1
|
Van Ligten MJ, Rappaport DE, Querin LB, Martini WA. Atrial Septal Defect (ASD) Repair Unveiling an Unusual Conduction Conundrum: A Wenckebach Case Report. Cureus 2024; 16:e62073. [PMID: 38993432 PMCID: PMC11238892 DOI: 10.7759/cureus.62073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2024] [Indexed: 07/13/2024] Open
Abstract
Atrial septal defects are a common congenital malformation that can lead to an elevated risk for stroke due to the bypass of the lungs by deep vein thrombosis, as well as the expected repercussions of pulmonary hypertension if left untreated. Surgical intervention is definitive; however, recent advancements in treatment options, such as percutaneous intervention, represent a safer and equally effective way to treat this congenital complication. While safer, percutaneous interventions can also lead to adverse events that may force patients to present to the emergency department. Here, we present a unique case of a patient with congenital atrial septal defect status post-percutaneous intervention who developed a new-onset second-degree AV block, Mobitz type 1 Wenckebach rhythm.
Collapse
|
2
|
Kauling RM, Pelosi C, Cuypers JAAE, van den Bosch AE, Hirsch A, Carvalho JG, Bowen DJ, Kardys I, Bogers AJJC, Helbing WA, Roos-Hesselink JW. Long term outcome after surgical ASD-closure at young age: Longitudinal follow-up up to 50 years after surgery. Int J Cardiol 2024; 397:131616. [PMID: 38030038 DOI: 10.1016/j.ijcard.2023.131616] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 11/10/2023] [Accepted: 11/23/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVES To describe the clinical outcome and quality of life up to 50 years after surgical atrial septal defect (ASD) closure at young age. Primary outcome is defined as MACE (all-cause mortality, cardiac re-interventions, ischemic stroke, endocarditis, heart failure and symptomatic arrhythmia). METHODS Single-center, longitudinal cohort-study evaluating 135 consecutive patients who underwent ASD-closure before the age of 15 years between 1968 and 1980. Participants were invited for extensive cardiac evaluation and assessment of quality-of-life every 10 years. RESULTS Eighty patients (86%) of 93 eligible survivors were included in this study (mean age 52 ± 5 years (range 41-63), 40% male). Median follow-up since surgery was 45 years (range 40-51). Cumulative survival after 50 years was 86% and comparable to the normal Dutch population. Cumulative event-free survival after 45 and 50-years was 59% and 46% respectively (re-intervention in 6, symptomatic arrhythmia in 25, and pacemaker implantation in 10 patients). Right ventricular ejection fraction on CMR was diminished in 6%. Exercise capacity was normal in 77%. There was no pulmonary hypertension. NT-proBNP was elevated in 61%. Quality of life was comparable with the general population. No predictors for late events were identified. CONCLUSION Long-term survival after surgical ASD-closure in childhood is good and not statistically different at 50 years compared to the normal Dutch population. Re-intervention rate is low, there is no pulmonary hypertension. Right ventricular function was diminished in 6%, exercise capacity was good and stable over time with quality of life comparable to the general population. However, supraventricular tachycardia is common.
Collapse
Affiliation(s)
- Robert M Kauling
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), Amsterdam, the Netherlands.
| | - Chiara Pelosi
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Judith A A E Cuypers
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), Amsterdam, the Netherlands
| | - Annemien E van den Bosch
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), Amsterdam, the Netherlands
| | - Alexander Hirsch
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - João G Carvalho
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Radiology, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Daniel J Bowen
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Isabella Kardys
- Clinical Epidemiology and Innovation Unit, Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Wim A Helbing
- Department of Pediatrics, division of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Jolien W Roos-Hesselink
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), Amsterdam, the Netherlands
| |
Collapse
|
3
|
Abdul Jabbar A, Jaradat M, Hasan M, Yoo JW, Jenkins JS, Crittendon I, Lucas VS, Ramee S, Collins T. Systematic review of multiple versus single device closure of Secundum atrial septal defects in adults. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 58:90-97. [PMID: 37596193 DOI: 10.1016/j.carrev.2023.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/24/2023] [Accepted: 07/31/2023] [Indexed: 08/20/2023]
Abstract
INTRODUCTION Multiple device closure (MDC) strategy has been used in treating of complex Atrial septal defects (ASDs) in adults. The safety profile of MDC compared to conventional single device closure (SDC) is unknown in this population. This report represents the first review examining the outcomes of single versus multiple device ASD closure in adults with ostium secundum defects. METHODS Literature databases and manual search from their inception until June 30th, 2017 followed the Preferred Reporting Items of Systemic Review and Meta-Analysis (PRISMA) guideline. Main outcomes are 1) overall complication incidence, 2) arrhythmia incidence, 3) residual shunt rate. Each outcome profile was pooled by MDC and SDC, respectively and chi-square analysis was applied to examine statistical significance between MDC and SDC strategies (two-sided and p < .050). RESULTS A total of 1806 + studies were initially screened, and 20 studies were finally selected (MDC group, 147 patients; SDC group, 1706 patients). There was no difference in overall complication incidence (χ2 = 1.269; p = .259) and arrhythmia incidence (χ2 = 0.325; p = .568) between MDC and SDC. There was no difference in residual shunt rate between the SDC (4.10 %; 70/1706) and MDC groups (6.80 %; 10/147; χ2 = 2.387; p = .122). CONCLUSIONS The outcomes of percutaneous multiple ASD closure (MDC) seem to be safe and effective as compared to conventional single ASD (SDC) closure in terms of device - related complications and technical success of the procedure. Prospective registry data and randomized trials are needed to determine the long-term outcomes of percutaneous ASD closure using MDC.
Collapse
Affiliation(s)
- Ali Abdul Jabbar
- Section of Interventional Cardiology, Cardiology Department, John Ochsner Heart and vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, United States of America; The Tampa Bay Heart Institue at HCA Florida Northside Hospital, University of South Florida Morsani College of Medicine, HCA West FL Division GME Program, St. Petersburg, FL, United States of America
| | - Mohammad Jaradat
- Department of Internal Medicine, University of Nevada School of Medicine, Las Vegas, NV, United States of America
| | - Mohanad Hasan
- Section of Interventional Cardiology, Cardiology Department, John Ochsner Heart and vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, United States of America
| | - Ji Won Yoo
- Department of Internal Medicine, University of Nevada School of Medicine, Las Vegas, NV, United States of America
| | - J Stephen Jenkins
- Section of Interventional Cardiology, Cardiology Department, John Ochsner Heart and vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, United States of America
| | - Ivory Crittendon
- Section of Pediatric Cardiology, Cardiology Department, John Ochsner Heart and vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, United States of America
| | - Victor S Lucas
- Section of Pediatric Cardiology, Cardiology Department, John Ochsner Heart and vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, United States of America
| | - Stephen Ramee
- Section of Interventional Cardiology, Cardiology Department, John Ochsner Heart and vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, United States of America
| | - Tyrone Collins
- Section of Interventional Cardiology, Cardiology Department, John Ochsner Heart and vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, United States of America; Section of Pediatric Cardiology, Cardiology Department, John Ochsner Heart and vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, United States of America.
| |
Collapse
|
4
|
Sjöberg P, Arheden H, Heiberg E, Stephensen S, Carlsson M. Haemodynamic left-ventricular changes during dobutamine stress in patients with atrial septal defect assessed with magnetic resonance imaging-based pressure-volume loops. Clin Physiol Funct Imaging 2022; 42:422-429. [PMID: 35838181 PMCID: PMC9796342 DOI: 10.1111/cpf.12781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 06/03/2022] [Accepted: 07/13/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Atrial septal defect (ASD) results in a left-to-right shunt causing right-ventricular (RV) volume overload and decreased cardiac output from the left ventricle. Pressure-volume (PV) loops enable comprehensive assessment of ventricular function and might increase understanding of the pathophysiology of ASD. The aim of this study was to investigate if left-ventricular (LV) haemodynamic response to stress in patients with ASD differs from controls. MATERIAL AND METHODS Patients with ASD (n = 18, age 51 ± 18) and healthy controls (n = 16, age 35 ± 13) underwent cardiac magnetic resonance (CMR) and brachial cuff pressure measurements at rest and during dobutamine stress. An in-house, validated method was used to compute PV loops. RESULTS Patients had lower stroke work, potential energy and external power at rest than controls (p < 0.001; p < 0.05; p < 0.05). Stroke work and external power increased and potential energy decreased during stress in patients (p < 0.05; p < 0.0001; p < 0.01) and controls (p < 0.0001; p < 0.001; p < 0.01). Contractility and arterial elastance at rest were higher in patients than controls (p < 0.01; p < 0.01). Contractility increased during stress in both groups (p < 0.0001; p < 0.001). There was no difference between patients and controls in arterio-ventricular coupling. CONCLUSION LV haemodynamic response to stress can be assessed using noninvasive PV loops derived from CMR and brachial blood pressure. Patients with ASD had normal LV energy efficiency, in contrast to other patient groups with decreased cardiac output. Data suggest that patients with ASD had an increased inotropic level at rest with high contractility and heart rate but were able to respond with a further increase during stress, albeit to not as high a cardiac output as controls.
