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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.
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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
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Bahrami F, Sattartabar B, Larti F, Rahmanian M, Mollazadeh R. Late recognition of cardiac implantable electronic device misplacement in left ventricle: a case report. Future Cardiol 2024; 20:269-274. [PMID: 38899509 PMCID: PMC11318706 DOI: 10.1080/14796678.2024.2363627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 05/31/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Cardiac electronic device implantation may be associated with complications. Case Summary: This is a report of inadvertent implantation of implantable cardioverter-defibrillator lead through an unrecognized sinus venosus atrial septal defect into the left ventricle that was not diagnosed early after implantation. Six months later chest x-ray showed an abnormal lead course that was confirmed with echocardiography as to be in the left ventricle. Surgical removal of the implantable cardioverter-defibrillator lead, repair of atrial septal defect, and correction of abnormal pulmonary venous connections were performed. Meanwhile, follow-up of the patient receiving a new dual chamber permanent pacemaker from the contralateral side and discussion of the aforementioned complication are addressed. Conclusion: Early diagnosis of device implantation complication is of paramount importance and prevents potential catastrophic complications.
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Affiliation(s)
- Fatemeh Bahrami
- Department of Cardiology, School of Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, PO Box: 1419733141, Tehran, Iran
| | - Babak Sattartabar
- Department of Cardiology, Research Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Farnoosh Larti
- Department of Cardiology, School of Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, PO Box: 1419733141, Tehran, Iran
| | - Mehrzad Rahmanian
- Department of Cardiothoracic Surgery, School of Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, PO Box: 1419733141, Tehran, Iran
| | - Reza Mollazadeh
- Department of Cardiology, School of Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, PO Box: 1419733141, Tehran, Iran
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Amirghofran AA, Nirooei E, Edraki M, Ramsheh AR, Ajami G, Amoozgar H, Arabi H, Hemmati R. Minimally invasive versus sternotomy approach for double-patch repair of partial anomalous pulmonary venous connection and sinus venosus defect in pediatric and adult patients: Mid to long-term outcomes. J Card Surg 2022; 37:4808-4815. [PMID: 36321721 DOI: 10.1111/jocs.17093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 10/06/2022] [Accepted: 10/08/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Several surgical techniques have been proposed to repair right partial anomalous pulmonary venous connection (PAPVC) along with sinus venosus defect (SVD). This study aimed to compare the perioperative data and outcomes of double-patch repair using a minimally invasive approach versus conventional sternotomy in pediatric and adult patients. METHODS This retrospective study was conducted on 48 minimally invasive cases and 35 sternotomy cases, undergoing surgery by a single surgeon between July 2002 and August 2020. For all patients, repair was performed using the double-patch technique. In the minimally invasive approach, right mini-thoracotomy was performed with central cannulation for children and with peripheral cannulation for adults. The patients were classified into two pediatric and adult groups, and each group was categorized into minimally invasive and sternotomy approaches. They were followed-up by transthoracic echocardiography and electrocardiography before and early after surgery, 3 and 6 months after surgery, and then annually. The relative data were compared between the two approaches in terms of perioperative findings, postoperative pulmonary vein or superior vena cava (SVC) stenosis, and sinus node dysfunction. RESULTS This study included 25 minimally invasive cases and 19 sternotomy cases in the pediatric group (mean age, 4.99 ± 4.28 and 6.10 ± 4.39 years, respectively) and 23 minimally invasive cases and 16 sternotomy cases in the adult group (mean age, 35.73 ± 8.06 and 32.62 ± 9.80 years, respectively). The mean and median follow-ups were 6.31 ± 4.92 years and 6 years (range: 6 month-18 year) in the pediatric group and 6.15 ± 4.53 years and 5 years (range: 6 month-18 year) in the adult group, respectively. The mean chest tube drainage was significantly lower in the minimally invasive pediatric group (p = .03), and the mean blood transfusion volume was significantly lower in the minimally invasive adult group compared to the other groups (p = .03). No stenosis occurred in the pulmonary veins. Mild SVC stenosis occurred in one patient in the minimally invasive pediatric group, with no need for reintervention. All patients had a normal sinus rhythm, except for the mentioned case with a transient, first-degree atrioventricular block, which spontaneously reverted to the normal sinus rhythm. CONCLUSIONS The minimally invasive approach can be a safe and practical alternative for the double-patch repair of PAPVC and SVD. It ensures a repair with comparable quality to sternotomy, but with better cosmetic and psychological outcomes.
