Cyanosis due to an isolated atrial septal defect: case report and review of the literature

2020 ◽  
Vol 30 (11) ◽  
pp. 1741-1743
Author(s):  
Thomas Krasemann ◽  
Lennie van Osch-Gevers ◽  
Pieter van de Woestijne
Keyword(s):  
Atrial Septal Defect ◽  
Septal Defect ◽  
Ventricular Volume ◽  
The Body ◽  
Marfan’S Syndrome ◽  
Marfan's Syndrome ◽  
Surgical Closure ◽  
Inferior Caval Vein ◽  
Volume Load ◽  
The Right

AbstractIsolated atrial defects usually lead to left-to-right shunt and right ventricular volume load. Descriptions of cyanosis with this congenital heart defect are rare.We describe a rare case of inferior caval vein flow directed through an atrial septal defect in the fossa ovalis leading to severe cyanosis, but without any additional intracardiac anatomical abnormalities. The baby with clinical features of Marfan’s syndrome had an eventration of the right-sided diaphragm. Surgical closure of the defect resolved the cyanosis, but the child died 10 weeks later of severe valvar dysfunction, related to Marfan’s syndrome.Mechanisms of cyanosis in patients with atrial septal defects are discussed. Echocardiographic bubble studies both from the lower and upper half of the body may help to clarify the mechanism of an otherwise unexplained cyanosis.

Persistent electrical and morphological atrial abnormalities after early closure of atrial septal defect

2004 ◽  
Vol 14 (5) ◽  
pp. 481-487 ◽  
Author(s):  
Clifford L. Cua ◽  
Elizabeth E. Sparks ◽  
David P. Chan ◽  
Curt J. Daniels
Keyword(s):  
Atrial Septal Defect ◽  
Septal Defect ◽  
Pearson Correlation ◽  
P Wave ◽  
Surgical Closure ◽  
Septal Defects ◽  
Atrial Septal Defects ◽  
Pr Interval ◽  
Early Closure ◽  
The Right

Atrial arrhythmias are associated with enlarged atrial chambers and an increased duration of the P wave. Repair of atrial defects within the oval fossa is expected to normalize atrial size. Few studies, however, have evaluated electrical and morphological atrial features after repair. Our study was performed to determine if atrial abnormalities exist after surgical closure of such atrial septal defects, and whether early closure improves outcome. We recruited patients who had undergone surgical closure of a defect within the oval fossa, so-called “secundum” atrial septal defects. Electrocardiograms, signal averaged electrocardiograms, and echocardiograms were performed. Two-tailed test and Pearson correlation was utilized for statistical analysis. The population consisted of 20 patients and 27 controls, with the mean age of the patient being 11.25 ± 5.10 years, their age at surgery 6.55 ± 5.10 years, and the time since surgery 4.70 ± 2.61 years. The size of the right (23.88 ± 6.35 ml/m2 versus 18.84 ± 4.43 ml/m2) and left (21.91 ± 12.47 ml/m2 versus 17.72 ± 4.83 ml/m2) atrium were significantly larger in the patients. The duration of the P wave (108 ± 16 ms versus 96 ± 8 ms) and the duration of the PR interval (155 ± 18 ms versus 138 ± 23 ms) were longer. No correlation existed between age or interval since surgery with atrial sizes or measurements of the signal averaged electrocardiogram. We conclude that, despite surgical repair, abnormalities exist in patients with an atrial septal defect. Early surgery does not appear to prevent the atrial abnormalities.

Inferior-type caval vein defect – echocardiographic and surgical description of a large series of patients

2011 ◽  
Vol 22 (3) ◽  
pp. 270-278 ◽  
Author(s):  
Munesh Tomar ◽  
Sitaraman Radhakrishnan ◽  
Sunil K. Kaushal ◽  
Kulbhushan S. Dagar ◽  
Krishna S. Iyer ◽  
...  
Keyword(s):  
Atrial Septal Defect ◽  
Pulmonary Vein ◽  
Septal Defect ◽  
Pulmonary Veins ◽  
Venous Drainage ◽  
Transoesophageal Echocardiography ◽  
Caval Vein ◽  
Inferior Caval Vein ◽  
The Right ◽  
Echocardiographic Findings

