Repair of isolated atrial septal defect in infants less than 12 months improves symptoms of chronic lung disease or shunt-related pulmonary hypertension

2020 ◽  
Vol 30 (4) ◽  
pp. 511-520 ◽  
Author(s):  
Dafni Charisopoulou ◽  
Roberta Margarita Bini ◽  
Gillian Riley ◽  
Kalai Janagarajan ◽  
Shahin Moledina ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Atrial Septal Defect ◽  
Lung Disease ◽  
Chronic Lung Disease ◽  
Septal Defect ◽  
Z Score ◽  
Disease Group ◽  
Early Signs ◽  
Group A ◽  
Group B

AbstractIntroduction:Infants with isolated atrial septal defects are usually minimally symptomatic, and repair is typically performed after infancy. Early repair may be considered if there is high pulmonary blood flow and reduced respiratory reserve or early signs of pulmonary hypertension. Our aim was to review the characteristics and outcomes of a cohort of patients who underwent infant repair at our institute.Methods:The study included 56 infants (28 female, 19 trisomy 21) with isolated atrial septal defect (age: 8 months (1.5–12), weight: 6 kg (2.8–7.5), echo Qp/Qs: 1.9 ± 0.1) who underwent surgical closure (20 fenestrated). Three groups were identified: 1) chronic lung disease and pulmonary hypertension (group A: n = 28%); 2) acutely unwell infants with pulmonary hypertension but no chronic lung disease (group B: n = 20, 36%); and 3) infants with refractory congestive heart failure without either pulmonary hypertension or chronic lung disease (group C: n = 9, 16%).Results:Post-operatively, pulmonary hypertension infants (47/56) showed improvement in tricuspid annular plane systolic excursion z-score (p < 0.001) and right ventricular systolic/diastolic duration ratio (p < 0.05). All ventilator (14.3%) or oxygen-dependent (31.6%) infants could be weaned within 2 weeks after repair. One year later, weight z-score increased in all patients and by +1 in group A, +1.3 in group B and +2 in group C. Over a median follow-up of 1.4 years, three patients died, four patients continued to have pulmonary hypertension evidence and two remained on targeted pulmonary hypertension therapy.Conclusion:Atrial septal defect repair within the first year may improve the clinical status and growth in infants with early signs of pulmonary hypertension or those requiring respiratory support and facilitate respiratory management.

Closure of a secundum atrial septal defect in two infants with chronic lung disease using the Gore HELEX Septal Occluder

2015 ◽  
Vol 26 (1) ◽  
pp. 79-83 ◽  
Author(s):  
Matt E. Zussman ◽  
Grace Freire ◽  
Shawn D. Cupp ◽  
Gary E. Stapleton
Keyword(s):  
Atrial Septal Defect ◽  
Lung Disease ◽  
Premature Infants ◽  
Chronic Lung Disease ◽  
Septal Defect ◽  
Right Atrial ◽  
Secundum Atrial Septal Defect ◽  
Atrial Septal Defect Closure ◽  
Significant Clinical Improvement ◽  
Helex Septal Occluder

AbstractChildren with a secundum atrial septal defect are usually asymptomatic and are referred for elective closure after 3–4 years of age; however, in premature infants with chronic lung disease, bronchopulmonary dysplasia, or pulmonary hypertension, increased pulmonary blood flow secondary to a left-to-right atrial shunt, may exacerbate their condition. Closure of the atrial septal defect in these patients can result in significant clinical improvement. We report the cases of two premature infants with chronic lung disease, who underwent atrial septal defect closure with the Gore HELEX Septal Occluder and discuss the technical aspects of using the device in these patients and their clinical outcomes.

scholarly journals The Combination of Oral PDE5-Inhibitor (Sildenafil) And Oral Prostacy- clin Analogue (Beraphrost) Therapy for Increasing Quality of Life in Adults with Pulmonary Arterial Hypertension Related to Uncorrected Secundum Atrial Septal Defect

