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Zwijnenburg RD, Baggen VJ, Witsenburg M, Boersma E, Roos-Hesselink JW, van den Bosch AE. Risk Factors for Pulmonary Hypertension in Adults After Atrial Septal Defect Closure. Am J Cardiol 2019; 123:1336-1342. [PMID: 30709596 DOI: 10.1016/j.amjcard.2019.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 01/08/2019] [Accepted: 01/11/2019] [Indexed: 10/27/2022]
Abstract
Atrial septal defect (ASD) closure is performed to prevent pulmonary hypertension (PH), which is associated with poor outcome. This study investigated the prevalence of PH in adults before and after ASD closure and explored associations between patient characteristics and PH after ASD closure. Consecutive adult patients who underwent surgical or percutaneous ASD closure in the Erasmus MC, the Netherlands, were included (2000 to 2014). Echocardiograms before and after ASD closure were retrospectively assessed. Patients were categorized into 3 groups (no PH, possible PH, and PH) based on tricuspid regurgitation velocity (<2.9, 2.9 to 3.4, and ≥3.4 m/s) or mean pulmonary arterial pressure (<20, 20 to 24, and ≥25 mm Hg). Cox regression was performed to identify associations between patient characteristics and PH after ASD closure. Of the 244 eligible patients who underwent ASD closure, 198 (81%) had echocardiograms both before and median 15 (interquartile range 12 to 35) months after ASD closure (median age at closure 45 [interquartile range 30 to 57] years, 75% woman). The prevalence of PH was 13.1% (n = 26) before ASD closure and 5.0% (n = 10) after closure. New York Heart Association III to IV (hazard ratio [HR] 11.07, 95% confidence interval [CI] 3.12 to 39.29, p <0.001), pulmonary disease (HR 10.43, 95% CI 2.12 to 51.21, p = 0.004), cardiac medication use (HR 3.96, 95% CI 1.02 to 15.34, p = 0.047), right ventricular fractional area change (HR 0.87, 95% CI 0.81 to 0.93, p <0.001), and tricuspid annular plane systolic excursion (HR 0.75, 95% CI 0.59 to 0.95, p = 0.018) were significantly associated with PH. In conclusion, adult patients with low pulmonary pressures before ASD closure are not at risk of PH after closure. Nevertheless, PH remained prevalent in approximately 5% of patients. Especially those patients with high New York Heart Association functional class, presence of pulmonary disease, cardiac medication use and impaired RV function at baseline are at risk.
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Zwijnenburg RD, Baggen VJM, Geenen LW, Voigt KR, Roos-Hesselink JW, van den Bosch AE. The prevalence of pulmonary arterial hypertension before and after atrial septal defect closure at adult age: A systematic review. Am Heart J 2018; 201:63-71. [PMID: 29910057 DOI: 10.1016/j.ahj.2018.03.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 03/19/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND The development or persistence of pulmonary arterial hypertension (PAH) after atrial septal defect (ASD) closure at adult age is associated with a poor prognosis. The objective of this review was to investigate the prevalence of PAH before and after ASD closure and to identify factors that are associated with PAH. METHODS EMBASE and MEDLINE databases were searched for publications until March 2017. All studies reporting the prevalence of PAH or data on pulmonary artery pressures both before and after surgical or percutaneous ASD closure in an adult population (≥16 years of age) were included. Papers were methodologically checked and data was visualized in tables, bar charts and plots. RESULTS A total of 30 papers were included. The prevalence of PAH ranged from 29% to 73% before ASD closure and from 5% to 50% after closure; being highest in older studies, small study cohorts, and studies with high rates of loss to follow-up. The pooled systolic pulmonary artery pressure (PAP) was 43±13 before ASD closure and 32±10 after closure. The overall mean PAP was 34±10 before closure and 28±8 after closure. Studies with a higher mean PAP before closure and a higher mean age of the study cohort reported greater PAP reductions. CONCLUSIONS The prevalence of PAH and mean pulmonary pressures decreased in all studies, regardless of the mean age or pulmonary pressures of the cohort. The reported prevalence of PAH after ASD closure is substantial, although widely varying (5%-50%), which is likely affected by selection of the study cohort.
