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Randhawa S, Mehta JL, Dhar G. Percutaneous Patent Foramen Ovale Closure: Stroke and Beyond. Curr Cardiol Rev 2024; 20:77-86. [PMID: 38485682 DOI: 10.2174/011573403x276984240304044109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 01/13/2024] [Accepted: 01/20/2024] [Indexed: 07/20/2024] Open
Abstract
Over 750,000 individuals suffer from stroke annually in the United States, with 87% of these strokes being ischemic in nature. Roughly 40% of ischemic strokes occur in individuals 60 years of age or under. A quarter of all ischemic strokes have no identifiable cause despite extensive workup and are deemed cryptogenic in nature. Patent Foramen Ovales (PFO) has been postulated in stroke causation by either paradoxical embolization or platelet activation in the tunnel of the defect. The incidence of PFO is reported to be 15-25% in the general population but rises to 40% in patients with cryptogenic stroke. While the initial trials evaluating PFO closures were non-revealing, subsequent long-term follow-ups, as well as recent trials evaluating PFO closures in cryptogenic stroke patients 60 years of age or under, demonstrated the superiority of percutaneous closure compared to medical therapy alone, leading to FDA approval of PFO closure devices. In this review, we review the diagnosis of PFO, postulated stroke mechanisms, literature supporting PFO closure, patient selection for percutaneous closure, procedural considerations, and associated procedural complications.
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Affiliation(s)
- Sandeep Randhawa
- Division of Cardiology, The University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Jawahar L Mehta
- Division of Cardiology, The University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Gaurav Dhar
- Division of Cardiology, The University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Al Maddallah WS, Bhat YA, Al Mesned A, Al Qwaee A, Hassan MA, Al Akhfash A. The Burden of Neonatal Referrals on a Pediatric Cardiology Service: A Local Center Experience. Cureus 2023; 15:e47011. [PMID: 37965404 PMCID: PMC10641434 DOI: 10.7759/cureus.47011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Congenital heart disease (CHD) is a common occurrence in live births, with some exhibiting critical congenital heart disease; therefore, cardiology services should be available around the clock to ensure timely diagnosis and management. This study aims to describe the workload and the need for pediatric cardiac services in a maternity hospital for newborn referrals. Moreover, the study describes the indications for neonatal cardiology consultations. METHODS The prospective cohort study was conducted over four months, from January to April 2022, in the Prince Sultan Cardiac Center Al Qassim region of Saudi Arabia. Prince Sultan Cardiac Center's pediatric cardiology department provides cardiac services to the Maternity and Children Hospital Buraidah Al Qassim. Out of the total 2,606 live births during the study period, the cardiology team evaluated 352 neonates. Neonates less than 30 days of age who were born in the maternity hospital were enrolled in the study. The outborn babies referred from other centers as suspected congenital heart disease for whom a cardiac evaluation was done were excluded. In addition, babies assessed in the emergency room and born elsewhere were excluded. Only new consultations have been considered, excluding follow-up consultations. STATISTICAL ANALYSIS Data about patients' demographic, clinical and echocardiographic findings were recorded on Google Forms and converted to a Google spreadsheet. The Google spreadsheet's inbuilt statistical software was used for analysis. Categorical data were presented as percentages, and numerical data as median and range. RESULTS The cardiology team evaluated 352 neonates from 2,606 live births over four months, accounting for 13.5 per 100 live births. The median weight was 2.8 kilograms, with a 0.5-4.3 kilogram range. Males comprised 187 (53%), and females comprised 165 (47%). Moreover, full-term, preterm, and post-term accounted for 236 (67%), 113 (32%), and 3 (0.8%) of patients, respectively. The common indications for neonatal cardiac referral were respiratory distress 60 (17%), infants born to diabetic mothers 50 (14%), abnormal fetal echocardiogram 49 (13.9%), family history of abortion or neonatal death 31 (8.8%), and congenital anomalies 30 (8.5%). Systolic murmur was the commonest clinical finding that prompted cardiology referrals 82 (23.2%), followed by desaturation 38 (10.7%) and dysmorphic features 31 (8.8%). Among the congenital cardiac defects, an isolated atrial septal defect (ASD) was seen in 66 (18.5%), isolated patent ductus arteriosus in 50 (14.2%), and ventricular septal defect in 21 (5.9%). Moreover, 13 (4.4%) lesions were critical CHDs. Finally, 27 (7.6%) had a diagnosis of pulmonary hypertension. CONCLUSION Knowing the burden of neonatal cardiac assessment on pediatric cardiology services in any maternity center may help the healthcare authorities to allocate resources and optimize the delivery of cardiac services among the neonatal population. Properly allocating pediatric cardiologists to the needed centers may optimize neonatal cardiac services. Moreover, it may decide on the number of pediatric cardiologists that need to be trained each year to meet the requirements of neonatal cardiac services.
