1
|
Rivera E, Trivedi K, Cao G. Septal Defects: Unveiling Sex-Based Disparities and Screening Challenges for Timely Intervention Through a Case Report and Systematic Literature Review. Cureus 2024; 16:e65752. [PMID: 39144879 PMCID: PMC11324003 DOI: 10.7759/cureus.65752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2024] [Indexed: 08/16/2024] Open
Abstract
Atrial septal defects (ASDs), comprising a significant portion of congenital cardiac anomalies, encompass a rarer and more diagnostically challenging subset known as sinus venosus ASDs (SVASDs). ASDs are more prevalent in females, and the prognosis for patients under 40 years of age is generally favorable with advancements in surgical and transcatheter interventions. However, undiagnosed ASDs in adults above 40 years old, especially females, often lead to severe complications, including pulmonary hypertension, atrial fibrillation, Eisenmenger syndrome, and a mortality rate exceeding 50%. Our detailed case study focuses on an obese 42-year-old Hispanic migrant female with chronic respiratory failure misattributed to pulmonary hypertension, resulting in the progression of complications from undiagnosed SVASD. Further investigation using contrast-enhanced transesophageal echocardiography (TEE) elucidated the correct diagnosis four years after her initial presentation. This report explores the potential factors contributing to the patient's delayed diagnosis and development of advanced cardiac complications of pulmonary hypertension leading to Eisenmenger syndrome that precluded her from procedural intervention. Furthermore, this report pioneers the first thorough review of case reports in adults newly diagnosed with SVASD, revealing sex-based differences in complications.
Collapse
Affiliation(s)
- Elsy Rivera
- Internal Medicine, Methodist Health System, Dallas, USA
| | - Kathan Trivedi
- Internal Medicine, Methodist Dallas Medical Center, Dallas, USA
| | - George Cao
- Internal Medicine, Methodist Health System, Dallas, USA
| |
Collapse
|
2
|
Sivakumar K. Transcatheter Correction of Superior Venacaval Form of Sinus Venosus Defects Using Balloon-Mounted Covered STENTS. Interv Cardiol Clin 2024; 13:291-306. [PMID: 38839164 DOI: 10.1016/j.iccl.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
Superior sinus venosus defects (SVD) are interatrial communications located above the confines of the oval fossa, where unroofing of the right upper pulmonary vein leads to its anomalous drainage to the superior venacava. Recent emergence of transcatheter closure of these defects using covered stents is an attractive alternative option especially in adults with additional comorbidities. This article focuses on various aspects of non-surgical closure of SVD, including patient selection, appropriate hardware options, step-by-step procedural details, evolution and modifications in the techniques over the last decade, protocols for follow-up evaluation, and potential complications associated with this intervention.
Collapse
Affiliation(s)
- Kothandam Sivakumar
- Institute of Cardio Vascular Diseases, Madras Medical Mission, 4A Dr J J Nagar, Mogappair, Chennai 600037, India.
| |
Collapse
|
3
|
El‐Andari R, Moolla M, John K, Slingerland A, Campbell S, Nagendran J, Hong Y, Mathew A. Outcomes Following Surgical Repair of Sinus Venosus Atrial Septal Defects: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2024; 13:e033686. [PMID: 38874063 PMCID: PMC11255747 DOI: 10.1161/jaha.123.033686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 04/15/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Sinus venosus atrial septal defect (SVASD) is a rare congenital cardiac anomaly comprising 5% to 10% of all atrial septal defects. Although surgical closure is the standard treatment for SVASD, data on outcomes have been confined to small cohorts. Thus, we conducted a systematic review of the outcomes of SVASD repair. METHODS AND RESULTS The primary outcome was death. Secondary outcomes encompassed atrial fibrillation, sinus node dysfunction, pacemaker insertion, cerebrovascular accident, reoperation, residual septal defect, superior vena cava obstruction, and reimplanted pulmonary vein obstruction. Pooled incidences of outcomes were calculated using a random-effects model. Forty studies involving 1320 patients who underwent SVASD repair were included. The majority were male patients (55.4%), with 88.0% presenting with associated anomalous pulmonary venous connection. The weighted mean age was 18.6±12.5 years, and the overall weighted mean follow-up period was 8.6±10.4 years. The in-hospital mortality rate was 0.24%, with a 30-day mortality rate of 0.5% reported in 780 patients. Incidences of atrial fibrillation, sinus node dysfunction, pacemaker insertion, and cerebrovascular accident over the long-term follow-up were 3.3% (2.18%-4.93%), 6.5% (5.09%-8.2%), 2.23% (1.34%-3.57%), and 2.03% (0.89%-2.46%) respectively. Reoperation occurred in 1.36% (0.68%-2.42%) of surgeries, residual septal defect in 1.34% (0.69%-2.42%), superior vena cava obstruction in 1.76% (1.02%-2.9%), and reimplanted pulmonary vein obstruction in 1.4% (0.7%-2.49%). CONCLUSIONS This is the first comprehensive analysis of outcomes following surgical repair of SVASD. The findings affirm the safety and effectiveness of surgery, establishing a reference point for evaluating emerging transcatheter therapies. Safety and efficacy profiles comparable to surgical repair are essential for widespread adoption of transcatheter treatments.
Collapse
Affiliation(s)
- Ryaan El‐Andari
- Division of Cardiac Surgery, Department of Surgery, Mazankowski Alberta Heart InstituteUniversity of AlbertaEdmontonAlbertaCanada
| | - Muhammad Moolla
- Division of Cardiology, Department of Medicine, Mazankowski Alberta Heart InstituteUniversity of AlbertaEdmontonAlbertaCanada
| | - Kevin John
- Division of Internal Medicine, Department of MedicineTufts UniversityMedfordMAUSA
| | - Ashley Slingerland
- Faculty of Medicine and DentistryUniversity of AlbertaEdmontonAlbertaCanada
| | | | - Jeevan Nagendran
- Division of Cardiac Surgery, Department of Surgery, Mazankowski Alberta Heart InstituteUniversity of AlbertaEdmontonAlbertaCanada
| | - Yongzhe Hong
- Division of Cardiac Surgery, Department of Surgery, Mazankowski Alberta Heart InstituteUniversity of AlbertaEdmontonAlbertaCanada
| | - Anoop Mathew
- Division of Cardiology, Department of Medicine, Mazankowski Alberta Heart InstituteUniversity of AlbertaEdmontonAlbertaCanada
| |
Collapse
|
4
|
Sagar P, Sivakumar K, Thejaswi P, Rajendran M. Transcatheter Covered Stent Exclusion of Superior Sinus Venosus Defects. J Am Coll Cardiol 2024; 83:2179-2192. [PMID: 38811095 DOI: 10.1016/j.jacc.2024.03.417] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 03/11/2024] [Accepted: 03/20/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Transcatheter correction of sinus venosus defects (SVDs) using balloon-mounted covered stents provides an attractive surgical alternative. Surgery may be complicated by superior vena caval or right upper pulmonary vein (RUPV) stenosis, sinus nodal dysfunction, and residual additional pulmonary veins. OBJECTIVES Being a new intervention, technical modifications would simplify the procedure, improve universal applicability, and reduce or tackle complications. METHODS Patients were included if balloon interrogation of cavoatrial junction confirmed closure of SVD and redirected RUPV to the left atrium. A single-center experience was analyzed to summarize the procedural modifications over 8 years. Transesophageal echocardiogram (TEE) on follow-up was done to identify residual shunt, RUPV flows, and stent thrombosis. RESULTS A total of 100 patients including 9 children with a median age of 35 years (range, 4-69 years) underwent SVD closure after balloon interrogation. Among 57 patients balloon interrogated in the first 5 years, 70% underwent transcatheter closure, with 2 failures. RUPV occlusion caused the exclusions. Inclusions improved to 94% among the subsequent 65 balloon interrogations when RUPV protection was implemented, with 1 failure. Stent embolization caused the 3 failures warranting surgery. Recent modifications included limited transesophageal echocardiogram without anesthesia, avoiding venovenous circuit, interrogation with semicompliant balloons, trans-septal RUPV protection, overlapping stents to permit additional vein drainage to superior vena cava and tackle embolizations. There were no deaths. Minor complications included stent embolizations stabilized in catheterization laboratory in 2 patients, left innominate vein jailing in 2 patients, insignificant residual flows, and nonocclusive asymptomatic stent thrombosis in 4 patients. CONCLUSIONS Procedural success was 97%. Recent modifications increased patient inclusions, decreased complications, and simplified the intervention.
Collapse
Affiliation(s)
- Pramod Sagar
- Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, India
| | - Kothandam Sivakumar
- Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, India.
| | - Puthiyedath Thejaswi
- Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, India
| | - Monica Rajendran
- Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, India
| |
Collapse
|
5
|
Vicenty-Rivera S, Molina-Lopez VH, Diaz-Rodriguez PE, Molinary-Jimenez LA. Sinus Venosus Atrial Septal Defect as an Overlooked Source of Shortness of Breath Among Patients With Pulmonary Arterial Hypertension. Cureus 2024; 16:e62935. [PMID: 38915839 PMCID: PMC11195326 DOI: 10.7759/cureus.62935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2024] [Indexed: 06/26/2024] Open
Abstract
Sinus venosus atrial septal defects (SVASD) associated with partial anomalous pulmonary venous return (PAPVR) can be overlooked as a source of dyspnea in adult patients with pulmonary hypertension. We present the case of a 61-year-old male with exertional dyspnea initially attributed to pulmonary hypertension, who was subsequently diagnosed with SVASD and right superior PAPVR. This case underscores the critical importance of maintaining high clinical awareness and utilizing multimodal imaging techniques in cardiology to accurately diagnose and manage pulmonary hypertension secondary to congenital heart disease. Timely surgical correction can significantly improve morbidity and mortality outcomes.