Collapse
Affiliation(s)
- Pia Sjöberg
- Department of Clinical Sciences Lund, Skåne University Hospital, Clinical PhysiologyLund UniversityLundSweden
| | - Håkan Arheden
- Department of Clinical Sciences Lund, Skåne University Hospital, Clinical PhysiologyLund UniversityLundSweden
| | - Einar Heiberg
- Department of Clinical Sciences Lund, Skåne University Hospital, Clinical PhysiologyLund UniversityLundSweden,Wallenberg Centre for Molecular MedicineLund UniversityLundSweden
| | - Sigurdur Stephensen
- Department of Clinical Sciences Lund, Skåne University Hospital, Clinical PhysiologyLund UniversityLundSweden
| | - Marcus Carlsson
- Department of Clinical Sciences Lund, Skåne University Hospital, Clinical PhysiologyLund UniversityLundSweden
| |
Collapse
|
5
|
Wang J, Xie W, Cheng M, Wu Q, Wang F, Li P, Fan B, Zhang X, Wang B, Liu X. Assessment of Transcatheter or Surgical Closure of Atrial Septal Defect using Interpretable Deep Keypoint Stadiometry. RESEARCH (WASHINGTON, D.C.) 2022; 2022:9790653. [PMID: 36340508 PMCID: PMC9620637 DOI: 10.34133/2022/9790653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/03/2022] [Indexed: 12/01/2023]
Abstract
Automated echocardiogram interpretation with artificial intelligence (AI) has the potential to facilitate the serial diagnosis of heart defects by primary clinician. However, the fully automated and interpretable analysis pipeline for suggesting a treatment plan is largely underexplored. The present study targets to build an automatic and interpretable assistant for the transthoracic echocardiogram- (TTE-) based assessment of atrial septal defect (ASD) with deep learning (DL). We developed a novel deep keypoint stadiometry (DKS) model, which learns to precisely localize the keypoints, i.e., the endpoints of defects and followed by the absolute distance measurement with the scale. The closure plan and the size of the ASD occluder for transcatheter closure are derived based on the explicit clinical decision rules. A total of 3,474 2D and Doppler TTE from 579 patients were retrospectively collected from two clinical groups. The accuracy of closure classification using DKS (0.9425 ± 0.0052) outperforms the "black-box" model (0.7646 ± 0.0068; p < 0.0001) for within-center evaluation. The results in cross-center cases or using the quadratic weighted kappa as an evaluation metric are consistent. The fine-grained keypoint label provides more explicit supervision for network training. While DKS can be fully automated, clinicians can intervene and edit at different steps of the process as well. Our deep learning keypoint localization can provide an automatic and transparent way for assessing size-sensitive congenital heart defects, which has huge potential value for application in primary medical institutions in China. Also, more size-sensitive treatment planning tasks may be explored in the future.
Collapse
Affiliation(s)
- Jing Wang
- School of Basic Medical Sciences, Capital Medical University, Beijing 10069, China
| | - Wanqing Xie
- Department of Intelligent Medical Engineering, School of Biomedical Engineering, Anhui Medical University, Hefei 230032, China
- Beth Israel Deaconess Medical Center, Harvard Medical School, Harvard University, Boston, MA 02215, USA
| | - Mingmei Cheng
- Department of Intelligent Medical Engineering, School of Biomedical Engineering, Anhui Medical University, Hefei 230032, China
| | - Qun Wu
- Heart Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 10045, China
| | - Fangyun Wang
- Heart Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 10045, China
| | - Pei Li
- Heart Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 10045, China
| | - Bo Fan
- School of Basic Medical Sciences, Capital Medical University, Beijing 10069, China
| | - Xin Zhang
- Heart Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 10045, China
| | - Binbin Wang
- Center for Genetics, National Research Institute for Family Planning, Beijing 100730, China
- Graduated school, Peking Union Medical College, Beijing 100730, China
| | - Xiaofeng Liu
- Gordon Center for Medical Imaging, Harvard Medical School, and Massachusetts General Hospital, Boston, MA 02114, USA
| |
Collapse
|
6
|
Choi JH, Kim JY, Hwang JK, Kim HR, Chung TW, Kim J, Park SW, Kang IS, Song J, Park SJ, Park KM, On YK, Kim JS, Huh J. Assessment of left atrial remodeling using speckle tracking echocardiography after percutaneous atrial septal defect closure in adult patients. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2022. [DOI: 10.1186/s42444-022-00074-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Atrial fibrillation (AF) is a well-known, long-term complication of atrial septal defect (ASD) in adults, even after device closure. Left atrial (LA) strain rate applied to the analysis of chamber function has been demonstrated to be an important predictor of LA reverse remodeling. This study aimed to determine the changes in chamber function after device closure of ASD.
Methods
This prospective study enrolled adults with secundum ASD undergoing transcatheter device closure from December 2016 to August 2017. We analyzed the clinical characteristics and LA strain rate before and six months after ASD closure.
Results
A total of 11 patients were enrolled. The mean age was 42.6 ± 9.9 years, and six (54.5%) were females. There was no significant change of conventional echocardiographic parameters after ASD closure. The mean global LA reservoir strain rate before ASD closure was 1.17 ± 0.34 and 0.85 ± 0.30 after ASD closure (p = 0.030). The median global LA conduit strain rate was 0.68 (0.42–1.16) and 0.41 (0.16–0.79) before and after ASD closure (p = 0.213), respectively. The mean global LA contractile strain rate at the six-month follow-up showed significant improvement compared with pre-procedural strain rate (0.33 ± 0.65 vs. − 0.43 ± 0.38, p = 0.006).
Conclusions
LA functional changes occurred during the six-month follow-up, while LA and right atrial (RA) geometric changes were not significant. LA reverse remodeling was proved by restoration of LA late diastolic contractile function.
Collapse
|
7
|
Ahern S, McMahon CJ, Nölke L. An invited commentary on 'Clinical outcomes of early closure versus conservative diagnosis with atrial septal defect: a nationwide population-based cohort study'. Eur J Cardiothorac Surg 2022; 62:6555519. [PMID: 35349672 DOI: 10.1093/ejcts/ezac199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Shane Ahern
- Department of Cardiothoracic Surgery, Children's Health Ireland (CHI) at Crumlin, Dublin, Ireland
| | - Colin J McMahon
- Department of Cardiology, Children's Health Ireland (CHI) at Crumlin, Dublin, Ireland
| | - Lars Nölke
- Department of Cardiothoracic Surgery, Children's Health Ireland (CHI) at Crumlin, Dublin, Ireland
| |
Collapse
|
8
|
Van Praagh R. Interatrial Communications. CONGENIT HEART DIS 2022. [DOI: 10.1016/b978-1-56053-368-9.00009-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
9
|
Wu SJ, Fan YF, Chien CY. Surgical or interventional treatment for adult patients with atrial septal defect and atrial fibrillation: A systemic review and meta-analysis. Asian J Surg 2022; 45:62-67. [PMID: 34217557 DOI: 10.1016/j.asjsur.2021.06.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 05/31/2021] [Accepted: 06/11/2021] [Indexed: 11/02/2022] Open
Abstract
The prevalence of atrial fibrillation (AFib) in adult patients with atrial septal defect (ASD) who did not undergo ASD repair in the childhood is higher than that in general population. The primary aim of this study is to collect various related articles published in the literature and to compare the clinical outcomes with different treatment strategies by systemic reviews and meta-analyses. Of the 1299 initially screened articles, 13 studies with 213 patients were included in this study. All the patients were adults and the mean age at presentation was 55.7 years (range 34-79 years) and 47.8% of the patients were male. Regarding the types of the AFib, there were paroxysmal AFib in 62 patients, persistent AFib in 40 patients and long-standing persistent AFib in 111 patients. For adult patients with ASD and AFib, ASD closure is beneficial for most of the patients if significant left-to-right shunt exists but risk stratification cannot be overlooked because worsening of the functional class may be experienced by some patients post-operatively, especially for the patients with advanced age (>75 years). Reduction of prevalence of AFib could be observed after ASD closure alone which is mainly effective for paroxysmal AFib but not for persistent or long-standing persistent AFib. The successful ablation rate of paroxysmal AFib by catheter ablation is similar to that of all kinds of AFib by surgical ablation. Regarding AFib recurrence, bi-atrial surgical ablation is better than right-atrial ablation for the adult patients with ASD and AFib.
Collapse
Affiliation(s)
- Shye-Jao Wu
- Division of Cardiovascular Surgery, Department of Surgery, MacKay Memorial Hospital, Taipei, Taiwan.
| | - Ya-Fen Fan
- Division of Cardiovascular Surgery, Department of Surgery, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chen-Yen Chien
- Division of Cardiovascular Surgery, Department of Surgery, MacKay Memorial Hospital, Taipei, Taiwan
| |
Collapse
|
10
|
OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 62:6524993. [DOI: 10.1093/ejcts/ezac076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 01/05/2022] [Accepted: 01/29/2022] [Indexed: 11/12/2022] Open
|
11
|
Himelfarb JD, Shulman H, Olesovsky CJ, Rumman RK, Oliva L, Friedland J, Farrell A, Huszti E, Horlick E, Abrahamyan L. Atrial fibrillation following transcatheter atrial septal defect closure: a systematic review and meta-analysis. Heart 2021; 108:1216-1224. [PMID: 34675040 DOI: 10.1136/heartjnl-2021-319794] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/28/2021] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE The ostium secundum atrial septal defect (ASD) is among the most common congenital cardiac anomalies diagnosed in adulthood. A known complication of transcatheter ASD closure is the development of new-onset atrial fibrillation and flutter (AFi/AFl). These arrhythmias confer an increased risk of postoperative stroke, thrombus formation and systemic emboli. This systematic review examines the burden of de novo AFi/AFl in adults following transcatheter closure and seeks to identify risk factors for AFi/AFl development. METHODS Studies were identified by a search of MEDLINE, EMBASE and Cochrane databases from inception until 29 April 2020. A meta-analysis of AFi/AFl incidence was performed using a random-effects model. RESULTS A total of 31 studies met inclusion criteria, comprising 4788 adult patients without a history of AFi/AFl. Twenty-three studies were included in quantitative synthesis and demonstrated an overall incidence rate of 1.82 patients per 100 person-years of follow-up (I2=83%). In studies that enrolled only patients ≥60 years old, the incidence was 5.21 patients per 100 person-years (I2=0%). Studies with follow-up duration ≤2 years reported an incidence of 4.05 per 100 person-years (I2=55%) compared with a rate of 1.19 per 100 person-years (I2=85%) for studies with follow-up duration >2 years. CONCLUSIONS The incidence of new-onset AFi/AFl is relatively low following transcatheter closure of secundum ASDs. The rate of de novo AFi/AFl, however, was significantly higher in elderly patients. Shorter follow-up time was associated with a higher reported incidence of AFi/AFl.
