Response to fluid challenge in patients with atrial septal defect

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M D'Alto ◽  
M Chessa ◽  
G Gaio ◽  
G Santoro ◽  
M Giordano ◽  
...  
Keyword(s):  
Atrial Septal Defect ◽  
Vascular Resistance ◽  
Pulmonary Circulation ◽  
Septal Defect ◽  
Fluid Challenge ◽  
Left Ventricular ◽  
Percutaneous Closure ◽  
Right Atrial ◽  
Pulmonary Vascular Disease ◽  
Pulmonary Arterial

Abstract Background A fluid challenge test (FCT) with a rapid infusion of saline allows for discrimination between pre- and post-capillary pulmonary hypertension (PH) and may unmask hidden post-capillary PH. Patients with atrial septal defect (ASD) may develop pre- or post-capillary PH after shunt closure respectively in case of pulmonary vascular disease or left ventricular disease. Aim To evaluate the haemodynamic changes of the pulmonary circulation in ASD patients undergoing percutaneous closure with indicated according to the current ESC guidelines. Methods Twenty-three patients (mean age 42.9±12.4 years; 15 female) underwent right heart catheterization in basal conditions and after FCT (volume loading with rapid saline infusion of 7 ml/kg in 10 min) before percutaneous closure of the ASD. Right atrial pressure (RAP), systolic, mean and diastolic pulmonary arterial pressure (sPAP, mPAP and dPAP), pulmonary arterial wedge pressure (PAWP), cardiac output (CO), pulmonary vascular resistance (PVR), systemic vascular resistance (SVR) and the ratio between pulmonary and systemic flow (QP/QS) were calculated four times: before and after inflating the sizing balloon both at baseline and immediately after FCT (Fig. 1). Results The patients had an increase in pressures and flows after FCT with open ASD: mPAP (18.7±4.4 vs 16.7±4.6 mmHg, p<0.001), PAWP (11.3±3.1 vs 9.2±3.0 mmHg, p<0.001), QP (12.5±2.3 vs 10.3±2.0 l/min, p<0.001), and QS (6.6±1.4 vs 5.9±1.2 l/min, p<0.001) but RAP remained unchanged (8.7±3.0 vs 8.3±2.4 mmHg, p=0.35). PVR (0.2±0.4 vs 0.8±0.3 Wood Units, p<0.001) and SVR (11.2±3.2 vs 12.5±3.2 Wood Units, p=0.02) decreased, and PVR/SVR (0.06±0.02 vs 0.06±0.3, p=0.25) remained unchanged. QP/QS increased in all patients after FCT (mean±SD: 2.0±0.4 vs 1.8±0.4, p<0.001). During a temporary ASD closure by sizing balloon, the patients had increases of RAP (9.0±2.6 vs 7.6±2.6 mmHg, p<0.001) mPAP (19.5±4.0 vs 17.4±3.7 mmHg, p<0.001), PAWP (13.2±2.1 vs 11.2±2.9 mmHg, p<0.001), and CO (7.7±2.7 vs 6.8±2.3 l/min, p<0.001) after FCT. PVR remained unchanged (0.9±0.4 vs 1.1±0.6, p=0.12) and SVR reduced (9.8±2.7 vs 11.3±2.9, p<0.001) after FCT. Conclusions None of the reported ASD patients presented with FCT criteria of post-capillary PH (that is a PAWP >18 mmHg). The FCT was associated with an increase in QP/QS suggesting that the patients still had a distensible pulmonary circulation. Further studies are needed to explore the relevance of a FCT in ASD patients, particularly those with higher PVR values. Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals Heart and lung transplantation in pulmonary arterial hypertension related to congenital heart disease: an unusual indication

2020 ◽  
Vol 4 (S1) ◽  
Author(s):  
Rosaria Barracano ◽  
Heba Nashat ◽  
Andrew Constantine ◽  
Konstantinos Dimopoulos
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Arterial Hypertension ◽  
Arterial Hypertension ◽  
Lung Transplantation ◽  
Atrial Septal Defect ◽  
Septal Defect ◽  
Pulmonary Vascular Disease ◽  
Eisenmenger Syndrome ◽  
Pulmonary Arterial ◽  
Recurrent Haemoptysis

Abstract Background Eisenmenger syndrome is a multisystem disorder, characterised by a significant cardiac defect, severe pulmonary hypertension and long-standing cyanosis. Despite the availability of pulmonary hypertension therapies and improved supportive care in specialist centres, Eisenmenger patients are still faced with significant morbidity and mortality. Case presentation We describe the case of a 44-year-old woman with Eisenmenger syndrome secondary to a large secundum atrial septal defect. Her pulmonary vascular disease was treated with pulmonary vasodilators, but she experienced a progressive decline in exercise tolerance, increasing atrial arrhythmias, resulting in referral for transplantation. Her condition was complicated by significant recurrent haemoptysis in the context of extremely dilated pulmonary arteries and in-situ thrombosis, which prompted successful heart and lung transplantation. She made a slow recovery but remains well 3 years post-transplant. Conclusions Patients with Eisenmenger syndrome secondary to a pre-tricuspid lesion, such as an atrial septal defect have a natural history that differs to patients with post-tricuspid shunts; the disease tends to present later in life but is more aggressive, prompting early and aggressive medical intervention with pulmonary arterial hypertension therapies. This case illustrates that severe recurrent haemoptysis can be an indication for expediting transplantation in Eisenmenger syndrome patients.