2021 ◽  
Vol 2 (4) ◽  
pp. 20-24
Author(s):  
Heny Martini ◽  
Muhammad Rizki Fadlan ◽  
Akhmad Isna Nurudinulloh
Keyword(s):  
Quality Of Life ◽  
Atrial Septal Defect ◽  
Septal Defect ◽  
Secundum Atrial Septal Defect ◽  
Phone Calls ◽  
Group A ◽  
Pulmonary Arterial ◽  
Group B ◽  
Dependent Mechanism

Background : Sildenafil, an oral phosphodiesterase type-5 inhibitor, has vasodilatory effects through a cyclic guanosine 3,5-monophosphate–dependent mechanism, whereas beraprost, an oral prostacyclin analog, induces vasorelaxation through a cAMP-dependent mechanism. This combination has often used but there was little detailed study on it Objectives : To investigate whether the combination of oral sildenafil and beraprost is superior to sildenafil alone in in adult patients with Pulmonary Arterial Hypertention (PAH) related uncorrected secundum Atrial Septal Defect (ASD). Methods : Patients with secundum ASD who developed PAH divided into two group. Group A received oral sildenafil 3x40 mg and oral beraphrost 3x20 mcg. Group B received oral sildenafil only 3x40 mg in a 12-week. Health-related quality of life (HRQoL) was recorded by patients using the Medical Outcomes Study 36-item short form (SF-36) questionnaires at baseline and after 12 of therapy. Therapy adherence was achieved through a series of phone calls and a four-weekly hospital visit. Every normal follow-up appointment included an examina- tion of side effects and a dosage modification based on the clinical situation Results: We didn’t found any significant of proportion different in cofounding factor between groups. Compared with Group B, Group A had better functional capacity, limitation to physical health, energy fatigue, pain, and health change (P=0.00, P=0.03, P=0.044, P=0.026, P=0.008, respectively). Conclusion: Combination between oral sildenafil therapy 40 mg three times per day and beraphrost 20 mcg two times per day significantly increase the HRQoL in PAH patients in uncorrected secundum ASD compared sildena- fil alone

scholarly journals The Effect of Preoperative Pulmonary Arterial Hypertension on Incidence of Postoperative Atrial Fibrillation after Surgical Closure of Atrial Septal Defect (Secundum)

2018 ◽  
Vol 13 (1) ◽  
pp. 17-20
Author(s):  
AKM ManzurulAlam ◽  
Istiaq Ahmed ◽  
Manzil Ahmed ◽  
Mohammad Ashraf ◽  
Mamun Hossaim ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Arterial Hypertension ◽  
Arterial Hypertension ◽  
Atrial Septal Defect ◽  
Septal Defect ◽  
Group A ◽  
Pulmonary Arterial ◽  
Group B ◽  
Substantial Morbidity

Background: Atrial tachyarrhythmias are common among adults with ASD and contribute to substantial morbidity. Atrial flutter and atrial fibrillation are well-described complications of atrial septal defect (ASD) and are associated with substantial morbidity. The cause of AF in ASD is multifactorial in nature. It has been proposed that it is related to atrial dilatation, the increase in pulmonary pressure, and ventricular dysfunction. Early surgical intervention may reduce the long-term risk of developing atrial arrhythmias. Studies demonstrated that cardiac remodeling occurred after closure of an ASD, even in older patients. This study aimed to find out the pulmonary hypertension (PAH) as a predictor of postoperative atrial fibrillation in patients after surgery for secundum type atrial septal defect closure.Methods: This Prospective Observational Study carried out in department of cardiac surgery, National Institute of Cardiovascular Disease (NICVD) and Hospital, Dhaka, Bangladesh during the period of July, 2015 to June, 2016. Total 54 patients are taken and then grouped into group A and group B. Each group contains 27 patients. Group A include Patients with ASD secundum without PAH. Group B Patients with ASD secundum with PAH. All patients were evaluated with M-mode, 2D and color Doppler transthoracic echocardiography and ECG before operation, at discharge, after one month and at 3 months follow-up. Statistical analysis of the results was obtained by windows based computer software with statistical package for the social sciences program (SPSS version 21).Results: To compare atrial fibrillation postoperative at discharge and postoperative after 1 and 3 months follow-up it was found In group B 8 (29.62%) patients had AF postoperatively, during discharge 8 (29.62%) patients had AF, after 1 month 7 (25.93%) patient had AF, after 3 months 6 (22.22%) patients had AF. No AF was found in Group A patients during postoperatively, during discharge, after 1 month & 3 months follow up. Statistical significant difference was found in between two groups (p<0.05).Conclusion: The surgical correction of atrial septal defect (ASD) is safe and effective procedure. Our studyshowed that the haemodynamic and electrophysiological results of the surgical repair of ASD secundum was superior before the development of pulmonary arterial hypertension. After surgical correction of ASD secundum raised pulmonary artery pressure became lower gradually. Atrial fibrillation developed in patient group with pulmonary arterial hypertension in postoperative period remain persistent in most patients in the follow up period, few converted to sinus rhythmUniversity Heart Journal Vol. 13, No. 1, January 2017; 17-20