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Affiliation(s)
| | - Yasser A Bhat
- Pediatric Cardiology, Prince Sultan Cardiac Center, Buraidah, SAU
| | | | | | - Mohammad Ahmad Hassan
- Pediatric Cardiology, Prince Sultan Cardiac Center, Buraidah, SAU
- Pediatric Department, Sohag Faculty of Medicine, Sohag University, Sohag, EGY
| | - Ali Al Akhfash
- Pediatric Cardiology, Prince Sultan Cardiac Center, Buraidah, SAU
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Gaffar S, Siassi B, Cayabyab R, Ebrahimi M, Barton L, Uzunyan M, Ramanathan R. Outcomes of patent foramen ovale greater than 3 mm at birth in extremely low birthweight infants. BMC Pediatr 2023; 23:293. [PMID: 37322472 PMCID: PMC10268431 DOI: 10.1186/s12887-023-04119-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 06/08/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Foramen ovale (FO) is an obligate fetal shunt that typically resolves after birth, although patency throughout life is not uncommon. The natural history of patent FO (PFO) is known in term infants, but less is known about its course in extremely preterm infants. We describe the echocardiographic changes in FO size from birth to discharge in extremely low birth weight (ELBW) infants in this retrospective study. METHODS Cohort was divided based on size of FO at birth. Size of FO at discharge was measured and evaluated relative to postnatal weight gain. Demographics and clinical outcomes were compared between the two groups. RESULTS Of the 54 ELBW infants, 50 were born with FO less than 3 mm in diameter (small), and 4 were born with FO greater than 3 mm (large). Of small defects, the majority (44/50, 88%) did not increase in size with weight gain, and minority (6/50, 12%) increased in size, and three of these 6 patients, FO grew to be slightly larger than 3 mm. In contrast, all large defects (4 of 4, 100%) nearly doubled in size with postnatal growth. These 4 ELBW infants with enlargement of FO had a flap valve evident on echocardiogram obtained prior to discharge, and subsequently closed on outpatient follow-up echocardiograms, although time to resolution was variable (6 months - 3 years). One infant had presumptive resolution because of the presence of flap valve. CONCLUSION No maternal or neonatal demographic characteristics were predictive of FO enlargement, although, demonstrable flap valve on discharge echocardiogram correlated with resolution of FO on outpatient follow-up echocardiogram. Therefore, based on our data, we recommend that ELBW infants born with large FO should have echocardiographic re-evaluation of the atrial septal opening prior to discharge, to specify the presence of a flap valve or lack thereof, which is an important detail that can help a neonatologist determine the need for outpatient cardiac follow-up.
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Affiliation(s)
- Sheema Gaffar
- Division of Neonatology, Department of Pediatrics, Keck School of Medicine, University of Southern California, LAC General Medical Center, 1200 N State St, IRD Building, Room 820, Los Angeles, CA, 90033-1029, USA.