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Affiliation(s)
| | - Elahe Nirooei
- Cardiac surgery department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammadreza Edraki
- Pediatric cardiology department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir Rajaei Ramsheh
- Cardiac surgery department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Gholamhossein Ajami
- Pediatric cardiology department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamid Amoozgar
- Pediatric cardiology department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamid Arabi
- Cardiac surgery department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Rahim Hemmati
- Cardiac surgery department, Shiraz University of Medical Sciences, Shiraz, Iran
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Rosenthal E, Qureshi SA, Jones M, Butera G, Sivakumar K, Boudjemline Y, Hijazi ZM, Almaskary S, Ponder RD, Salem MM, Walsh K, Kenny D, Hascoet S, Berman DP, Thomson J, Vettukattil JJ, Zahn EM. Correction of sinus venosus atrial septal defects with the 10 zig covered Cheatham-platinum stent - An international registry. Catheter Cardiovasc Interv 2021; 98:128-136. [PMID: 33909945 DOI: 10.1002/ccd.29750] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 04/19/2021] [Accepted: 04/25/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Covered stent correction of sinus venosus ASDs (SVASD) is a relatively new technique. Challenges include anchoring a sufficiently long stent in a nonstenotic superior vena cava (SVC) and expanding the stent at the wider SVC-RA junction without obstructing the anomalous right upper pulmonary vein (RUPV). The 10-zig covered Cheatham-platinum (CCP) stent has the advantage of being available in lengths of 5-11 cm and dilatable to 34 mm in diameter. METHODS An international registry reviewed the outcomes of 10-zig CCP stents in 75 patients aged 11.4-75.9 years (median 45.4) from March 2016. Additional stents were used to anchor the stent in the SVC or close residual shunts in 33/75. An additional stent was placed in 4/5 (80%) with 5/5.5 cm CCPs, 18/29 (62%) with 6 cm CCPs, 5/18 (28%) with 7 cm CCPs, 5/22 (23%) with 7.5/8 cm CCPs and 0/1 with an 11 cm CCP. A "protective" balloon catheter was inflated in the RUPV in 17. RESULTS Early stent embolization in two patients required surgical removal and defect repair and tamponade was drained in one patient. The CT at 3 months showed occlusion of the RUPV in one patient. Follow up is from 2 months to 5.1 years (median 1.8 years). QP:QS has reduced from 2.5 ± 0.5 to 1.2 ± 0.36 (p < .001) and RVEDVi from 149.1 ± 35.4 to 95.6 ± 21.43 ml/m2 (p < .001). CONCLUSIONS Ten-zig CCPs of 7-8 cm appear to provide reliable SVASD closure with a low requirement for additional stents. Careful selection of patients and meticulous attention to detail is required to avoid complications.
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Affiliation(s)
- Eric Rosenthal
- Department of Paediatric and Adult Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Shakeel A Qureshi
- Department of Paediatric and Adult Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Matthew Jones
- Department of Paediatric and Adult Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Gianfranco Butera
- Department of Paediatric and Adult Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Department of Paediatric Cardiology, Cardiac Surgery and Heart Lung Transplantation, ERN GUARD HEART: Bambino Gesù Hospital and Research Institute, Rome, Italy
| | | | | | | | | | - Reid D Ponder
- Division of Cardiology, Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California, USA
| | - Morris M Salem
- Division of Cardiology, Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California, USA
| | - Kevin Walsh
- Department of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Damien Kenny
- Department of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Sebastien Hascoet
- Department of Congenital Heart Diseases, Centre de Reference Cardiopathies Congenitales Complexes M3C, Hospital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Universite Paris-Saclay, Paris, France
| | - Darren P Berman
- Cardiac Catheterization Laboratory, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - John Thomson
- Department of Congenital Cardiology, Leeds General Infirmary, Leeds, UK
| | - Joseph J Vettukattil
- Congenital Cardiology, Congenital Heart Center, Spectrum Health Helen DeVos Children's Hospital, Grand Rapids, Michigan, USA
| | - Evan M Zahn
- The Department of Pediatrics, The Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, California, USA
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