Italy
| | - Nguyen Tuong Nghia
- Department of Interventional cardiology, Cho-Ray Hospital, Ho Chi minh City, Vietnam
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Cressman S, Rheinboldt M, Klochko C, Nadig J, Spizarny D. Chest Radiographic Appearance of Minimally Invasive Cardiac Implants and Support Devices: What the Radiologist Needs to Know. Curr Probl Diagn Radiol 2018; 48:274-288. [PMID: 30033187 DOI: 10.1067/j.cpradiol.2018.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 05/01/2018] [Accepted: 05/18/2018] [Indexed: 11/22/2022]
Abstract
Minimally invasive implantable cardiac devices used in valve repair and replacement, cardiovascular support, and partial chamber and appendageal occlusion represent a burgeoning area of both bioengineering and clinical innovation. In addition to familiarizing the reader with the radiographic appearance of the most commonly utilized and encountered newer devices, this review will also address the relevant clinical and pathophysiological indications for usage and deployment as well as potentially encountered complications.
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Affiliation(s)
| | | | - Chad Klochko
- Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI
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Yang MC, Wu JR. Recent review of transcatheter closure of atrial septal defect. Kaohsiung J Med Sci 2018; 34:363-369. [PMID: 30063008 DOI: 10.1016/j.kjms.2018.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 05/02/2018] [Accepted: 05/04/2018] [Indexed: 01/11/2023] Open
Abstract
Atrial septal defect (ASD) is one of the two most common congenital heart diseases in children and adult. After the application of catheter intervention for ASD, this became an alternative treatment other than surgery from late 1990. In 2001, the procedure was further approved by the US Food and Drug Administration (FDA), and become the first choice for most cases of secundum type of ASD worldwide. The success rate is more than 98% in literature reviews, with low complication rates in percutaneous ASD closure. Major complications are around 1%, including device embolization, cardiac erosions, new-onset atrial arrhythmia, and other comorbidities. We reviewed indications for percutaneous secundum type ASD closure, technique, successful rate and major complications in this article. To complete the catheter intervention with difficult ASD conditions, various procedural techniques have been developed recently. We also report a challenging case by a current balloon-assisted technique for huge ASD closure.
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Affiliation(s)
- Ming-Chun Yang
- Department of Pediatrics, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan
| | - Jiunn-Ren Wu
- Department of Pediatrics, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan.
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Dewi LG, Yantie NP, Gunawijaya E. Cardiac catheterization and percutaneus catheter in grown-up congenital heart diseases: single center experience at developing country. MEDICAL JOURNAL OF INDONESIA 2018. [DOI: 10.13181/mji.v27i1.2284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
Background: Grown-up congenital heart disease (GUCH) patients are unique and challenges especially at developing country. The numbers of diagnostic as well as interventional cardiac catheterization procedures in GUCH patients are growing. The aim of this study was to report the outcome of cardiac catheterization including intervention procedure in GUCH.Methods: The descriptive study was conducted at Sanglah Hospital, Denpasar, Bali, Indonesia. All patients (age of more than 12 years) who underwent cardiac catheterization from 2011 until 2017 were included in this study. Patients, characteristic, types of catheter procedures, immediate complications, and outcomes were documented.Results: A total 54 subjects were included with median age of 23 years and 70% were female. The first symptom that brought patients to hospital is dyspnea 46% and palpitation 32%. Five subjects underwent a diagnostic catheter procedure and 49 (91%) diagnostic and catheter based interventions. Transcatheter interventions procedures included atrial septal defect (ASD) (success rate of 20 per 21), patent ductus arteriosus (PDA) (success rate of 16 per16), ventricular septal defect (VSD) (success rate of 9 per 9), pulmonal stenosis (PS) (success rate of 1 per 2), and aortic stenosis (AS) (success rate of 1 per 1). The complications encountered were transient dysrhythmias in 15 subjects, device embolization in 4 subjects, massive bleeding in 1 subject, and overall mortality in 2 subjects.Conclusion: The number of the catheterization interventions in GUCH was 91% and ASD device closure was the most common procedure. Transcatheter intervention has a high procedural success rates (96%) and low procedural-related complications.