| | - Bijan Siassi
- Division of Neonatology, Department of Pediatrics, Keck School of Medicine, University of Southern California, LAC General Medical Center, 1200 N State St, IRD Building, Room 820, Los Angeles, CA, 90033-1029, USA
| | - Rowena Cayabyab
- Division of Neonatology, Department of Pediatrics, Keck School of Medicine, University of Southern California, LAC General Medical Center, 1200 N State St, IRD Building, Room 820, Los Angeles, CA, 90033-1029, USA
| | - Mahmood Ebrahimi
- Division of Neonatology, Department of Pediatrics, Keck School of Medicine, University of Southern California, LAC General Medical Center, 1200 N State St, IRD Building, Room 820, Los Angeles, CA, 90033-1029, USA
| | - Lorayne Barton
- Division of Neonatology, Department of Pediatrics, Keck School of Medicine, University of Southern California, LAC General Medical Center, 1200 N State St, IRD Building, Room 820, Los Angeles, CA, 90033-1029, USA
| | - Merujan Uzunyan
- Division of Neonatology, Department of Pediatrics, Keck School of Medicine, University of Southern California, LAC General Medical Center, 1200 N State St, IRD Building, Room 820, Los Angeles, CA, 90033-1029, USA
- Division of Cardiology, Department of Pediatrics, Keck School of Medicine, University of Southern California, LAC General Medical Center, Los Angeles, CA, USA
| | - Rangasamy Ramanathan
- Division of Neonatology, Department of Pediatrics, Keck School of Medicine, University of Southern California, LAC General Medical Center, 1200 N State St, IRD Building, Room 820, Los Angeles, CA, 90033-1029, USA
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Pulmonary hemorrhage in extremely low birth weight infants: Significance of the size of left to right shunting through a valve incompetent patent foramen ovale. J Perinatol 2022; 42:1233-1237. [PMID: 35851183 DOI: 10.1038/s41372-022-01464-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 06/20/2022] [Accepted: 07/06/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Pulmonary hemorrhage is a rare but severe complication of extremely low birth weight (ELBW) infants. The association of hemodynamically significant patent ductus arteriosus (hsPDA) and the diameter of the foramen ovale (FO) with pulmonary hemorrhage has not been reported. STUDY DESIGN Case control study of ELBW infants with and without pulmonary hemorrhage. Each ELBW infant with an echocardiogram within 48 h of pulmonary hemorrhage was analyzed. RESULT 16 infants with pulmonary hemorrhage were matched with 32 controls by birth weight and gestational age. Echocardiogram showed hsPDA in all infants and those with pulmonary hemorrhage had significantly smaller patent FO [PFO] (1 vs 2.4 mm, p < 0.01) (OR 0.007; 95% CI 0.00007, 0.67 p = 0.03). Incidence of pulmonary hemorrhage was 8.9%. CONCLUSION ELBW infants with hsPDA who experienced pulmonary hemorrhage had a significantly restricted or closed FO. Evaluation of FO should be considered with serial echocardiograms when evaluating for hsPDA.
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Fernández-Hernández L, Reyna-Fabián ME, Alcántara-Ortigoza MA, Aláez-Verson C, Flores-Lagunes LL, Carrillo-Sánchez K, González-del Angel A. Unusual Clinical Manifestations in a Mexican Patient with Sanfilippo B Syndrome. Diagnostics (Basel) 2022; 12:diagnostics12051268. [PMID: 35626423 PMCID: PMC9140210 DOI: 10.3390/diagnostics12051268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/18/2022] [Accepted: 04/26/2022] [Indexed: 12/04/2022] Open
Abstract
We present an unusual Mexican patient affected with mucopolysaccharidosis type IIIB (MPS IIIB; also called Sanfilippo B syndrome, MIM #252920) bearing clinical features that have not previously been described for MPS IIIB (growth arrest, hypogonadotropic hypogonadism, and congenital heart disease). Chromosomal microarray analysis was useful in identifying runs of homozygosity at 17q11.1–q21.33 and supporting the diagnosis of an underlying autosomal recessive condition. Sanger sequencing of NAGLU (17q21.2, MIM*609701) allowed us to identify a pathogenic homozygous p.(Arg234Cys) genotype. This NAGLU allele could be related to that previously described in an Iberian MPS IIIB founder haplotype; results from the polymorphic marker D17S800 and rs2071046 led us to hypothesize that it may have been introduced to Mexico through the Spanish settlement. The analysis of a clinical exome sequencing ruled out other monogenic etiologies for the previously undescribed clinical MPS IIIB manifestations. Our findings contribute to further delineating the MPS IIIB phenotype and suggest possible phenotype–genotype correlations.
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Affiliation(s)
- Liliana Fernández-Hernández
- Laboratorio de Biología Molecular, Subdirección de Investigación Médica, Instituto Nacional de Pediatría, Insurgentes Sur 3700-C, Insurgentes Cuicuilco, Coyoacán, Mexico City CP 04530, Mexico; (L.F.-H.); (M.E.R.-F.); (M.A.A.-O.)
| | - Miriam Erandi Reyna-Fabián
- Laboratorio de Biología Molecular, Subdirección de Investigación Médica, Instituto Nacional de Pediatría, Insurgentes Sur 3700-C, Insurgentes Cuicuilco, Coyoacán, Mexico City CP 04530, Mexico; (L.F.-H.); (M.E.R.-F.); (M.A.A.-O.)