Collapse
Affiliation(s)
- Sonia Vicenty-Rivera
- Cardiology, Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, USA
| | | | | | | |
Collapse
|
6
|
Font CM, Fernandez AB, Kadariya D. Unveiling sinus venosus atrial septal defect and partial anomalous pulmonary venous return in an elderly patient. J Geriatr Cardiol 2024; 21:462-464. [PMID: 38800542 PMCID: PMC11112156 DOI: 10.26599/1671-5411.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Affiliation(s)
- Cristina M Font
- Department of Medicine, Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Anamarys Blanco Fernandez
- Department of Medicine, Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Dinesh Kadariya
- Department of Medicine, Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, USA
| |
Collapse
|
7
|
Kim KM, Moon CH, Lee WJ, Kim WJ, Kim M, Jeong J, Lee HB, Jeong SM, Choi HJ, Hwang TS, Lee HC, Yu JH, Nam A, Kim DH. Surgical Correction of a Sinus Venosus Atrial Septal Defect with Partial Anomalous Pulmonary Venous Connections Using Cardiac Computed Tomography Imaging and a 3D-Printed Model. Animals (Basel) 2024; 14:1094. [PMID: 38612332 PMCID: PMC11010815 DOI: 10.3390/ani14071094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 03/27/2024] [Accepted: 04/02/2024] [Indexed: 04/14/2024] Open
Abstract
Sinus venosus atrial septal defects (SVASDs), concurrent with partial anomalous pulmonary venous connections (PAPVCs), are a rare congenital heart disease in dogs. Surgical correction is essential when clinical signs or significant hemodynamic changes are present. We aimed to report on the successful surgical correction of an SVASD with PAPVCs, using a computed tomography (CT)-based customized 3D cardiac model. A 10-month-old male poodle was referred for corrective surgery for an ASD. Echocardiography confirmed a hemodynamically significant left-to-right shunting flow through an interatrial septal defect and severe right-sided heart volume overload. For a comprehensive diagnosis, a CT scan was performed, which confirmed an SVASD with PAPVCs. A customized 3D cardiac model was used for preoperative decision-making and surgical rehearsal. The defect was repaired using an autologous pericardial patch under a cardiopulmonary bypass (CPB). Temporary pacing was applied for sinus bradycardia and third-degree atrioventricular block. The patient recovered from the anesthesia without further complications. The pacemaker was removed during hospitalization and the patient was discharged without complications 2 weeks post-surgery. At the three-month follow-up, there was no shunting flow in the interatrial septum and the right-sided volume overload had been resolved. The cardiac medications were discontinued, and there were no complications. This report indicates the validity of surgical correction under CPB for an SVASD with PAPVCs, and the advantages of utilizing a CT-based 3D cardiac model for preoperative planning to increase the surgical success rate.
Collapse
Affiliation(s)
- Kyung-Min Kim
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungnam National University, 99 Daehak-ro, Yuseong-gu, Daejeon 34134, Republic of Korea; (K.-M.K.); (C.-H.M.); (W.-J.L.); (W.-J.K.); (J.J.); (H.-B.L.); (S.-M.J.)
| | - Chang-Hwan Moon
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungnam National University, 99 Daehak-ro, Yuseong-gu, Daejeon 34134, Republic of Korea; (K.-M.K.); (C.-H.M.); (W.-J.L.); (W.-J.K.); (J.J.); (H.-B.L.); (S.-M.J.)
| | - Won-Jong Lee
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungnam National University, 99 Daehak-ro, Yuseong-gu, Daejeon 34134, Republic of Korea; (K.-M.K.); (C.-H.M.); (W.-J.L.); (W.-J.K.); (J.J.); (H.-B.L.); (S.-M.J.)
| | - Woo-Jin Kim
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungnam National University, 99 Daehak-ro, Yuseong-gu, Daejeon 34134, Republic of Korea; (K.-M.K.); (C.-H.M.); (W.-J.L.); (W.-J.K.); (J.J.); (H.-B.L.); (S.-M.J.)
| | - Mihyung Kim
- Chungnam National University Sejong Hospital, 20 Bodeum 7-ro, Sejong-si 30099, Republic of Korea;
| | - Jaemin Jeong
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungnam National University, 99 Daehak-ro, Yuseong-gu, Daejeon 34134, Republic of Korea; (K.-M.K.); (C.-H.M.); (W.-J.L.); (W.-J.K.); (J.J.); (H.-B.L.); (S.-M.J.)
| | - Hae-Beom Lee
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungnam National University, 99 Daehak-ro, Yuseong-gu, Daejeon 34134, Republic of Korea; (K.-M.K.); (C.-H.M.); (W.-J.L.); (W.-J.K.); (J.J.); (H.-B.L.); (S.-M.J.)
| | - Seong-Mok Jeong
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungnam National University, 99 Daehak-ro, Yuseong-gu, Daejeon 34134, Republic of Korea; (K.-M.K.); (C.-H.M.); (W.-J.L.); (W.-J.K.); (J.J.); (H.-B.L.); (S.-M.J.)
| | - Ho-Jung Choi
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Chungnam National University, 99 Daehak-ro, Yuseong-gu, Daejeon 34134, Republic of Korea;
| | - Tae Sung Hwang
- Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University, 501 Jinju-daero, Jinju-si 52828, Republic of Korea; (T.S.H.); (H.C.L.)
| | - Hee Chun Lee
- Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University, 501 Jinju-daero, Jinju-si 52828, Republic of Korea; (T.S.H.); (H.C.L.)
| | - Jae Hyeon Yu
- Department of Cardiothoracic Surgery, Chungnam National University Hospital, College of Medicine, Chungnam National University, 282 Munhwa-ro, Jung-gu, Daejeon 35015, Republic of Korea;
| | - Aryung Nam
- Department of Veterinary Internal Medicine, College of Veterinary Medicine, Konkuk University, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, Republic of Korea
| | - Dae-Hyun Kim
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungnam National University, 99 Daehak-ro, Yuseong-gu, Daejeon 34134, Republic of Korea; (K.-M.K.); (C.-H.M.); (W.-J.L.); (W.-J.K.); (J.J.); (H.-B.L.); (S.-M.J.)
| |
Collapse
|
8
|
Hascoët S, Roussin R, Batteux C. Treatment of sinus venosus defect: Time to tune. Int J Cardiol 2024; 399:131630. [PMID: 38048883 DOI: 10.1016/j.ijcard.2023.131630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 11/26/2023] [Accepted: 11/29/2023] [Indexed: 12/06/2023]
Affiliation(s)
- Sebastien Hascoët
- Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Faculté de médecine, Université Paris-Saclay, BME laboratory, 133 avenue de la résistance, 92350 Le Plessis Robinson, France; Inserm UMR-S 999, Marie Lannelongue hospital, Paris-Saclay university, 92350 Le Plessis Robinson, France.
| | - Régine Roussin
- Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Faculté de médecine, Université Paris-Saclay, BME laboratory, 133 avenue de la résistance, 92350 Le Plessis Robinson, France
| | - Clément Batteux
- Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Faculté de médecine, Université Paris-Saclay, BME laboratory, 133 avenue de la résistance, 92350 Le Plessis Robinson, France; Inserm UMR-S 999, Marie Lannelongue hospital, Paris-Saclay university, 92350 Le Plessis Robinson, France
| |
Collapse
|
9
|
Muroke V, Jalanko M, Haukka J, Anttila V, Pätilä T, Sinisalo J. Long-term outcome after surgical correction of sinus venosus defect in a nationwide register-based cohort study. Int J Cardiol 2024; 395:131433. [PMID: 37827284 DOI: 10.1016/j.ijcard.2023.131433] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 09/12/2023] [Accepted: 10/08/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVES Long-term results after sinus venosus defect (SVD) closure are sparse and many studies lack a proper control cohort. This nationwide cohort evaluated the long-term outcome after SVD surgery. METHODS The study enrolled every surgical SVD correction from the nationwide hospital discharge registry (FHDR) and surgical registries of two tertiary centers. Patients with more complex congenital heart defects were excluded. Surgeries were performed from 1969 to 2019. Five sex and birth-year-matched controls per SVD patient were gathered from the general population. RESULTS In total, 182 surgical SVD corrections were performed during the study period. The median age at the time of surgery was 8.3 years (range 0.06-75.7), and the majority (77.5%, n = 141) were under 18 years old. The median follow-up period was 18 years (range 0.1-53). There was no significant difference in mortality during the follow-up (logrank p = 0.62, MRR 0.78, 95% CI: 0.30-2.0). However, SVD patients had elevated risk for new-onset atrial fibrillation (RR 4.9, 95% CI: 2.2-10.9), heart failure (RR 4.0, 95% CI: 1.2-13.2), ischemic heart disease (4.3, 95% CI, 1.5-11.7), migraine (RR 3.6, 95% CI: 1.5-9.1) and sick sinus syndrome, II- or III-degree AV-block or pacemaker implantation (RR 11.3, 95% CI: 2.9-43.8). CONCLUSION Young patients with SVD have an excellent survival prognosis after the surgery. Risk for sick sinus syndrome or conduction disorders, atrial fibrillation, and heart failure remains elevated in the long-term follow-up.
Collapse
Affiliation(s)
- V Muroke
- Department of Cardiology, Helsinki University Hospital, Finland.
| | - M Jalanko
- Department of Cardiology, Helsinki University Hospital, Finland
| | - J Haukka
- Department of Public Health, University of Helsinki, Finland
| | - V Anttila
- Department of Cardiothoracic Surgery, Turku University Hospital, Finland
| | - T Pätilä
- Department of Cardiac Surgery, New Children's Hospital, Helsinki University Hospital, University of Helsinki, Finland
| | - J Sinisalo
- Department of Cardiology, Helsinki University Hospital, Finland
| |
Collapse
|
10
|
Sagar P, Sivakumar K. Different mechanisms for persistent and residual left-to-right shunt after transcatheter sinus venosus defect closure and their management. Ann Pediatr Cardiol 2024; 17:45-51. [PMID: 38933051 PMCID: PMC11198930 DOI: 10.4103/apc.apc_190_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 04/06/2024] [Accepted: 04/06/2024] [Indexed: 06/28/2024] Open
Abstract
Transcatheter closure of superior vena cava (SVC) form of sinus venosus defects (SVDs) using covered stents is emerging as an alternative to surgery in the current decade. A covered stent placed in the cavoatrial junction creates a roof for the right upper pulmonary vein (RUPV) that stops the left-to-right shunt and redirects the vein to the left atrium. While surgical literature has clearly documented the incidence of stenosis of SVC and RUPV, sinus nodal dysfunction, and persistent residual shunts following surgical correction, it is imperative to have similar data after this new transcatheter intervention on the incidence of complications and follow-up outcomes. Since patients with pretricuspid shunts are often clinically asymptomatic, correction is primarily performed to prevent a persistent right heart volume overload and allow remodeling of the heart chambers. Any residual left-to-right shunt after a correction will result in persistent right heart dilatation. Residual flows can result from various mechanisms, including lack of apposition of the covered stent to the free edge of the SVD, fabric breach, and persistent anomalous drainage of additional right-sided pulmonary veins that drain very high in the SVC or can be due to a coexistent defect in the oval fossa. This review analyzes the different mechanisms, explains the transesophageal and angiographic images for each one, and offers solutions tailored for various reasons. Different mechanisms warrant different treatment principles. A solution for residual shunt from one mechanism may not be appropriate for residual flow through another mechanism. A thorough understanding would aid the operator in effective interventions for these SVDs.
Collapse
Affiliation(s)
- Pramod Sagar
- Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, Tamil Nadu, India
| | - Kothandam Sivakumar
- Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, Tamil Nadu, India
| |
Collapse
|
11
|
Sivakumar K, Sagar P, Thejaswi P, Ramaswamy R, Chandrasekaran R. Innominate vein occlusion by the fabric of covered stent during transcatheter closure of sinus venosus defects - Causes, management, and outcome. Ann Pediatr Cardiol 2024; 17:59-63. [PMID: 38933047 PMCID: PMC11198928 DOI: 10.4103/apc.apc_186_23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/03/2024] [Accepted: 02/21/2024] [Indexed: 06/28/2024] Open
Abstract
Transcatheter sinus venosus defect (SVD) closure with covered stents is emerging as an alternative to surgery. An adequate anchor zone in the superior vena cava is mandatory for the stability of the covered stent to prevent caudal embolization. There is a potential risk of innominate vein occlusion by the fabric of the covered stent in patients with a very short superior caval vein. Three among a total of 105 patients who underwent SVD closure at our institution developed innominate vein occlusion. Predisposing anatomical factors, identification and management of occluded innominate vein, and follow-up outcomes are discussed.
