1
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Lai WT, Yu HP, Lin CC, Yin WH, Ko TY, Hwang JJ, Lin LC, Huang KC. Right Ventricular Pump Efficiency in Secundum-Type Atrial Septal Defect. ACTA CARDIOLOGICA SINICA 2022; 38:47-55. [PMID: 35068883 PMCID: PMC8743475 DOI: 10.6515/acs.202201_38(1).20210721a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 07/21/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND A well-functioning cardiopulmonary system, which works as a pump, should generate adequate stroke volume with as little stroke work as possible. We propose a new composite parameter, right ventricular (RV) pump efficiency (η) = left ventricular stroke volume / right ventricular stroke work, to describe this idea in a volume overload population with secundum-type atrial septal defect (ASD). METHODS We consecutively enrolled 50 patients with secundum-type ASD to investigate the relationship between right-sided volume overload and RV pump efficiency. Sixteen patients with a pulmonary to systemic flow ratio (Qp/Qs) > 1.5 underwent implantation of an occluder. The paired t test was used to compare RV pump efficiency before and after ASD closure. RESULTS RV pump efficiency was inversely correlated with Qp/Qs and was 60 ± 20‰ · mmHg-1 at Qp/Qs = 1. After ASD closure, RV volume, ejection fraction and free wall strain all significantly decreased, while RV pump efficiency significantly increased from 27.4 ± 13.6 to 63.9 ± 20.4‰ · mmHg-1. CONCLUSIONS RV pump efficiency can superiorly reflect the chronicity and severity of secundum-type ASD.
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Affiliation(s)
| | - Ho-Ping Yu
- Heart Center, Cheng-Hsin General Hospital
| | - Chang-Chyi Lin
- Heart Center, Cheng-Hsin General Hospital;
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Cardiology, Department of Internal Medicine, National Defense Medical Center
| | | | - Tsung-Yu Ko
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei;
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National Taiwan University Hospital Hsin-Chu Biomedical Park Branch, Hsinchu
| | - Juey-Jen Hwang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Lung-Chun Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Kuan-Chih Huang
- Heart Center, Cheng-Hsin General Hospital;
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Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei
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2
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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.
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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
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White BR, Katcoff H, Faerber JA, Lin KY, Rossano JW, Mercer-Rosa L, O'Connor MJ. Echocardiographic Assessment of Right Ventricular Function in Clinically Well Pediatric Heart Transplantation Patients and Comparison With Normal Control Subjects. J Am Soc Echocardiogr 2019; 32:537-544.e3. [PMID: 30954122 DOI: 10.1016/j.echo.2019.01.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Echocardiographic follow-up after pediatric heart transplantation is important because of the lifelong risk for rejection and resultant ventricular dysfunction. Although adult studies have shown that echocardiographic measures of right ventricular function are changed after transplantation, similar results have not been reported in the pediatric population. METHODS A single-center retrospective study of echocardiograms obtained among pediatric heart transplant recipients was conducted. All echocardiograms were selected remote from transplantation, rejection, or graft vasculopathy. These criteria identified 127 patients. Right ventricular systolic function was measured using tricuspid annular plane systolic excursion, fractional area change (FAC), and peak systolic tricuspid annular tissue velocity (S'). Results were compared with those in 380 healthy age-matched echocardiographic control subjects. RESULTS Tricuspid annular plane systolic excursion values in pediatric heart transplant recipients were significantly lower than in control subjects at all ages (P < .0001), with a mean Z score of -3.38. FAC and S' did not vary by age in control patients >6 months of age. FAC values in transplantation patients were significantly decreased compared with those in control subjects (P < .0001), but 83% of transplantation patients had FAC values within the control-derived normal range. S' values were also significantly lower in transplantation patients than control subjects (P < .0001). CONCLUSIONS Heart transplantation patients have significantly decreased quantitative metrics of right ventricular function relative to healthy control subjects; longitudinal shortening (tricuspid annular plane systolic excursion and S') is particularly affected. FAC is relatively preserved and may be a better metric in this population. These results establish nomograms of RV function in pediatric heart transplantation patients and in normal pediatric control subjects, which may allow quantification of changes in this vulnerable population.
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Affiliation(s)
- Brian R White
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Hannah Katcoff
- Healthcare Analytics Unit, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jennifer A Faerber
- Healthcare Analytics Unit, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kimberly Y Lin
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph W Rossano
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Laura Mercer-Rosa
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew J O'Connor
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Jadhav T, Kareem H, Nayak K, Pai U, Devasia T, Padmakumar R. A study of right ventricular function in pre- and post-valvular surgeries. Interv Med Appl Sci 2019; 10:137-144. [PMID: 30713752 PMCID: PMC6343576 DOI: 10.1556/1646.10.2018.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Aims The aim of this study is to compare tricuspid annular plane systolic excursion (TAPSE) in pre- and postoperative valvular heart surgery patients using M-mode imaging, to determine changes in tissue Doppler parameters among patients undergoing valvular heart surgery, and to analyze tissue deformation parameters of right ventricle (RV) and RV strain in pre- and postoperative patients. Materials and methods This was an observational, cross-sectional, single-center study that included 24 patients who underwent echocardiographic assessment prior to surgery, after surgery, and at 1-month follow-up. Assessment of left and right ventricles by M-mode echocardiography, evaluation of RV by 2D Doppler echocardiography, tissue Doppler imaging, and strain imaging were performed. Results The TAPSE was significantly reduced immediately after surgery (14.8 ± 0.37 vs. 10.9 ± 0.26 mm), which was then improved on follow-up assessment (17.8 ± 34 mm) (p = 0.001). Tricuspid valve diastolic velocity was increased after surgery and then gradually declined at 1-month follow-up (p = 0.003). Presurgery RV free wall strain was found to be reduced, which was then improved during post-procedure analysis as well as on follow-up (p = 0.001). Conclusions After cardiac valvular surgery, RV myocardial deformation showed a gradual improvement after 1 month, although there was an immediate decline in RV function postsurgery. The pattern of RV contraction, as showed by RV strain, varied postsurgery, which was remarkably increased in postoperative patients at the time of follow-up. Tissue deformation imaging being an emerging technique helps in the assessment of minute, subtle changes that occur in the RV myocardial function in cardiac patients undergoing valve surgery.
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Affiliation(s)
- Tejaswi Jadhav
- Department of Cardiovascular Technology, School of Allied Health Sciences, Manipal University, Manipal, India
| | - Hashir Kareem
- Department of Cardiology, Kasturba Hospital, Kasturba Medical College, Manipal University, Manipal, India
| | - Krishnananda Nayak
- Department of Cardiovascular Technology, School of Allied Health Sciences, Manipal University, Manipal, India
| | - Umesh Pai
- Department of Cardiovascular Technology, School of Allied Health Sciences, Manipal University, Manipal, India
| | - Tom Devasia
- Department of Cardiology, Kasturba Hospital, Kasturba Medical College, Manipal University, Manipal, India
| | - Ramachandran Padmakumar
- Department of Cardiology, Kasturba Hospital, Kasturba Medical College, Manipal University, Manipal, India
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Konagai N, Fukui S, Kitano M, Asaumi Y, Nakanishi M, Ogo T, Fujita T, Ohnishi Y, Kobayashi J, Yasuda S. Successful Transcatheter Atrial Septal Defect Closure Prior to Coronary Artery Bypass Grafting Using Anti-Congestive Therapies and Intraaortic Balloon Pumping in a Patient with Severe Ischemic Cardiomyopathy and Triple-Vessel Coronary Artery Disease. Int Heart J 2018; 59:1480-1484. [DOI: 10.1536/ihj.17-563] [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: 11/18/2022]
Affiliation(s)
- Nao Konagai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
- Department of Advanced Cardiovascular Medicine, Kumamoto University Graduate School of Medical Sciences
| | - Shigefumi Fukui
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Masataka Kitano
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
| | - Yasuhide Asaumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Michio Nakanishi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Takeshi Ogo
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Tomoyuki Fujita
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center
| | - Yoshihiko Ohnishi
- Department of Anesthesiology, National Cerebral and Cardiovascular Center
| | - Junjiro Kobayashi
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
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Prochownik P, Przewłocki T, Podolec P, Wilkołek P, Sobień B, Gancarczyk U, Podolec N, Komar M. Improvement of physical capacity in patients undergoing transcatheter closure of atrial septal defects. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2018; 14:90-94. [PMID: 29743909 PMCID: PMC5939550 DOI: 10.5114/aic.2018.74360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 08/29/2017] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Atrial septal defect (ASD) is the most common congenital cardiac anomaly diagnosed in adults. It often remains asymptomatic until the fourth or fifth decade of life. Significant left-to-right interatrial shunting is associated with the risk of heart failure, pulmonary hypertension and atrial fibrillation. Percutaneous ASD closure is a recognized method of treatment. AIM To evaluate the clinical outcomes and physical capacity in patients undergoing transcatheter closure of ostium secundum ASD. MATERIAL AND METHODS One hundred and twenty adult patients (75 females and 45 males) with a mean age of 43.1 ±13.3 (17-78) years who underwent transcatheter device closure of ostium secundum ASD were analyzed. Clinical evaluation and transthoracic color Doppler echocardiographic study were repeated in all patients before as well as 1 and 24 months after the procedure. To assess the physical capacity symptom-limited treadmill exercise tests with respiratory gas-exchange analysis were performed in all patients before the procedure and after 24 months of follow-up. RESULTS The devices were successfully implanted in all patients. During 24 months of follow-up all patients showed significant clinical and spiroergometric improvement of exercise capacity, and a significant decrease of right heart chamber overload features on echocardiography. CONCLUSIONS Transcatheter closure of ASD in patients with significant shunt resulted in significant clinical and hemodynamic improvement regardless of the baseline functional class.