Collapse
Affiliation(s)
| | - Healey Shulman
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Rawan K Rumman
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Laura Oliva
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
| | - Joshua Friedland
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ashley Farrell
- Library and Information Services, University Health Network, Toronto, Ontario, Canada
| | - Ella Huszti
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada.,Biostatistics Research Unit, University Health Network, Toronto, Ontario
| | - Eric Horlick
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre (PMCC), University Health Network, Toronto, Ontario, Canada
| | - Lusine Abrahamyan
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada.,Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
12
|
Brida M, Chessa M, Celermajer D, Li W, Geva T, Khairy P, Griselli M, Baumgartner H, Gatzoulis MA. Atrial septal defect in adulthood: a new paradigm for congenital heart disease. Eur Heart J 2021; 43:2660-2671. [PMID: 34535989 DOI: 10.1093/eurheartj/ehab646] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 07/09/2021] [Accepted: 09/03/2021] [Indexed: 11/13/2022] Open
Abstract
Atrial septal defects (ASDs) represent the most common congenital heart defect diagnosed in adulthood. Although considered a simple defect, challenges in optimal diagnostic and treatment options still exist due to great heterogeneity in terms of anatomy and time-related complications primarily arrhythmias, thromboembolism, right heart failure and, in a subset of patients, pulmonary arterial hypertension (PAH). Atrial septal defects call for tertiary expertise where all options may be considered, namely catheter vs. surgical closure, consideration of pre-closure ablation for patients with atrial tachycardia and suitability for closure or/and targeted therapy for patients with PAH. This review serves to update the clinician on the latest evidence, the nuances of optimal diagnostics, treatment options, and long-term follow-up care for patients with an ASD.
Collapse
Affiliation(s)
- Margarita Brida
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton & Harefield Hospitals, National Heart and Lung Institute, Imperial College, Sydney Street, London SW3 6NP, UK.,Division of Adult Congenital Heart Disease, Department of Cardiovascular Medicine, University Hospital Centre Zagreb, Kispaticeva ul. 12, Zagreb 10000, Croatia.,Department of Medical Rehabilitation, Medical Faculty, University of Rijeka, Ul. Braće Branchetta 20/1, Rijeka 51000, Croatia
| | - Massimo Chessa
- ACHD Unit - Pediatric and Adult Congenital Heart Centre, IRCCS-Policlinico San Donato, Piazza Edmondo Malan, 2, Milan 20097, Italy.,UniSR - Vita Salute San Raffaele University, Via Olgettina, 58, Milan 20132, Italy
| | - David Celermajer
- Heart Research Institute, University of Sydney, Camperdown, NSW 2050, Australia
| | - Wei Li
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton & Harefield Hospitals, National Heart and Lung Institute, Imperial College, Sydney Street, London SW3 6NP, UK
| | - Tal Geva
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA.,Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA
| | - Paul Khairy
- Department of Medicine, Montreal Heart Institute, Université de Montréal, 5000 Rue Bélanger, Montréal, QC H1T 1C8, Canada
| | - Massimo Griselli
- Division of Pediatric Cardiovascular Surgery, Masonic Children's Hospital, University of Minnesota, 2450 Riverside Ave, Minneapolis, MN 55454, USA
| | - Helmut Baumgartner
- Department of Cardiology III: Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer-Campus 1, Muenster 48149, Germany
| | - Michael A Gatzoulis
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton & Harefield Hospitals, National Heart and Lung Institute, Imperial College, Sydney Street, London SW3 6NP, UK
| |
Collapse
|
13
|
Doi T, Nagao K, Higashida A, Aoki M, Yokoyama S, Yamashita S, Yamashita A, Fukahara K, Yoshimura N. Iatrogenic diversion of the inferior vena cava into the left atrium diagnosed 43 years after surgical atrial septal defect closure. Clin Case Rep 2021; 9:e04618. [PMID: 34429998 PMCID: PMC8365539 DOI: 10.1002/ccr3.4618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/06/2021] [Indexed: 11/06/2022] Open
Abstract
The diversion of the inferior vena cava into the left atrium after surgical atrial septal defect closure is a fatal complication. Cases of atrial septal defect with no inferior rim should be treated with this complication in mind.
Collapse
Affiliation(s)
- Toshio Doi
- First Department of SurgeryUniversity of ToyamaToyamaJapan
| | | | | | - Masaya Aoki
- First Department of SurgeryUniversity of ToyamaToyamaJapan
| | | | | | - Akio Yamashita
- First Department of SurgeryUniversity of ToyamaToyamaJapan
| | | | | |
Collapse
|
14
|
Liang Y, Hei F, Guan Y. Electrical storm after correction of an uncomplicated congenital atrial septal defect in an adult: a case report. BMC Cardiovasc Disord 2021; 21:348. [PMID: 34294038 PMCID: PMC8296736 DOI: 10.1186/s12872-021-02164-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 07/15/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND There is a paucity of published literature describing electrical storm after the correction of uncomplicated atrial septal defect (ASD) in an adult. CASE PRESENTATION We present a 49-year-old woman with a congenital ASD combined with mild tricuspid regurgitation who denied any history of arrhythmia or other medical history. She suffered from electrical storm (≥ 3 episodes of ventricular tachycardias or ventricular fibrillations) in the early stage after ASD repair with combined tricuspid valvuloplasty. During electrical storm, her electrolytes were within normal ranges and no ischemic electrocardiographic changes were detected, which suggested that retained air embolism or acute coronary thrombosis were unlikely. Additionally, echocardiographic findings and her central venous pressure (5-8 mmHg during the interval between attacks) failed to support the diagnosis of pericardial tamponade. After a thorough discussion, the surgeons conducted an emergent re-exploration and repeated closure of the ASD with combined DeVega's annuloplasty. Eventually, the patient recovered uneventfully, without reoccurring arrhythmias during follow-up. Although we fail to determine the definite cause, we speculate that the causes probably are iatrogenic injury of the conduction system due to a rare anatomic variation, poor intraoperative protection, latent coronary distortion during tricuspid valvuloplasty, or idiopathic or secondary abnormalities of the conduction system. CONCLUSIONS For most surgeons, performing re-exploration without a known etiology is a difficult decision to make. This case illustrates that re-exploration could be an option when electrical storm occurs in the early stage postoperatively. Nevertheless, surgeons should assess the benefit-risk ratio when taking this unconventional measure.
Collapse
Affiliation(s)
- Ying Liang
- Department of Extracorporeal Circulation, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, People's Republic of China
| | - Feilong Hei
- Department of Extracorporeal Circulation, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, People's Republic of China
| | - Yulong Guan
- Department of Extracorporeal Circulation, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, People's Republic of China.
| |
Collapse
|
15
|
Gravesteijn B, Krijkamp E, Busschbach J, Geleijnse G, Helmrich IR, Bruinsma S, van Lint C, van Veen E, Steyerberg E, Verhoef K, van Saase J, Lingsma H, Baatenburg de Jong R. Minimizing Population Health Loss in Times of Scarce Surgical Capacity During the Coronavirus Disease 2019 Crisis and Beyond: A Modeling Study. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:648-657. [PMID: 33933233 PMCID: PMC7933792 DOI: 10.1016/j.jval.2020.12.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/29/2020] [Accepted: 12/13/2020] [Indexed: 05/04/2023]
Abstract
OBJECTIVES Coronavirus disease 2019 has put unprecedented pressure on healthcare systems worldwide, leading to a reduction of the available healthcare capacity. Our objective was to develop a decision model to estimate the impact of postponing semielective surgical procedures on health, to support prioritization of care from a utilitarian perspective. METHODS A cohort state-transition model was developed and applied to 43 semielective nonpediatric surgical procedures commonly performed in academic hospitals. Scenarios of delaying surgery from 2 weeks were compared with delaying up to 1 year and no surgery at all. Model parameters were based on registries, scientific literature, and the World Health Organization Global Burden of Disease study. For each surgical procedure, the model estimated the average expected disability-adjusted life-years (DALYs) per month of delay. RESULTS Given the best available evidence, the 2 surgical procedures associated with most DALYs owing to delay were bypass surgery for Fontaine III/IV peripheral arterial disease (0.23 DALY/month, 95% confidence interval [CI]: 0.13-0.36) and transaortic valve implantation (0.15 DALY/month, 95% CI: 0.09-0.24). The 2 surgical procedures with the least DALYs were placing a shunt for dialysis (0.01, 95% CI: 0.005-0.01) and thyroid carcinoma resection (0.01, 95% CI: 0.01-0.02). CONCLUSION Expected health loss owing to surgical delay can be objectively calculated with our decision model based on best available evidence, which can guide prioritization of surgical procedures to minimize population health loss in times of scarcity. The model results should be placed in the context of different ethical perspectives and combined with capacity management tools to facilitate large-scale implementation.