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Jia Y, Meng X, Li Y, Xu C, Zeng W, Jiao Y, Han W. Percutaneous occluder device closure through femoral vein guidance by transthoracic echocardiography in adult atrial septal defect patients. J Thorac Dis 2018; 10:1460-1467. [PMID: 29707295 DOI: 10.21037/jtd.2018.02.06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background This study aimed to summarize percutaneous occluder device closure of atrial septal defects (ASD) through the femoral vein, using guidance by transthoracic echocardiography under local anesthesia without radiation or fluoroscopic guidance. Methods This was a case series of fourteen patients, 3 males and 11 females, diagnosed with central ASD, the diameter of the defect ranged from 9 to 32 mm, and the patients had no other heart malformations or organ dysfunction. The patients underwent a novel surgical technique of occluder device closure for ASD. The occluder closure procedures were completed through puncture of the femoral vein, and fluoroscopy-free catheter guidance by transthoracic echography without radiation. Results All of the cases had successful closure of the ASD, without residual shunt or complications. The median operation time was 18.7±22.5 min (range, 12-56 min), with no ICU-stay time and a short hospital stay of 2.3±0.5 days (range, 1-3 days). All patients were followed up for 2 years and there were no cases of residual shunt. All occluders remained in place. Conclusions Percutaneous occluder device closure of ASDs through the femoral vein with fluoroscopy-free guidance by transthoracic echography without radiation under local anesthesia could be an easy choice for some simple ASD patients, and may also be favored by cardiac surgeons.
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Affiliation(s)
- Yixin Jia
- Department of Cardiac Surgery, Capital Medical University Affiliated Anzhen Hospital, Beijing 100029, China
| | - Xu Meng
- Department of Cardiac Surgery, Capital Medical University Affiliated Anzhen Hospital, Beijing 100029, China
| | - Yan Li
- Department of Cardiac Surgery, Capital Medical University Affiliated Anzhen Hospital, Beijing 100029, China
| | - Chunlei Xu
- Department of Cardiac Surgery, Capital Medical University Affiliated Anzhen Hospital, Beijing 100029, China
| | - Wen Zeng
- Department of Cardiac Surgery, Capital Medical University Affiliated Anzhen Hospital, Beijing 100029, China
| | - Yuqing Jiao
- Department of Cardiac Surgery, Capital Medical University Affiliated Anzhen Hospital, Beijing 100029, China
| | - Wei Han
- Department of Cardiac Surgery, Capital Medical University Affiliated Anzhen Hospital, Beijing 100029, China
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Nguyên UC, Weijs B, Luyten P, Blokzijl C, Witsenburg M, Volders PG, Bekkers SC. Late complications of an atrial septal occluder provoked by anticoagulant therapy. J Cardiol Cases 2018; 17:68-71. [PMID: 30279858 PMCID: PMC6149637 DOI: 10.1016/j.jccase.2017.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 09/13/2017] [Accepted: 09/28/2017] [Indexed: 11/19/2022] Open
Abstract
Late complications of an atrial septal occluder device (ASO) are rare but may be serious. We report a case with extensive hemopericardium five years after ASO implantation most likely triggered by anticoagulant therapy. Although not surgically confirmed, indirect clues for erosion of the atrial wall by the device were the exclusion of other etiologies, lack of recurrence after pericardial drainage and withdrawal of anticoagulants. In addition, multimodality imaging using echocardiography, computed tomography, and cardiac magnetic resonance imaging were helpful to elucidate this unusual cause. Initiation of anticoagulant treatment in patients with an ASO should be carefully balanced and may warrant more frequent echocardiographic follow-up. .
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Affiliation(s)
- Uyên Châu Nguyên
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Physiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Bob Weijs
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Peter Luyten
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Carin Blokzijl
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Maarten Witsenburg
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Paul G.A. Volders
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Sebastiaan C.A.M. Bekkers
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
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Tashiro H, Suda K, Iemura M, Teramachi Y. Intergenerational differences in the effects of transcatheter closure of atrial septal defects on cardiac function. J Cardiol 2017; 70:620-626. [PMID: 28511801 DOI: 10.1016/j.jjcc.2017.03.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Revised: 03/14/2017] [Accepted: 03/19/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Little is known regarding intergenerational differences in the effects of atrial sepal defect (ASD) closure on the left heart. We therefore analyzed age-related serial changes in the left heart following ASD closure. METHODS We studied 50 patients with an isolated ASD who underwent successful transcatheter closure using Amplatzer septal occluders (St. Jude Medical, Little Canada, MN, USA) between June 2007 and June 2013. Patients were divided into three age groups: young patients aged ≤17 years; middle-aged patients aged 18-50 years; and older patients aged >50 years. Multi-modal echocardiographic studies with different views were performed before and at 1 day, 1-3 months, and 6-12 months after ASD closure. Echocardiographic variables were compared among the groups at different time points after closure. RESULTS Left ventricular end-diastolic and end-systolic volume indices (EDVI and ESVI) in the older group were significantly smaller than those in the other groups before closure. EDVI and ESVI increased with time after closure in all groups with stable ejection fractions. However, EDVI and ESVI remained significantly smaller in the older group compared with the other groups. There was a significant interaction among the age groups only in terms of left atrial volume index (LAVI). LAVI increased significantly with time in the older group, but did not change in the other groups. CONCLUSION Although the left ventricle enlarged with time after ASD closure in all age groups, left ventricular size in older patients never reached that in younger patients. In addition to this inadequate enlargement of the left ventricle, diastolic dysfunction might also result in late left atrial enlargement in older patients following ASD closure.