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Affiliation(s)
- Paweł Prochownik
- Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland
| | - Tadeusz Przewłocki
- Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland
| | - Piotr Podolec
- Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland
| | - Piotr Wilkołek
- Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland
| | - Bartosz Sobień
- Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland
| | - Urszula Gancarczyk
- Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland
| | - Natalia Podolec
- Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Monika Komar
- Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland
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Aloia E, Cameli M, D'Ascenzi F, Sciaccaluga C, Mondillo S. TAPSE: An old but useful tool in different diseases. Int J Cardiol 2016; 225:177-183. [DOI: 10.1016/j.ijcard.2016.10.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 10/03/2016] [Accepted: 10/04/2016] [Indexed: 01/08/2023]
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8
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Karavelioğlu Y, Özkurt S, Kalçik M, Karapinar H, Arisoy A. Echocardiographic assessment of right ventricular functions in nondiabetic normotensive hemodialysis patients. Interv Med Appl Sci 2015; 7:95-101. [PMID: 26527323 DOI: 10.1556/1646.7.2015.3.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 06/07/2015] [Accepted: 06/09/2015] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Heart is affected structurally and functionally in end-stage renal disease (ESRD). However, the data available about adverse effects of ESRD on right ventricle (RV) is scarce. We aimed to evaluate echocardiographic parameters of RV in nondiabetic, normotensive patients with ESRD undergoing hemodialysis (HD). METHODS A total of 45 (24 women; mean age 52.4 ± 12.4 years) consecutive nondiabetic, normotensive patients with ESRD undergoing HD and 39 healthy age and sex-matched control subjects (22 women; mean age 50.3 ± 6.6 years) were enrolled in the study. M-mode and two dimensional images, color, pulsed and continuous wave Doppler, and tissue Doppler measurements were acquired from all subjects. Echocardiographic evaluation was performed in the days between HD dates of the patients. RESULTS RV fractional area change, tricuspid annular plane systolic excursion, tricuspid E velocity, E/A ratio, tricuspid annular E´ velocity, and E´/A´ ratio were lower in patients than controls (p < 0.001, p = 0.003, p = 0.007, p = 0.005, p < 0.001, and p = 0.034, respectively). However, RV diastolic area, RV myocardial performance index, E/E´ ratio, and mean and systolic pulmonary artery pressure were higher in patients than controls (p < 0.001, p = 0.007, p = 0.005, p < 0.001, p = 0.006, respectively). CONCLUSIONS RV systolic and diastolic functions of nondiabetic, normotensive HD patients are deteriorated as compared to healthy controls.
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Agha HM, El-Saiedi SA, Shaltout MF, Hamza HS, Nassar HH, Abdel-Aziz DM, Tantawy AEE. Incomplete RV Remodeling After Transcatheter ASD Closure in Pediatric Age. Pediatr Cardiol 2015; 36:1523-31. [PMID: 25981566 DOI: 10.1007/s00246-015-1196-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 05/06/2015] [Indexed: 10/23/2022]
Abstract
Published data showing the intermediate effect of transcatheter device closure of atrial septal defect (ASD) in the pediatric age-group are scarce. The objective of the study was to assess the effects of transcatheter ASD closure on right and left ventricular functions by tissue Doppler imaging (TDI). The study included 37 consecutive patients diagnosed as ASD secundum by transthoracic echocardiography and TEE and referred for transcatheter closure at Cairo University Specialized Pediatric Hospital, Egypt, from October 2010 to July 2013. Thirty-seven age- and sex-matched controls were selected. TDI was obtained using the pulsed Doppler mode, interrogating the right cardiac border (the tricuspid annulus) and lateral mitral annulus, and myocardial performance index (MPI) was calculated at 1-, 3-, 6- and 12-month post-device closure. Transcatheter closure of ASD and echocardiographic examinations were successfully performed in all patients. There were no significant differences between two groups as regards the age, gender, weight or BSA. TDI showed that patients with ASD had significantly prolonged isovolumetric contraction, relaxation time and MPI compared with control group. Decreased tissue Doppler velocities of RV and LV began at one-month post-closure compared with the controls. Improvement in RVMPI and LVMPI began at 1-month post-closure, but they are still prolonged till 1 year. Reverse remodeling of right and left ventricles began 1 month after transcatheter ASD closure, but did not completely normalize even after 1 year of follow-up by tissue Doppler imaging.
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Affiliation(s)
- Hala M Agha
- Pediatric Cardiology Division, Pediatric Department, Faculty of Medicine, Specialized Pediatric Hospital, Cairo University, Kasr Al Aini street, Cairo, 11562, Egypt.
| | - Sonia A El-Saiedi
- Pediatric Cardiology Division, Pediatric Department, Faculty of Medicine, Specialized Pediatric Hospital, Cairo University, Kasr Al Aini street, Cairo, 11562, Egypt.
| | - Mohamed F Shaltout
- Pediatric Cardiology Division, Pediatric Department, Faculty of Medicine, Specialized Pediatric Hospital, Cairo University, Kasr Al Aini street, Cairo, 11562, Egypt.
| | - Hala S Hamza
- Pediatric Cardiology Division, Pediatric Department, Faculty of Medicine, Specialized Pediatric Hospital, Cairo University, Kasr Al Aini street, Cairo, 11562, Egypt.
| | - Hayat H Nassar
- Pediatric Cardiology Division, Pediatric Department, Faculty of Medicine, Specialized Pediatric Hospital, Cairo University, Kasr Al Aini street, Cairo, 11562, Egypt.
| | - Doaa M Abdel-Aziz
- Pediatric Cardiology Division, Pediatric Department, Faculty of Medicine, Specialized Pediatric Hospital, Cairo University, Kasr Al Aini street, Cairo, 11562, Egypt.
| | - Amira Esmat El Tantawy
- Pediatric Cardiology Division, Pediatric Department, Faculty of Medicine, Specialized Pediatric Hospital, Cairo University, Kasr Al Aini street, Cairo, 11562, Egypt.
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Vijayvergiya R, Singh J, Rana SS, Shetty R, Mittal BR. Early and six-month assessment of bi-ventricular functions following surgical closure of atrial septal defect. Indian Heart J 2014; 66:617-21. [PMID: 25634395 DOI: 10.1016/j.ihj.2014.10.411] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 04/28/2014] [Accepted: 10/09/2014] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND The effect of surgical closure of atrial septal defect (ASD) on biventricular functions is not well studied. We studied effect of surgical closure of ASD on bi-ventricular functions. METHODS Patients undergoing surgical closure of ASD from December 2007 to June 2009 had 3 sequential echocardiograms examination: pre-procedure, post surgery at 1-month and at 6-month of follow up. Pulse Doppler velocities across mitral and tricuspid valves were measured as peak early diastolic (E wave) and peak late diastolic (A wave). Tissue Doppler velocities across lateral wall of both right ventricle (RV) and left ventricle (LV) were measured as peak early diastolic (E'), peak late diastolic (A'), and peak systolic (S') wave. Radionuclide angiography was performed to assess RV and LV ejection fraction at baseline and at 1-month follow up. RESULTS The mean age of 20 enrolled patients was 21.85 ± 10.9 years; 8 females & 12 males. Trans-tricuspid flow velocities significantly decreased following surgery at one and 6-month (p < 0.005). There was no significant change in trans-mitral flow velocities at one and 6-months. Tricuspid and mitral E/A ratio and E/E' ratio also had an insignificant change following surgery. There was no significant change in LV ejection fraction as assessed by echocardiography (p = 0.132) and radionuclide scan (p = 0.143). Right ventricular ejection fraction had a significant improvement at 1-month of follow up (p = 0.005). CONCLUSIONS There was a significant improvement in RV systolic function and an insignificant change in RV and LV diastolic functions following surgical closure of ASD.