Collapse
Affiliation(s)
- Benjamin Gravesteijn
- Department of Otorhinolaryngology (ENT), Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Eline Krijkamp
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands; Netherlands Institute for Health Sciences, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Jan Busschbach
- Department of Medical Psychology, Erasmus University Medical Center, Rotterdam, The Netherlands; Netherlands Institute for Health Sciences, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Geert Geleijnse
- Department of Otorhinolaryngology (ENT), Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Isabel Retel Helmrich
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Sophie Bruinsma
- Department of Quality and Patient Care, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Céline van Lint
- Department of Quality and Patient Care, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ernest van Veen
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ewout Steyerberg
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Biostatistics, Leiden University Medical Center, Leiden, The Netherlands
| | - Kees Verhoef
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jan van Saase
- Department of Internal Medicine - Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Hester Lingsma
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Rob Baatenburg de Jong
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
16
|
Evertz R, Reinders M, Houck C, Ten Cate T, Duijnhouwer AL, Beukema R, Westra S, Vernooy K, de Groot NMS. Atrial fibrillation in patients with an atrial septal defect in a single centre cohort during a long clinical follow-up: its association with closure and outcome of therapy. Open Heart 2020; 7:openhrt-2020-001298. [PMID: 32817255 PMCID: PMC7437693 DOI: 10.1136/openhrt-2020-001298] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/29/2020] [Accepted: 06/27/2020] [Indexed: 11/15/2022] Open
Abstract
Objective Currently, consensus is lacking on the relation between closure of atrial septal defect (ASD) and the incidence of atrial fibrillation (AF), which is a known complication in ASD patients. More importantly, studies reporting on the treatment applied for AF in ASD patients are scarce. The aims of this study were (1) to assess the incidence of AF in ASD patients, (2) to study the relation between closure and AF and (3) to evaluate applied treatment strategies. Methods A single-centre retrospective study in 173 patients with an ASD was performed. We analysed the incidence of AF, the relation of AF with closure, method of closure and the treatment success of therapies applied. Results Almost 20% of patients with an ASD developed AF, with a mean age of 59 (±14) years at first presentation of AF during a median clinical follow-up of 43 (29–59) years. Older age (OR 1.072; p<0.001) and a dilated left atrium (OR 3.727; p=0.009) were independently associated with new-onset AF. Closure itself was not independently associated with AF. First applied treatment strategy was rhythm control in 77%. Of the 18 patients treated with antiarrhythmic drugs 50% had at least 1 recurrence of AF. Conclusion No clear relation between closure of the ASD and AF could be assessed. This is the first study describing applied therapy for AF in ASD patients of which medical rhythm control was the most applied strategy with a disappointing efficacy.
Collapse
Affiliation(s)
- Reinder Evertz
- Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Manon Reinders
- Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Charlotte Houck
- Cardiology, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands
| | - Tim Ten Cate
- Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Rypko Beukema
- Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Sjoerd Westra
- Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Kevin Vernooy
- Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | |
Collapse
|
17
|
Barracano R, Nashat H, Constantine A, Dimopoulos K. Heart and lung transplantation in pulmonary arterial hypertension related to congenital heart disease: an unusual indication. JOURNAL OF CONGENITAL CARDIOLOGY 2020. [DOI: 10.1186/s40949-020-00047-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Abstract
Background
Eisenmenger syndrome is a multisystem disorder, characterised by a significant cardiac defect, severe pulmonary hypertension and long-standing cyanosis. Despite the availability of pulmonary hypertension therapies and improved supportive care in specialist centres, Eisenmenger patients are still faced with significant morbidity and mortality.
Case presentation
We describe the case of a 44-year-old woman with Eisenmenger syndrome secondary to a large secundum atrial septal defect. Her pulmonary vascular disease was treated with pulmonary vasodilators, but she experienced a progressive decline in exercise tolerance, increasing atrial arrhythmias, resulting in referral for transplantation. Her condition was complicated by significant recurrent haemoptysis in the context of extremely dilated pulmonary arteries and in-situ thrombosis, which prompted successful heart and lung transplantation. She made a slow recovery but remains well 3 years post-transplant.
Conclusions
Patients with Eisenmenger syndrome secondary to a pre-tricuspid lesion, such as an atrial septal defect have a natural history that differs to patients with post-tricuspid shunts; the disease tends to present later in life but is more aggressive, prompting early and aggressive medical intervention with pulmonary arterial hypertension therapies. This case illustrates that severe recurrent haemoptysis can be an indication for expediting transplantation in Eisenmenger syndrome patients.
Collapse
|
18
|
Muroke V, Jalanko M, Simonen P, Holmström M, Ventilä M, Sinisalo J. Non-invasive dye dilution method for measuring an atrial septal defect shunt size. Open Heart 2020; 7:e001313. [PMID: 33020256 PMCID: PMC7537437 DOI: 10.1136/openhrt-2020-001313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/26/2020] [Accepted: 08/25/2020] [Indexed: 11/19/2022] Open
Abstract
AIMS Objective of this study was to evaluate the feasibility of the non-invasive dye dilution method to quantify shunt size related to atrial septal defects (ASD).The diagnostic accuracy of shunt size determination in ASD's has been suboptimal with common non-invasive methods. We have previously developed a cost-effective and time-effective non-invasive dye dilution method. In this method, the indocyanine green solution is injected into the antecubital vein and the appearance of the dye is detected with an earpiece densitometer. METHODS AND RESULTS We studied 192 patients with an ASD. Mean pulmonary blood flow/systemic blood flow (Qp/Qs) was measured with dye dilution technique and compared with following methods: Fick's invasive oximetry (n=49), transoesophageal echocardiography (TEE) measuring ASD size (n=143) and cardiac MR (CMR) (n=9).For the first 49 patients, Qp/Qs was 2.05±0.70 with the Fick's invasive oximetry and 2.12±0.68 with dye dilution method with an excellent correlation between the two methods (R=0.902, p<0.001). In the second study sample, the ASD size by TEE was 15±6 mm on average, and the mean Qp/Qs 2.16±0.65 measured with dye dilution method with a good correlation between the methods (R=0.674, p<0.001). Qp/Qs measured with CMR was 1.87±0.40 resulting in a good correlation with the dye dilution method (R=0.696, p=0.037). CONCLUSION The dye dilution method with earpiece densitometer recording is a clinically feasible and reliable method to assess shunt size in ASDs.
Collapse
|
19
|
Umemoto S, Sakamoto I, Abe K, Ishikita A, Yamasaki Y, Hiasa KI, Ide T, Tsutsui H. Preoperative Threshold for Normalizing Right Ventricular Volume After Transcatheter Closure of Adult Atrial Septal Defect. Circ J 2020; 84:1312-1319. [PMID: 32554952 DOI: 10.1253/circj.cj-20-0136] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The latest guidelines recommend early intervention in adult atrial septal defect (ASD) patients with signs of right ventricular (RV) enlargement. However, the criteria of RV enlargement for optimal intervention remain unclear. We investigated the preoperative determinants for normalizing the RV volume after transcatheter closure of ASD in adults.Methods and Results:We retrospectively analyzed 52 ASD patients who underwent transcatheter closure. Cardiac magnetic resonance imaging (CMR) measured RV volume before and 1 year after the closure. The patients were divided into normalized (postoperative RV end-systolic volume index [RVESVI] <47 mL/m2and end-diastolic volume index [RVEDVI] <108 mL/m2) and non-normalized (postoperative RVESVI ≥47 mL/m2or RVEDVI ≥108 mL/m2) groups. Preoperative RVESVI was significantly smaller (72 mL/m2vs. 80 mL/m2) and RVEF was higher (56% vs. 51%) in the normalized group compared with the non-normalized group. Receiver-operating characteristic analysis for the normalization of postoperative RV volume showed that the preoperative threshold value of RVESVI was 75 mL/m2. In addition, multivariate analysis showed that preoperative RVESVI was an independent predictor for normalization of RV volume. CONCLUSIONS Preoperative RVESVI is an independent predictor for normalization of RV volume at 1 year after transcatheter closure of ASD in adults. Early intervention before RVESVI reaches 75 mL/m2may confer optimal timing for normalizing RV volume.
Collapse
Affiliation(s)
- Shintaro Umemoto
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | - Ichiro Sakamoto
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | - Kohtaro Abe
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | - Ayako Ishikita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | - Yuzo Yamasaki
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University
| | - Ken-Ichi Hiasa
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | - Tomomi Ide
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| |
Collapse
|
20
|
Garg J, Shah K, Turagam MK, Janagam P, Natale A, Lakkireddy D. Safety and efficacy of catheter ablation for atrial fibrillation in patients with percutaneous atrial septal closure device. J Cardiovasc Electrophysiol 2020; 31:2328-2334. [DOI: 10.1111/jce.14616] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/19/2020] [Accepted: 05/21/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Jalaj Garg
- Division of Cardiology, Cardiac Arrhythmia Service Medical College of Wisconsin Milwaukee Wisconsin USA
| | - Kuldeep Shah
- Division of Cardiology West Virginia University Morgantown West Virginia USA
| | - Mohit K. Turagam
- Cardiac Arrhythmia Service Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai New York New York USA
| | - Pragna Janagam
- Department of Medicine East Tennessee State University Johnson City Tennessee USA
| | - Andrea Natale
- Division of Electrophysiology Texas Cardiac Arrhythmia Institute at St. David's Medical Center Austin Texas USA
| | - Dhanunjaya Lakkireddy
- Division of Electrophysiology Kansas City Heart Rhythm Institute and Research Foundation Kansas City Kansas USA
| |
Collapse
|
21
|
Tobler D, Greutmann M. Simple cardiac shunts in adults: atrial septal defects, ventricular septal defects, patent ductus arteriosus. Heart 2020; 106:307-314. [DOI: 10.1136/heartjnl-2019-314700] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
|
22
|
The Future of Adult Congenital Heart Disease Research: Precision Health Services Delivery for the Next Decade. Can J Cardiol 2019; 35:1609-1619. [DOI: 10.1016/j.cjca.2019.09.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 09/23/2019] [Accepted: 09/23/2019] [Indexed: 02/06/2023] Open
|
23
|
Evertz R, Houck CA, Ten Cate T, Duijnhouwer AL, Beukema R, Westra S, Vernooy K, de Groot NMS. Concomitant pulmonary vein isolation and percutaneous closure of atrial septal defects: A pilot project. CONGENIT HEART DIS 2019; 14:1123-1129. [PMID: 31692272 PMCID: PMC7003759 DOI: 10.1111/chd.12859] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 10/04/2019] [Accepted: 10/25/2019] [Indexed: 11/29/2022]
Abstract
Background Patients with an atrial septal defect (ASD) are at increased risk of developing atrial fibrillation (AF). Currently percutaneous ASD closure is the preferred therapeutic strategy and although pulmonary vein isolation (PVI) for AF is feasible after ASD closure, the transseptal puncture can be technically challenging and probably increases the perioperative risk. A staged approach, with PVI several months before ASD closure, has been recommended for patients already scheduled for closure, but no data are available on combined procedures. Purpose This pilot study evaluates the feasibility of a combined procedure of PVI and ASD closure in patients with a hemodynamic important ASD and documented AF. Methods In one procedure, PVI was performed prior to placement of the ASD closure device. Transseptal access for PVI was obtained via wire passage through the ASD in all patients. Patients were followed with 5‐day‐holter monitoring at 3, 6, and 12 months. Recurrence of AF was defined as a documented, symptomatic episode of AF. Results The study population consisted of five patients (four females, mean age: 58 (±3) years). Acute PVI was achieved in all patients. Only one patient had a small residual ASD after closure. Besides a small groin hematoma in two patients, no complications occurred. After 12‐month follow‐up, three patients were free of AF recurrence (60%). Conclusion This study shows that a combined PVI with ASD closure is feasible with an acceptable success rate of AF free survival. These preliminary results in a small patient group warrants a larger trial.