| | - Miguel Angel Alcántara-Ortigoza
- Laboratorio de Biología Molecular, Subdirección de Investigación Médica, Instituto Nacional de Pediatría, Insurgentes Sur 3700-C, Insurgentes Cuicuilco, Coyoacán, Mexico City CP 04530, Mexico; (L.F.-H.); (M.E.R.-F.); (M.A.A.-O.)
| | - Carmen Aláez-Verson
- Laboratorio de Diagnóstico Genómico, Instituto Nacional de Medicina Genómica (INMEGEN), Periférico Sur 4809, Arenal Tepepan, Tlalpan, Mexico City CP 14610, Mexico; (C.A.-V.); (L.L.F.-L.); (K.C.-S.)
| | - Luis L. Flores-Lagunes
- Laboratorio de Diagnóstico Genómico, Instituto Nacional de Medicina Genómica (INMEGEN), Periférico Sur 4809, Arenal Tepepan, Tlalpan, Mexico City CP 14610, Mexico; (C.A.-V.); (L.L.F.-L.); (K.C.-S.)
| | - Karol Carrillo-Sánchez
- Laboratorio de Diagnóstico Genómico, Instituto Nacional de Medicina Genómica (INMEGEN), Periférico Sur 4809, Arenal Tepepan, Tlalpan, Mexico City CP 14610, Mexico; (C.A.-V.); (L.L.F.-L.); (K.C.-S.)
| | - Ariadna González-del Angel
- Laboratorio de Biología Molecular, Subdirección de Investigación Médica, Instituto Nacional de Pediatría, Insurgentes Sur 3700-C, Insurgentes Cuicuilco, Coyoacán, Mexico City CP 04530, Mexico; (L.F.-H.); (M.E.R.-F.); (M.A.A.-O.)
- Correspondence: ; Tel.: +52-(55)-10-84-09-00 (ext. 1306)
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DE Marco F, Romano A, Casenghi M, Berti S. Patient selection, procedural planning and interventional guidance for non-valvular structural intervention. Minerva Cardiol Angiol 2021; 69:720-734. [PMID: 34870383 DOI: 10.23736/s2724-5683.21.05696-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Percutaneous non-valvular structural interventions, encompassing patent foramen ovale, atrial or ventricular septal defect closure and left atrial appendage closure, are usually performed in young and healthy patients and represent a valid alternative to pharmacological or surgical interventions. In order to minimize procedural and device related complications, a careful pre-procedural planning together with an accurate intra-procedural imaging are crucial to improve patient's outcome. In this article, we review currently available evidence on patient selection, procedural planning and interventional guidance helping physician to determine who will derive the most benefit from the procedure.
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Affiliation(s)
- Federico DE Marco
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | - Andrea Romano
- Unit of Diagnostic and Interventional Cardiology, C.N.R. Reg. Toscana G. Monasterio Foundation, Ospedale del Cuore, Massa, Italy -
| | - Matteo Casenghi
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | - Sergio Berti
- Unit of Diagnostic and Interventional Cardiology, C.N.R. Reg. Toscana G. Monasterio Foundation, Ospedale del Cuore, Massa, Italy
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Lwin MT, Branco Mano T, Li W. ASD or PFO: State-of-the-art echocardiography says it all. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2021. [DOI: 10.1016/j.ijcchd.2021.100285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Di Girolamo N, Palmieri C, Baron Toaldo M, Nicoletti A, Spattini G, Zeyen U, Selleri P. First Description of Partial Atrioventricular Septal Defect in a Rabbit. J Exot Pet Med 2018. [DOI: 10.1053/j.jepm.2017.10.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Patel PA, Hall A, Augoustides JGT, Patel S, Feinman JW, Weber B, Gutsche JT, Fabbro M, Maldonado Y. Dynamic Shunting Across a Patent Foramen Ovale in Adult Cardiac Surgery-Perioperative Challenges and Management. J Cardiothorac Vasc Anesth 2017; 32:542-549. [PMID: 29223721 DOI: 10.1053/j.jvca.2017.05.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Indexed: 01/27/2023]
Affiliation(s)
- Prakash A Patel
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Andrew Hall
- Department of Anesthesiology, Perioperative Medicine and Pain Management, Miller School of Medicine, University of Miami, Miami, FL
| | - John G T Augoustides
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | - Saumil Patel
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jared W Feinman
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Beth Weber
- Department of Anesthesiology, Perioperative Medicine and Pain Management, Miller School of Medicine, University of Miami, Miami, FL
| | - Jacob T Gutsche
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Michael Fabbro
- Department of Anesthesiology, Perioperative Medicine and Pain Management, Miller School of Medicine, University of Miami, Miami, FL
| | - Yasdet Maldonado
- Department of Anesthesiology, Allegheny Health Network, Pittsburgh, PA
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Koh TW. When to use femoral vein injection for diagnosis of patent foramen ovale-Effect of a persistent eustachian valve on right atrial flow patterns during contrast transesophageal echocardiography. Echocardiography 2017; 34:768-772. [PMID: 28299822 DOI: 10.1111/echo.13511] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Contrast echocardiography using agitated saline injected into the antecubital vein is the most common method used for the diagnosis of patent foramen ovale. We describe a case whereby the presence of a persistent eustachian valve and a "negative contrast sign" during contrast transesophageal echocardiography raised suspicion of a false-negative result. Femoral vein injection of contrast successfully demonstrated a patent foramen ovale. Femoral vein injection should be considered if this scenario is recognized because the eustachian valve directs blood preferentially from the inferior vena cava toward the interatrial septum and this route may prove to be more reliable.