Collapse
Affiliation(s)
- Kothandam Sivakumar
- Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, Tamil Nadu, India
| | - Pramod Sagar
- Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, Tamil Nadu, India
| | - Puthiyedath Thejaswi
- Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, Tamil Nadu, India
| | | | | |
Collapse
|
12
|
Al Maskari SN, Maddali MM, Al Alawi K, Raju S, Al-Farqani A. Device Closure of Superior Sinus Venosus Atrial Septal Defects: A single centre experience. Sultan Qaboos Univ Med J 2023; 23:44-50. [PMID: 38161760 PMCID: PMC10754301 DOI: 10.18295/squmj.12.2023.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/02/2023] [Accepted: 06/15/2023] [Indexed: 01/03/2024] Open
Abstract
Sinus venosus atrial septal defects present a wide variety of anatomical features and are frequently associated with partial anomalous pulmonary venous drainage of one or more right pulmonary veins. Surgical correction used to be the standard treatment. In recent times, transcatheter correction of superior sinus venosus atrial septal defects has come into vogue. The transcatheter closure of these defects with covered stents at a tertiary care centre in Oman between 2018 and 2023 is reported.
Collapse
Affiliation(s)
| | - Madan M. Maddali
- Cardiac Anesthesia, National Health Center, The Royal Hospital, Muscat, Oman
| | | | - Sowmiya Raju
- Cardiac Anesthesia, National Health Center, The Royal Hospital, Muscat, Oman
| | | |
Collapse
|
13
|
Maddali MM, Anderson RH, Al Maskari SN, Al Kindi F, Al Kindi HN. The Sinus Venosus Veno-Venous Bridge: Not a septal defect. Sultan Qaboos Univ Med J 2023; 23:5-9. [PMID: 38161764 PMCID: PMC10754305 DOI: 10.18295/squmj.12.2023.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/25/2023] [Accepted: 11/14/2023] [Indexed: 01/03/2024] Open
Abstract
This review provides an update on the morphology of the sinus venosus defect. It was earlier believed that a 'common wall' separated the right pulmonary veins from the superior caval vein. In the sinus venosus defects, this wall was absent. Current evidence shows that the superior rim of the oval fossa, rather than forming a second septum or representing a common wall, is an infolding between the walls of the caval veins and the right pulmonary veins. The sinus venosus defect is caused by the anomalous connection of one or more pulmonary veins to a systemic vein. However, the pulmonary vein(s) retain their left atrial connections, leading to a veno-venous bridge that allows interatrial shunting outside the oval fossa. True atrial septal defects are located within the oval fossa or in the anteo-inferior buttress, while sinus venosus defects, ostium defects and coronary sinus defects are morphologically distinct from them.
Collapse
Affiliation(s)
| | - Robert H. Anderson
- Institute of Genetic Medicine, Newcastle University, Newcastle, United Kingdom
| | | | | | - Hamood N. Al Kindi
- Cardiothoracic Surgery, National Heart Center, The Royal Hospital, Muscat, Oman
| |
Collapse
|
14
|
Baruteau AE, Hascoet S, Malekzadeh-Milani S, Batteux C, Karsenty C, Ciobotaru V, Thambo JB, Fraisse A, Boudjemline Y, Jalal Z. Transcatheter Closure of Superior Sinus Venosus Defects. JACC Cardiovasc Interv 2023; 16:2587-2599. [PMID: 37855807 DOI: 10.1016/j.jcin.2023.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 07/12/2023] [Accepted: 07/18/2023] [Indexed: 10/20/2023]
Abstract
Superior sinus venosus defect is a communication between the right and left atrium located above the upper margin of the oval fossa, immediately inferior to the junction of the superior vena cava and the right atrium. It is systematically associated with partial anomalous pulmonary venous drainage, especially of the right upper pulmonary vein. Surgical repair has been the gold standard approach to close that defect. Introduced in 2014, percutaneous closure has gradually become a safe and effective alternative to surgery in carefully selected patients, although worldwide experience remains limited. This article provides an appraisal of the patients' selection process and a step-by-step description of the procedure as well as a comprehensive review of its outcomes.
Collapse
Affiliation(s)
- Alban-Elouen Baruteau
- Nantes Université, Centre Hospitalier Universitaire Nantes, Department of Pediatric Cardiology and Pediatric Cardiac Surgery, Nantes, France; Nantes Université, Centre Hospitalier Universitaire Nantes, Centre National de la Recherche Scientifique, Institut National de la Santé et de la Recherche Scientifique, l'institut du thorax, Nantes, France; Nantes Université, Centre Hospitalier Universitaire Nantes, Institut National de la Santé et de la Recherche Scientifique, Centre d'Investigations Cliniques Femmes-Enfants-Adolescents 1413, Nantes, France; Nantes Université, Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement, Unité Mixte de Recherche 1280, Physiologie des Adaptations Nutritionnelles, Nantes, France.
| | - Sébastien Hascoet
- Malformations Cardiaques Congénitales Complexes-Hôpital Marie Lannelongue, Department of Pediatric Cardiology and Congenital Heart Disease, Groupe Hospitalier Paris Saint Joseph, BME Lab, Institut National de la Santé et de la Recherche Scientifique UMR-S 999, Université Parsis Saclay, Le Plessis Robinson, France
| | - Sophie Malekzadeh-Milani
- Malformations Cardiaques Congénitales Complexes-Necker, Department of Congenital and Pediatric Cardiology, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Université de Paris, Paris, France
| | - Clément Batteux
- Malformations Cardiaques Congénitales Complexes-Hôpital Marie Lannelongue, Department of Pediatric Cardiology and Congenital Heart Disease, Groupe Hospitalier Paris Saint Joseph, BME Lab, Institut National de la Santé et de la Recherche Scientifique UMR-S 999, Université Parsis Saclay, Le Plessis Robinson, France
| | - Clément Karsenty
- Department of Pediatrics, Centre Hospitalier Universitaire Toulouse, Université de Toulouse, Toulouse, France; Institut des Maladies Métaboliques et Cardiovasculaires, Université de Toulouse, Toulouse, France
| | - Vlad Ciobotaru
- Malformations Cardiaques Congénitales Complexes-Hôpital Marie Lannelongue, Department of Pediatric Cardiology and Congenital Heart Disease, Groupe Hospitalier Paris Saint Joseph, BME Lab, Institut National de la Santé et de la Recherche Scientifique UMR-S 999, Université Parsis Saclay, Le Plessis Robinson, France; Clinique des Franciscaines, 3Dheartmodeling, Nîmes, France
| | - Jean-Benoit Thambo
- Department of Pediatric and Adult Congenital Cardiology, Centre Hospitalier Universitaire Bordeaux, Bordeaux, France; Electrophysiology and Heart Modeling Institute, Institut Hospital-Universitaire Liryc, Fondation Bordeaux Université, Bordeaux, France
| | - Alain Fraisse
- National Heart and Lung Institute, Imperial College London, Royal Brompton and Harefield Hospitals, London, United Kingdom
| | - Younes Boudjemline
- Sidra Heart Center, Sidra Medicine, Weil Cornell Medical College, Doha, Qatar
| | - Zakaria Jalal
- Department of Pediatric and Adult Congenital Cardiology, Centre Hospitalier Universitaire Bordeaux, Bordeaux, France; Electrophysiology and Heart Modeling Institute, Institut Hospital-Universitaire Liryc, Fondation Bordeaux Université, Bordeaux, France
| |
Collapse
|
15
|
Thejaswi P, Sagar P, Sivakumar K. Simultaneous Transcatheter Closure of Coexistent Superior Sinus Venosus Defects and Oval Fossa Defects. Pediatr Cardiol 2023; 44:1591-1598. [PMID: 37505266 DOI: 10.1007/s00246-023-03235-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 07/06/2023] [Indexed: 07/29/2023]
Abstract
Device closure has become the preferred procedure for treating oval fossa defects in the last two decades. More recently, transcatheter sinus venosus defect (SVD) closure has emerged as an alternative to surgery. Transcatheter stenting aims to overcome potential late surgical complications such as stenosis of the superior vena cava (SVC) and right upper pulmonary vein (RUPV), as well as sinus node dysfunction. Balloon interrogation of the cavoatrial junction is able to identify patients who are suitable candidates for nonsurgical closure. Successful closure is possible when the balloon seals the SVD and redirects the RUPV towards the left atrium. Oval fossa (secundum) defects can coexist in approximately 9-16% of patients with SVD. Among a group of 80 patients who underwent transcatheter closure of SVD, five adult patients aged between 22 and 52 years also required device closure of an associated oval fossa defect. The procedure involved simultaneous balloon interrogation of both the SVD and oval fossa defect, with continuous monitoring of the RUPV using bilateral femoral venous sheaths. Covered stent exclusion of the SVD was performed with concurrent device closure of the oval fossa defect using 12-36 mm atrial septal occluders. During the procedure, two patients required protective balloon inflation in the RUPV while expanding the covered stent. In one patient, a higher small accessory RUPV was intentionally left to drain into the SVC through the struts of a bare stent anchoring the covered stent in the upper SVC. In another patient, a second overlapping covered stent was used to address residual flows from a fabric tear that became apparent after balloon deflation. There were no vascular complications and only one patient exhibited an insignificant 6 mm residual flow from the caudal edge of the SVD during a follow-up of 5 to 72 months. In conclusion, the closure of both SVD and associated oval fossa defects can be successfully performed in a single procedure, with comparable procedural times and favourable mid-term outcomes.