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Affiliation(s)
| | - Vivan J M Baggen
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Laurie W Geenen
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Kelly R Voigt
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
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Erkut B, Becit N, Unlu Y, Ceviz M, Kocogullari CU, Ates A, Karapolat BS, Kaygin MA, Kocak H. The effect of surgical treatment for secundum atrial septal defect in patients more than 30 years old. Heart Surg Forum 2007; 10:E376-80. [PMID: 17855202 DOI: 10.1532/hsf98.20071059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND We prospectively examined whether surgical treatment of secundum atrial septal defects in patients 30 years old improves their early- and mid-term clinical outcomes. Our clinical experience is reviewed to assess the importance of surgical management in elderly patients with atrial septal defect. METHODS We analyzed 41 patients older than 30 years of age who underwent surgical correction of a secundum atrial septal defect. To evaluate the effects of surgical treatment, we compared functional capacity, diuretic administration, rhythm status, and echocardiographic parameters of all patients before and after the operation. RESULTS The median follow-up period was 4.2 years (range, 6 months-7 years). There were no operative deaths. Functional class in most of the patients improved after operation. Two patients reverted to normal sinus rhythm after the operation. There was only one new atrial fibrilation among patients in the postoperative term. Right atrial and right ventricular dimensions and pulmonary artery pressures were significantly decreased, and ejection fractions were significantly increased after the operation. The need for diuretic treatment was decreased after surgical repair. No residual intracardiac shunts were identified during follow-up. There were no cerebrovascular thromboembolic accidents in the early postoperative period. CONCLUSION Surgical closure of atrial septal defects in patients over 30 years old can improve their clinical status and prevent right ventricular dilatation and insufficiency. The operation must be performed as soon as possible, even if the symptoms or the hemodynamic impact seem to be minimal.
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Affiliation(s)
- Bilgehan Erkut
- Department of Cardiovascular Surgery, Medical Faculty of Ataturk University, Erzurum, Turkey.
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Schussler JM, Anwar A, Phillips SD, Roberts BJ, Vallabhan RC, Grayburn PA. Effect on right ventricular volume of percutaneous Amplatzer closure of atrial septal defect in adults. Am J Cardiol 2005; 95:993-5. [PMID: 15820174 DOI: 10.1016/j.amjcard.2004.12.046] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2004] [Revised: 12/27/2004] [Accepted: 12/27/2004] [Indexed: 10/25/2022]
Abstract
In adult patients with atrial septal defects (ASDs), right ventricular (RV) cavity size may return to normal after operative closure. This study demonstrated improved RV volumes and right atrial areas in 20 adult patients after successful transcatheter closure of large ASDs. RV volumes decreased by 22%, 30%, and 41% at 1 day, 1 month, and 6 months, respectively, after the procedure. Right atrial areas decreased by 5%, 23%, and 26%, respectively, over the same time.
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Affiliation(s)
- Jeffrey M Schussler
- Department of Internal Medicine, Division of Cardiology, Baylor University Medical Center, Dallas, Texas, USA
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Santoro G, Pascotto M, Sarubbi B, Cappelli Bigazzi M, Calvanese R, Iacono C, Pisacane C, Palladino MT, Pacileo G, Russo MG, Calabrò R. Early electrical and geometric changes after percutaneous closure of large atrial septal defect. Am J Cardiol 2004; 93:876-80. [PMID: 15050492 DOI: 10.1016/j.amjcard.2003.12.027] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2003] [Revised: 12/04/2003] [Accepted: 12/04/2003] [Indexed: 11/20/2022]
Abstract
Cardiac arrhythmias and right chamber enlargement are well known long-term sequelae of atrial septal defect (ASD). Surgical ASD closure relieves patient symptoms but often fails to revert cardiac volume overload findings. Transcatheter ASD closure might be an attractive alternative to surgery, also because of the possibility to study the amount and time-course of the electro-geometric modifications following shunt disappearance. Between March 2000 and December 2002, 24 patients (age 22.7 +16.8 years) underwent percutaneous closure of large ASD (stretched diameter >20 mm and/or QP/QS ratio >1.5:1). ASD closure was performed with the Amplatzer Septal Occluder device (mean 25 +/- 7 mm), achieving a complete occlusion in all patients at 1 month. In 6 patients, right