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Affiliation(s)
- Rajesh Vijayvergiya
- Associate Professor, Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Sector 12, Chandigarh 160 012, India.
| | - Jiten Singh
- Cardio-thoracic Surgery, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Sandeep S Rana
- Cardio-thoracic Surgery, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Ranjan Shetty
- Associate Professor, Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Sector 12, Chandigarh 160 012, India
| | - Bhagwant R Mittal
- Nuclear Medicine, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
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Cakal S, Eroglu E, Baydar O, Cakal B, Yazicioglu MV, Bulut M, Dundar C, Tigen K, Ozkan B, Acar G, Avci A, Esen AM. Two-dimensional strain and strain rate imaging of the left atrium and left ventricle in adult patients with atrial septal defects before and after the later stage of percutaneous device closure. Echocardiography 2014; 32:470-4. [PMID: 25059711 DOI: 10.1111/echo.12693] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
AIM Atrial septal defect (ASD) causes chronic volume overload of the right heart. The potential adverse effects of this long-standing volume overload to left atrium (LA) and left ventricle (LV) and their response to ASD closure has been poorly studied. METHODS We studied 20 ASD patients before the procedure, at the 24-hour and 1 month following the percutaneous closure. Twenty age-matched controls served as the control group. The analysis for atrial deformation was performed on the lateral wall, mid segment of the LA from apical four-chamber view. Peak longitudinal strain (S) and strain rate (SR) during LA reservoir, passive emptying, atrial contraction phases and LV global longitudinal systolic S and SR were measured. RESULTS Peak S and SR at LA reservoir, conduit and late contraction phases in ASD patients were similar to controls. All of these parameters increased immediately after the closure of the defect. Similarly, SLV and SRLV in ASD patients were not significantly different from the controls and significantly increased after the closure. But LA S, SR and LV S, SR results decreased in 1 month after the closure. SLV in ASD patients was significantly correlated with echocardiographic findings and the invasively measured defect size. CONCLUSION LA and LV S and SR are not significantly affected in ASD patients. However, correction of the long-standing volume overload by percutaneous closure causes an early increase in LA and LV longitudinal deformation that correlates with the magnitude of the atrial septal defect. But this increase decreased in 1 month after closure.
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Affiliation(s)
- Sinem Cakal
- Department of Cardiology, Kartal Kosuyolu Yuksek Ihtisas Heart and Research Hospital, Istanbul, Turkey
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Nguyen T, Cao L, Movahed A. Altered Right Ventricular Contractile Pattern after Cardiac Surgery: Monitoring of Septal Function Is Essential. Echocardiography 2014; 31:1159-65. [DOI: 10.1111/echo.12657] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Tin Nguyen
- Department of Cardiovascular Sciences; Brody School of Medicine; East Carolina Heart Institute; East Carolina University; Greenville North Carolina
| | - Long Cao
- Department of Cardiovascular Sciences; Brody School of Medicine; East Carolina Heart Institute; East Carolina University; Greenville North Carolina
| | - Assad Movahed
- Department of Cardiovascular Sciences; Brody School of Medicine; East Carolina Heart Institute; East Carolina University; Greenville North Carolina
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13
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Baydar O, Oktay V, Sinan UY, Cakal S, Cakal B, Coskun U, Yildiz A. Strain Analysis during Exercise in Patients with Asymptomatic Atrial Septal Defect. Echocardiography 2014; 31:1239-44. [DOI: 10.1111/echo.12570] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Onur Baydar
- Department of Cardiology; Mus State Hospital; Mus Turkey
| | - Veysel Oktay
- Department of Cardiology; Kahta State Hospital; Kahta Turkey
| | - Umit Yasar Sinan
- Department of Cardiology; Viransehir State Hospital; Viransehir Turkey
| | - Sinem Cakal
- Department of Cardiology; Mus State Hospital; Mus Turkey
| | | | - Ugur Coskun
- Department of Cardiology; Institute of Cardiology; Istanbul University; Istanbul Turkey
| | - Ahmet Yildiz
- Department of Cardiology; Institute of Cardiology; Istanbul University; Istanbul Turkey
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Klitsie LM, Roest AAW, Blom NA, ten Harkel ADJ. Ventricular performance after surgery for a congenital heart defect as assessed using advanced echocardiography: from doppler flow to 3D echocardiography and speckle-tracking strain imaging. Pediatr Cardiol 2014; 35:3-15. [PMID: 24121730 DOI: 10.1007/s00246-013-0802-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Accepted: 09/14/2013] [Indexed: 02/01/2023]
Abstract
A varying degree of impairment of ventricular performance is observed over the long-term after surgery for a congenital heart defect (CHD). Impaired ventricular performance has been shown to be of prognostic value for increased risk of cardiovascular events in adult CHD patients. This emphasizes the importance of delineating the timing and cause of this postoperative impairment. Impairment of ventricular performance could develop over time as a consequence of residua, sequelae and complications of the CHD or surgical procedure. Yet, impaired ventricular performance has also been observed immediately after surgery and can persist and/or worsen over time. This postoperative impairment of ventricular performance is the focus of this review. This article provides an overview of echocardiographic techniques currently used to assess ventricular performance. Furthermore, we review current literature describing ventricular performance, as assessed using echocardiography, after correction of a CHD. In general, a decrease in ventricular performance is observed directly after surgery for CHD’s. Subsequent follow-up of ventricular performance is characterized by a varying degree of postoperative recovery. A consistent observation is the persistent impairment of right-ventricular performance after repair in several different subgroups of CHD patients ranging from ventricular septal defect repair to surgery for Tetralogy of Fallot.
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Okada DR, Rahmouni HW, Herrmann HC, Bavaria JE, Forfia PR, Han Y. Assessment of right ventricular function by transthoracic echocardiography following aortic valve replacement. Echocardiography 2013; 31:552-7. [PMID: 24304365 DOI: 10.1111/echo.12421] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Tricuspid annular plane systolic excursion (TAPSE) is a widely used clinical measure of right ventricular (RV) systolic performance. However, postsurgical changes in the pattern of RV contraction may limit the utility of TAPSE for assessing global RV function. We retrospectively examined pre- and postoperative TAPSE and RV fractional area change (FAC) in patients undergoing 3 different types of aortic valve replacement (AVR). METHODS Fifty-two patients enrolled in the Placement of AoRTic TraNscathetER Valve Trial at our institution were randomized to receive open AVR or transcatheter AVR (TAVR) by either the transapical or transfemoral access routes. Thirty-seven of these patients had analyzable transthoracic echocardiography (TTE) before and after AVR. Using M-mode echocardiography, TAPSE was measured in the apical four-chamber view. Using two-dimensional echocardiography, RV FAC was measured in the apical four-chamber view. RESULTS The mean change in TAPSE was -0.7 ± 0.6 cm for open AVR (P = 0.002), -0.2 ± 0.4 cm for transapical TAVR (P = 0.26), and 0.1 ± 0.5 cm for transfemoral TAVR (P = 0.64). The mean change in RV FAC was -1 ± 5% for open AVR (P = 0.91), 2 ± 4% for transapical TAVR (P = 0.37), and 7 ± 10% for transfemoral TAVR (P = 0.07). CONCLUSIONS The normal pattern of RV contraction was unchanged by transapical and transfemoral TAVR, while open AVR led to a significant decrease in TAPSE with preserved RV FAC. Thus, RV FAC is a preferable method for assessing RV function in the postoperative patient.
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Affiliation(s)
- David R Okada
- Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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D’Andrea A, Riegler L, Nunziata L, Scarafile R, Gravino R, Salerno G, Amarelli C, Maiello C, Limongelli G, Di Salvo G, Caso P, Bossone E, Calabrò R, Pacileo G, Russo MG. Right heart morphology and function in heart transplantation recipients. J Cardiovasc Med (Hagerstown) 2013; 14:648-58. [DOI: 10.2459/jcm.0b013e32835ec634] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Monfredi O, Luckie M, Mirjafari H, Willard T, Buckley H, Griffiths L, Clarke B, Mahadevan VS. Percutaneous device closure of atrial septal defect results in very early and sustained changes of right and left heart function. Int J Cardiol 2013; 167:1578-84. [PMID: 22608895 DOI: 10.1016/j.ijcard.2012.04.081] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Accepted: 04/14/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Oliver Monfredi
- Cardiovascular Research Group, School of Biomedicine, The University of Manchester, Level 3 Core Technology Facility, Grafton Street, Manchester M13 9NT, United Kingdom.