Collapse
Affiliation(s)
- Puthiyedath Thejaswi
- Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, 4A Dr J J Nagar, Mogappair, Chennai, 600037, India
| | - Pramod Sagar
- Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, 4A Dr J J Nagar, Mogappair, Chennai, 600037, India
| | - Kothandam Sivakumar
- Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, 4A Dr J J Nagar, Mogappair, Chennai, 600037, India.
| |
Collapse
|
16
|
Capone J, Brown IE, Mukherji J. Unrecognized Patent Foramen Ovale in Patient With Sinus Venosus-Type Atrial Septal Defect With Partial Anomalous Pulmonary Venous Return. A A Pract 2023; 17:e01669. [PMID: 37043390 PMCID: PMC10144289 DOI: 10.1213/xaa.0000000000001669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2023] [Indexed: 04/13/2023]
Affiliation(s)
- Joseph Capone
- From the Department of Anesthesiology and Perioperative Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Irwin E. Brown
- From the Department of Anesthesiology and Perioperative Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Jayanta Mukherji
- From the Department of Anesthesiology and Perioperative Medicine, Loyola University Medical Center, Maywood, Illinois
| |
Collapse
|
17
|
Brancato F, Stephenson N, Rosenthal E, Hansen JH, Jones MI, Qureshi S, Austin C, Speggiorin S, Caner S, Butera G. Transcatheter versus surgical treatment for isolated superior sinus venosus atrial septal defect. Catheter Cardiovasc Interv 2023; 101:1098-1107. [PMID: 37002948 DOI: 10.1002/ccd.30650] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 02/07/2023] [Accepted: 03/14/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND The superior sinus venosus atrial septal defect is a congenital communication between the left and right atria. Open surgical approach by patch closure has historically been the only treatment option. Recently, a transcatheter approach has been developed. This study aims to compare the efficacy and safety of surgical and transcatheter approach in treatment of sinus venosus atrial septal defect. METHODS Between March 2010 and December 2020, 58 patients (median age: 45.4, range 14.8-73.8) underwent either surgical or transcatheter correction of superior sinus venosus atrial septal defect with partial anomalous pulmonary venous drainage. RESULTS Twenty-four patients (median age: 35.4, range 14.8-66.8) underwent surgery while 34 patients (median age: 46.8, range 15.5-73.8) had a transcatheter treatment. During the catheterization era, 41 patients was considered suitable for a transcatheter closure. In 5 patients, surgery was the patient's or referring physician's choice. In 2 cases, the procedure was unsuccessful; the remaining 34 were successfully closed (94.4% of cases). Intensive care unit stay (median of 1 day, range 0.5-4, vs. 0, range 0-2, p < 0.0001) and hospital stay (median 7 days, range 2-15 vs. 2 days, range 1-12, p < 0.0001), were significantly longer in the surgery group. Total early complication rate, consisted on procedural and in-hospital complication, were higher in the surgical group (62.5% vs. 23.5%; p = 0.005). However, complications in both groups were clinically mild. At follow-up, a small residual shunt was present in 6 patients (surgery group: 2 pts; catheterization group: 4 pts; p: NS). Imaging studies showed significant improvement of right ventricular size and unobstructed pulmonary venous return in all patients. No late complications occurred at follow-up. CONCLUSIONS Transcatheter correction of sinus venosus atrial septal defect is effective and safe in selected patients and may be considered as a valid alternative to surgery.
Collapse
Affiliation(s)
- Federica Brancato
- Department of Congenital Cardiology, Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
- Department of Pediatrics, Department of Woman, Child Health and Public Health, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
- Pediatric Unit, San Jacopo Hospital, Pistoia, Italy
| | - Natasha Stephenson
- Department of Congenital Cardiology, Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Eric Rosenthal
- Department of Congenital Cardiology, Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Jan H Hansen
- Department of Congenital Cardiology, Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
- Department of Congenital Heart Disease and Paediatric Cardiology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Matthew I Jones
- Department of Congenital Cardiology, Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Shakeel Qureshi
- Department of Congenital Cardiology, Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Conal Austin
- Department of Congenital Cardiology, Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Simone Speggiorin
- Department of Congenital Cardiology, Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Salih Caner
- Department of Congenital Cardiology, Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Gianfranco Butera
- Department of Congenital Cardiology, Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
- School of Biomedical Engineering and Imaging Sciences-Kings College, London, UK
- Cardiology, Cardiac Surgery and Heart Lung Transplantation, ERN GUARD Heart: Bambino Gesù Hospital and Research Institute, IRCCS, Rome, Italy
| |
Collapse
|
18
|
Patel H, Barmore W. A rare case of sinus venosus atrial septal defect: Malpositioned right atrial pacemaker lead in the left atrium. J Cardiol Cases 2023; 27:203-206. [PMID: 37180217 PMCID: PMC10173402 DOI: 10.1016/j.jccase.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 12/31/2022] [Accepted: 01/13/2023] [Indexed: 02/17/2023] Open
Abstract
Incidental discovery of sinus venosus atrial septal defect (SV-ASD) in the elderly is rare. This defect allows for lead malpositioning during pacemaker placement and can lead to catastrophic cardioembolic events. Post-pacemaker implantation, chest radiography should be obtained to detect malpositioning early, and if detected, lead adjustment is recommended; if identified later, treatment with an anticoagulant is feasible. SV-ASD repair may be considered as well.
Collapse
|
19
|
Bhende VV, Sharma TS, Mehta DV, Trivedi BY, Kumar A, Patel VB, Panesar G, Soni K, Dhami KB, Patel N, Pathan SR, Majmudar HP. Midterm postoperative outcomes of different types of surgical reconstruction of sinus venosus atrial septal defects with anomalous pulmonary venous connection: The Results of Prospective Cohort Study. Health Sci Rep 2022; 6:e990. [PMID: 36579156 PMCID: PMC9773915 DOI: 10.1002/hsr2.990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 10/17/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022] Open
Abstract
Background and Aims Sinus venosus atrial septal defects (SVASDs) constitute a substantial part of atrial septal defects and are usually characterized by anomalous pulmonary venous connection (APVC), causing complications like sinus node dysfunction and arrhythmias. Several surgical approaches are used for treating SVASDs in pediatric patients, including single- and two-patch techniques. The study aimed to prospectively evaluate and compare the safety and efficacy of these two methods with different follow-up periods. Methods Ten patients aged 1-8 years with SVASDs and partial APVC were enrolled in the study at Bhanubhai and Madhuben Patel Cardiac Centre, Karamsad, India, between December 2018 and October 2021. The single-patch (sandwich-patch) technique was used in two patients, whereas the two-patch (dual-patch) technique with autologous pericardium was used in seven. Safety was assessed as the absence of complications in the follow-up periods of 6 months, 1, and 2 years, whereas efficacy was estimated by the preserved sinus rhythm and the development of arrhythmias. Electrocardiographic and echocardiographic methods were used to evaluate both parameters. Results No deaths, reoperations, pulmonary vein, and superior vena cava (SVC) stenosis or phrenic nerve palsy were observed among the 10 patients in the three follow-up periods. Sinus rhythm was arrested in two of the seven patients who underwent two-patch repair, whereas no rhythm disturbances occurred in those who underwent single-patch repair. Conclusion Both techniques used in SVASD repair with autologous pericardium proved to cause the smaller rate of complications in midterm postsurgical phase. However, there is a potentially great risk of the development of sinus node malfunction after the application of the two-patch technique. Therefore, methods avoiding sinus node interference are preferred in patients with partial APVC involving SVC.
Collapse
Affiliation(s)
- Vishal V. Bhende
- Department of Pediatric Cardiac Surgery, Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna HospitalBhaikaka UniversityAnandGujaratIndia
| | - Tanishq S. Sharma
- Department of Pediatric Cardiac Surgery, Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna HospitalBhaikaka UniversityAnandGujaratIndia
| | - Deepakkumar V. Mehta
- Department of Radiodiagnosis & Imaging, Pramukhswami Medical College & Shree Krishna HospitalBhaikaka UniversityAnandGujaratIndia
| | - Bhadra Y. Trivedi
- Department of Pediatric Cardiology, Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna HospitalBhaikaka UniversityAnandGujaratIndia
| | - Amit Kumar
- Department of Pediatric Cardiac Intensive Care, Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna HospitalBhaikaka UniversityAnandGujaratIndia
| | - Viral B. Patel
- Department of Radiodiagnosis & Imaging, Pramukhswami Medical College & Shree Krishna HospitalBhaikaka UniversityAnandGujaratIndia
| | - Gurpreet Panesar
- Department of Cardiac Anaesthesiology, Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna HospitalBhaikaka UniversityAnandGujaratIndia
| | - Kunal Soni
- Department of Cardiac Anaesthesiology, Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna HospitalBhaikaka UniversityAnandGujaratIndia
| | - Kartik B. Dhami
- Department of Cardiac Anaesthesiology, Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna HospitalBhaikaka UniversityAnandGujaratIndia
| | - Nirja Patel
- Department of Cardiac Anaesthesiology, Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna HospitalBhaikaka UniversityAnandGujaratIndia
| | - Sohilkhan R. Pathan
- Department of Clinical Research Services, Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna HospitalBhaikaka UniversityAnandGujaratIndia
| | - Hardil P. Majmudar
- Department of Pediatric Cardiac Surgery, Bhanubhai and Madhuben Patel Cardiac Centre, Shree Krishna HospitalBhaikaka UniversityAnandGujaratIndia
| |
Collapse
|
20
|
Morgan GJ, Zablah J. A new FDA approved stent for congenital heart disease: First-in-man experiences with G-ARMOR TM. Catheter Cardiovasc Interv 2022; 100:1261-1266. [PMID: 36321626 DOI: 10.1002/ccd.30447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 09/25/2022] [Accepted: 10/08/2022] [Indexed: 11/07/2022]
Abstract
We present the first clinical experience with a new hybrid cell structure covered stent, designed for congenital heart disease applications. It represents a significant redesign of the Cheatham Platinum (CP) Stent (Numed Inc.), maintaining the traditional benefits of the covered CP whilst significantly decreasing shortening and allowing controlled flaring at the ends through its combination of larger and standard sized cells. We first implanted the stent in 2 patients with superior sinus venosus defects with anomalous drainage of the right upper and middle lobe pulmonary veins. The first was a 40 year male and the second a 36 year old female. The third case was a 60 year old patient with near atresia of the aorta, with pre and poststenotic aortic dilation. The clinical result in all cases was excellent with no obstruction to pulmonary venous return and no visible L-R shunt on the transthoracic echo on 24 h and 2 week follow-up for the patient with sinus venosus defects and uniform complete revascularization of the aorta without any vascular complications in the patient with coarctation. These are the first uses of this stent in human subjects. The design is specifically aimed toward procedures where stent shortening is undesirable. Hence, coarctation of the aorta as well as stent implantation in preparation for percutaneous pulmonary valve placement are obvious use areas, as well as the growing body of evidence supporting percutaneous treatment of sinus venosus defects.
Collapse
Affiliation(s)
- Gareth J Morgan
- School of Medicine, University of Colorado Anschutz Medical Campus, Denver, Colorado, USA
| | - Jenny Zablah
- School of Medicine, University of Colorado Anschutz Medical Campus, Denver, Colorado, USA
| |
Collapse
|
21
|
Tan W, Stefanescu Schmidt AC, Horlick E, Aboulhosn J. Transcatheter Interventions in Patients With Adult Congenital Heart Disease. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2022; 1:100438. [PMID: 39132367 PMCID: PMC11307551 DOI: 10.1016/j.jscai.2022.100438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 07/17/2022] [Accepted: 08/01/2022] [Indexed: 08/13/2024]
Abstract
Patients with congenital heart disease now live well into adulthood because of advances in surgical techniques, improvements in medical management, and the development of novel therapeutic agents. As patients grow older into adults with congenital heart disease, many require catheter-based interventions for the treatment of residual defects, sequelae of their initial repair or palliation, or acquired heart disease. The past 3 decades have witnessed an exponential growth in both the type and number of transcatheter interventions in patients with congenital heart disease. With improvements in medical technology and device design, including the use of devices designed for the treatment of acquired valve stenosis or regurgitation, patients who previously would have required open-heart surgery for various conditions can now undergo percutaneous cardiac catheter-based procedures. Many of these procedures are complex and occur in complex patients who are best served by a multidisciplinary team. This review aims to highlight some of the currently available transcatheter interventional procedures for adults with congenital heart disease, the clinical outcomes of each intervention, and any special considerations so that the reader may better understand both the procedure and patients with adult congenital heart disease.