Collapse
Affiliation(s)
- Reinder Evertz
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Charlotte A Houck
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Tim Ten Cate
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Rypko Beukema
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Sjoerd Westra
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands.,Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands
| | - Natasja M S de Groot
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| |
Collapse
|
24
|
Ranard LS, Mallah WE, Awerbach JD, Abernethy A, Halane M, Qureshi AM, Krasuski RA. Impact of Pulmonary Hypertension on Survival Following Device Closure of Atrial Septal Defects. Am J Cardiol 2019; 124:1460-1464. [PMID: 31481180 DOI: 10.1016/j.amjcard.2019.07.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/16/2019] [Accepted: 07/17/2019] [Indexed: 10/26/2022]
Abstract
Pulmonary hypertension (PH), defined as mean pulmonary arterial pressure ≥25 mm Hg, may be a complication of a secundum atrial septal defect (ASD). This study sought to evaluate the impact of PH at time of ASD device closure on patient survival. A prospectively collected database of ASD closures was utilized. Patients were stratified by age above and below the cohort median (48 years). Survival was analyzed by preprocedural PH status, age cohort, and echocardiographic resolution of PH at 3 months postdevice closure. PH was present in 48 of 228 patients (21.1%) and was more common in the older cohort (31.3% vs 10.6%, p <0.01). ASD size was unrelated to the presence of PH (p = 0.33). Older patients had more medical co-morbidities including diabetes (p = 0.02), hyperlipidemia (p <0.01), and systemic hypertension (p <0.01) compared with younger patients. PH did not impact survival in patients ≤48 years, but PH was associated with fivefold increased risk of death in patients >48 years (p < 0.01). Patients with preprocedural PH and RVSP ≥40 mm Hg at 3-month follow-up continued to have an increased risk of mortality (p <0.01), whereas those with resolution of PH had similar survival to those without PH at time of closure. In conclusion, PH is common in adults with unrepaired ASDs and appears unrelated to defect size. PH in older adults and its persistence closure are strong predictors of a worsened clinical outcome. These patients may benefit from additional risk assessment and advanced medical therapies to mitigate this risk.
Collapse
|
25
|
Nyboe C, Karunanithi Z, Nielsen-Kudsk JE, Hjortdal VE. Long-term mortality in patients with atrial septal defect: a nationwide cohort-study. Eur Heart J 2019; 39:993-998. [PMID: 29211856 PMCID: PMC6037065 DOI: 10.1093/eurheartj/ehx687] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 11/08/2017] [Indexed: 11/29/2022] Open
Abstract
Aims In this nationwide cohort of atrial septal defect (ASD) patients, the largest to date, we report the longest follow-up time with and without closure in childhood and adulthood compared with a general population cohort. Methods and results Using population-based registries, we included Danish individuals born before 1994 who received an ASD diagnosis between 1959 and 2013. All diagnoses were subsequently validated (n = 2277). Using the Kaplan–Meier estimates and Cox proportional hazards regression adjusted for sex, birth year, and a modified Charlson Comorbidity Index, we compared the mortality of ASD patients with that of a birth year and sex matched general population cohort. The median follow-up from ASD diagnosis was 18.1 years (range 1–53 years). Patients with ASD had a higher mortality [adjusted hazard ratio (HR): 1.7; 95% confidence interval (CI): 1.5–1.9] compared with the general population cohort. The adjusted HR 30 days after closure was 1.4 (95% CI: 1.2–1.7), and it was 2.4 (95% CI: 2.0–2.9) for patients without closure. Conclusion Overall, ASD patients had a higher long-term mortality than a general population cohort matched on birth year and gender. Our data indicate a lower relative mortality of those ASD patients undergoing closure than the ASD patients not undergoing closure.
Collapse
Affiliation(s)
- Camilla Nyboe
- Department of Cardiothoracic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Zarmiga Karunanithi
- Department of Cardiothoracic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Jens Erik Nielsen-Kudsk
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Vibeke E Hjortdal
- Department of Cardiothoracic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| |
Collapse
|
26
|
Taha F, Elshedoudy S. Role of 3D transesophageal echocardiography in transcatheter closure of atrial septal aneurysms. Echocardiography 2019; 36:1884-1894. [PMID: 31541598 DOI: 10.1111/echo.14482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 09/03/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Three dimensional transesophageal echocardiography (3DTEE) is superior to two dimensional transesophageal echocardiography (2DTEE) as it provides all atrial septal information from a single view. AIM To evaluate 3DTEE role in analysis of atrial septal aneurysm (ASA) and in device closure guiding. METHODS Three dimensional transesophageal echocardiography were recorded with Vivid*E9,GE system over 14 months. ASAs were classified into 4 types (A: with PFO, B: with one ASD, C: with 2 ASDs, and D: with multiple fenestrations). Each aneurysm was assessed according to its type, shape, dimensions, orientation, aneurysmal tissue, and the surrounding rims. All patients passed to transcatheter aneurysm closure. RESULTS A total of 26 patients with ASAs were assessed (7 imperforated aneurysms excluded). The remaining 19 patients' age was 12.84 ± 5.82years. Four patients had type A aneurysms, 6 had type B, 4 had type C, and 5 had type D. 3DTEE demonstrated oval aneurysms in 17 patients. The orientation was oblique in 8 patients, vertical in 7, and horizontal in 4. The ASAs dimensions were 23.5 ± 5.1, 23.2 ± 5.1, and 22.0 ± 4.0 mm for oblique, vertical, and horizontal axes. Percutaneous closure succeeded in 18 patients. Balloon sizing was used in 4 patients. Devices used were: In type A:PFO devices, in type B:ASO devices, in type C:two patients required two ASO devices in each patient and two patients required one cribriform device, and in type D:Cribriform devices used for three patients, PFO for one and ASO for one. LA, LUPV, and RUPV approaches were used. Aspirin was received for 6 months. CONCLUSION Three dimensional transesophageal echocardiography helps to select aneurysms suitable for transcatheter closure, select the suitable devices, and guide the transcatheter procedure.