scholarly journals Transcatheter and intraoperative device closure of atrial septal defect in infants under three years of age

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Yangyang Han ◽  
Xiquan Zhang ◽  
Fengwei Zhang
Keyword(s):  
Atrial Septal Defect ◽  
Hospital Stay ◽  
Clinical Data ◽  
Septal Defect ◽  
Postoperative Hospital Stay ◽  
Device Closure ◽  
Young Infants ◽  
Group A ◽  
Group B

Abstract Background Transcatheter and intraoperative device closures have been widely used in the treatment of secundum atrial septal defect (ASD). However, for young infants with ASD, device closure remains controversial, and such treatment features limited data. We compared the clinical data and follow-up results of percutaneous and intraoperative device closure for ASD to evaluate the feasibility, safety, and efficacy of both treatments in infants under 3 years of age. Methods From September 2010 to September 2018, 186 children under 3 years of age with significant secundum ASD were included in this study. A total of 88 and 98 patients were divided into groups A (transcatheter device closure) and B (intraoperative device closure), respectively. The clinical data and follow-up results of the two groups were analyzed retrospectively. Result The mean age and weight of patients in group A were significantly higher than those in group B. The proportion of complex ASDs (multiples or rims deficiency) and the device/weight ratio in group B were significantly higher than those in group A. Successful closure was obtained in 86 (97.7%) and 96 (98.0%) infants in groups A and B, respectively, with two failed cases in each group (2.3% vs 2%). The rate of periprocedural complications reached 13.6 and 26.5% for groups A and B (P = 0.058), respectively. The durations of the procedure and postoperative hospital stay in group A were significantly shorter than those in group B (P < 0.05). Excellent follow-up results were observed in both groups. At present, no death nor major complications have occurred. Symptoms either resolved completely or improved significantly for all symptomatic infants. No residual shunts at the 6th month of follow-up evaluation were observed. Patients with failure to thrive gained weight appropriately for age, and the structure and hemodynamic parameters significantly improved during follow-up. Conclusion Transcatheter and intraoperative device closure are feasible, effective, and safe methods for the treatment of ASDs in infants under 3 years of age. Considering improved cosmetic effect and the short duration of the procedure and postoperative hospital stay, transcatheter is preferred for patients with appropriate conditions. Intraoperative device closure can be performed as an alternative to percutaneous closure, particularly for infants with large, complex ASDs, young age, or low-body weight.

scholarly journals The Challenge to Decide between Pulmonary Hypertension Due to Chronic Lung Disease and PAH with Chronic Lung Disease