Collapse
Affiliation(s)
- Weiyi Tan
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ada C. Stefanescu Schmidt
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Eric Horlick
- Peter Munk Cardiac Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jamil Aboulhosn
- Ahmanson/UCLA Adult Congenital Heart Disease Center, David Geffen School of Medicine, University of California, Los Angeles, California
| |
Collapse
|
22
|
Multimodality imaging in delineation of complex sinus venosus defects and treatment outcomes over the last decade. Cardiol Young 2022; 32:1112-1120. [PMID: 34521491 DOI: 10.1017/s1047951121003851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Diagnosis of sinus venosus defects, not infrequently associated with complex anomalous pulmonary venous drainage, may be delayed requiring multimodality imaging. METHODS Retrospective review of all patients from February 2008 to January 2019. RESULTS Thirty-seven children were diagnosed at a median age of 4.2 years (range 0.5-15.5 years). In 32 of 37 (86%) patients, diagnosis was achieved on transthoracic echocardiography, but five patients (14%) had complex variants (four had high insertion of anomalous vein into the superior caval vein and three had multiple anomalous veins draining to different sites, two of whom had drainage of one vein into the high superior caval vein). In these five patients, the final diagnosis was achieved by multimodality imaging and intra-operative findings. The median age at surgery was 5.2 years (range 1.6-15.8 years). Thirty-one patients underwent double patch repair, four patients a Warden repair, and two patients a single-patch repair. Of the four Warden repairs, two patients had a high insertion of right-sided anomalous pulmonary vein into the superior caval vein, one patient had bilateral superior caval veins, and one patient had right lower pulmonary vein insertion into the right atrium/superior caval vein junction. There was no post-operative mortality, reoperation, residual shunt or pulmonary venous obstruction. One patient developed superior caval vein obstruction and one patient developed atrial flutter. CONCLUSION Complementary cardiac imaging modalities improve diagnosis of complex sinus venosus defects associated with a wide variation in the pattern of anomalous pulmonary venous connection. Nonetheless, surgical treatment is associated with excellent outcomes.
Collapse
|
23
|
Paneitz DC, Premkumar A, Stefanescu Schmidt AC, Cameron DE, Bloom JP. When a Pacemaker Leads to a New Diagnosis. Circ Cardiovasc Imaging 2022; 15:e013995. [PMID: 35735015 DOI: 10.1161/circimaging.122.013995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Dane C Paneitz
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston. (D.C.P., A.P., D.E.C., J.P.B.)
| | - Akash Premkumar
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston. (D.C.P., A.P., D.E.C., J.P.B.)
| | - Ada C Stefanescu Schmidt
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston. (A.C.S.S.)
| | - Duke E Cameron
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston. (D.C.P., A.P., D.E.C., J.P.B.)
| | - Jordan P Bloom
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston. (D.C.P., A.P., D.E.C., J.P.B.)
| |
Collapse
|
24
|
Qiu JK, Bamira D, Vainrib AF, Latson LA, Halpern DG, Chun A, Saric M. Multimodality Imaging of Sinus Venosus Atrial Septal Defect: A Challenging Diagnosis in Adults. CASE 2022; 6:107-113. [PMID: 35602989 PMCID: PMC9120852 DOI: 10.1016/j.case.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
SVASD should be suspected in cases of unexplained RV volume overload. Direct visualization of SVASD with TTE is difficult in adults compared with children. TEE is helpful for diagnosing SVASD and associated pulmonary venous abnormalities. Multimodal imaging techniques offer incremental value in the workup of SVASD.
Collapse
|
25
|
Cardiovascular Computed Tomography in Pediatric Congenital Heart Disease: A State of the Art Review. J Cardiovasc Comput Tomogr 2022; 16:467-482. [DOI: 10.1016/j.jcct.2022.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 01/04/2023]
|
26
|
Lim SC, Kwak JG, Cho S, Min J, Lee S, Kwon HW, Kim WH. Outcomes of the Warden Procedure for Anomalous Pulmonary Venous Return to the Superior Vena Cava: A 17-Year Experience. J Chest Surg 2022; 55:206-213. [PMID: 35292601 PMCID: PMC9178303 DOI: 10.5090/jcs.21.142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/17/2022] [Accepted: 02/03/2022] [Indexed: 12/02/2022] Open
Abstract
Background Surgical repair of partial anomalous pulmonary venous return (PAPVR) to the superior vena cava (SVC) using the Warden procedure has favorable outcomes. However, there remain some concerns after the Warden procedure, such as sinoatrial nodal dysfunction and systemic or pulmonary venous stenosis. We investigated the outcomes of the Warden procedure for repair of PAPVR to the SVC. Methods This retrospective study included 22 consecutive patients who underwent the Warden procedure for PAPVR between 2002 and 2018. The median age and body weight at operation were 27.5 months (interquartile range [IQR], 5.0–56.8 months) and 13.2 kg (IQR, 6.5–16.0 kg), respectively. The median follow-up duration was 6.2 years (IQR, 3.5–11.6 years). Results There were no cases of early or late mortality. No patients had postoperative heart rhythm problems, except 1 patient who showed transient sinoatrial nodal dysfunction in the immediate postoperative period. Procedure-related complications requiring reintervention occurred in 5 patients, including 3 of 4 SVC stenosis cases and 2 pulmonary venous stenosis cases during follow-up. The rate of freedom from reintervention related to the Warden procedure was 75.9% at 10 years. Conclusion In cases requiring extension or creation of an atrial septal defect to achieve a sufficient venous pathway, or interposition of an entire circumferential conduit between the SVC and right atrium due to the shortness of the SVC in the Warden procedure, stenotic complications of the venous pathway occurred. Careful observation of changes in the pressure gradient or anatomical stenosis is required in such patients.
Collapse
Affiliation(s)
- Su Chan Lim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Gun Kwak
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sungkyu Cho
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jooncheol Min
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sangjun Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hye Won Kwon
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Woong-Han Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
27
|
Filomena D, Monosilio S, Sannino M, Cimino S, Maestrini V, Bruno E, Miraldi F, Fedele F, Vizza CD, Agati L. Complex connections: A young man presenting with shortness of breath, hypoxemia, right lumbar pain and left limb swelling. Echocardiography 2022; 39:631-636. [PMID: 35253264 PMCID: PMC9314040 DOI: 10.1111/echo.15330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/17/2022] [Accepted: 02/09/2022] [Indexed: 12/02/2022] Open
Abstract
A 43‐year‐old Caucasian man was admitted to hospital due to shortness of breath, right lumbar pain and lower left limb swelling. Arterial blood gas sample showed mild hypoxemia and respiratory alkalosis. CT scan confirmed pulmonary embolism, splenic and bilateral renal ischemic lesions. Echocardiography showed right ventricular and coronary sinus (CS) dilatation. Using contrast echocardiography, a superior sinus venous atrial septal defect and persistent left superior vena cava (PLSVC) draining in CS were suspected. Cardiac CT confirmed the diagnosis and showed overriding right superior vena cava (RSVC) draining in both atria. The patient underwent successful surgical correction.
Collapse
Affiliation(s)
- Domenico Filomena
- Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences "Sapienza", University of Rome, Policlinico Umberto I, Rome, Italy
| | - Sara Monosilio
- Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences "Sapienza", University of Rome, Policlinico Umberto I, Rome, Italy
| | - Michele Sannino
- Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences "Sapienza", University of Rome, Policlinico Umberto I, Rome, Italy
| | - Sara Cimino
- Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences "Sapienza", University of Rome, Policlinico Umberto I, Rome, Italy
| | - Viviana Maestrini
- Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences "Sapienza", University of Rome, Policlinico Umberto I, Rome, Italy
| | - Emanuele Bruno
- Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences "Sapienza", University of Rome, Policlinico Umberto I, Rome, Italy
| | - Fabio Miraldi
- Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences "Sapienza", University of Rome, Policlinico Umberto I, Rome, Italy
| | - Francesco Fedele
- Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences "Sapienza", University of Rome, Policlinico Umberto I, Rome, Italy
| | - Carmine Dario Vizza
- Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences "Sapienza", University of Rome, Policlinico Umberto I, Rome, Italy
| | - Luciano Agati
- Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences "Sapienza", University of Rome, Policlinico Umberto I, Rome, Italy
| |
Collapse
|
28
|
Akbar A, Hussain I, Wazir HD, Rehman Y, Ilyas S, Khan S, Ahmed T, Khan AM, Ullah I, Afridi A. Pattern of Vascular Anomalies Associated With Sinus Venosus Atrial Septal Defect. Cureus 2022; 14:e21892. [PMID: 35273854 PMCID: PMC8901160 DOI: 10.7759/cureus.21892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2022] [Indexed: 11/05/2022] Open
Abstract
Objective To evaluate children with sinus venosus atrial septal defect (SV-ASD) for associated vascular anomalies. Methodology A total of 72 children with sinus venosus atrial septal defect with partial anomalous pulmonary venous return who presented to pediatric cardiology unit, Lady Reading Hospital Peshawar, from January 2019 till June 2021 were included in this cross-sectional study. Diagnosis of sinus venosus atrial septal defect was confirmed through two-dimensional (2D) and Doppler echocardiography performed by a pediatric cardiologist. Cardiac CT angiography was performed and assessed by a pediatric cardiac interventionist and radiologist. Patients were managed according to standard protocols and guidelines. The data were entered and analyzed with Statistical Package for the Social Sciences (SPSS) version 20. Percentages were used to express frequencies. Results Mean age was 8.3 ± 2.7 years (interquartile range (IQR): two months to 18 years). There were 37 (51.4%) male and 35 (48.6%) female patients. Out of 72 patients, 64 (88.8%) patients had superior sinus venosus atrial septal defect, while inferior sinus venosus atrial septal defect was found in eight (11.1%) patients. In six (8.3%) patients, associated secundum atrial septal defect was identified. Bilateral superior vena cava was found in seven (9.7%) patients. Left aortic arch was seen in 70 (97.2%) patients, whereas two (2.7%) patients had right aortic arch. Conclusion Sinus venosus ASD is a rare type of atrial septal defect which is also associated with both pulmonary and systemic vascular anomalies. Diagnosing these vascular anomalies is of paramount importance before any corrective intervention can be done. Recognizing the pattern of these anomalies should be known to every interventional cardiologist, radiologist, and cardiac surgeon. Echocardiography alone is not a good tool to assess these extracardiac structures. Imaging modalities like CT angiography and MRI have refined our preoperative workup which is essential for the ultimate outcome of the corrective intervention.
Collapse
|
29
|
Shimajiri H, Harada Y, Kinoshita M, Mikami S. Sinus venosus atrial septal defect and partial anomalous pulmonary venous connection in a patient with dextrocardia. BMJ Case Rep 2022; 15:15/2/e245523. [PMID: 35228216 PMCID: PMC8886361 DOI: 10.1136/bcr-2021-245523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
An 85-year-old woman presenting with symptomatic pulmonary hypertension (PH) with a history of dextrocardia was referred to our facility for treatment of heart failure. Significant shunting was detected by measuring oxygen saturation during right heart catheterisation (RHC). CT with contrast revealed sinus venosus atrial septal defect (SVASD) and partial anomalous pulmonary venous connection (PAPVC), in which the left upper and middle lobar pulmonary veins returned to the superior vena cava and right atrium. Despite medical treatment, the patient died, and an autopsy was performed. SVASD and PAPVC are rare congenital anomalies. RHC with measurement of oxygen saturation and CT with contrast should be considered in patients with unexplained right atrial and ventricular enlargement or suspected PH.