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Fang F, Henein MY, Yu CM, Li W, Kaya MG, Coats AJ, Lam YY. Right ventricular long-axis response to different chronic loading conditions: Its relevance to clinical symptoms. Int J Cardiol 2013; 167:378-82. [DOI: 10.1016/j.ijcard.2011.12.086] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Revised: 12/06/2011] [Accepted: 12/25/2011] [Indexed: 10/14/2022]
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Noble S, Ibrahim R. Percutaneous atrial septal defect closure in patients with left ventricle failure or pulmonary hypertension. PROGRESS IN PEDIATRIC CARDIOLOGY 2012. [DOI: 10.1016/j.ppedcard.2012.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Eroglu E, Cakal SD, Cakal B, Dundar C, Alici G, Ozkan B, Yazicioglu MV, Tigen K, Esen AM. Time Course of Right Ventricular Remodeling after Percutaneous Atrial Septal Defect Closure: Assessment of Regional Deformation Properties with Two-Dimensional Strain and Strain Rate Imaging. Echocardiography 2012. [DOI: 10.1111/echo.12053] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Elif Eroglu
- Department of Cardiology; Yeditepe University Hospital; İstanbul; Turkey
| | - Sinem Deniz Cakal
- Department of Cardiology; Kartal Kosuyolu Yuksek Ihtisas Heart and Research Hospital; İstanbul; Turkey
| | - Beytullah Cakal
- Department of Cardiology; Kartal Kosuyolu Yuksek Ihtisas Heart and Research Hospital; İstanbul; Turkey
| | - Cihan Dundar
- Department of Cardiology; Kartal Kosuyolu Yuksek Ihtisas Heart and Research Hospital; İstanbul; Turkey
| | - Gokhan Alici
- Department of Cardiology; Kartal Kosuyolu Yuksek Ihtisas Heart and Research Hospital; İstanbul; Turkey
| | - Birol Ozkan
- Department of Cardiology; Kartal Kosuyolu Yuksek Ihtisas Heart and Research Hospital; İstanbul; Turkey
| | - Mehmet Vefik Yazicioglu
- Department of Cardiology; Kartal Kosuyolu Yuksek Ihtisas Heart and Research Hospital; İstanbul; Turkey
| | - Kursat Tigen
- Department of Cardiology; Kartal Kosuyolu Yuksek Ihtisas Heart and Research Hospital; İstanbul; Turkey
| | - Ali Metin Esen
- Department of Cardiology; Kartal Kosuyolu Yuksek Ihtisas Heart and Research Hospital; İstanbul; Turkey
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Durukan AB, Gurbuz HA, Tavlasoglu M, Salman N, Ucar HI, Yorgancioglu C. Surgical treatment of amplatzer embolus in a secundum atrial septal defect patient. J Tehran Heart Cent 2012; 7:182-4. [PMID: 23323080 PMCID: PMC3537208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Accepted: 01/23/2012] [Indexed: 10/24/2022] Open
Abstract
A secundum atrial septal defect is the most common congenital heart defect. Transcatheter treatment of secundum atrial septal defects is a popular and less invasive alternative to surgery. Procedural complications may occur in a wide spectrum, particularly device embolus as the most emergent one, but luckily they do not commonly occur in the clinical setting. Mortality from adverse events related to transcatheter treatment strategies is twentyfold higher than that of primary elective surgical closure. Here, we report an Amplatzer device embolus in a secundum atrial septal defect patient. The device was successfully removed with surgery, postoperative course was uneventful, and the patient was discharged from the hospital on the 5(th) postoperative day.
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Affiliation(s)
- Ahmet Baris Durukan
- Medicana International Ankara Hospital, Ankara, Turkey.,Corresponding Author: Ahmet Baris Durukan, Medicana International Ankara Hospital, Umit Mahallesi 2463.sokak 4/18, 06810, Yenimahalle, Ankara, Turkey. Tel: +90 532 2273814. Fax: +90 312 2203170. E-mail:
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Deformation Imaging in Selected Congenital Heart Disease: Is It Evolving to Clinical Use? J Am Soc Echocardiogr 2012; 25:919-31. [DOI: 10.1016/j.echo.2012.06.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Indexed: 11/21/2022]
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23
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Assessment of right ventricular function by three-dimensional echocardiography and myocardial strain imaging in adult atrial septal defect before and after percutaneous closure. Int J Cardiovasc Imaging 2012; 28:1905-16. [PMID: 22310981 DOI: 10.1007/s10554-012-0022-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Accepted: 01/19/2012] [Indexed: 10/14/2022]
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Tateishi M, Hiramatsu T, Tomizawa Y, Matsumura G, Konuma T, Yamazaki K, Yamamura H, Nakanishi T. Cardiac tamponade due to perforation by an Amplatzer atrial septal occluder in a patient with Marfan syndrome. J Artif Organs 2011; 14:261-3. [DOI: 10.1007/s10047-011-0576-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2011] [Accepted: 05/15/2011] [Indexed: 11/30/2022]
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Kowalik E, Kowalski M, Hoffman P. Is right ventricular myocardial deformation affected by degree of interatrial shunt in adults? EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2011; 12:400-5. [DOI: 10.1093/ejechocard/jer036] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Zhao Y, Lindqvist P, Nilsson J, Holmgren A, Näslund U, Henein MY. Trans-catheter aortic valve implantation – early recovery of left and preservation of right ventricular function. Interact Cardiovasc Thorac Surg 2011; 12:35-9. [DOI: 10.1510/icvts.2010.251348] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Samiei N, Bayat F, Moradi M, Parsaei M, Haghighi SZO, Mohebbi A, Hamzepour N, Noohi F. Comparison of the response of the right ventricle with endovascular occlusion and surgical closure in adults with atrial septal defect one year after intervention. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2010; 4:143-7. [PMID: 21234294 PMCID: PMC3018896 DOI: 10.4137/cmc.s6493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Use of the Amplatzer septal occluder (ASO) for the closure of secundum atrial septal defect (ASD) has recently become the procedure of choice, while earlier the only treatment for ASD was surgical closure. This study compares the right ventricular indices of the ASO group with the surgical closure group one year after intervention in adults. METHODS From January 2008 to February 2010, 38 patients with isolated atrial septal defect of the secundum type one year after surgical (n = 20, age = 27 ± 4 years, 13 females, 7 males) or Amplatzer septal occluder closure (n = 18, age = 25 ± 4 years, 12 females, 6 males) were studied. At the same time, thirty-one age-matched normal subjects (age = 26 ± 6 years, 23 females, 9 males) were included as the control group. Strain and strain rate of the right ventricle were measured. RESULTS The mean values of strain of the midportion were -26% ± 11.7%, -8.9% ± 4.2%, and 24.5% ± 7.4% (P < 0.001). Strain rates of the midportion were -2.19 ± 0.6 s(-1), -1.2 ± 0.4 s(-1), -1.9 ± 0.6 s(-1) (P < 0.001) in ASO, surgery, and control groups, respectively. CONCLUSION This study showed that the right ventricle might show better performance in the ASO than the surgery group in adults with ASD in midterm follow-up.
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Van De Bruaene A, Buys R, Vanhees L, Delcroix M, Voigt JU, Budts W. Regional right ventricular deformation in patients with open and closed atrial septal defect. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2010; 12:206-13. [DOI: 10.1093/ejechocard/jeq169] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Rao PS, Lorch S. Left Ventricular Function after Percutaneous Occlusion of Atrial Septal Defects. Echocardiography 2010; 27:351-3. [PMID: 20486968 DOI: 10.1111/j.1540-8175.2009.01100.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Lee YS, Jeng MJ, Tsao PC, Yang CF, Soong WJ, Hwang B, Tang RB. Pulmonary function changes in children after transcatheter closure of atrial septal defect. Pediatr Pulmonol 2009; 44:1025-32. [PMID: 19768807 DOI: 10.1002/ppul.21100] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This study was performed to assess changes in pulmonary function test (PFT) and pulmonary outcome after transcatheter closure of atrial septal defect (ASD) in pediatric patients. A total 55 pediatric patients undergoing transcatheter ASD closure received PFT at baseline (day before ASD closure), and at 3 days and 6 months after procedure. Forced vital capacity (FVC), forced expired volume in 1 sec (FEV(1)), FEV(1) to FVC ratio (FEV(1)/FVC), peak expiratory flow (PEF), and mean forced expiratory flow during the middle half of FVC (FEF(25-75)) were measured. Individually, subjects were classified by spirometry as normal, obstructive or restrictive, to evaluate the effect of transcatheter closure on pulmonary outcome. These 55 children had significantly reduced mean PEF and FEF(25-75) (84 +/- 24%, P = 0.040 and 76 +/- 22%, P = 0.010, respectively) at baseline, with FEF(25-75) reduced significantly at 3 days and 6 months (78 +/- 24%, P = 0.010 and 81 +/- 24%, P = 0.040, respectively) after transcatheter closure. Six months after transcatheter closure of ASD, significant improvement was observed in mean FVC (94 +/- 19% vs. 98 +/- 15%, P = 0.034) and FEV(1) (90 +/- 20% vs. 96 +/- 19%, P = 0.008). Assessed individually, better pulmonary outcome was found in patients without pulmonary hypertension (PH) (chi(2) = 8.333, P = 0.044). PFT disturbance was observed in significant flow limitation in the peripheral airway of ASD patients. Improved PFT was found after transcatheter closure and better pulmonary outcome was observed in patients without PH. ASD children need monitoring pulmonary function and should receive transcatheter closure before PH develops.