Diagnostics ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 311
Author(s):  
Horst Olschewski
Keyword(s):  
Pulmonary Hypertension ◽  
Lung Disease ◽  
Chronic Lung Disease ◽  
Diagnostic Procedures ◽  
Disease Group ◽  
Group 4 ◽  
Pulmonary Arterial ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Chronic lung diseases are strongly associated with pulmonary hypertension (PH), and even mildly elevated pulmonary arterial pressures are associated with increased mortality. Chronic obstructive pulmonary disease (COPD) is the most common chronic lung disease, but few of these patients develop severe PH. Not all these pulmonary pressure elevations are due to COPD, although patients with severe PH due to COPD may represent the largest subgroup within patients with COPD and severe PH. There are also patients with left heart disease (group 2), chronic thromboembolic disease (group 4, CTEPH) and pulmonary arterial hypertension (group 1, PAH) who suffer from COPD or another chronic lung disease as co-morbidity. Because therapeutic consequences very much depend on the cause of pulmonary hypertension, it is important to complete the diagnostic procedures and to decide on the main cause of PH before any decision on PAH drugs is made. The World Symposia on Pulmonary Hypertension (WSPH) have provided guidance for these important decisions. Group 2 PH or complex developmental diseases with elevated postcapillary pressures are relatively easy to identify by means of elevated pulmonary arterial wedge pressures. Group 4 PH can be identified or excluded by perfusion lung scans in combination with chest CT. Group 1 PAH and Group 3 PH, although having quite different disease profiles, may be difficult to discern sometimes. The sixth WSPH suggests that severe pulmonary hypertension in combination with mild impairment in the pulmonary function test (FEV1 > 60 and FVC > 60%), mild parenchymal abnormalities in the high-resolution CT of the chest, and circulatory limitation in the cardiopulmonary exercise test speak in favor of Group 1 PAH. These patients are candidates for PAH therapy. If the patient suffers from group 3 PH, the only possible indication for PAH therapy is severe pulmonary hypertension (mPAP ≥ 35 mmHg or mPAP between 25 and 35 mmHg together with very low cardiac index (CI) < 2.0 L/min/m2), which can only be derived invasively. Right heart catheter investigation has been established nearly 100 years ago, but there are many important details to consider when reading pulmonary pressures in spontaneously breathing patients with severe lung disease. It is important that such diagnostic procedures and the therapeutic decisions are made in expert centers for both pulmonary hypertension and chronic lung disease.

scholarly journals Antrinių prieširdžių pertvaros defektų gydymo chirurginiu ir perkateteriniu būdu ankstyvųjų rezultatų ir komplikacijų palyginimas

2010 ◽  
Vol 8 (3) ◽  
pp. 0-0
Author(s):  
Lina Gumbienė ◽  
Vytautas Juknevičius ◽  
Valdas Bilkis ◽  
Virgilijus Tarutis ◽  
Diana Zakaraitė ◽  
...  
Keyword(s):  
Atrial Septal Defect ◽  
Hospital Stay ◽  
Septal Defect ◽  
Secundum Atrial Septal Defect ◽  
Atrial Septal Defect Closure ◽  
Surgical Closure ◽  
Early Results ◽  
Group A ◽  
The Mean ◽  
Group B