Collapse
Affiliation(s)
- Hiroto Shimajiri
- Department of Cardiology, Shobara Red Cross Hospital, Shobara, Hiroshima, Japan
| | - Yu Harada
- Department of Cardiology, Shobara Red Cross Hospital, Shobara, Hiroshima, Japan
| | - Mirai Kinoshita
- Department of Cardiology, Shobara Red Cross Hospital, Shobara, Hiroshima, Japan
| | - Shinsuke Mikami
- Department of Cardiology, Shobara Red Cross Hospital, Shobara, Hiroshima, Japan
| |
Collapse
|
30
|
Mamatov JM, Robinson JM, Sanchez EZ. Cardiac CT and Transesophageal Echocardiogram Evaluation of a Sinus Venosus-Type Atrial Septal Defect With Partial Anomalous Pulmonary Venous Return and a Persistent Left Superior Vena Cava. Cureus 2021; 13:e20367. [PMID: 35036201 PMCID: PMC8752401 DOI: 10.7759/cureus.20367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2021] [Indexed: 12/05/2022] Open
Abstract
The sinus venosus (SV) plays a significant role in the embryological heart as the initial structure where the cardinal, umbilical, and vitelline veins drain before remodeling into the caval veins. As the human heart develops, the SV incorporates into the posterior wall of the right atrium. Sinus venosus atrial septal defects (SVASDs) result from a defect in the wall present among the right pulmonary veins, the superior vena cava (SVC), and the right atrium. Persistent left superior vena cava (PLSVC) occurs when the Marshall ligament does not regress, and in most cases, the PLSVC enters the coronary sinus before draining into the right atrium. Pulmonary hypertension from chronic left to right shunting makes recognizing this condition clinically significant. In this case report, both cardiac CT and transesophageal echocardiogram were used to further evaluate an SVASD with partial anomalous pulmonary venous return (PAPVR) of the right superior pulmonary vein, in addition to a PLSVC. The incidence of the co-occurrence of SVASD and PLSVC, as well as the association between the two, were discussed in this case report. Future research should focus on the potential genetic causes of this co-occurrence. It should also focus on patient treatment and outcomes at different stages of presentation to optimize patient management and improve mortality.
Collapse
|
31
|
Mendelson MA. Pregnancy in women with left-to-right cardiac shunts: Any risk? INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2021. [DOI: 10.1016/j.ijcchd.2021.100209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
32
|
Moldovan H, Sibișan AM, Țigănașu R, Popescu BȘ, Vasile G, Gheorghiță D, Zaharia O, Costache VS, Guță A, Molnar A. Superior Sinus Venosus Atrial Septal Defect with Partial Anomalous Pulmonary Venous Drainage-Minimally Invasive Approach-Case Report. MEDICINA-LITHUANIA 2021; 57:medicina57090984. [PMID: 34577907 PMCID: PMC8468142 DOI: 10.3390/medicina57090984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/13/2021] [Accepted: 09/15/2021] [Indexed: 11/17/2022]
Abstract
The atrial septal defect is, after bicuspid aortic valve disease, the most common congenital cardiac disease present in the adult population. The most common atrial septal defects are the ostium secundum type (75–80%), followed by the ostium primum type (15%). The sinus venosus atrial septal defects (SV-ASD), defined as a communication in the posterior part of the interatrial septum, account for about 5 to 10% of atrial septal defects. Approximately 90% of SV-ASDs are associated with partial anomalous pulmonary venous drainage (PAPVD). The minimally invasive approach has gained ground in the treatment of ASDs, especially those of the ostium secundum type. The sinus venosus type is a relatively uncommon form of ASD, which, when associated with a PAPVD, is considered a complex cardiac malformation, and is usually treated in a classical manner, through median sternotomy. We describe the case of a 45-year-old woman diagnosed in adolescence with SV-ASD with PAPVD, who successfully underwent minimally invasive repair with fresh autologous pericardial patch reconstruction through an anterolateral mini-thoracotomy incision. The patient presented with shortness of breath and fatigue after heavy exertions, episodes of paroxysmal nocturnal dyspnea, palpitations during effort and at rest, and had a history of syncope dating from 17 years previously. Echocardiography revealed an SV-ASD with PAPVD in the right atrium and the intraoperative examination discovered that both right pulmonary veins were draining into the superior vena cava.
Collapse
Affiliation(s)
- Horațiu Moldovan
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 014461 Bucharest, Romania; (H.M.); (G.V.); (O.Z.)
- Clinical Emergency Hospital Bucharest, 014461 Bucharest, Romania; (A.-M.S.); (R.Ț.); (B.-Ș.P.)
| | - Andra-Mădălina Sibișan
- Clinical Emergency Hospital Bucharest, 014461 Bucharest, Romania; (A.-M.S.); (R.Ț.); (B.-Ș.P.)
| | - Robert Țigănașu
- Clinical Emergency Hospital Bucharest, 014461 Bucharest, Romania; (A.-M.S.); (R.Ț.); (B.-Ș.P.)
| | - Bogdan-Ștefan Popescu
- Clinical Emergency Hospital Bucharest, 014461 Bucharest, Romania; (A.-M.S.); (R.Ț.); (B.-Ș.P.)
| | - Gabriel Vasile
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 014461 Bucharest, Romania; (H.M.); (G.V.); (O.Z.)
- Clinical Emergency Hospital Bucharest, 014461 Bucharest, Romania; (A.-M.S.); (R.Ț.); (B.-Ș.P.)
| | - Daniela Gheorghiță
- Faculty of Materials Science and Engineering, Politehnica University of Bucharest, 060042 Bucharest, Romania
- Correspondence:
| | - Ondin Zaharia
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 014461 Bucharest, Romania; (H.M.); (G.V.); (O.Z.)
- Prof. Dr. Theodor Burghele Clinical Hospital, 050659 Bucharest, Romania
| | - Victor Sebastian Costache
- Faculty of Medicine, Titu Maiorescu University, 031593 Bucharest, Romania;
- “Sf. Constantin” Hospital Brasov, 500388 Brașov, Romania
| | - Andrada Guță
- Sanador Clinical Hospital, 010991 Bucharest, Romania;
| | - Adrian Molnar
- Iuliu Hateganu University of Medicine and Pharmacy, 400012 Cluj Napoca, Romania;
- Heart Institute, 400001 Cluj Napoca, Romania
| |
Collapse
|
33
|
Relan J, Gupta SK, Rajagopal R, Ramakrishnan S, Gulati GS, Kothari SS, Saxena A, Sharma S, Rajashekar P, Anderson RH. Clarifying the anatomy of the superior sinus venosus defect. Heart 2021; 108:689-694. [PMID: 34417206 DOI: 10.1136/heartjnl-2021-319334] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 08/03/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES We sought to clarify the variations in the anatomy of the superior cavoatrial junction and anomalously connected pulmonary veins in patients with superior sinus venosus defects using computed tomographic (CT) angiography. METHODS CT angiograms of 96 consecutive patients known to have superior sinus venosus defects were analysed. RESULTS The median age of the patients was 34.5 years. In seven (7%) patients, the defect showed significant caudal extension, having a supero-inferior dimension greater than 25 mm. All patients had anomalous connection of the right superior pulmonary vein. The right middle and right inferior pulmonary vein were also connected anomalously in 88 (92%) and 17 (18%) patients, respectively. Anomalous connection of the right inferior pulmonary vein was more common in those with significant caudal extension of the defect (57% vs 15%, p=0.005). Among anomalously connected pulmonary veins, the right superior, middle, and inferior pulmonary veins were committed to the left atrium in 6, 17, and 11 patients, respectively. The superior caval vein over-rode the interatrial septum in 67 (70%) patients, with greater than 50% over-ride in 3 patients. CONCLUSION Anomalous connection of the right-sided pulmonary veins is universal, but is not limited to the right upper lobe. Not all individuals have over-riding of superior caval vein. In a minority of patients, the defect has significant caudal extension, and anomalously connected pulmonary veins are committed to the left atrium. These findings have significant clinical and therapeutic implications.
Collapse
Affiliation(s)
- Jay Relan
- Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Rengarajan Rajagopal
- Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | | | - Gurpreet Singh Gulati
- Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Shyam S Kothari
- Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Anita Saxena
- Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjiv Sharma
- Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Palleti Rajashekar
- Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Robert H Anderson
- Biosciences Institute, University of Newcastle, Newcastle-upon Tyne, UK
| |
Collapse
|
34
|
Mathew N, Hegde NN. An adult patient with previously undiagnosed sinus venosus atrial septal defect presenting with brain abscess: a case report. Eur Heart J Case Rep 2021; 5:ytab267. [PMID: 34377913 PMCID: PMC8343453 DOI: 10.1093/ehjcr/ytab267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/20/2021] [Accepted: 06/09/2021] [Indexed: 11/23/2022]
Abstract
Background Brain abscess is a common complication in children with cyanotic congenital heart disease. The presence of an underlying acyanotic congenital heart disease is usually not suspected in an adult patient presenting with brain abscess. Case summary A 51-year-old male patient with no known co-morbidities came with complaints of recent onset right lower limb weakness needing support while walking and on evaluation was found to have brain abscess. He underwent robotic endoscope assisted endoport excision of the brain abscess. Two-dimensional transthoracic echocardiography showed right atrial and right ventricular dilatation with mild low-pressure tricuspid regurgitation. Transoesophageal echocardiography (TOE) revealed sinus venosus atrial septal defect (ASD) with left-to-right shunt with the right upper pulmonary vein draining into superior vena cava. Contrast echocardiography revealed a small transient right-to-left shunt. He has been advised to undergo elective surgical closure of ASD with partial anomalous pulmonary venous connection repair. Discussion Right-to-left shunting in ASDs can occur in the early systole even in the absence of raised pressures in the right side of the heart, even when the predominant shunt is left to right, but the magnitude of such a shunt is small and transient and is easily missed. Contrast echocardiography and TOE should be done as a part of evaluation of patients presenting with brain abscess.