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Affiliation(s)
- Hideki Tashiro
- Division of Cardiology, St. Mary's Hospital, Kurume, Japan.
| | - Kenji Suda
- Department of Pediatrics, Kurume University, Kurume, Japan
| | - Motofumi Iemura
- Division of Pediatric Cardiology, St. Mary's Hospital, Kurume, Japan
| | - Youzou Teramachi
- Division of Pediatric Cardiology, St. Mary's Hospital, Kurume, Japan
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Schneeberger Y, Schaefer A, Conradi L, Brickwedel J, Reichenspurner H, Kozlik-Feldmann R, Detter C. Minimally invasive endoscopic surgery versus catheter-based device occlusion for atrial septal defects in adults: reconsideration of the standard of care. Interact Cardiovasc Thorac Surg 2017; 24:603-608. [PMID: 28040751 DOI: 10.1093/icvts/ivw366] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 10/10/2016] [Indexed: 11/14/2022] Open
Abstract
Objectives Percutaneous ostium secundum atrial septal defect (ASD II) closure has become the standard of care for treatment of congenital ASD II in adults. Nevertheless, patients are frequently ineligible for this technique due to challenging morphology. In such cases, closure via minimally invasive cardiac surgery (MICS) is an appropriate treatment option. The aim of this study is to compare outcomes of MICS and use of a percutaneous Amplatzer septal occluder (ASO) device for treatment of ASD II in adults. Methods From July 2002 to June 2014, 95 patients underwent MICS for congenital ASD II closure. During the same period, 169 patients underwent ASO procedure. Outcomes in terms of remaining ASD II, new onset atrial fibrillation (AF), post-interventional stroke, myocardial infarction and the post procedural implementation of anticoagulation were compared. Results Apart from age (38.3 ± 12.7 vs 49.6 ± 15.7 years, P < 0.0001) the groups did not differ in baseline characteristics. A significantly higher rate of residual ASD II was found in the ASO group at 3 months (0% vs 30.8%, P < 0.0001), 6 months (0% vs 15.9%, P < 0.0001) and 12 months follow-up (0% vs 7.1%, P = 0.005). A significantly higher rate of new-onset AF was seen in the ASO group (0% vs 9.5%, P = 0.0008). Conclusions MICS for ASD II is a safe and reproducible procedure with 0% mortality in our cohort. More complete closure of ASD, decreased rates of new onset AF and decreased need for oral anticoagulation are the advantages of the MICS procedure. Compared with the current standard of care, the MICS approach is feasible regardless of ASD morphology.
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Affiliation(s)
- Yvonne Schneeberger
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - Andreas Schaefer
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - Jens Brickwedel
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | | | - Rainer Kozlik-Feldmann
- Department of Pediatric Cardiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Detter
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
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Takaya Y, Akagi T, Kijima Y, Nakagawa K, Watanabe N, Oe H, Taniguchi M, Ito H. Echocardiographic Estimates of Left Ventricular Diastolic Dysfunction Do Not Predict the Clinical Course in Elderly Patients Undergoing Transcatheter Atrial Septal Defect Closure: Impact of Early Diastolic Mitral Annular Velocity. J Interv Cardiol 2017; 30:79-84. [DOI: 10.1111/joic.12365] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Yoichi Takaya
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine; Dentistry and Pharmaceutical Science; Okayama Japan
| | - Teiji Akagi
- Cardiac Intensive Care Unit, Okayama University Graduate School of Medicine; Dentistry and Pharmaceutical Science; Okayama Japan
| | - Yasufumi Kijima
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine; Dentistry and Pharmaceutical Science; Okayama Japan
| | - Koji Nakagawa
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine; Dentistry and Pharmaceutical Science; Okayama Japan
| | - Nobuhisa Watanabe
- Division of Medical Support; Okayama University Hospital; Okayama Japan
| | - Hiroki Oe
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine; Dentistry and Pharmaceutical Science; Okayama Japan
| | - Manabu Taniguchi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine; Dentistry and Pharmaceutical Science; Okayama Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine; Dentistry and Pharmaceutical Science; Okayama Japan
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Zdradzinski MJ, Elkin RL, Lee JM, Qureshi AM, El-Mallah W, Krasuski RA. Contributors to and impact of residual shunting after device closure of atrial septal defects. Am Heart J 2016; 177:112-9. [PMID: 27297856 DOI: 10.1016/j.ahj.2016.03.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Accepted: 03/30/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND The prevalence of residual shunt in patients after device closure of atrial septal defect and its impact on long-term outcome has not been previously defined. METHODS From a prospective, single-institution registry of 408 patients, we selected individuals with agitated saline studies performed 1 year after closure. Baseline echocardiographic, invasive hemodynamic, and comorbidity data were compared to identify contributors to residual shunt. Survival was determined by review of the medical records and the Social Security Death Index. Survival analysis according to shunt included construction of Kaplan-Meier curves and Cox proportional hazards modeling. RESULTS Among 213 analyzed patients, 27% were men and age at repair was 47 ± 17 years. Thirty patients (14%) had residual shunt at 1 year. Residual shunt was more common with Helex (22%) and CardioSEAL/STARFlex (40%) occluder devices than Amplatzer devices (9%; P = .005). Residual shunts were more common in whites (79% vs 46%, P = .004). At 7.3 ± 3.3 years of follow-up, 13 (6%) of patients had died, including 8 (5%) with Amplatzer, 5 (25%) with CardioSEAL/STARFlex, and 0 with Helex devices. Patients with residual shunting had a higher hazard of death (20% vs 4%, P = .001; hazard ratio 4.95 [1.59-14.90]). In an exploratory multivariable analysis, residual shunting, age, hypertension, coronary artery disease, and diastolic dysfunction were associated with death. CONCLUSIONS Residual shunt after atrial septal defect device closure is common and adversely impacts long-term survival.