AbstractAimThis study was carried out to define the anatomical criteria for the diagnosis of inferior-type caval vein defect and compare the echocardiographic findings with surgical findings.MethodsThe records of 19 patients – 13 male and six female patients in the age group of 18 months to 27 years, who were diagnosed as inferior-type caval vein defect with or without anomalous drainage of right pulmonary vein(s) on echocardiography – were retrospectively reviewed and compared with surgical findings.ResultsSurgical diagnosis of inferior-type caval vein defect was confirmed in 17 of the 19 patients. In two patients, the surgical diagnosis was that of a large fossa ovalis atrial septal defect – confluent defect and fossa ovalis atrial septal defect with deficient inferior rim in one patient each. Surgical diagnosis of anomalous drainage of pulmonary vein(s) was based on the course of the superior rim of the defect in relation to the pulmonary veins. Our echocardiographic impression of the pulmonary veins appearing in its normal position but showing abnormal drainage to right atrium was in agreement with the surgical notes. Discrepancy was found in the number of pulmonary veins draining anomalously. The discordance was related to overdiagnosis of anomalous drainage in all except one, that is, three out of four. In one, only the right lower pulmonary vein was diagnosed to be anomalous, whereas both right upper and lower pulmonary veins were found to be anomalous.ConclusionsEchocardiography provides definite diagnosis of inferior-type caval vein defect. Inferior caval vein straddling and an intact fossa ovalis are prerequisites for diagnosis. Anomalous pulmonary venous drainage of the right pulmonary veins is very common in our series, although accurate diagnosis of the number of pulmonary veins was not possible in all cases. Multiple views on transthoracic echocardiography starting from the subxiphoid views delineate the morphology accurately. Transoesophageal echocardiography is required only in patients in whom the windows, especially the subxiphoid, are not adequate.

scholarly journals Estimation of the right ventricular volume overload in children with atrial septal defect by body surface mapping.

1991 ◽  
Vol 55 (3) ◽  
pp. 262-270 ◽  
Author(s):  
TOSHIYUKI ASAI ◽  
NORIKO NAGAI ◽  
TAKAHIRO NAKASHIMA ◽  
MASAMI NAGASHIMA ◽  
HIROSHI HAYASHI
Keyword(s):  
Right Ventricular ◽  
Atrial Septal Defect ◽  
Body Surface ◽  
Septal Defect ◽  
Volume Overload ◽  
Ventricular Volume ◽  
Right Ventricular Volume ◽  
Body Surface Mapping ◽  
Surface Mapping ◽  
The Right

scholarly journals Comparison of the Response of the Right Ventricle with Endovascular Occlusion and Surgical Closure in Adults with Atrial Septal Defect One Year after Intervention

2010 ◽  
Vol 4 ◽  
pp. CMC.S6493 ◽  
Author(s):  
Niloufar Samiei ◽  
Fariba Bayat ◽  
Masoud Moradi ◽  
Mozhgan Parsaei ◽  
Seyedeh Zahra Ojaghi Haghighi ◽  
...  
Keyword(s):  
Right Ventricle ◽  
Atrial Septal Defect ◽  
Septal Defect ◽  
Control Group ◽  
Amplatzer Septal Occluder ◽  
Mean Values ◽  
Surgical Closure ◽  
Strain And Strain Rate ◽  
One Year ◽  
The Right

Background Use of the Amplatzer septal occluder (ASO) for the closure of secundum atrial septal defect (ASD) has recently become the procedure of choice, while earlier the only treatment for ASD was surgical closure. This study compares the right ventricular indices of the ASO group with the surgical closure group one year after intervention in adults. Methods From January 2008 to February 2010, 38 patients with isolated atrial septal defect of the secundum type one year after surgical (n = 20, age = 27 ± 4 years, 13 females, 7 males) or Amplatzer septal occluder closure (n = 18, age = 25 ± 4 years, 12 females, 6 males) were studied. At the same time, thirty-one age-matched normal subjects (age = 26 ± 6 years, 23 females, 9 males) were included as the control group. Strain and strain rate of the right ventricle were measured. Results The mean values of strain of the midportion were −26% ± 11.7%, −8.9% ± 4.2%, and 24.5% ± 7.4% ( P < 0.001). Strain rates of the midportion were −2.19 ± 0.6 s−1, −1.2 ± 0.4 s−1, −1.9 ± 0.6 s−1 ( P < 0.001) in ASO, surgery, and control groups, respectively. Conclusion This study showed that the right ventricle might show better performance in the ASO than the surgery group in adults with ASD in midterm follow-up.

Closure of Secundum Atrial Septal Defect with Autologous Right Atrial Patch: Case Report

2005 ◽  
Vol 8 (2) ◽  
pp. 96 ◽  
Author(s):  
Osman Tansel Dar�in ◽  
Alper Sami Kunt ◽  
Mehmet Halit Andac
Keyword(s):  
Atrial Septal Defect ◽  
Right Atrium ◽  
Septal Defect ◽  
Complete Recovery ◽  
Interatrial Septum ◽  
Right Atrial ◽  
Atrial Wall ◽  
Residual Shunt ◽  
Asd Closure ◽  
The Right

