Cardiac remodeling and factors determining occurrence of atrial arrhythmia after surgical closure of atrial septal defect in adults

Background & objective: Cardiac remodeling manifested clinically as changes in size, shape and function of the heart. The extent of remodeling depends on initial morphological changes. So the time at which the surgical correction of atrial septal defect (ASD) done is important. Apparently surgical outcome and remodeling is better at earlier age in comparison to adult age. The aim of this study was to find whether surgical correction of ASD is beneficial at younger age (up to 18 years) in comparison to adult age (above 18 years). Methods: This prospective cohort study was carried out on a total of 70 patients who underwent surgical closure of atrial septal defect over a period of twenty three months (23) months (from February 2013 to December 2014) in the Department of Cardiac Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka. The recruited patients were divided into two groups – Group-A (comprised of ≤ 18 years old patients) and Group-B (comprised of >18 years old patients) 35 patients in each. Condition of the heart was evaluated preoperatively by echocardiography and the result was compared with postoperative echocardiographic findings at follow-ups after 1 and 3 months after surgery. Results: The comparison of echocardiographic parameters between baseline (preoperative) and those at 1 and 3 months after surgery in Group-A demonstrated that statistically significant remodeling occurred after 1st month (p < 0.001) and it further improved at 3 months. In Group-B the comparison of echo parameters between baseline and at 1 month revealed that all the parameters responded significantly indicating that remodeling occurred well after 1 month. But the same parameters when compared between baseline and at months after repair revealed insignificant differences in all the parameters, except PWT indicating that remodeling that occurred at month 1 regressed at 3 months interval. Cardiac remodeling occurred in both groups, but the degree of remodeling between patients of early age (Group-A) and late age (Group-B) revealed that ASD repair at early age responded well with respect to all the echocardiographic variables of remodeling. Conclusion: Cardiac remodeling occurs after surgical closure of atrial septal defect. But the degree of remodeling is better if the closure is done at earlier age (at or below 18 years). Ibrahim Card Med J 2018; 8 (1&2): 48-52

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Echocardiographic Evaluation of Cardiac Remodeling After Surgical Closure of Ventricular Septal Defect in Different Age Group

Journal of National Institute of Neurosciences Bangladesh ◽

10.3329/jninb.v2i2.34097 ◽

2017 ◽

Vol 2 (2) ◽

pp. 69-74

Author(s):

Mohammad Aminullah ◽

Fahmida Akter Rima ◽

Asraful Hoque ◽

Mokhlesur Rahman Sazal ◽

Prodip Biswas ◽

...

Keyword(s):

Ventricular Septal Defect ◽

Ejection Fraction ◽

Cardiac Remodeling ◽

Septal Defect ◽

Left Ventricular ◽

Age Group ◽

Surgical Closure ◽

Group A ◽

Group B ◽

Fractional Shortening

Background: Cardiac remodeling is important issue after surgical closure of ventricular septal defect.Objective: The purpose of the present study was to evaluate cardiac remodeling by echocardiography by measuring the ejection fraction, fractional shortening, left ventricular internal diameter during diastole (LVIDd) and left ventricular internal diameter during systole (LVIDs) after surgical closure of ventricular septal defect in different age group. Methodology: This prospective cohort studies was conducted in the Department of Cardiac Surgery at National Institute of Cardiovascular Disease (NICVD), Dhaka. Patient with surgical closure of VSD were enrolled into this study purposively and were divided into 3 groups according to the age. In group A (n=10), patients were within the age group of 2.0 to 6.0 years; age of group B (n=8) patients were 6.1-18.0 years and the group C (n=6) aged range was 18.1-42.0 years. Echocardiographic variables such as ejection fraction, fractional shortening, LVIDd, LVIDs were taken preoperatively and at 1st and 3rd month of postoperative values. Result: A total number of 24 patients was recruited for this study. The mean ages of all groups were 12.60±12.09. After 1 month ejection fraction were decreased by 5.97%, 6.71% and 5.66% in group A, group B and group C respectively. After 3 months ejection fraction were increased by 6.13%, 5.13% and 5.14% in group A, group B and group C respectively. After 1 month fractional shortening were decreased by 13.55%, 9.30% and 9.09% in group A, group B and group C respectively. After 3 months fractional shortening were increased by 7.23%, 7.35% and 4.55% in group A, group B and group C respectively. After 1 month LVIDd were increased by 1.97%, 1.91% and 1.32% in group A, group B and group C respectively. After 3 months LVIDd were decreased by 10.84%, 9.89% and 7.34% in group A, group B and group C respectively. After 1 month LVIDs were increased by 2.19%, 2.86% and 1.98% in group A, group B and group C respectively. After 3 months LVIDs were decreased by 11.68%, 10.97% and 8.87% in group A, group B and group C respectively.Conclusion: Cardiac remodeling occurred after surgical closure of ventricular septal defect and remodeling were more significant in younger age group. Journal of National Institute of Neurosciences Bangladesh, 2016;2(2):69-74

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Long-term cost-effectiveness of transcatheter versus surgical closure of secundum atrial septal defect in adults

International Journal of Cardiology ◽

10.1016/j.ijcard.2013.12.144 ◽

2014 ◽

Vol 172 (1) ◽

pp. 109-114 ◽

Cited By ~ 29

Author(s):

Darren Mylotte ◽

Stéphane P. Quenneville ◽

Mark A. Kotowycz ◽

Xuanqian Xie ◽

James M. Brophy ◽

...