Collapse
Affiliation(s)
- Fatma Taha
- Pediatric Cardiology and Congenital Heart Diseases Unit, Cardiology Department, Tanta University, Tanta, Egypt
| | - Sahar Elshedoudy
- Pediatric Cardiology and Congenital Heart Diseases Unit, Cardiology Department, Tanta University, Tanta, Egypt
| |
Collapse
|
27
|
Constantine A, Dimopoulos K. Evaluating a strategy of PAH therapy pre-treatment in patients with atrial septal defects and pulmonary arterial hypertension to permit safe repair (“treat-and-repair”). Int J Cardiol 2019; 291:142-144. [DOI: 10.1016/j.ijcard.2019.05.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 05/17/2019] [Indexed: 10/26/2022]
|
28
|
Goeddel LA, Jung YH, Patel P, Upchurch P, Fernando RJ, Ramakrishna H. Analysis of the 2018 American Heart Association/American College of Cardiology Guidelines for the Management of Adults With Congenital Heart Disease: Implications for the Cardiovascular Anesthesiologist. J Cardiothorac Vasc Anesth 2019; 34:1348-1365. [PMID: 31494006 DOI: 10.1053/j.jvca.2019.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 08/01/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Lee A Goeddel
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Youn Hoa Jung
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Prakash Patel
- Department of Anesthesiology and Critical Care Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Patrick Upchurch
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Rohesh J Fernando
- Division of Cardiothoracic Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
| |
Collapse
|
29
|
Bradley EA, Ammash N, Martinez SC, Chin K, Hebson C, Singh HS, Aboulhosn J, Grewal J, Billadello J, Chakinala MM, Daniels CJ, Zaidi AN. "Treat-to-close": Non-repairable ASD-PAH in the adult: Results from the North American ASD-PAH (NAAP) Multicenter Registry. Int J Cardiol 2019; 291:127-133. [PMID: 31031077 DOI: 10.1016/j.ijcard.2019.03.056] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 02/14/2019] [Accepted: 03/26/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Adults presenting with an unrepaired atrial septal defect and pulmonary arterial hypertension (ASD-PAH) are typically classified as "correctable" or "non-correctable". The use of directed PAH medical therapy in non-correctable ASD-PAH leading to favorable closure candidacy, repair status and long-term follow-up is not well studied. We therefore sought to characterize response to PAH targeted therapy in 'non-correctable' ASD-PAH. METHODS AND RESULTS Nine North American tertiary care centers submitted retrospective data from adults with unrepaired ASD-PAH that did not meet recommendations for repair at initial presentation (1996-2017). Sixty-nine patients (women 51(74%), 40 ± 15 years, mean pulmonary artery pressure (mPA) 51 ± 13 mm Hg, pulmonary vascular resistance (PVR) 8.7 ± 4.9 Wood units, Qp:Qs 1.6 ± 0.4) were enrolled. All patients were prescribed PAH targeted therapy and late shunt repair occurred in 19(28%) (Women 15(29%) vs. Men 4(22%), p = 0.6). At late follow-up (4.4 ± 2.9 years) 6-minute walk test distance (6MWTD) was significantly better in the group that underwent repair (486 ± 89 m vs. 375 ± 139 m, p < 0.05). Transthoracic echo showed significant improvement in right ventricular (RV) function (severe dysfunction in repaired 8(40%) vs. unrepaired groups 35(69%), p < 0.05). Divergent survival curves suggest that with larger studies and more follow-up, differences in survival between repaired and unrepaired groups may be important. (repaired: 17(94%) vs. unrepaired: 32(81%), p = 0.18). CONCLUSIONS This is the first and largest multicenter study evaluating the "treat-to-close" approach in non-correctable ASD-PAH. Our new data supports further study of this strategy in patients who have reversibility of PAH in response to targeted therapy. We demonstrate that in the carefully selected patient with non-correctable ASD-PAH, successful shunt repair is possible if post-therapy PVR is ≤6.5 Wood units. Patients who underwent repair had improved RV function following PAH targeted therapy. Divergent survival curves suggest that with further study, defect repair may affect medium-term to late survival.
Collapse
Affiliation(s)
- Elisa A Bradley
- The Ohio State University & Nationwide Children's Hospital, Department of Internal Medicine, Division of Cardiovascular Medicine, Columbus, OH, United States of America; AARCC (Alliance for Adult Research in Congenital Cardiology) Investigator/Site, United States of America.
| | - Naser Ammash
- Mayo Clinic, Department of Cardiovascular Medicine, Rochester, MN, United States of America; AARCC (Alliance for Adult Research in Congenital Cardiology) Investigator/Site, United States of America
| | - Sara C Martinez
- Mayo Clinic, Department of Cardiovascular Medicine, Rochester, MN, United States of America
| | - Kelly Chin
- University of Texas Southwestern, Division of Pulmonary Medicine, Dallas, TX, United States of America
| | - Camden Hebson
- Emory University School of Medicine, Department of Medicine, Division of Cardiology, Atlanta, GA, United States of America; AARCC (Alliance for Adult Research in Congenital Cardiology) Investigator/Site, United States of America
| | - Harsimran S Singh
- Weill Cornell Medicine New York Presbyterian Hospital, Division of Cardiovascular Medicine, New York, NY, United States of America
| | - Jamil Aboulhosn
- Ahmanson/University of California, Los Angeles, David Geffen School of Medicine at UCLA, Divisions of Adult and Pediatric Cardiology, Los Angeles, CA, United States of America; AARCC (Alliance for Adult Research in Congenital Cardiology) Investigator/Site, United States of America
| | - Jasmine Grewal
- University of British Columbia, St. Paul's Hospital and Vancouver General Hospital, Division of Cardiovascular Medicine, Vancouver, BC, Canada; AARCC (Alliance for Adult Research in Congenital Cardiology) Investigator/Site, United States of America
| | - Joseph Billadello
- Washington University, Division of Cardiovascular Medicine, St. Louis, MO, United States of America
| | - Murali M Chakinala
- Washington University, Division of Pulmonary and Critical Care Medicine, St. Louis, MO, United States of America
| | - Curt J Daniels
- The Ohio State University & Nationwide Children's Hospital, Department of Internal Medicine, Division of Cardiovascular Medicine, Columbus, OH, United States of America; AARCC (Alliance for Adult Research in Congenital Cardiology) Investigator/Site, United States of America
| | - Ali N Zaidi
- Montefiore Einstein Center for Heart & Vascular Care & The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, United States of America; AARCC (Alliance for Adult Research in Congenital Cardiology) Investigator/Site, United States of America
| |
Collapse
|
30
|
Oster M, Bhatt AB, Zaragoza-Macias E, Dendukuri N, Marelli A. Interventional Therapy Versus Medical Therapy for Secundum Atrial Septal Defect: A Systematic Review (Part 2) for the 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease. J Am Coll Cardiol 2019; 73:1579-1595. [DOI: 10.1016/j.jacc.2018.08.1032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
31
|
Miranda WR, Hagler DJ, Reeder GS, Warnes CA, Connolly HM, Egbe AC, Taggart NW. Temporary balloon occlusion of atrial septal defects in suspected or documented left ventricular diastolic dysfunction: Hemodynamic and clinical findings. Catheter Cardiovasc Interv 2019; 93:1069-1075. [DOI: 10.1002/ccd.28150] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 01/29/2019] [Indexed: 11/09/2022]
Affiliation(s)
| | - Donald J. Hagler
- Department of Pediatric and Adolescent Medicine/Division of Pediatric CardiologyMayo Clinic Rochester Minnesota
| | - Guy S. Reeder
- Department of Cardiovascular MedicineMayo Clinic Rochester Minnesota
| | - Carole A. Warnes
- Department of Cardiovascular MedicineMayo Clinic Rochester Minnesota
| | - Heidi M. Connolly
- Department of Cardiovascular MedicineMayo Clinic Rochester Minnesota
| | - Alexander C. Egbe
- Department of Cardiovascular MedicineMayo Clinic Rochester Minnesota
| | - Nathaniel W. Taggart
- Department of Pediatric and Adolescent Medicine/Division of Pediatric CardiologyMayo Clinic Rochester Minnesota
| |
Collapse
|
32
|
Brida M, Diller GP, Kempny A, Drakopoulou M, Shore D, A Gatzoulis M, Uebing A. Atrial septal defect closure in adulthood is associated with normal survival in the mid to longer term. Heart 2019; 105:1014-1019. [DOI: 10.1136/heartjnl-2018-314380] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 01/02/2019] [Accepted: 01/07/2019] [Indexed: 01/14/2023] Open
Abstract
ObjectiveThe prognostic benefit of atrial septal defect (ASD) closure in adulthood, particularly in advanced age, remains uncertain. The aim of our study was to examine the impact of ASD closure in a contemporary adult cohort on mid to longer term survival as compared with expected survival in the general population.MethodsWe study herewith all consecutive patients (≥16 years of age) who underwent ASD closure, catheter or surgical, at our tertiary centre between 2001 and 2012. Furthermore, we compare survival of our ASD closure cohort with expected survival in age and gender-matched general population and standardised mortality ratios (SMR) were calculated.ResultsA total of 608 patients (mean age 45.4±16.7 years) underwent ASD closure (catheter 433(71.2%), surgical 175(28.8%)). There was no 30-day mortality and periprocedural complications were low (n=40, 6.6%). During a median follow-up of 6.7 (IQR 4.2–9.3) years 16 (2.6%) patients died; survival was similar to the general population (p=0.80) including patients >40 or >60 years of age at ASD closure (p=0.58 and p=0.64, respectively). There was no survival difference between gender (male: SMR 0.93; 95% CI 0.52 to 1.64, p=0.76; female: SMR 0.99; 95% CI 0.58 to 1.66, p=0.95) or mode of closure compared with general population (catheter: SMR 1.03; 95% CI 0.68 to 1.55, p=0.89; surgical: SMR 0.65; 95% CI 0.22 to 1.88, p=0.38).ConclusionPerioperative mortality and morbidity in a large contemporary adult cohort undergoing ASD closure, catheter or surgical, is extremely low. Mid to longer term survival is excellent irrespective of age, gender and mode of closure, and similar to matched general population.
Collapse
|
33
|
Kumar P, Sarkar A, Kar SK. Assessment of ventricular function in patients of atrial septal defect by strain imaging before and after correction. Ann Card Anaesth 2019; 22:41-46. [PMID: 30648678 PMCID: PMC6350442 DOI: 10.4103/aca.aca_153_17] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Atrial septal defect (ASD) is a common congenital heart disease associated with volume overload of Right ventricle (RV) with variable effect on Left ventricle (LV). Two-dimensional (2D) Strain analysis is a new tool for objective analysis of myocardial function. This prospective study evaluated the systolic function of right and left ventricle by conventional 2D echo and strain echo and measured changes in cardiac hemodynamics that occurred in patients of ASD before and after correction. Patients and Methods: 2D echo and strain analysis of each patient before and at 48 hrs, 3 months and 6 months after correction was performed. Routine 2D echo parameters and global longitudinal strain of both ventricles were measured. Result: Improvement in LV ejection fraction (P = 0.0001) and myocardial performance index (MPI) (P < 0.0001) occurred at the end of 6 months, whereas decrease in RV MPI (P < 0.0001) and tricuspid annular plane systolic excursion (P < 0.0001) became statistically significant after 3 months of ASD correction. In comparison to conventional 2D echo, global longitudinal strain of RV decreased significantly only after 48 hours of ASD correction while there was no improvement in left ventricular global longitudinal strain after 6 month of correction. Conclusion: There was improvement in RV function with subtle change in LV function by strain imaging and most of these changes were completed within 6 months of ASD correction and nearly correlated with conventional 2DEchocardiography.