Background: Although various synthetic materials and pericardium have been used for atrial septal defect (ASD) closure, investigators are continuing to search for an ideal material for this procedure. We report and evaluate a case in which autologous right atrial wall tissue was used for ASD closure. Case: In this case, we closed a secundum ASD of a 22-year-old woman who also had right atrial enlargement due to the defect. After establishing standard bicaval cannulation and total cardiopulmonary bypass, we opened the right atrium with an oblique incision in a superior position to a standard incision. After examining the secundum ASD, we created a flap on the inferior rim of the atrial wall. A stay suture was stitched between the tip of the flap and the superior rim of the defect, and suturing was continued in a clockwise direction thereafter. Considering the size and shape of the defect, we incised the inferior attachment of the flap, and suturing was completed. Remnants of the flap on the inferior rim were resected, and the right atrium was closed in a similar fashion. Results: During an echocardiographic examination, neither a residual shunt nor perigraft thrombosis was seen on the interatrial septum. The patient was discharged with complete recovery. Conclusion: Autologous right atrial patch is an ideal material for ASD closure, especially in patients having a large right atrium. A complete coaptation was achieved because of the muscular nature of the right atrial tissue and its thickness, which is a closer match to the atrial septum than other materials.

Cobra head deformity of atrial septal occluder: blessing in disguise

2020 ◽  
pp. 1-2
Author(s):  
Uma Devi Karuru ◽  
Saurabh Kumar Gupta
Keyword(s):  
Atrial Septal Defect ◽  
Left Atrial ◽  
Septal Defect ◽  
Atrial Septum ◽  
Right Atrial ◽  
Septal Occluder Device ◽  
Occluder Device ◽  
The Right

Abstract It is not uncommon to have prolapse of the atrial septal occluder device despite accurate measurement of atrial septal defect and an appropriately chosen device. This is particularly a problem in cases with large atrial septal defect with absent aortic rim. Various techniques have been described for successful implantation of atrial septal occluder in such a scenario. The essence of all these techniques is to prevent prolapse of the left atrial disc through the defect while the right atrial disc is being deployed. In this brief report, we illustrate the use of cobra head deformity of the device to successfully deploy the device across the atrial septum.

scholarly journals P649 Before and after: sinus venosus atrial septal defect

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
I Marco Clement ◽  
R Eiros ◽  
R Dalmau ◽  
T Lopez ◽  
G Guzman ◽  
...  
Keyword(s):  
Atrial Septal Defect ◽  
Left Atrium ◽  
Atrial Flutter ◽  
Superior Vena Cava ◽  
Right Atrium ◽  
Septal Defect ◽  
Superior Vena ◽  
Pulmonary Veins ◽  
Vena Cava ◽  
The Right

Abstract Introduction The diagnosis of sinus venosus atrial septal defect (SVASD) is complex and requires special imaging. Surgery is the conventional treatment; however, transcatheter repair may become an attractive option. Case report A 60 year-old woman was admitted to the cardiology department with several episodes of paroxysmal atrial flutter, atrial fibrillation and atrioventricular nodal reentrant tachycardia. She reported a 10-year history of occasional palpitations which had not been studied. A transthoracic echocardiography revealed severe right ventricle dilatation and moderate dysfunction. Right volume overload appeared to be secondary to a superior SVASD with partial anomalous pulmonary venous drainage. A transesophageal echocardiography confirmed the diagnosis revealing a large SVASD of 16x12 mm (Figure A) with left-right shunt (Qp/Qs 2,2) and two right pulmonary veins draining into the right superior vena cava. Additionally, it demonstrated coronary sinus dilatation secondary to persistent left superior vena cava. CMR and cardiac CT showed right superior and middle pulmonary veins draining into the right superior vena cava 18 mm above the septal defect (Figures B and C). After discussion in clinical session, a percutaneous approach was planned to correct the septal defect and anomalous pulmonary drainage. For this purpose, anatomical data obtained from CMR and CT was needed to plan the procedure. During the intervention two stents graft were deployed in the right superior vena cava. The distal stent was flared at the septal defect level so as to occlude it while redirecting the anomalous pulmonary venous flow to the left atrium (Figure D). Control CT confirmed the complete occlusion of the SVASD without residual communication from pulmonary veins to the right superior vena cava or the right atrium (Figure E). Anomalous right superior and middle pulmonary veins drained into the left atrium below the stents. Transthoracic echocardiographies showed progressive reduction of right atrium and ventricle dilatation. The patient also underwent successful ablation of atrial flutter and intranodal tachycardia. She is currently asymptomatic, without dyspnea or arrhythmic recurrences. Conclusions In this case, multimodality imaging played a key role in every stage of the clinical process. First, it provided the diagnosis and enabled an accurate understanding of the patient’s anatomy, particularly of the anomalous pulmonary venous connections. Secondly, it allowed a transcatheter approach by supplying essential information to guide the procedure. Finally, it assessed the effectiveness of the intervention and the improvement in cardiac hemodynamics during follow-up. Abstract P649 Figure.

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

2014 ◽  
Vol 172 (1) ◽  
pp. 109-114 ◽  
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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