Collapse
Affiliation(s)
- Navin Mathew
- Department of Cardiology, Amrita Institute of Medical Sciences, Ponekkara, P. O, Kochi, Kerala 682041, India
| | - Nischal N Hegde
- Department of Cardiology, Amrita Institute of Medical Sciences, Ponekkara, P. O, Kochi, Kerala 682041, India
| |
Collapse
|
35
|
|
36
|
Furlani AC, Lazarus M, Shmukler A, Levsky JM, Sutton NJ, Choueiter NF. Superior Vena Cava Stenosis Manifesting with Brain Abscess 2 Decades after Atrial Septal Defect Repair. Radiol Cardiothorac Imaging 2021; 3:e200561. [PMID: 33969312 DOI: 10.1148/ryct.2021200561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/29/2021] [Accepted: 02/09/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Andrea C Furlani
- Department of Radiology (A.C.F., M.L., J.M.L.) and Division of Cardiology, Department of Medicine (J.M.L.), Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467; Department of Radiology, New York University, New York, NY (A.S.); and Division of Pediatric Cardiology, Children's Hospital at Montefiore, Bronx, NY (N.J.S., N.F.C.)
| | - Matthew Lazarus
- Department of Radiology (A.C.F., M.L., J.M.L.) and Division of Cardiology, Department of Medicine (J.M.L.), Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467; Department of Radiology, New York University, New York, NY (A.S.); and Division of Pediatric Cardiology, Children's Hospital at Montefiore, Bronx, NY (N.J.S., N.F.C.)
| | - Anna Shmukler
- Department of Radiology (A.C.F., M.L., J.M.L.) and Division of Cardiology, Department of Medicine (J.M.L.), Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467; Department of Radiology, New York University, New York, NY (A.S.); and Division of Pediatric Cardiology, Children's Hospital at Montefiore, Bronx, NY (N.J.S., N.F.C.)
| | - Jeffrey M Levsky
- Department of Radiology (A.C.F., M.L., J.M.L.) and Division of Cardiology, Department of Medicine (J.M.L.), Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467; Department of Radiology, New York University, New York, NY (A.S.); and Division of Pediatric Cardiology, Children's Hospital at Montefiore, Bronx, NY (N.J.S., N.F.C.)
| | - Nicole J Sutton
- Department of Radiology (A.C.F., M.L., J.M.L.) and Division of Cardiology, Department of Medicine (J.M.L.), Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467; Department of Radiology, New York University, New York, NY (A.S.); and Division of Pediatric Cardiology, Children's Hospital at Montefiore, Bronx, NY (N.J.S., N.F.C.)
| | - Nadine F Choueiter
- Department of Radiology (A.C.F., M.L., J.M.L.) and Division of Cardiology, Department of Medicine (J.M.L.), Montefiore Medical Center, 111 E 210th St, Bronx, NY 10467; Department of Radiology, New York University, New York, NY (A.S.); and Division of Pediatric Cardiology, Children's Hospital at Montefiore, Bronx, NY (N.J.S., N.F.C.)
| |
Collapse
|
37
|
Budts W, Miller O, Babu-Narayan SV, Li W, Valsangiacomo Buechel E, Frigiola A, van den Bosch A, Bonello B, Mertens L, Hussain T, Parish V, Habib G, Edvardsen T, Geva T, Roos-Hesselink JW, Hanseus K, Dos Subira L, Baumgartner H, Gatzoulis M, Di Salvo G. Imaging the adult with simple shunt lesions: position paper from the EACVI and the ESC WG on ACHD. Endorsed by AEPC (Association for European Paediatric and Congenital Cardiology). Eur Heart J Cardiovasc Imaging 2021; 22:e58-e70. [PMID: 33338215 DOI: 10.1093/ehjci/jeaa314] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 11/03/2020] [Indexed: 01/08/2023] Open
Abstract
In 2018, the position paper 'Imaging the adult with congenital heart disease: a multimodality imaging approach' was published. The paper highlights, in the first part, the different imaging modalities applied in adult congenital heart disease patients. In the second part, these modalities are discussed more detailed for moderate to complex anatomical defects. Because of the length of the paper, simple lesions were not touched on. However, imaging modalities to use for simple shunt lesions are still poorly known. One is looking for structured recommendations on which they can rely when dealing with an (undiscovered) shunt lesion. This information is lacking for the initial diagnostic process, during repair and at follow-up. Therefore, this paper will focus on atrial septal defect, ventricular septal defect, and persistent arterial duct. Pre-, intra-, and post-procedural imaging techniques will be systematically discussed. This position paper will offer algorithms that might help at a glance. The document is prepared for general cardiologists, trainees, medical students, imagers/technicians to select the most appropriate imaging modality and to detect the requested information for each specific lesion. It might serve as reference to which researchers could refer when setting up a (imaging) study.
Collapse
Affiliation(s)
- Werner Budts
- Department Cardiovascular Sciences (KU Leuven), Congenital and Structural Cardiology (CSC UZ Leuven), Herestraat 49, B-3000 Leuven, Belgium
| | - Owen Miller
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Sonya V Babu-Narayan
- Department of Adult Congenital Heart Disease, National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London, UK
| | - Wei Li
- Department of Adult Congenital Heart Disease, National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London, UK
| | | | - Alessandra Frigiola
- Department of Adult Congenital Heart Disease, Guy's and St Thomas' Hospital and School of Biomedical Engineering and Imaging Sciences, Kings College, London, UK
| | | | - Beatrice Bonello
- Department of Pediatric Cardiology, Great Ormond Street Hospital, London, UK
| | - Luc Mertens
- Division of Cardiology, Labatt Family Heart Centre, Hospital for Sick Children and University of Toronto, SickKids, Ontario, Canada
| | - Tarique Hussain
- Department of Paediatrics, University of Texas, Southwestern Medical Center, Dallas, TX, USA
| | - Victoria Parish
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK
| | - Gilbert Habib
- Cardiology Department, APHM, La Timone Hospital, Boulevard Jean Moulin, Marseille, France
| | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, University of Oslo, Oslo, Norway
| | - Tal Geva
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | - Laura Dos Subira
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Helmut Baumgartner
- Department of Cardiology III-Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Cardiology, Muenster, Germany
| | - Michael Gatzoulis
- Department of Adult Congenital Heart Disease, National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London, UK
| | - Giovanni Di Salvo
- Department of Adult Congenital Heart Disease, National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London, UK
| |
Collapse
|
38
|
Nielsen AKM, Hjortdal VE. Partial Anomalous Pulmonary Venous Connection: Forty-Six Years of Follow-Up. World J Pediatr Congenit Heart Surg 2021; 12:70-75. [PMID: 33407025 DOI: 10.1177/2150135120960482] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Surgical repair of partial anomalous pulmonary venous connection (PAPVC) may disturb the electrical conduction in the atria. This study documents long-term outcomes, including the late occurrence of atrial tachyarrhythmia and bradyarrhythmia. METHODS This retrospective study covers all PAPVC operations at Aarhus University Hospital between 1970 and 2010. Outcome measures were arrhythmias, sinus node disease, pacemaker implantation, pathway stenosis (pulmonary vein(s), intra-atrial pathway, and/or superior vena cava), and mortality. Data were collected from databases, surgical protocols, and hospital records until May 2018. RESULTS A total of 83 patients were included with a postoperative follow-up period up to 46 years. Average age at follow-up was 43 ± 21 years. During follow-up, new-onset atrial fibrillation or atrial flutter appeared in four patients (5%). Sinus node disease was present in nine patients (11%). A permanent pacemaker was implanted in seven patients (8%) at an average of 12.7 years after surgery. Pulmonary venous and/or superior vena cava obstruction was seen in five patients (6%). Stenosis was most prevalent in the two-patch technique, and arrhythmia was most prevalent in the single-patch technique. Sixty-seven (81%) of 83 patients had neither bradyarrhythmias nor tachyarrhythmias or pacemaker need. CONCLUSIONS This study contributes important long-term data concerning the course of patients who have undergone repair of PAPVC. It confirms that PAPVC can be operated with low postoperative morbidity. However, late-onset stenosis, bradyarrhythmias and tachyarrhythmias, and need for pacemaker call for continued follow-up.
Collapse
Affiliation(s)
| | - Vibeke E Hjortdal
- Department of Cardiothoracic Surgery, 53146Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
39
|
Rees S, Tahir M, Ahmad SJ, Subkovas E. Rare case of right ventricular dilatation associated with anomalous pulmonary venous drainage, sinus venosus atrial septal defect and persistent left superior vena cava. BMJ Case Rep 2021; 14:14/1/e239687. [PMID: 33431524 PMCID: PMC7802694 DOI: 10.1136/bcr-2020-239687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
A 34-year-old woman was seen in the emergency department for shortness of breath and chest pain. During a pandemic, it is easy to 'think horses and not zebras', and with a patient presenting with the classic coronavirus symptoms it would have been easy to jump to that as her diagnosis. After a careful history and examination, it became clear that there was another underlying diagnosis. Chest X-ray, echocardiogram and CT scan revealed marked right ventricular dilatation and pulmonary hypertension, alongside a persistent left superior vena cava (PLSVC). Further investigation with cardiac MRI and coronary angiography at a tertiary centre demonstrated that she not only have a PLSVC but also a partial anomalous pulmonary venous drainage and sinus venosus atrial septal defect. This case highlights the importance of considering all differentials and approaching investigations in a logical manner.
Collapse
Affiliation(s)
- Stephanie Rees
- Acute Medicine, Betsi Cadwaladr University Health Board, Rhyl, UK
| | - Muhammad Tahir
- Cardiology, Betsi Cadwaladr University Health Board, Rhyl, UK
| | - Syed Jawad Ahmad
- Acute Medicine, Betsi Cadwaladr University Health Board, Rhyl, UK
| | | |
Collapse
|
40
|
Partial Anomalous Pulmonary Venous Connection Repair: Customized Approach and Outcomes. Pediatr Cardiol 2021; 42:1064-1073. [PMID: 33811269 PMCID: PMC8192397 DOI: 10.1007/s00246-021-02583-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/12/2021] [Indexed: 11/06/2022]
Abstract
Alternative options for the correction of partial anomalous pulmonary venous connection (PAPVC) have been proposed. Each can be associated with variable risk for dysrhythmias, caval or pulmonary venous (PV) obstruction. A selective customized strategy to address PAPVC taking into account atrial shunt (AS) and growth potential was pursued. Between September 2014 and August 2018 21 PAPVC patients were identified. Two levels of reference determined the chosen repair strategy; azygous vein (AzV) and cavoatrial junction (CAJ). Six (Group-A) with PAPVC entering SVC cephalad to AV underwent a combined in-situ cavoatrial autologous reconstruction with atrial appendage advancement flap (CARAF). PAPVC entering caudally to AzV (Group-B) underwent alternative repair (caval division/Warden-type or intraatrial rerouting) (n = 15). Age was 8.3 (IQR:4.2-18.5) years for Group-A (vs 11.9; IQR:8.8-34.7 in Group-B) (p = 0.07). In Group-A 5(83%) had AS (vs 12[80%] Group-B; p = 0.9). None had left SVC in Group-A (vs 1 in Group-B; p = 0.9). Preoperative advanced imaging and echocardiographic hemodynamic evaluation was undertaken. Follow-up was complete (median 2.9; IQR:1.2-3.7 years). Freedom from atrial dysrhythmias, caval or PV obstruction was assessed. There were no early or late deaths. ICU and hospital length of stay were 1.8 ± 1.1 and 3.2 ± 0.5 days, respectively. No atrial dysrhythmias occurred postoperatively in Group-A (vs 1 in Group-B; p = 0.9). No permanent pacemaker was implanted. All patients remained in normal sinus rhythm. There were no early or late caval/PV obstruction. A customized approach reserves the advantages of each technique tailored to patient's needs. Expanding surgical capacity with favorable outlook for all PAPVC variations, irrespective of association with AS, can maximize efficiency and reproducibility paired with the lowest morbidity.