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Affiliation(s)
- Tat W Koh
- Department of Cardiology, Barts Heart Centre, London, United Kingdom
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Ding C, Chang JK, Lin CC, Wu YJ, Hsieh KS. Efficacy and Safety of Transthoracic Echocardiography Alone in Transcatheter Closure of Secundum-Type Atrial Septal Defects in Adults. Echocardiography 2015; 33:579-85. [PMID: 26522626 DOI: 10.1111/echo.13106] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND On-site transthoracic echocardiography (TTE) to guide the transcutaneous closure of secundum-type atrial septal defects (ASDs) in the catheterization laboratory remains unclear, especially in adults. METHODS Between 2005 and 2012, a total of 82 adults underwent transcutaneous closure of ASDs. The initial 15 cases underwent the procedure with both on-site transesophageal echocardiography (TEE) and TTE monitoring. Since January 2008, a total of 67 patients underwent on-site TTE alone to guide the procedure. RESULTS Among the 82 adult patients who underwent a transcutaneous closure of the secundum-type ASD procedure, all had successful closure of the defects, and no periprocedural adverse complications occurred. No statistical significance was observed in the successful complete shunt closure rate between the TEE plus TTE and TTE groups during sequential follow-up (postprocedure 24 hour [87% vs. 92%],1 month [93% vs. 95%], 3 month [93% vs. 97%], and 12 month [93% vs. 97%], P > 0.05, respectively) nor was a significant difference observed between the two groups, including decreased right ventricular dimension (29.5 ± 3.3 vs. 32.0 ± 4.9 mm, 26.5 ± 3.0 vs. 28.7 ± 4.6 mm, 26.2 ± 3.1 vs. 28.2 ± 4.8 mm, and 25.6 ± 2.8 vs. 27.7 ± 4.7 mm, P > 0.05, respectively) or increased left ventricular end-diastolic dimension (41.1 ± 2.0 vs. 42.6 ± 3.0 mm, 44.3 ± 2.7 vs. 45.5 ± 3.1 mm, 44.2 ± 2.8 vs. 45.4 ± 3.1 mm, 44.9 ± 2.7 vs. 45.8 ± 2.6 mm, P > 0.05, respectively) before the procedure, and at the 3-, 6-, and 12-month follow-up evaluations. CONCLUSION This study showed that TTE guidance alone may be considered efficacious and safe as TEE during a transcutaneous ASD occlusion procedure in select adults.
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Affiliation(s)
- Cheng Ding
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Cardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jia-Kan Chang
- Department of Pediatrics, Cheng-Hsin General Hospital, Taipei, Taiwan
| | - Chang-Chyi Lin
- Division of Cardiology, Department of Internal Medicine, Cheng-Hsin General Hospital, Taipei, Taiwan
| | - Yong-Jian Wu
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Cardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kai-Sheng Hsieh
- Department of Pediatrics, Kaohsiung Chang-Gung Memorial Hospital, Kaohsiung, Taiwan
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De Vry DJ, Ferron DR, Kersten JR, Rashid ZA, Pagel PS. How Can a Large Left Atrial Myxoma Cause a Selective Mid-Diastolic Right-to-Left Atrial Shunt? J Cardiothorac Vasc Anesth 2015; 29:820-3. [DOI: 10.1053/j.jvca.2014.10.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Indexed: 11/11/2022]
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