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Affiliation(s)
- Michael J Zdradzinski
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH
| | - Rachel L Elkin
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH
| | - Joanne M Lee
- Cardiovascular Medicine, Cleveland Clinic's Heart and Vascular Institute, Cleveland, OH
| | - Athar M Qureshi
- Pediatric Cardiology, Texas Children's Hospital/Baylor College of Medicine, Houston, TX
| | - Wael El-Mallah
- Cardiovascular Medicine, Texas Tech University Health Sciences Center, Lubbock, TX
| | - Richard A Krasuski
- Cardiology Division, Duke University Health System/Duke University School of Medicine, Durham, NC.
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Kijima Y, Akagi T, Takaya Y, Akagi S, Nakagawa K, Kusano K, Sano S, Ito H. Treat and Repair Strategy in Patients With Atrial Septal Defect and Significant Pulmonary Arterial Hypertension. Circ J 2016; 80:227-34. [DOI: 10.1253/circj.cj-15-0599] [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] [Indexed: 11/09/2022]
Affiliation(s)
- Yasufumi Kijima
- Department of Cardiovascular Medicine, Okayama University Hospital
| | - Teiji Akagi
- Cardiac Intensive Care Unit, Okayama University Hospital
| | - Yoichi Takaya
- Department of Cardiovascular Medicine, Okayama University Hospital
| | - Satoshi Akagi
- Department of Cardiovascular Medicine, Okayama University Hospital
| | - Koji Nakagawa
- Department of Cardiovascular Medicine, Okayama University Hospital
| | - Kengo Kusano
- Department of Cardiovascular Medicine, Okayama University Hospital
| | - Shunji Sano
- Cardiac Intensive Care Unit, Okayama University Hospital
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Hospital
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Lee WC, Fang CY, Huang CF, Lin YJ, Wu CJ, Fang HY. Predictors of Atrial Septal Defect Occluder Dislodgement. Int Heart J 2015; 56:428-31. [PMID: 26118595 DOI: 10.1536/ihj.15-065] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of this study was to identify the factors that influence atrial septal occluder dislodgement in adults and children.From June 2003 to June 2013, a total of 213 patients (115 adults and 98 children) diagnosed with secundum atrial septal defects (ASD) underwent transcatheter closure of their defects with an atrial septal occluder (ASO) in our hospital. The ASO was implanted under transesophageal echocardiography (TEE) guidance. Ten patients suffered from ASO dislodgement, and the other 203 patients comprised the successful group. We compared the preprocedural data related to general demographics, defects, margins, and minor post-implantation complications between the two groups with the goal of identifying the factors that affected ASO dislodgement.Univariate logistic regression analyses identified a high Qp/Qs value, the Qp/Qs ratio > 3.13, ASO size, ASO size greater than 32 mm, ASO size/BSA ratio > 15.13 and IAS erosion, floppiness or aneurysm formation as factors with significant predictive value. Multivariate analysis revealed that a Qp/Qs ratio > 3.13, and interatrial septum (IAS) erosion, floppiness and aneurysm formation post-implantation were independent predictors of ASO dislodgement (P = 0.001 and P = 0.006, respectively) in both adults and children.Percutaneous device closure of ASDs is safe and effective in the current era. The Qp/Qs ratio > 3.13 and IAS erosion, floppiness or aneurysm formation post-implantation might be predictors of ASO dislodgement in adults and children.
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Affiliation(s)
- Wei-Chieh Lee
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital - Kaohsiung Medical Center, Chang Gung University, College of Medicine
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