Lina Gumbienė1, Vytautas Juknevičius2 , Valdas Bilkis1 , Virgilijus Tarutis1 , Diana Zakaraitė1 , Rimantas Karalius1 , Giedrė Nogienė1 , Alicija Dranenkienė1 1 Vilniaus universiteto Širdies ir kraujagyslių ligų klinika, Santariškių g. 2, LT-08661 VilniusEl. paštas: [email protected] Vilniaus universitetas Medicinos fakultetas Tikslas: Palyginti prieširdžių pertvaros defekto chirurginio ir perkateterinio gydymo metodų ankstyvuosius rezultatus ir komplikacijas. Ligoniai ir metodai: Retrospektyviai tirti vyresni nei 13 metų amžiaus ligoniai, kuriems 2006–2009 m. mūsų ligoninėje buvo gydytas antrinis prieširdžių pertvaros defektas. Rezultatai: 62 ligoniams atlikta chirurginė defekto korekcija (A grupė), 35 ligoniams defektas buvo panaikintas perkateteriniu būdu (B grupė). Vidutinis A grupės ligonių amžius buvo 36,1 metų (nuo 13 iki 71), B grupės – 40,51 metų (nuo 14 ik 72). Viena A grupės ligonė mirė po operacijos išsivysčius infekcinei komplikacijai ir dauginiam organų nepakankamumui. Vienai B grupės ligonei defekto panaikinti nepavyko, dar vienai pacientei po procedūros liko nedidelis nuosrūvis tarp prieširdžių. Komplikacijų nepatyrė daugiau B grupės ligonių negu A grupės (atitinkamai 91,4 % ir 59,67 %, p < 0,05). Sunkių komplikacijų išsivystė tik chirurginiu būdu gydytiems ligoniams. B grupės ligonių hospitalizacijos trukmė buvo statistiškai reikšmingai mažesnė negu A grupės (atitinkamai 4,4 ± 2,6 ir 16,7 ± 16,6 paros, p < 0,0001). Išvados: Ligoniams, kuriems prieširdžių pertvaros defektas uždaromas perkateteriniu būdu, išsivysto mažiau ankstyvųjų pooperacinių komplikacijų ir jų hospitalizacijos laikas trumpesnis. Po chirurginės prieširdžių pertvaros defekto korekcijos atsiradusios ankstyvosios pooperacinės komplikacijos sietinos su buvusiu triburio vožtuvo nesandarumu. Reikšminiai žodžiai: įgimtos širdies ydos, prieširdžių pertvaros defektas, chirurgija, perkateterinis uždarymas Comparison of early results and complications in transcatheter and surgical closure of secundum atrial septal defect Lina Gumbienė1, Vytautas Juknevičius2 , Valdas Bilkis1 , Virgilijus Tarutis1 , Diana Zakaraitė1 , Rimantas Karalius1 , Giedrė Nogienė1 , Alicija Dranenkienė1 1Vilnius University, Clinic of Cardiovascular Diseases, Santariškių str. 2, LT-08661 Vilnius, LithuaniaE-mail: [email protected] University Faculty of Medicine Objective: To compare early results and complications in transcatheter and surgical closure of the secundum atrial septal defect (ASD). Patients and methods: rectal prolapse, rectal cancer, faecal incontinence, Altemeyer operation Results: Sixty-two patients underwent surgical correction (Group A), 35 patients underwent transcatheter ASD closure with Amplatzer septal occluder (Group B). The mean age in Group A was 36.14 (13–71) years, in Group B 40,51 (14–72) years. One patient in Group A died because of postoperative infection, heart and renal failure. In Group B, the procedure was unsuccessful in one patent, and residual shunt was found in one patient. The percentage of patients without complications was higher in Group B (91.4% versus 59.7% in Group A, p < 0.05). Severe complications were diagnosed only in the surgical (A) group. The mean length of hospital stay was shorter in Group B (4.4 ± 2.64 days) compared with Group A (16.69 ± 16.55 days, p < 0.0001). Conclusions: The lower rate of early complications and a shorter hospital stay were observed in the transcatheter atrial septal defect closure group. More frequent complications after surgery could have been caused by the insufficiency of the tricuspid valve. Key words: congenital heart disease, atrial septal defect, surgery, transcatheter closure

scholarly journals Evaluation of Cardiac Remodeling After Surgical Closure of Atrial Septal Defect in Different Age Groups

2019 ◽  
Vol 8 (1-2) ◽  
pp. 48-52
Author(s):  
SMG Saklayen ◽  
Laila Akter Zahan ◽  
Jubayer Ahmad ◽  
Mohammad Armane Wadud ◽  
Tarana Fariah Monalisa ◽  
...  
Keyword(s):  
Atrial Septal Defect ◽  
Cardiac Remodeling ◽  
Septal Defect ◽  
Early Age ◽  
Age Group ◽  
Old Patients ◽  
Adult Age ◽  
Surgical Closure ◽  
Group A ◽  
Group B

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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