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Affiliation(s)
- Yu-Sheng Lee
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
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Ding J, Ma G, Huang Y, Wang C, Zhang X, Zhu J, Lu F. Right Ventricular Remodeling after Transcatheter Closure of Atrial Septal Defect. Echocardiography 2009; 26:1146-52. [DOI: 10.1111/j.1540-8175.2009.00941.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Tamborini G, Muratori M, Brusoni D, Celeste F, Maffessanti F, Caiani EG, Alamanni F, Pepi M. Is right ventricular systolic function reduced after cardiac surgery? A two- and three-dimensional echocardiographic study. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2009; 10:630-4. [DOI: 10.1093/ejechocard/jep015] [Citation(s) in RCA: 157] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Teo KSL, Dundon BK, Molaee P, Williams KF, Carbone A, Brown MA, Worthley MI, Disney PJ, Sanders P, Worthley SG. Percutaneous closure of atrial septal defects leads to normalisation of atrial and ventricular volumes. J Cardiovasc Magn Reson 2008; 10:55. [PMID: 19040763 PMCID: PMC2633333 DOI: 10.1186/1532-429x-10-55] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2008] [Accepted: 12/01/2008] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Percutaneous closure of atrial septal defects (ASDs) should potentially reduce right heart volumes by removing left-to-right shunting. Due to ventricular interdependence, this may be associated with impaired left ventricular filling and potentially function. Furthermore, atrial changes post-ASD closure have been poorly understood and may be important for understanding risk of atrial arrhythmia post-ASD closure. Cardiovascular magnetic resonance (CMR) is an accurate and reproducible imaging modality for the assessment of cardiac function and volumes. We assessed cardiac volumes pre- and post-percutaneous ASD closure using CMR. METHODS Consecutive patients (n = 23) underwent CMR pre- and 6 months post-ASD closure. Steady state free precession cine CMR was performed using contiguous slices in both short and long axis views through the ASD. Data was collected for assessment of left and right atrial, ventricular end diastolic volumes (EDV) and end systolic volumes (ESV). Data is presented as mean +/- SD, volumes as mL, and paired t-testing performed between groups. Statistical significance was taken as p < 0.05. RESULTS There was a significant reduction in right ventricular volumes at 6 months post-ASD closure (RVEDV: 208.7 +/- 76.7 vs. 140.6 +/- 60.4 mL, p < 0.0001) and RVEF was significantly increased (RVEF 35.5 +/- 15.5 vs. 42.0 +/- 15.2%, p = 0.025). There was a significant increase in the left ventricular volumes (LVEDV 84.8 +/- 32.3 vs. 106.3 +/- 38.1 mL, p = 0.003 and LVESV 37.4 +/- 20.9 vs. 46.8 +/- 18.5 mL, p = 0.016). However, there was no significant difference in LVEF and LV mass post-ASD closure. There was a significant reduction in right atrial volumes at 6 months post-ASD closure (pre-closure 110.5 +/- 55.7 vs. post-closure 90.7 +/- 69.3 mL, p = 0.019). Although there was a trend to a decrease in left atrial volumes post-ASD closure, this was not statistically significant (84.5 +/- 34.8 mL to 81.8 +/- 44.2 mL, p = NS). CONCLUSION ASD closure leads to normalisation of ventricular volumes and also a reduction in right atrial volume. Further follow-up is required to assess how this predicts outcomes such as risk of atrial arrhythmias after such procedures.
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Affiliation(s)
- Karen SL Teo
- Cardiovascular Research Centre, Royal Adelaide Hospital and The University of Adelaide, Adelaide, South Australia, Australia
- The University of Adelaide, Adelaide, South Australia, Australia
| | - Benjamin K Dundon
- Cardiovascular Research Centre, Royal Adelaide Hospital and The University of Adelaide, Adelaide, South Australia, Australia
- The University of Adelaide, Adelaide, South Australia, Australia
| | - Payman Molaee
- Cardiovascular Research Centre, Royal Adelaide Hospital and The University of Adelaide, Adelaide, South Australia, Australia
- The University of Adelaide, Adelaide, South Australia, Australia
| | - Kerry F Williams
- Cardiovascular Research Centre, Royal Adelaide Hospital and The University of Adelaide, Adelaide, South Australia, Australia
| | - Angelo Carbone
- Cardiovascular Research Centre, Royal Adelaide Hospital and The University of Adelaide, Adelaide, South Australia, Australia
| | - Michael A Brown
- Cardiovascular Research Centre, Royal Adelaide Hospital and The University of Adelaide, Adelaide, South Australia, Australia
| | - Matthew I Worthley
- Cardiovascular Research Centre, Royal Adelaide Hospital and The University of Adelaide, Adelaide, South Australia, Australia
- The University of Adelaide, Adelaide, South Australia, Australia
| | - Patrick J Disney
- Cardiovascular Research Centre, Royal Adelaide Hospital and The University of Adelaide, Adelaide, South Australia, Australia
| | - Prashanthan Sanders
- Cardiovascular Research Centre, Royal Adelaide Hospital and The University of Adelaide, Adelaide, South Australia, Australia
- The University of Adelaide, Adelaide, South Australia, Australia
| | - Stephen G Worthley
- Cardiovascular Research Centre, Royal Adelaide Hospital and The University of Adelaide, Adelaide, South Australia, Australia
- The University of Adelaide, Adelaide, South Australia, Australia
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Blake GE, Lakkireddy D. Atrial Septal Defect and Atrial Fibrillation: The Known and Unknown. J Atr Fibrillation 2008; 1:45. [PMID: 28496588 DOI: 10.4022/jafib.45] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2008] [Revised: 05/19/2008] [Accepted: 08/25/2008] [Indexed: 11/10/2022]
Abstract
Atrial fibrillation (AF) is a common complication in patients with atrial septal defects (ASDs). The link between AF and ASD is fairly complex and entails modifications in electrophysiologic, contractile and structural properties, at the cellular and tissue level, of both atria, mainly due to chronic atrial stretch and dilation. Surgical repair or percutaneous closure of ASDs are equally effective in reducing mortality and symptoms but limited in preventing or curbing AF, unless combined with an arrhythmia-specific procedure. Transesophageal echocardiography (TEE) and intracardiac echocardiography (ICE) have improved the safety and success of the above procedures. Finally, clearer understanding of the pathophysiology of AF in patients with ASD (and CHF, in general) has led to target-specific advances in medical management.
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Affiliation(s)
- George E Blake
- Mid America Cardiology @ University of Kansas Hospital, Kansas City, KS
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Numan M, El Sisi A, Tofeig M, Gendi S, Tohami T, El-Said HG. Cribriform amplatzer device closure of fenestrated atrial septal defects: feasibility and technical aspects. Pediatr Cardiol 2008; 29:530-5. [PMID: 17999105 DOI: 10.1007/s00246-007-9079-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2007] [Accepted: 06/28/2007] [Indexed: 11/28/2022]
Abstract
Fenestrated atrial septal defects (F-ASDs) may pose a challenge to device closure; recently, a cribriform device with a minimal connecting intrawaist diameter and large, equal left- and right-sided discs has been designed to cover more than one adjacent defect. This study demonstrates the feasibility and technical aspects of closing F-ASDs using this new device. Sixteen patients between August 2003 and January 2006 were included in this study. The inclusion criterion was the presence of a F-ASD diagnosed by transesophageal echocardiography. One of the three available cribriform ASD device sizes (18, 25, or 35 mm) was implanted. Patients were followed for at least 1 year after the procedure. Thirteen patients had successful cribriform ASD device implantation (median age and weight, 12.5 years and 36 kg, respectively). Ten patients (62%) had an associated atrial septal aneurysm. The mean procedure time was 75.6 +/- 28.5 min and the mean fluoroscopy time 14.8 +/- 6.3 min. The RVEDD was significantly reduced, from a mean of 24.2 mm to 21.0 (p < 0.05). One patient developed atrial tachycardia requiring cardioversion during the procedure. There were no embolic events, heart block, or mortality. Complete closure was 10 of 13 (77 %) the next day and 12 of 13 (92%) at 6 and 12 months. We conclude that the cribriform Amplatzer device can be successfully and safely used in patients with F-ASDs. Complete closure may take up to 6 months.