Collapse
Affiliation(s)
- Prashant Kumar
- Department of Cardiology, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Achyut Sarkar
- Department of Cardiology, Institute of Post Graduation Medical Education and Research, Kolkata, India
| | - Sandeep Kumar Kar
- Department of Cardiac Anaesthesia, Institute of Post Graduation Medical Education and Research, Kolkata, India
| |
Collapse
|
34
|
|
35
|
Alnasser S, Lee D, Austin PC, Labos C, Osten M, Lightfoot DT, Kutty S, Shah A, Meier L, Benson L, Horlick E. Long term outcomes among adults post transcatheter atrial septal defect closure: Systematic review and meta-analysis. Int J Cardiol 2018; 270:126-132. [DOI: 10.1016/j.ijcard.2018.06.076] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 05/22/2018] [Accepted: 06/18/2018] [Indexed: 10/28/2022]
|
36
|
Dalvi B, Jain S, Pinto R. Device closure of atrial septal defect with severe pulmonary hypertension in adults: Patient selection with early and intermediate term results. Catheter Cardiovasc Interv 2018; 93:309-315. [DOI: 10.1002/ccd.27853] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 07/28/2018] [Accepted: 08/04/2018] [Indexed: 11/05/2022]
|
37
|
Safety and efficacy of transcatheter closure of atrial septal defect type II under transthoracic echocardiographic guidance: A case control study. J Saudi Heart Assoc 2018; 31:2-8. [PMID: 30337795 PMCID: PMC6187049 DOI: 10.1016/j.jsha.2018.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 05/28/2018] [Accepted: 08/10/2018] [Indexed: 11/22/2022] Open
Abstract
Background Transcatheter closure of secundum atrial septal defect is routinely performed under general anesthesia and transesophageal echocardiography guidance. If patients have good echo windows, the procedure could be performed under transthoracic echo guidance. Aim of study To evaluate safety and efficacy of the intervention using fluoroscopy and echo guidance. Methods In a case control study design, 180 patients underwent atrial septal defect closure between January 2010 and December 2016. In 32 patients, the intervention was performed under fluoroscopy and transthoracic echo guidance. Our study group consisted of 22 out of 32 patients (<13 years old). For the other 10 patients, we could not find a matching pair. The data of the study group were compared with an age, weight, and height matched group (controls), who underwent the procedure under transesophageal echocardiography guidance. Results The diameter of the atrial septal defect, septal length, and most of the rims were comparable. The superior rim and inferior rims were longer in the study group. The devices chosen for the cases were larger than the control group. Procedure time and fluoroscopy times were shorter in the study group. Success rate was comparable. On follow-up, both groups had almost no or minimal incidence of residual shunt. Conclusion We conclude that transcatheter closure of atrial septal defect under fluoroscopy and transthoracic echo guidance is safe and successful in selected patients who have single central atrial septal defect with adequate septal lengths and adequate septal rims, with high incidence of complete occlusion rate.
Collapse
|
38
|
Kempny A, Gatzoulis MA. Percutaneous repair of sinus venosus ASD: the end of congenital cardiac surgery? EUROINTERVENTION 2018; 14:843-845. [PMID: 30339128 DOI: 10.4244/eijv14i8a150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Aleksander Kempny
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom
| | | |
Collapse
|
39
|
Foeller ME, Foeller TM, Druzin M. Maternal Congenital Heart Disease in Pregnancy. Obstet Gynecol Clin North Am 2018; 45:267-280. [PMID: 29747730 DOI: 10.1016/j.ogc.2018.01.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Congenital heart disease comprises most maternal cardiac diseases in pregnancy and is an important cause of maternal, fetal, and neonatal morbidity and mortality worldwide. Pregnancy is often considered a high-risk state for individuals with structural heart disease as a consequence of a limited ability to adapt to the major hemodynamic changes associated with pregnancy. Preconception counseling and evaluation are of utmost importance, as pregnancy is contraindicated in certain cardiac conditions. Pregnancy can be safely accomplished in most individuals with careful risk assessment before conception and multidisciplinary care throughout pregnancy and the postpartum period.
Collapse
Affiliation(s)
- Megan E Foeller
- Obstetrics and Gynecology, Stanford University, Stanford Hospital, 300 Pasteur Drive, Room G302, 5317, Stanford, CA 94305-5317, USA.
| | - Timothy M Foeller
- Internal Medicine, Stanford Health Care-ValleyCare, 5555 West Positas Boulevard, 1 West Hospitalist Room 1, Pleasanton, CA 94588, USA
| | - Maurice Druzin
- Obstetrics and Gynecology, Stanford University, Stanford Hospital, 300 Pasteur Drive, Room G302, 5317, Stanford, CA 94305-5317, USA
| |
Collapse
|
40
|
Katritsis DG, Boriani G, Cosio FG, Hindricks G, Jaïs P, Josephson ME, Keegan R, Kim YH, Knight BP, Kuck KH, Lane DA, Lip GYH, Malmborg H, Oral H, Pappone C, Themistoclakis S, Wood KA, Blomström-Lundqvist C, Gorenek B, Dagres N, Dan GA, Vos MA, Kudaiberdieva G, Crijns H, Roberts-Thomson K, Lin YJ, Vanegas D, Caorsi WR, Cronin E, Rickard J. European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulación Cardiaca y Electrofisiologia (SOLAECE). Europace 2018; 19:465-511. [PMID: 27856540 DOI: 10.1093/europace/euw301] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- Demosthenes G Katritsis
- Athens Euroclinic, Athens, Greece; and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Giuseppe Boriani
- Cardiology Department, Modena University Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | - Pierre Jaïs
- University of Bordeaux, CHU Bordeaux, LIRYC, France
| | | | - Roberto Keegan
- Hospital Privado del Sur y Hospital Español, Bahia Blanca, Argentina
| | - Young-Hoon Kim
- Korea University Medical Center, Seoul, Republic of Korea
| | | | | | - Deirdre A Lane
- Asklepios Hospital St Georg, Hamburg, Germany.,University of Birmingham Institute of Cardiovascular Science, City Hospital, Birmingham, UK; and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Gregory Y H Lip
- University of Birmingham Institute of Cardiovascular Science, City Hospital, Birmingham, UK; and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Helena Malmborg
- Department of Cardiology and Medical Science, Uppsala University, Uppsala, Sweden
| | - Hakan Oral
- University of Michigan, Ann Arbor, MI, USA
| | - Carlo Pappone
- IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | | | | | | | - Bulent Gorenek
- Cardiology Department, Eskisehir Osmangazi University, Eskisehir, Turkey
| | | | - Gheorge-Andrei Dan
- Colentina University Hospital, 'Carol Davila' University of Medicine, Bucharest, Romania
| | - Marc A Vos
- Department of Medical Physiology, Division Heart and Lungs, Umc Utrecht, The Netherlands
| | | | - Harry Crijns
- Mastricht University Medical Centre, Cardiology & CARIM, The Netherlands
| | | | | | - Diego Vanegas
- Hospital Militar Central - Unidad de Electrofisiologìa - FUNDARRITMIA, Bogotà, Colombia
| | | | | | | |
Collapse
|
41
|
Jain S, Dalvi B. Atrial septal defect with pulmonary hypertension: when/how can we consider closure? J Thorac Dis 2018; 10:S2890-S2898. [PMID: 30305949 DOI: 10.21037/jtd.2018.07.112] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Patients having atrial septal defect (ASD) with moderate and more importantly severe pulmonary arterial hypertension (PAH) pose a clinical dilemma. Closing ASD in those with irreversible PAH and not closing it when the PAH is reversible can cost patients dearly, both in terms of quality of life and longevity. In our experience, there is no single parameter that can help in decision making in this difficult subset of patients and therefore we recommend a multi-dimensional approach, which takes into consideration clinical, radiological, electrocardiographic and hemodynamic variables as a whole. ASD with restrictive left ventricular (LV) physiology can lead to pulmonary venous hypertension, which can manifest as life threatening acute pulmonary edema following device closure. All high-risk candidates prone to having this combination should be prepared with diuretics and vasodilators prior to bringing them to catheterization laboratory and should be assessed with temporary balloon/device occlusion prior to permanent closure of the defect. In those cases of ASD with borderline operability either due to severe PAH or LV restrictive physiology, perforated device may be helpful in preventing acute or long-term complications of complete closure.
Collapse
Affiliation(s)
- Shreepal Jain
- Department of Pediatric Cardiology, Sir HN Reliance Foundation Hospital, Mumbai, Maharashtra, India
| | - Bharat Dalvi
- Glenmark Cardiac Center, Mumbai, Maharashtra, India
| |
Collapse
|
42
|
Parikh RV, Boyd J, Lee DP, Witteles R. Atrial Septal Defect as Unexpected Cause of Pulmonary Artery Hypertension. Tex Heart Inst J 2018; 45:42-44. [PMID: 29556152 DOI: 10.14503/thij-17-6208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Methamphetamine abuse is an increasingly prevalent cause of pulmonary artery hypertension in the United States. Conversely, an atrial septal defect rarely presents late as pulmonary artery hypertension. We present the case of a 44-year-old methamphetamine abuser who had a 3-month history of worsening fatigue and near-syncope. She had elevated cardiac enzyme levels and right-sided heart strain. Angiographic findings suggested methamphetamine-induced pulmonary artery hypertension; however, we later heard S2 irregularities that raised suspicion of an atrial septal defect. Ultimately, the diagnosis was pulmonary artery hypertension and a large secundum atrial septal defect with left-to-right flow. One year after defect closure, the patient was asymptomatic. In addition to discussing this unexpected case of a secundum atrial septal defect masquerading as methamphetamine-induced pulmonary artery hypertension, we briefly review the natural history of atrial septal defects and emphasize the importance of thorough examination in avoiding diagnostic anchoring bias.