Collapse
|
41
|
Waldmann V, Combes N, Ladouceur M, Celermajer DS, Iserin L, Gatzoulis MA, Khairy P, Marijon E. Understanding Electrocardiography in Adult Patients With Congenital Heart Disease. JAMA Cardiol 2020; 5:1435-1444. [DOI: 10.1001/jamacardio.2020.3416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Victor Waldmann
- Cardiac Electrophysiology Section, European Georges Pompidou Hospital, Paris, France
- Adult Congenital Heart Disease Unit, Department of Cardiology, European Georges Pompidou Hospital, Paris, France
| | - Nicolas Combes
- Pasteur Clinic, Toulouse, France
- Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Magalie Ladouceur
- Adult Congenital Heart Disease Unit, Department of Cardiology, European Georges Pompidou Hospital, Paris, France
| | | | - Laurence Iserin
- Adult Congenital Heart Disease Unit, Department of Cardiology, European Georges Pompidou Hospital, Paris, France
| | | | - Paul Khairy
- Montreal Heart Institute, Montreal, Quebec, Canada
| | - Eloi Marijon
- Cardiac Electrophysiology Section, European Georges Pompidou Hospital, Paris, France
| |
Collapse
|
42
|
Sivakumar K, Qureshi S, Pavithran S, Vaidyanathan S, Rajendran M. Simple Diagnostic Tools May Guide Transcatheter Closure of Superior Sinus Venosus Defects Without Advanced Imaging Techniques. Circ Cardiovasc Interv 2020; 13:e009833. [PMID: 33233933 DOI: 10.1161/circinterventions.120.009833] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is a recent interest in nonsurgical correction of superior sinus venosus defects. Patient selection is currently based on advanced imaging and printing technologies. Simple clinical tools to select patients will expand its applicability in developing countries. METHODS Defects caudally extending toward the oval fossa and right upper pulmonary veins draining beyond the cavoatrial junction on transesophageal echocardiography were excluded. Balloon interrogation of cavoatrial junction confirmed complete occlusion of the defect with unobstructed pulmonary venous drainage to left atrium. Single long covered stents or overlapping covered stents were used to exclude sinus venosus defects. Closure of left-to-right interatrial shunt without causing pulmonary vein occlusion was confirmed on follow-up imaging. RESULTS Forty-four patients selected after transesophageal echocardiography underwent balloon interrogation with monitoring of right upper pulmonary vein. Eighteen out of 44 patients were ineligible. Twenty-four eligible patients with closure of left-to-right interatrial shunt without pulmonary vein occlusion underwent covered stent exclusion using single long stents in 15 and overlapping stents in the rest, while 2 patients are awaiting the procedure. Four patients aged 6 to 16 years received stents that were 18 mm or larger. Three patients had stent embolization that required surgical correction in 2 but in the last patient was managed nonsurgically with an overlapping covered stent with good final outcomes. Procedure was successful in 22 patients. At a median follow-up of 20 months (range, 3-54 months), there were no adverse events. Follow-up imaging showed trivial left-to-right shunt in 4 and unobstructed pulmonary veins in all patients. CONCLUSIONS Transesophageal echocardiography and balloon interrogation identified 60% of the patients with sinus venosus defects to be eligible for catheter closure. Overlapping stents are an alternative to custom-made long stents. Transesophageal echocardiography confirms procedural success on follow-up. Advanced imaging and printing technologies are not essential for successful outcomes and thus simple tests increase the feasibility in developing countries.
Collapse
Affiliation(s)
- Kothandam Sivakumar
- Department of Pediatric Cardiology, Madras Medical Mission, Chennai, India (K.S., S.P., S.V., M.R.)
| | - Shakeel Qureshi
- Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, United Kingdom (S.Q.)
| | - Sreeja Pavithran
- Department of Pediatric Cardiology, Madras Medical Mission, Chennai, India (K.S., S.P., S.V., M.R.)
| | - Sunitha Vaidyanathan
- Department of Pediatric Cardiology, Madras Medical Mission, Chennai, India (K.S., S.P., S.V., M.R.)
| | - Monica Rajendran
- Department of Pediatric Cardiology, Madras Medical Mission, Chennai, India (K.S., S.P., S.V., M.R.)
| |
Collapse
|
43
|
Chowdhury UK, Sharma S, Sankhyan LK, George N, Singh S, Hasija S, Pandey NN, Kalaivani M. Long-Term Outcomes of the Double-Barrel Technique for Superior Sinus Venosus Defect With Partially Anomalous Pulmonary Venous Connection. World J Pediatr Congenit Heart Surg 2020; 11:733-741. [DOI: 10.1177/2150135120938352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Repair of superior sinus venosus defect with high partially anomalous pulmonary venous connection (PAPVC) using an intracardiac baffle may be complicated by systemic or pulmonary venous pathway obstruction and sinus nodal dysfunction (SND). Our surgical strategy for repair of all types of superior sinus venosus defect has evolved chiefly to avoid the abovementioned complications and preserving the growth potential of the superior cavoatrial junction. Methods: Between 2007 and 2019, fifty consecutive patients aged 2 to 60 (mean, 17.6±16.7) years underwent repair of superior sinus venosus defect using the double-barrel technique as described. The anomalous pulmonary veins drained into the superior cavoatrial junction in 17 patients and more than 2 cm above the cavoatrial junction in 33 patients. Results: There were no early or late deaths and no reoperations. At a mean follow-up of 103.9 (±50.2) months, all survived the operation, and actuarial freedom from SND was 97.9% (±standard error, 0.02%; 95% CI: 0.86-0.99). No patient had systemic or pulmonary venous pathway obstruction. A permanent pacemaker was required in one (2%) patient for sick sinus syndrome. Conclusions: The double-barrel method is an expedient, safe, and effective technique in superior sinus venosus defect. It provides dual drainage of superior vena cava preserving the superior cavoatrial junction without causing systemic or pulmonary venous pathway obstruction and can be utilized in all cases including those with high PAPVC. Preservation of the cavoatrial junction and use of autogenous atrial tissue for systemic venous pathway avoids SND and preserves growth potential.
Collapse
Affiliation(s)
- Ujjwal Kumar Chowdhury
- Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Srikant Sharma
- Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | | | - Niwin George
- Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Sukhjeet Singh
- Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Suruchi Hasija
- Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Niraj Nirmal Pandey
- Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Mani Kalaivani
- Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
44
|
Samiei N, Akiash N, Djafari Naeini S, Nikpajouh A, Pazoki M. The Presence of Patent Foramen Ovale in the Superior Type of Sinus Venosus Atrial Septal Defect. J Tehran Heart Cent 2020; 15:98-104. [PMID: 33552204 PMCID: PMC7827115 DOI: 10.18502/jthc.v15i3.4218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: The superior type of sinus venosus atrial septal defect (SVASD) is a rare form of the atrial septal defect (ASD) in which the upper part of the atrial septum does not exist. The presence of other cardiac anomalies such as anomalous pulmonary venous connections has been reported in this type of congenital heart disease. This study aimed to assess the presence of the patent foramen ovale (PFO) in patients with the superior type of SVASD. Methods: This retrospective case-control study on 387 patients, consisting of 187 patients with a definite SVASD and 200 patients with problems other than the ASD, was conducted in Rajaie Cardiovascular Medical and Research Center between February 2005 and July 2014. Seven patients with inadequate data were excluded from the analysis. The presence/absence of the PFO was also evaluated in the case and control groups. Results: The analyses were performed on 182 male and 198 female patients at a mean age of 39.07±14.41 and 51.01±15.80 years in the case and control groups, respectively. The PFO was significantly more frequent in the patients with the superior type of SVASD than in those without the condition (P<0.001). The persistence of the left superior vena cava was seen in 34 out of 180 patients with SVASD and in 1 out of 200 patients without the condition (18.9% vs 0.5%; P<0.001). Conclusion: This study was the first to highlight the coexistence of the PFO and the superior type of SVASD. Physiological, genetic, or fetal factors may play an important role in the association between the PFO and the SVASD.
Collapse
Affiliation(s)
- Niloufar Samiei
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Nehzat Akiash
- Atherosclerosis Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Sepideh Djafari Naeini
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Akbar Nikpajouh
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mahboubeh Pazoki
- Rasul Akram General Hospital, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
45
|
Affiliation(s)
- Nicholas A Oh
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts
| | - John E Mayer
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts
| |
Collapse
|
46
|
Raptis DA, Bhalla S. Current Status of Cardiac CT in Adult Congenital Heart Disease. Semin Roentgenol 2020; 55:230-240. [PMID: 32859340 DOI: 10.1053/j.ro.2020.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
47
|
Abstract
Approximately 50 million adults worldwide have known congenital heart disease (CHD). Among the most common types of CHD defects in adults are atrial septal defects and ventricular septal defects followed by complex congenital heart lesions such as tetralogy of Fallot. Adults with CHDs are more likely to have hypertension, cerebral vascular disease, diabetes and chronic kidney disease than age-matched controls without CHD. Moreover, by the age of 50, adults with CHD are at a greater than 10% risk of experiencing cardiac dysrhythmias and approximately 4% experience sudden death. Consequently, adults with CHD require healthcare that is two- to four-times greater than adults without CHD. This paper discusses the diagnosis and treatment of adults with atrial septal defects, ventricular septal defects and tetralogy of Fallot.
Collapse
Affiliation(s)
- Robert J Henning
- School of Public Health, University of South Florida, Tampa, FL 33612, USA
| |
Collapse
|
48
|
Baruteau AE, Jones MI, Butera G, Qureshi SA, Rosenthal E. Transcatheter correction of sinus venosus atrial septal defect with partial anomalous pulmonary venous drainage: The procedure of choice in selected patients? Arch Cardiovasc Dis 2020; 113:92-95. [DOI: 10.1016/j.acvd.2019.09.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 08/30/2019] [Accepted: 09/02/2019] [Indexed: 11/25/2022]
|
49
|
Zubritskiy A, Naberukhin Y, Arkhipov A, Gorbatykh Y, Khapaev T, Nichay N, Kulyabin Y, Bogachev-Prokophiev A, Karaskov A. Outcomes of Double-patch and Warden Techniques in Patients With Supracardiac Partial Anomalous Pulmonary Venous Connection. Heart Lung Circ 2020; 29:156-161. [DOI: 10.1016/j.hlc.2018.11.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 11/10/2018] [Accepted: 11/24/2018] [Indexed: 11/17/2022]
|
50
|
Huang S, Aregullin EO, Gosnell JM, Samuel BP, Kaley VR, Castiaux A, Pinger C, Apkinar MH, Chinnadurai P, Spence DM, Contag CH, Vettukattil JJ. Rapid Prototyping and Image Fusion Guidance for Transcatheter Closure of Superior Sinus Venosus Atrial Septal Defect. ACTA ACUST UNITED AC 2019. [DOI: 10.1007/s42399-019-00169-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|