ventricular (RV) monophasic action potential was recorded during the procedure. All patients underwent standard 12-lead electrocardiography and transthoracic echocardiography before and at 24 hours and 1 month after ASD closure. After the procedure, monophasic action potential length increased from 359 +/- 27 to 372 +/- 27 ms (p <0.0001). At 1 month, QT dispersion decreased from 54 +/- 25 to 41 +/- 17 ms (p <0.05), RV diastolic diameter decreased from 42 +/- 6 to 34 +/- 5 mm (p <0.00001), and left ventricular (LV) diastolic diameter increased from 39 +/- 5 to 44 +/- 5 mm (p <0.0001), resulting in a decrease in the RV/LV ratio from 1.11 +/- 0.22 to 0.79 +/- 0.11 (-28.8%, p <0.00001). Electrocardiographic changes, as well as the amount and time-course of RV overload relief, did not significantly differ between pediatric (<16 years of age; n = 11) and adult patients (n = 13). In conclusion, regardless of age at procedure, percutaneous ASD closure results in early striking electrical and geometric cardiac changes that may be beneficial during long-term follow-up.
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Affiliation(s)
- Giuseppe Santoro
- Division of Pediatric Cardiology, A.O. Monaldi, 2nd University of Naples, Naples, Italy.
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Jemielity M, Dyszkiewicz W, Paluszkiewicz L, Perek B, Buczkowski P, Ponizyński A. Do patients over 40 years of age benefit from surgical closure of atrial septal defects? Heart 2001; 85:300-3. [PMID: 11179271 PMCID: PMC1729662 DOI: 10.1136/heart.85.3.300] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To determine the value of surgical closure of atrial septal defects in patients over 40 years of age. METHODS Retrospective analysis of 76 patients (63 women, 13 men), age range 40-62 years (mean (SD) 45.8 (5.1) years), who underwent surgical repair of atrial septal defect. Pre- and postoperative clinical status (New York Heart Association (NYHA) functional class) was assessed, and ECG, x ray, and echocardiographic investigations performed. Follow up was between 1 and 17 years. RESULTS One operative and one late death occurred during the study period. Before operation, 47 patients (61.8%) were in NYHA functional classes III and IV. After operation, 61 patients (82.4%) were in classes I and II. Four patients had atrial fibrillation before surgery versus nine after surgery. Before operation, 52 patients had intensified pulmonary vascularity compared with only seven after operation. Echocardiographic examination showed a significant reduction in right ventricular dimension (4.10 (0.91) v 2.95 (0.36) cm, p < 0.001). No residual intracardiac shunts were identified on echocardiographic follow up. CONCLUSIONS Surgical closure of atrial septal defects in patients over 40 years old can improve their clinical status and prevent right ventricular dilatation and insufficiency.
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Affiliation(s)
- M Jemielity
- Department of Cardiac Surgery, Institute of Cardiology, Karol Marcinkowski University of Medical Sciences, Poznań, Poland.
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Affiliation(s)
- C Ward
- Regional Cardiac Centre, Wynthenshawe Hospital, Manchester
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Brandenburg RO, Holmes DR, Brandenburg RO, McGoon DC. Clinical follow-up study of paroxysmal supraventricular tachyarrhythmias after operative repair of a secundum type atrial septal defect in adults. Am J Cardiol 1983; 51:273-6. [PMID: 6823836 DOI: 10.1016/s0002-9149(83)80048-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Adults with isolated secundum atrial septal defect (ASD) may present with paroxysmal atrial tachyarrhythmias. The clinical course of these rhythmic disturbances after correction of the ASD is unknown. Of 188 patients aged 44 years old or older with isolated ASD, 27 (14%) (mean age 52.7 years, range 44 to 71) had documented paroxysmal atrial tachyarrhythmias preoperatively: 16 had paroxysmal atrial fibrillation, 2 had atrial flutter, and 9 had supraventricular tachycardia. Among these 3 groups, there were no differences in age, sex, New York Heart Association class, duration of preoperative symptoms, mean right atrial and pulmonary arterial pressures, shunt size, atrial size, or follow-up period. After operative repair, follow-up data were available in all patients for a mean of 12 years (range 1.5 to 25). Of the 16 patients with preoperative paroxysmal atrial fibrillation, 14 (88%) continued to have increasingly frequent paroxysmal atrial fibrillation, culminating in sustained atrial fibrillation. In 1 of the 2 patients with paroxysmal atrial flutter, sustained atrial fibrillation developed. Of the 9 patients with preoperative paroxysmal supraventricular tachycardia, 5 had no further episodes of this arrhythmia postoperatively.