Collapse
|
43
|
Abstract
The purpose of this review is to discuss the management of atrial septal defects (ASD), paying particular attention to the most recent developments. There are four types of ASDs: ostium secundum, ostium primum, sinus venosus, and coronary sinus defects. The fifth type, patent foramen ovale-which is present in 25 to 30% of normal individuals and considered a normal variant, although it may be the seat of paradoxical embolism, particularly in adults-is not addressed in this review. The indication for closure of the ASDs, by and large, is the presence of right ventricular volume overload. In asymptomatic patients, the closure is usually performed at four to five years of age. While there was some earlier controversy regarding ASD closure in adult patients, currently it is recommended that the ASD be closed at the time of presentation. Each of the four defects is briefly described followed by presentation of management, whether by surgical or percutaneous approach, as the case may be. Of the four types of ASDs, only the ostium secundum defect is amenable to percutaneous occlusion. For ostium secundum defects, transcatheter closure has been shown to be as effective as surgical closure but with the added benefits of decreased hospital stay, avoidance of a sternotomy, lower cost, and more rapid recovery. There are several FDA-approved devices in use today for percutaneous closure, including the Amplatzer® Septal Occluder (ASO), Amplatzer® Cribriform device, and Gore HELEX® device. The ASO is most commonly used for ostium secundum ASDs, the Gore HELEX® is useful for small to medium-sized defects, and the cribriform device is utilized for fenestrated ASDs. The remaining types of ASDs usually require surgical correction. All of the available treatment modes are safe and effective and prevent the development of further cardiac complications.
Collapse
Affiliation(s)
- P Syamasundar Rao
- University of Texas-Houston McGovern Medical School, Children Memorial Hermann Hospital, Houston, USA
| | - Andrea D Harris
- University of Texas-Houston McGovern Medical School, Children Memorial Hermann Hospital, Houston, USA
| |
Collapse
|
44
|
Nayak SB. Functional and clinical importance of a large sized ostium secundum defect in a middle aged female cadaver: a case report. Anat Cell Biol 2017; 50:152-154. [PMID: 28713619 PMCID: PMC5509899 DOI: 10.5115/acb.2017.50.2.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 03/28/2017] [Accepted: 04/07/2017] [Indexed: 11/27/2022] Open
Abstract
Atrial septal defect (ASD) is one of the common congenital anomalies of the heart in humans. Its complications depend on the size of the defect and can manifest at any age. The common symptoms of ASD include dyspnea and fatigue. Most of the ASDs are associated with morbidity and mortality, Earlier the treatment, it is better to the patient. I saw a large ostium secundum defect in the heart of an adult female cadaver during dissection classes for undergraduate medical students. The interatrial septum had large defect at the region where fossa ovalis should have been located. It was about 1.25 inches in diameter and oval in shape. This type of large septal defect might result in cyanosis, stroke or death of the patient at any age.
Collapse
Affiliation(s)
- Satheesha B Nayak
- Department of Anatomy, Melaka Manipal Medical College (Manipal Campus), Manipal University, Manipal, India
| |
Collapse
|
45
|
Li J, Ma JR, Sun ZX, Jiang JJ, Dong YQ, Wang Q, Song HM. [A clinical analysis of 15 children with systemic lupus erythematosus accompanied by pulmonary hypertension]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2017; 19:658-662. [PMID: 28606232 PMCID: PMC7390294 DOI: 10.7499/j.issn.1008-8830.2017.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 03/02/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To evaluate the clinical features, laboratory findings, diagnosis and treatment, and prognosis of children with systemic lupus erythematosus (SLE) accompanied by pulmonary hypertension (PH). METHODS The clinical symptoms, laboratory findings, echocardiographic features, SLE disease activity index, and treatment outcome of 15 hospitalized children with SLE accompanied by PH were retrospectively analyzed. RESULTS Among the 15 patients, the median interval from diagnosis of SLE to diagnosis of PH was 0.1 year (range: 0-6.5 years). Aside from PH-related symptoms, Raynaud's phenomenon was observed in 6 (40%) of the 15 patients. There was no significant difference in SLE disease activity (evaluated by complements 3 and 4 levels, erythrocyte sedimentation rate, and positive rate of anti-double-stranded DNA) between patients with mild-to-moderate PH and those with severe PH (P<0.05). As for treatment, 13 patients received immunosuppressive therapy with glucocorticoids, and among them 2 patients received PH-targeted therapy. During a median follow-up of 8.0 years (range: 0.5-18.1 years) since the diagnosis of PH, 2 deaths were noted with class III or IV cardiac function (World Health Organization), while the other patients were in a stable condition. CONCLUSIONS Raynaud's phenomenon is a common clinical manifestation in children with SLE accompanied by pulmonary hypertension (PH). PH severity is not significantly associated with SLE disease activity, and thus greater focus should be placed upon early screening of pulmonary arterial pressure in SLE patients. Early diagnosis and early treatment can improve the prognosis of children with SLE.
Collapse
Affiliation(s)
- Ji Li
- Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China.
| | | | | | | | | | | | | |
Collapse
|
46
|
Lundqvist CB, Potpara TS, Malmborg H. Supraventricular Arrhythmias in Patients with Adult Congenital Heart Disease. Arrhythm Electrophysiol Rev 2017; 6:42-49. [PMID: 28835834 PMCID: PMC5517371 DOI: 10.15420/aer.2016:29:3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 10/20/2016] [Indexed: 12/18/2022] Open
Abstract
An increasing number of patients with congenital heart disease survive to adulthood; such prolonged survival is related to a rapid evolution of successful surgical repairs and modern diagnostic techniques. Despite these improvements, corrective atrial incisions performed at surgery still lead to subsequent myocardial scarring harbouring a potential substrate for macro-reentrant atrial tachycardia. Macroreentrant atrial tachycardias are the most common (75 %) type of supraventricular tachycardia (SVT) in patients with adult congenital heart disease (ACHD). Patients with ACHD, atrial tachycardias and impaired ventricular function - important risk factors for sudden cardiac death (SCD) - have a 2-9 % SCD risk per decade. Moreover, ACHD imposes certain considerations when choosing antiarrhythmic drugs from a safety aspect and also when considering catheter ablation procedures related to the inherent cardiac anatomical barriers and required expertise. Expert recommendations for physicians managing these patients are therefore mandatory. This review summarises current evidence-based developments in the field, focusing on advances in and general recommendations for the management of ACHD, including the recently published recommendations on management of SVT by the European Heart Rhythm Association.
Collapse
Affiliation(s)
| | - Tatjana S Potpara
- School of Medicine, University of Belgrade, Serbia; Cardiology Clinic, Clinical Center of Serbia.
| | - Helena Malmborg
- Institution of Medical Science, Uppsala University, Uppsala, Sweden
| |
Collapse
|
47
|
Transareolar Video-Assisted Approach to the Atrial Septal Defect and Tricuspid Valve. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017; 12:217-220. [PMID: 28538272 DOI: 10.1097/imi.0000000000000368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Minimally invasive atrial septal defect closure and tricuspid annuloplasty in female patients are normally performed through a right submammary anterior minithoracotomy approach. However, when the aortic root is located higher, the direction of aortic cannulation becomes not ideal through the submammary incision. In such cases, transareolar approach is useful. Through this approach, aortic cannulation and tricuspid operation can be performed with endoscopic assistance, and ASD closure can be performed under direct vision.
Collapse
|
48
|
Kitamura T, Torii S, Horai T, Sughimoto K, Kobayashi K, Irisawa Y, Hayashi H, Matsushiro T, Miyata Y, Tsuchida Y, Miyaji K. Transareolar Video-Assisted Approach to the Atrial Septal Defect and Tricuspid Valve. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017. [DOI: 10.1177/155698451701200310] [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]
Affiliation(s)
- Tadashi Kitamura
- From the Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Shinzo Torii
- From the Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Tetsuya Horai
- From the Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Koichi Sughimoto
- From the Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Kensuke Kobayashi
- From the Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yusuke Irisawa
- From the Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Hidenori Hayashi
- From the Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Takuya Matsushiro
- From the Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yurie Miyata
- From the Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yuta Tsuchida
- From the Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Kagami Miyaji
- From the Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| |
Collapse
|
49
|
Duong P, Ferguson LP, Lord S, Murray S, Shepherd E, Bourke JP, Crossland D, O'Sullivan J. Atrial arrhythmia after transcatheter closure of secundum atrial septal defects in patients ≥40 years of age. Europace 2016; 19:1322-1326. [DOI: 10.1093/europace/euw186] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 05/29/2016] [Indexed: 01/08/2023] Open
|
50
|
Cossío-Aranda J, Zamora KDV, Nanda NC, Uzendu A, Keirns C, Verdejo-Paris J, Martínez-Ríos MA, Espinola-Zavaleta N. Echocardiographic correlates of severe pulmonary hypertension in adult patients with ostium secundum atrial septal defect. Echocardiography 2016; 33:1891-1896. [DOI: 10.1111/echo.13358] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Affiliation(s)
- Jorge Cossío-Aranda
- Outpatient Department; National Institute of Cardiology Ignacio Chávez; Mexico City Mexico
| | | | - Navin C. Nanda
- Department of Medicine; University of Alabama; Birmingham Alabama
| | - Anezi Uzendu
- Department of Medicine; University of Alabama; Birmingham Alabama
| | - Candace Keirns
- Interpreters Service; Massachusetts General Hospital; Boston Massachusetts
| | | | | | | |
Collapse
|