Keyword(s):

Cost Effectiveness ◽

Atrial Septal Defect ◽

Septal Defect ◽

Secundum Atrial Septal Defect ◽

Surgical Closure

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Early and six-month assessment of bi-ventricular functions following surgical closure of atrial septal defect

Indian Heart Journal ◽

10.1016/j.ihj.2014.10.411 ◽

2014 ◽

Vol 66 (6) ◽

pp. 617-621 ◽

Cited By ~ 2

Author(s):

Rajesh Vijayvergiya ◽

Jiten Singh ◽

Sandeep S. Rana ◽

Ranjan Shetty ◽

Bhagwant R. Mittal

Keyword(s):

Atrial Septal Defect ◽

Septal Defect ◽

Surgical Closure ◽

Ventricular Functions

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Abstract 2130: Long-term Outcomes of Adult Atrial Septal Defect With Severe Pulmonary Hypertension After Surgical Closure

Circulation ◽

10.1161/circ.116.suppl_16.ii_461-c ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Jeong-Hoon Kim ◽

Duk-Hyun Kang ◽

Jong-Young Lee ◽

Jong-Min Song ◽

Tae-Jin Yun ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Elderly Patients ◽

Atrial Septal Defect ◽

Septal Defect ◽

Survival Rates ◽

Severe Pulmonary Hypertension ◽

Term Survival ◽

Surgical Closure

The benefits of surgical closure has been unclear in adult atrial septal defect (ASD) with severe pulmonary hypertension (PHT), and we tried to evaluate improvement of PHT and long-term survival after surgical closure compared to medical follow-up. Methods: From 1996 to 2006, we included a total of 71 adult ASD patients (age; 43±15 years) with severe PHT documented by echocardiography. The inclusion criteria were defined as ASD diameter > 15 mm, enlarged right ventricle, and the baseline peak velocity of tricuspid regurgitation (TR) ≥ 4.0 m/sec. We excluded 5 patients with Eisenmenger syndrome documented by cardiac catheterization. Surgical closure was performed on 55 patients (OP group) and the remaining 16 patients were followed up medically (MED group). The improvement of PHT was defined as TR velocity ≤ 3.5 m/sec on follow-up echo. Results: Baseline characteristics and clinical results were compared between the two groups in table . There were no significant differences in terms of gender, ASD diameter, cardiac rhythm, and TR velocity, but the MED group was significantly older. During follow-up of 46±33 months, there were 5 deaths in the MED group and no operative or late death in the OP group, and the 5-year actuarial survival rate of the OP group was significantly higher than the MED group (58±15%, p<0.05). On subgroup analysis according to age, the OP group showed significantly better survival rates than the MED group (p<0.05) in elderly patients (age > 50). In the OP group, TR velocity was significantly decreased from 4.5±0.4 to 3.0±0.7 m/sec on follow-up echo, and improvement of PHT was observed in 47 (85%) patients. On multivariate analysis, female gender and lower baseline TR velocity were the significant independent predictors of improved PHT after surgery. Conclusions: In adult ASD with severe PHT, surgical closure can be safely performed and improve PHT effectively. Especially in elderly patients, ASD closure is significantly related with the better survival rates.

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Clinical and hemodynamic observations after surgical closure of large atrial septal defect complicated by heart failure

The American Journal of Cardiology ◽

10.1016/0002-9149(69)90375-0 ◽

1969 ◽

Vol 23 (6) ◽

pp. 810-817 ◽

Cited By ~ 17

Author(s):

Gerasim Tikoff ◽

Thomas B. Keith ◽

Russell M. Nelson ◽

Hiroshi Kuida

Keyword(s):

Heart Failure ◽

Atrial Septal Defect ◽

Septal Defect ◽

Surgical Closure

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Inappropriate shocks from a transvenous implantable defibrillator caused by atrial fibrillation and a missed atrial septal defect in a patient with a modified Bentall procedure

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytab412 ◽

2021 ◽

Author(s):

Anna Kostopoulou ◽

Epameinontas Fountas ◽

Olga Karapanagiotou ◽

Stamatis Kyrzopoulos

Keyword(s):

Atrial Fibrillation ◽

Atrial Septal Defect ◽

Septal Defect ◽

Implantable Defibrillator ◽

Surgical Closure ◽

Inappropriate Shocks ◽

Bentall Procedure ◽

Complication Risk ◽

Amplatzer Device

Abstract Background Inappropriate shocks have been reported in approximately 1/3 of patients with implantable cardiac defibrillators (ICDs). We report an unusual case of inappropriate ICD shocks due to atrial fibrillation (AF) caused by a missed atrial septal defect (ASD) in a patient with a modified Bentall procedure. Case summary A 67-year-old Caucasian male, with an ICD and a history of a modified Bentall procedure 24 years ago, reported to our outpatient clinic with recurrent inappropriate ICD shocks due to episodes of fast AF. The transthoracic echocardiographic exam revealed 2 large aneurysms at the ostia of the coronary arteries. We performed further evaluation with transesophageal echocardiogram (TOE) and computed tomography (CT) angiography. The aneurysms measured on CT were 3.14*2.29 cm on the right ostium and 1.9*0.99 cm on the left. A large secundum-type atrial septal defect (ASD) of 1.5 cm was revealed that was missed in all previous echocardiographic studies. The therapeutic options of surgical closure of the ASD and repair of the aneurysms or a more conservative approach with percutaneous closure of the ASD and closer follow-up were discussed with the patient. The patient declined the surgical option due to high complication risk, and closure of the ASD with an Amplatzer device was performed 3 months later. A 3 -year Follow-up was uneventful. Conclusion It is of major importance to comprehensively and thoroughly assess patients before and after a surgical intervention to not miss other treatable conditions preoperatively and complications in the postoperative period.

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