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Wilson NJ, Smith J, Prommete B, O'Donnell C, Gentles TL, Ruygrok PN. Transcatheter closure of secundum atrial septal defects with the Amplatzer septal occluder in adults and children-follow-up closure rates, degree of mitral regurgitation and evolution of arrhythmias. Heart Lung Circ 2008; 17:318-24. [PMID: 18407789 DOI: 10.1016/j.hlc.2007.10.013] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Revised: 06/12/2007] [Accepted: 10/30/2007] [Indexed: 10/22/2022]
Abstract
AIM To report the results of transcatheter atrial septal defect (ASD) closure with the Amplatzer septal occluder (ASO) from the single centre providing interventions for congenital heart disease in New Zealand. METHODS A single centre retrospective review of all patients 1997-2004 inclusive, undergoing planned transcatheter ASD closure was undertaken. Implantation success, complications and latest patient follow-up are described. RESULTS Percutaneous ASD closure was planned in 227 adults and children. (55% had additional medical co-morbidities.) The mean ASD size was 22+/-6 mm, and device size ranged from 5 to 40 mm. Closure was successful in 93%, unsuccessful in 5% and not attempted in 2%. There were two device embolisations, one immediately post-release and one within 24h. Minor procedural complications occurred in 5% of patients. There were no cases of suspected or proven device erosion. Ninety-two percent had documented follow-up beyond 6 months. At latest follow-up the closure rate was 98.5%. There was no significant change in the degree of mitral regurgitation. Sixteen of 24 with pre-closure arrhythmias resolved while 10 remained in atrial fibrillation. Six patients developed new arrhythmias but these were well controlled medically. CONCLUSION There is a high implantation and closure rate using transcatheter ASD closure with the Amplatzer septal occluder in children and adults avoiding the need for cardiac surgery. Follow-up at one year shows there is no progression of mitral regurgitation, and supraventricular arrhythmias have usually resolved.
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Affiliation(s)
- Nigel J Wilson
- Green Lane Cardiovascular Service and Starship Children's Hospital, Auckland, New Zealand.
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Rossi RI, Cardoso CDO, Machado PR, Francois LG, Horowitz ESK, Sarmento-Leite R. Transcatheter closure of atrial septal defect with Amplatzer device in children aged less than 10 years old: immediate and late follow-up. Catheter Cardiovasc Interv 2008; 71:231-6. [PMID: 17985387 DOI: 10.1002/ccd.21361] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AIMS To analyze the efficacy and follow-up results of percutaneous closure of Atrial septal defect (ASD) with the Amplatzer septal occluder in children aged <10 years old. METHODS Between November 1998 and September 2005, 27 patients diagnosed with ASD were treated percutaneously with an Amplatzer septal occluder. The procedure was carried out in the cathlab, under general anesthesia and with both fluoroscopy and transesophageal echocardiography guidance. Basal physical examinations and echocardiograms were performed prior to the procedure and at 30 days, 6, and 12 months of follow-up. Survival free of symptom was estimated by Kaplan-Meier. RESULTS The mean age, weight, height, body mass index, and corporal surface was: 5.35 +/- 2.11 years, 23.07 +/- 9.43 kg, 110.55 +/- 17.6 cm, 16.77 +/- 2.42 kg/m(2), and 1.24 +/- 2.44 m(2). The prevalence of septal aneurysm was 3.7% and all patients presented single secundum ASD. The mean stretched diameter by fluoroscopy and transesophageal echocardiography were 17.18 +/- 6.75 mm and 16.77 +/- 5.99 mm, and the prostheses sizes were 18.83 +/- 6.98 mm, ranging from 10 to 30 mm. The systolic and diastolic pulmonary pressures were 25.26 +/- 5.97 mm Hg and 13.38 +/- 3.40 mm Hg, respectively. The procedure time was 82.92 +/- 29.14 min and the hospital stay was 2.20 +/- 0.26 days. Clinical and echocardiography follow-ups were performed within 11.59 +/- 4.42 months and all devices were in the correct position with no residual shunt. Right ventricular diameter decreased from 19.38 +/- 5.23mm to 11.38 +/- 11.92 (P 0.001). No major complications or deaths occurred; two patients had a hematoma at the vascular access. CONCLUSION Secundum atrial septal defect closure can be safely and successfully performed with the Amplatzer septal occluder in children younger than 10 years old.
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Affiliation(s)
- Raul I Rossi
- Department of Interventional Cardiology, Institute of Cardiology of Rio Grande Do Sul, Porto Alegre-RS, Brazil.
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LIM DS, GUTGESELL HOWARDP, ROCCHINI ALBERTP. Left Ventricular Function by Pressure-Volume Loop Analysis before and after Percutaneous Repair of Large Atrial Septal Defects. J Interv Cardiol 2008; 27:204-11. [DOI: 10.1111/j.1540-8183.2007.00334.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- D. S. LIM
- Assistant Professor of Pediatrics & Medicine; University of Virginia; Charlottesville Virginia
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El-Sisi AM, Gendi S, Dilawar M, Numan M. Helex septal occluder: feasibility study of closure of atrial septal defect. Pediatr Cardiol 2008; 29:84-9. [PMID: 17899244 DOI: 10.1007/s00246-007-9053-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2007] [Revised: 03/28/2007] [Accepted: 06/26/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND A variety of transcatheter atrial septal defect (ASD) occluders are currently in use, the most commonly used device is the Amplatzer Septal Occluder (ASO) yet there is no perfect device. The Helex Septal Occluder is a new device (by W.L. Gore & Associates, Inc.) designed to improve the results of transcatheter ASD closure. We report our first experience in closing secundum ASDs with this new device after its recent modifications. METHODS Thirteen patients were selected for Helex device closure with median age of 8 years (2.5-44 years) and median weight 30 Kg (12-96 Kg). Inclusion criteria were: small to moderate Secundum ASDs with sufficient rims by transthoracic echo (TTE) and confirmed by transoesophageal echo (TEE). Two cardiologists carried out the decision of device size. One of the five available Helex ASD device sizes was used (15-35 mm). Follow up TTE was performed the next day, one month, six months and one year later. RESULTS Twelve patients had successful Helex septal occluder implantation. One patient was switched to Cribriform ASD device during the procedure because of failure of the locking mechanism. Two patients had trivial residual left to right shunt which disappeared at one month follow up in one patient. No embolic event, AV block or mortality was observed. CONCLUSION This feasibility study of the novel Helex septal occluder after its recent modification showed that it can successfully and safely close well selected secundum ASDs. There are several advantages over the currently available devices.
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Restrictive Right Ventricular Physiology. J Am Coll Cardiol 2007; 50:1491-7. [DOI: 10.1016/j.jacc.2007.06.042] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2007] [Revised: 06/14/2007] [Accepted: 06/25/2007] [Indexed: 11/21/2022]
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Lam YY, Kaya MG, Li W, Mahadevan VS, Khan AA, Henein MY, Mullen M. Effect of endovascular stenting of aortic coarctation on biventricular function in adults. Heart 2007; 93:1441-7. [PMID: 17575331 PMCID: PMC2016938 DOI: 10.1136/hrt.2006.106377] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To investigate the effect of endovascular stenting of aortic coarctation on biventricular function in adults during intermediate-term follow-up. METHODS 21 patients (age 34 (10) years) were studied prospectively before and 14 (2) months after coarctation stenting from year 2002 to 2005. Biventricular function and blood pressure measurements were made. The post-stenting results were compared with pre-stenting values (group 1), with 22 age- and sex-matched post-surgical repair patients (group 2) and 30 normal controls (group 3). RESULTS The peak systolic gradient across the coarctation site fell (55 (15) mm Hg to 18 (8) mm Hg, p<0.001). Systolic, mean blood pressure and left ventricular (LV) mass dropped after stenting (p<0.05 for all). LV long-axis function improved at intermediate-term follow-up (tissue Doppler imaging lateral and septal systolic and diastolic velocities and E/Em ratios: LSm, 6.5 (1.4) cm/s to 7.9 (1.7) cm/s; SSm, 5.8 (1.2) cm/s to 7.3 (1.6) cm/s; LEm, 8.1 (1.3) to 9.4 (2.3) cm/s; SEm, 6.7 (1.5) cm/s to 7.8 (1.9) cm/s; LE/Em, 11.2 (2.7) to 9.8 (2.8); SE/Em, 14.8 (5.3) to 11.8 (3.9); p<0.05 for all). No significant difference in LV ejection fraction, conventional LV diastolic measurements (E, A, E/A ratio, IVRT and DT) was found after stenting. No significant deterioration of right ventricular function was seen in stented patients. Both post-stenting and post-surgical repair patients had poorer LV long-axis function than controls (p<0.01 for all). CONCLUSIONS Endovascular stenting of aortic coarctation resulted in medium-term LV mass regression and long-axis function improvement that may provide insight into long-term outcome of the stented patients. The results support aortic stenting in patients with anatomically suitable defects, given the additional benefit of avoiding cardiopulmonary bypass. The clinical significance of subclinical myocardial dysfunction in patients with stented or repaired coarctation warrants further studies.