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Kay H, Lepley D, Korns ME, Tector AJ, Flemma RJ. Surgery for congenital heart disease in the adult. Chest 1976; 69:356-62. [PMID: 971604 DOI: 10.1378/chest.69.3.356] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
A total of 205 adults with a variety of congenital heart lesions underwent operation for total correction of their defects. Operative and long-term mortality were 3 and 4 percent, respectively. There has been only one operative death in the past five years (85 patients). While most defects were repaired with good hemodynamic and symptomatic improvement, the three lesions associated with the worst results were cyanotic tetralogy of Fallot, severe pulmonic stenosis complicated by atrial septal defect, and ostium primum atrial septal defect. Myocardial failure due to end-stage myocardial fibrosis was the major cause of operative mortality. Myocardial fibrosis and irreversible pulmonary changes seemed to be the two factors limiting operative correctio
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Nasrallah AT, Hall RJ, Garcia E, Leachman RD, Cooley DA. Surgical repair of atrial septal defect in patients over 60 years of age. Long-term results. Circulation 1976; 53:329-31. [PMID: 1245039 DOI: 10.1161/01.cir.53.2.329] [Citation(s) in RCA: 39] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
In order to evaluate results of surgical repair of secundum atrial septal defect (ASD) in patients 60 years of age or older, a review was made of 16 patients who had undergone such operation between January 1964 and December 1974. Before operation eight patients were in functional classification III (New York Heart Association), seven were in class II, and one was in class I. Twelve patients had a left-to-right shunt greater than 3:1. Pulmonary artery systolic pressure was greater than 40 mm Hg in 12 patients and greater than 60 mm Hg in five. Four patients had documented paradoxical emboli and were being treated with Coumadin. Before operation all patients but one were receiving digoxin. Repair was accomplished by direct suture in two patients and Dacron patch graft in 14. No deaths occurred during the postoperative period. Postoperatively, ten patients were in class I, five in class II, and one remained in class III. The hospital stay ranged from eight to 20 days (average 11 days). Two patients died one year and another (at the age of 77) five years after surgery. The remaining 13 patients are alive and well three months to 11 years after surgery. We conclude that repair of secundum ASD in patients over the age of 60 is safe, has low morbidity, and produces considerable clinical improvement.
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Abstract
Two patients are described who presented with congestive heart failure and were found to have an atrial septal defect with a pulmonary blood flow approximately twice the systemic blood flow. Most of the usual clinical signs of atrial septal defect were absent, and the diagnosis was established by right heart catheterization and radioisotopic angiography. Both patients had hypertension and coronary artery disease. Atrial septal defect in the adult patient may not be recognized because of associated cardiac disease, including coronary artery disease and hypertension, or pulmonary disease which may obscure the usual clinical signs of a septal defect. Radioisotopic angiography and right heart catheterization should be considered in any patients with heart disease or congestive failure of obscure cause even if the usual diagnostic signs of atrial septal defect are absent.
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Clark DS, Hirsch HD, Tamer DM, Gelband H. Electrocardiographic changes following surgical treatment of congenital cardiac malformations. Prog Cardiovasc Dis 1975; 17:451-65. [PMID: 124901 DOI: 10.1016/s0033-0620(75)80004-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Dave KS, Pakrashi BC, Wooler GH, Ionescu MI. Atrial septal defect in adults. Clinical and hemodynamic results of surgery. Am J Cardiol 1973; 31:7-13. [PMID: 4682414 DOI: 10.1016/0002-9149(73)90803-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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