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Affiliation(s)
- Yat-Yin Lam
- Division of Cardiology, SH Ho Cardiovascular and Stroke Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
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Berbarie RF, Anwar A, Dockery WD, Grayburn PA, Hamman BL, Vallabhan RC, Schussler JM. Measurement of right ventricular volumes before and after atrial septal defect closure using multislice computed tomography. Am J Cardiol 2007; 99:1458-61. [PMID: 17493480 DOI: 10.1016/j.amjcard.2006.12.075] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2006] [Revised: 12/21/2006] [Accepted: 12/21/2006] [Indexed: 11/24/2022]
Abstract
Volumetric measurements of the right ventricle are helpful in patients with atrial septal defects (ASDs) in estimating the degree of right ventricular (RV) failure. They also may be important in following patients postoperatively after ASD closure. Traditional imaging modalities used to obtain such measurements have had limitations in measuring the complex shape of the right ventricle. Multislice computed tomography (MSCT) is a technique that provides excellent spatial resolution of the moving heart. This study was conducted to assess whether MSCT could be used to evaluate RV end-diastolic volume (EDV) before and after the closure of an ASD. From June 2004 to March 2006, 10 patients with ASDs underwent MSCT to calculate their RV volumes. The patients then had their ASDs closed by either a percutaneous or a surgical approach. Three months later, the patients' MSCT scans were repeated, and RV volumes were recalculated. EDV was approximated using 3-dimensional volume-rendered models of the right ventricle. At a mean follow-up of 3 months, a significant reduction in mean RV EDV, indexed for body surface area, was demonstrated, from 131 +/- 31 to 83 +/- 22 cm(3)/m(2) (p = 0.0007). In conclusion, this report is the first to describe the utility of MSCT to demonstrate RV EDV reduction after ASD closure.
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Affiliation(s)
- Rafic F Berbarie
- Department of Internal Medicine, Division of Cardiovascular Disease, Baylor University Medical Center, Dallas, Texas, USA
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Rosas M, Zabal C, Garcia-Montes J, Buendia A, Webb G, Attie F. Transcatheter versus surgical closure of secundum atrial septal defect in adults: impact of age at intervention. A concurrent matched comparative study. CONGENIT HEART DIS 2007; 2:148-55. [PMID: 18377458 DOI: 10.1111/j.1747-0803.2007.00091.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To compare the short- and mid-term outcomes of surgical (SUR) vs. transcatheter closure of secundum atrial septal defect (ASD) using Amplatzer septal occluder (ASO) in adults with a very similar spectrum of the disease; and to identify predictors for the primary end point. DESIGN Single-center, concurrent comparative study. Surgically treated patients were randomly matched (2:1) by age, sex, date of procedure, ASD size, and hemodynamic profile. SETTING Tertiary referral center. PATIENTS One hundred sixty-two concurrent patients with ASD submitted to ASO (n = 54) or SUR closure (n = 108) according with their preferences. MAIN OUTCOME MEASURES Primary end point was a composite index of major events including failure of the procedure, important bleeding, critical arrhythmias, serious infections, embolism, or any major cardiovascular intervention-related complication. Predictors of these major events were investigated. RESULTS Atrial septal defects were successfully closed in all patients, and there was no mortality. The primary event rate was 13.2% in ASO vs. 25.0% in SUR (P = .001). Multivariate analysis showed that higher rate of events was significantly associated with age >40 years; systemic/pulmonary output ratio <2.1; and systolic pulmonary arterial pressure >50 mm Hg; while in the ASO group the event rate was only associated with the ASD size (>15 cm(2)/m(2); relative risk = 1.75, 95% confidence interval 1.01-8.8). There were no differences in the event-free survival curves in adults with ages <40 years. CONCLUSIONS The efficacy for closure ASD was similar in both groups. The higher morbidity observed in SUR group was observed only in the patients submitted to the procedure with age >40 years. The length of hospital stay was shorter in the ASO group. Surgical closure is a safe and effective treatment, especially in young adults. There is certainly nothing wrong with continuing to do surgery in countries where the resources are limited.
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Affiliation(s)
- Martin Rosas
- Instituto Nacional de Cardiologia-Adult Cardiology, Mexico City, Mexico.
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Wu ET, Akagi T, Taniguchi M, Maruo T, Sakuragi S, Otsuki S, Okamoto Y, Sano S. Differences in right and left ventricular remodeling after transcatheter closure of atrial septal defect among adults. Catheter Cardiovasc Interv 2007; 69:866-71. [PMID: 17390329 DOI: 10.1002/ccd.21075] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To evaluate acute cardiac remodeling after transcatheter closure of atrial septal defect (ASD) in adult patients. BACKGROUND In adult patients with ASD, longer periods of cardiac adaptation should be expected after the procedure due to long-standing RV volume overload and subsequent changes in the pulmonary vasculature. There are limited reports about this remodeling in adult patients. METHODS We prospectively enrolled 17 adults (mean age 58.4 +/- 17.3 years) who underwent successful transcatheter closure of their ASDs from August 2005 to July 2006. We performed routine transthoracic echocardiographic studies, including LV and RV myocardial performance indices, or Tei indices, and plasma brain natriuretic peptide (BNP) sampling before closure of the ASD, and 1 day, 1 month, and 3 months after closure. RESULTS We found (1) LV end diastolic diameter increased, and RVEDD decreased markedly after the closure; (2) differences existed in LV and RV adaptation. While LV Tei index improved soon after the procedure, RV Tei index worsened until 1 month after the procedure, then recovered by the 3 month follow-up visit; and (3) BNP elevated 1 day after closure of the ASD and declined by the 1-month follow-up visit. CONCLUSION "Shrinkage" of the RV and "expansion" of the LV occurred soon after the procedure, even in elderly patients. Device closure of ASDs caused rapid improvement of LV function, but RV function underwent transient deterioration, probably due to delayed changes in RV ventricular mass in the face of acute volume reduction in this aged cohort.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Cardiac Catheterization
- Echocardiography
- Echocardiography, Doppler, Color
- Female
- Follow-Up Studies
- Heart Septal Defects, Atrial/blood
- Heart Septal Defects, Atrial/diagnostic imaging
- Heart Septal Defects, Atrial/physiopathology
- Heart Septal Defects, Atrial/therapy
- Heart Ventricles/diagnostic imaging
- Humans
- Male
- Middle Aged
- Natriuretic Peptide, Brain/blood
- Prospective Studies
- Reproducibility of Results
- Time Factors
- Treatment Outcome
- Ventricular Function, Left
- Ventricular Function, Right
- Ventricular Remodeling
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Affiliation(s)
- En-Ting Wu
- Cardiac Care Unit, Okayama University Hospital, Okayama, Japan
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Burgstahler C, Wöhrle J, Kochs M, Nusser T, Löffler C, Kunze M, Höher M, Gawaz MP, Hombach V, Merkle N. Magnetic resonance imaging to assess acute changes in atrial and ventricular parameters after transcatheter closure of atrial septal defects. J Magn Reson Imaging 2007; 25:1136-40. [PMID: 17520717 DOI: 10.1002/jmri.20911] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To evaluate acute changes in atrial and ventricular parameters by the use of cardiac magnetic resonance imaging (MRI) in patients with percutaneous transcatheter atrial septal defects (ASD) closure. MATERIALS AND METHODS The study included 14 patients (six males and eight females, 45 +/- 18 years) with congenital ASD. Cardiac MRI (1.5T Philips Intera CV) was performed before and within 24 hours after transcatheter ASD closure. Right atrial (RA) and left atrial (LA) dimensions, as well as right (RV) and left (LV) ventricular end-diastolic (ED) volumes were determined. Atrial size was assessed by planimetry of the maximum RA and LA areas in a standard four-chamber view, and ventricular volumes were calculated according to a modified Simpson's rule in short-axis views. RESULTS The mean RA decreased significantly from 27.6 +/- 6.4 cm(2) before closure to 24.4 +/- 5.6 cm(2) after the procedure (P = 0.0018), whereas the LA area did not change (24.1 +/- 4.7 cm(2) vs. 23.8 +/- 5.2 cm(2), P = 0.76). The RV volumes, volume index, and ejection fraction (EF) decreased significantly from 229 +/- 64 mL to 181 +/- 43 mL (P < 0.001, average reduction = 19% +/- 15%), from 126.0 +/- 37.2 mL/m(2) to 96.6 +/- 28.6 mL/m(2) (P < 0.0001) and from 64 +/- 5% to 58% +/- 7% (P = 0.01), respectively. The LV volumes and volume index remained unchanged (114 +/- 25 mL vs. 118 +/- 22 mL, P = 0.18, 63.5 +/- 13.5 mL/m(2) vs. 63.0 +/- 17.4 mL/m(2), P = 0.83). Left-right shunting decreased from 40% +/- 15% to 9% +/- 15% (P < 0.001). CONCLUSION Cardiac MRI can reveal detailed information on acute changes in shunt fraction and ventricular dimensions after ASD closure. ASD closure by percutaneous transcatheter device implantation results within 24 hours in a significant reduction of shunt fraction, RA and RV sizes, and RV function, whereas LA and LV dimensions remain unchanged.
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Affiliation(s)
- Christof Burgstahler
- Cardiology Division, Department of Internal Medicine III, University of Tübingen, Tübingen, Germany
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Lam YY, Yu CM. Improvement of biventricular function after transcatheter closure of atrial septal defect: a case report. Catheter Cardiovasc Interv 2006; 68:775-7. [PMID: 17039533 DOI: 10.1002/ccd.20614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We report a 17-year-old man presented with palpitation. Echocardiography demonstrated secundum atrial septal defect (ASD) with marked right sided dilatation, indicating significant left to right intracardiac shunting. Cardiac magnetic resonance imaging performed 3 months after transcatheter ASD closure demonstrated marked improvement in biventricular systolic function.
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Affiliation(s)
- Yat-Yin Lam
- Department of Medicine and Therapeutics, Division of Cardiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
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Eyskens B, Ganame J, Claus P, Boshoff D, Gewillig M, Mertens L. Ultrasonic strain rate and strain imaging of the right ventricle in children before and after percutaneous closure of an atrial septal defect. J Am Soc Echocardiogr 2006; 19:994-1000. [PMID: 16880094 DOI: 10.1016/j.echo.2006.02.001] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2005] [Indexed: 11/16/2022]
Abstract
This study examined the influence of preload alterations on systolic right ventricular (RV) velocities and deformation indices in patients with atrial septal defect (ASD). A total of 21 patients with ASD underwent 2-dimensional echocardiography and color Doppler myocardial imaging scan before and 24 hours after transcatheter ASD closure. The data were compared with those obtained from 30 healthy age-matched children. Longitudinal peak systolic velocities, peak systolic strain rate (SR), and end-systolic strain (epsilon) were calculated in the midsegment of the RV free wall and the septum. In patients with ASD, higher RV peak systolic velocities were recorded, which returned to normal values after closure of the defect. In contrast, RV deformation indices in the patients with ASD were not different from normal values. These RV indices did not change significantly after ASD closure. We found a significantly decreased septal function after percutaneous ASD closure. This may be attributed to the device within the atrial septum, affecting deformation of the interventricular septum. In conclusion, RV longitudinal systolic deformation indices were not significantly influenced by chronic ventricular volume overload and sudden abolishment of this volume overload. These findings suggest that SR/epsilon are relatively load-stable measures of contractile function in the clinical setting. In contrast, myocardial velocities are clearly load dependent.
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Affiliation(s)
- Benedicte Eyskens
- Department of Pediatric Cardiology, University Hospital Leuven, Leuven, Belgium
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48
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Thilén U, Persson S. Closure of atrial septal defect in the adult. Cardiac remodeling is an early event. Int J Cardiol 2006; 108:370-5. [PMID: 15982760 DOI: 10.1016/j.ijcard.2005.05.042] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2005] [Revised: 04/29/2005] [Accepted: 05/13/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Study aimed to describe the extent and the temporal profile of cardiac remodeling after atrial septal defect closure in the adult. METHODS Prospective and longitudinal echocardiographic assessment of right and left heart size before and after (1 day-1 week/1/4/12 months) surgical or catheter-based atrial septal closure in 39 adults (age 54+/-15 years). RESULTS Right ventricular and atrial sizes were markedly reduced, left ventricular size increased and left atrial size remained unchanged after closure. Older age and a history of atrial fibrillation reduced the potential to normalize right and left atrial size after closure. The greater part of the changes occurred very early, in the 1st day/1st week. From then on the speed of change gradually diminished and after 4 months no important changes were observed. The mode of closure did not influence the degree or the pace of the remodeling. CONCLUSION Cardiac remodeling after atrial septal closure in the adult is a common and early event that seems by and large completed within the first half year after closure. The ventricles seem to have a higher capacity of remodeling than the atria in this setting. The mode of closure does not seem to significantly impact remodeling.
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Affiliation(s)
- U Thilén
- Department of Cardiology, Lund University, Lund University Hospital, SE-221 85 LUND, Sweden.
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Pascotto M, Santoro G, Cerrato F, Caputo S, Bigazzi MC, Iacono C, Carrozza M, Russo MG, Caianiello G, Calabrò R. Time-course of cardiac remodeling following transcatheter closure of atrial septal defect. Int J Cardiol 2005; 112:348-52. [PMID: 16303193 DOI: 10.1016/j.ijcard.2005.10.008] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2005] [Revised: 09/27/2005] [Accepted: 10/02/2005] [Indexed: 11/29/2022]
Abstract
BACKGROUND Right chamber dilatation and right-to-left volumetric unbalance are well-known cardiac consequences of atrial septal defect (ASD) shunt, accounting for most of its long-term complications. Thus, cardiac volumetric unloading is a major aim of ASD closure. Different from surgery, transcatheter option might be considered as an "unbiased" tool to evaluate the cardiac geometric remodeling following ASD closure. METHODS Extent and time-course of cardiac geometric changes were assessed by echocardiography 24 h, 1 and 6 months after percutaneous closure of large ASD (mean diameter 17+/-6 mm, QP/QS 2.2+/-0.9) in 42 asymptomatic patients (age 22+/-18 years). RESULTS Transcatheter closure was accomplished using the Amplatzer Septal Occluder device (mean 23+/-7 mm, median 24 mm), achieving a complete occlusion in all patients at the 6-month follow-up control. After ASD closure, right atrial (RA) volume reduced from 45+/-24 to 28+/-12 ml (-37.8%, p<0.001), while left atrial (LA) volume did not significantly change. Inlet and infundibulum right ventricular (RV) end-diastolic diameters reduced by 23+/-2% and 23+/-3%, respectively (p<0.001 for both measurements), although with a different time-course of changes. Finally, transverse left ventricular (LV) end-diastolic diameter increased from 39+/-7 to 44+/-5 mm (+11.4%, p<0.01). These geometric changes resulted in an RV/LV diameter ratio decrease by 34+/-3% (p<0.001). Nearly 90% of cardiac remodeling ensued within 1 month from shunt disappearance (50% within 24 h). CONCLUSIONS Percutaneous ASD closure results in early and striking cardiac geometric changes that almost completely revert the right-to-left volumetric unbalance. Most of this geometric remodeling ensues within a few weeks from ASD closure.
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Affiliation(s)
- Marco Pascotto
- Division of Cardiology, A.O. Monaldi, 2nd University of Naples, Naples, Italy
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50
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Schoen SP, Kittner T, Bohl S, Braun MU, Simonis G, Schmeisser A, Strasser RH. Transcatheter closure of atrial septal defects improves right ventricular volume, mass, function, pulmonary pressure, and functional class: a magnetic resonance imaging study. Heart 2005; 92:821-6. [PMID: 16284222 PMCID: PMC1860672 DOI: 10.1136/hrt.2005.070060] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To characterise prospectively by magnetic resonance imaging (MRI) changes in right ventricular (RV) volume, function, and mass after transcatheter closure of atrial septal defects (ASDs) and to evaluate the course of pulmonary pressure and functional class criteria. METHODS In 20 patients with secundum-type ASD and dilated RV diameter, MRI was performed to quantify RV end diastolic (RVEDV) and end systolic volumes (RVESV), RV mass, tricuspid annular diameter, and RV ejection fraction before and 6 and 12 months after transcatheter closure of the ASD. RV systolic pressure was measured during follow up by transthoracic echocardiography. RESULTS Functional class improved in the majority of patients after ASD closure. RVESV (from 81 (18) ml/m2 to 53 (15) ml/m2, p < 0.001), RVEDV (from 127 (17) ml/m2 to 99 (18) ml/m2, p < 0.001), and RV mass (from 79 (10) g to 63 (8) g, p < 0.01) decreased significantly during follow up, although tricuspid annular diameter did not. RV ejection fraction improved (by 9% compared with baseline, p < 0.05) and RV systolic pressure decreased significantly (from 33 (8) mm Hg to 24 (6) mm Hg, p < 0.001) after closure. CONCLUSION MRI studies showed significant improvement of RV volumes, mass, and function after transcatheter closure of ASDs. Restoration of the RV leads to decreased pulmonary pressure resulting in a better functional class in the majority of patients.
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Affiliation(s)
- S P Schoen
- Department of Cardiology, University of Dresden, Dresden, Germany.
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