scholarly journals Sinus venosus atrial septal defect presenting with brain abscess in a 33-year-old man

2019 ◽  
Vol 11 (4) ◽  
pp. 322-324
Author(s):  
Roghayeh Pourkia ◽  
Seyed Habibollah Hassani ◽  
Simin Mouodi
Keyword(s):  
Atrial Septal Defect ◽  
Brain Abscess ◽  
Septal Defect ◽  
Vasogenic Edema ◽  
Brain Magnetic Resonance Imaging ◽  
Large Mass ◽  
Left Ventricular ◽  
Sinus Venosus ◽  
Right Atrial ◽  
Contrast Study

This study aimed to present a case of 33-year old man who was admitted with a history of one week headache and acute diplopia. No important finding was reported in his past medical history. Brain CT-scan revealed a large mass lesion in left parieto-occipital area with prominent vasogenic edema and midline shift. Brain magnetic resonance imaging (MRI) showed a mass with size of 5*4*5 centimeter with ring enhancement. After cranial surgery and removing the mass, transthoracic and transesophageal echocardiography (TEE) were conducted to find the source of brain abscess. Right ventricular (RV) and right atrial (RA) enlargement, significant left to right shunt, normal left ventricular (LV) and RV function, bidirectional shunt in addition to moderate size superior sinus venosus type atrial septal defect (ASD) were detected. Considering that most of brain abscesses have hematogenous source, a complete cardiac evaluation including TEE with contrast study is suggested for evaluation of patients with brain abscess.

INCREASING PULMONARY VASCULAR RESISTANCE DURING INFANCY IN ASSOCIATION WITH VENTRICULAR SEPTAL DEFECT

PEDIATRICS ◽  
1966 ◽  
Vol 38 (2) ◽  
pp. 220-230 ◽  
Author(s):  
Julien I. E. Hoffman ◽  
Abraham M. Rudolph
Keyword(s):  
Ventricular Septal Defect ◽  
Vascular Disease ◽  
Pulmonary Vascular Resistance ◽  
Vascular Resistance ◽  
Septal Defect ◽  
The Other ◽  
Pulmonary Vascular Disease ◽  
Ventricular Septal Defects ◽  
Septal Defects ◽  
Pulmonary Arterial

Three children with big ventricular septal defects, large pulmonary blood flows, and pulmonary hypertension were catheterized at the ages of 3, 6, and 6 months. Pulmonary vascular resistance was low in two and slightly raised in the other. Recatheterization at the ages of 9, 16, and 26 months, respectively, showed increases of pulmonary vascular resistance in all, and the ventricular septal defects were successfully closed by open-heart operation soon thereafter. In the one child who was recatheterized only after there was clinical evidence of a raised pulmonary vascular resistance, postoperative catheterization showed a progressive rise in pulmonary vascular resistance indicating progressive pulmonary vascular disease. The other two children who were clinically well were recatheterized specifically to try and detect early pulmonary vascular changes and, in contrast, in both of these children pulmonary arterial pressures and vascular resistances have returned to normal after operation. These patients demonstrate that in those at risk of developing pulmonary vascular disease (big ventricular septal defect with high pressures and flows), pulmonary vascular resistance can rise rapidly in early life. In these patients progressive pulmonary vascular disease could be prevented if surgery to lower pulmonary arterial pressure and blood flow is done early enough. Even in patients who appear to be improving, recatheterization is necessary to demonstrate a moderate rise in pulmonary vascular resistance, since a moderate rise is not detectable by current clinical techniques.

scholarly journals Correlation between Left Ventricular Eccentricity Index and Mean Pulmonary Arterial Pressure in Secundum Type Atrial Septal Defect Adult Patients

2018 ◽  
Vol 4 (1) ◽  
pp. 15
Author(s):  
Citra Dewi Wahyu Fitria ◽  
Azhafid Nashar ◽  
Dyah Wulan Anggrahini ◽  
Anggoro Budi Hartopo ◽  
Hasanah Mumpuni ◽  
...  
Keyword(s):  
Arterial Pressure ◽  
Atrial Septal Defect ◽  
Septal Defect ◽  
Pulmonary Arterial Pressure ◽  
Left Ventricular ◽  
Registry Data ◽  
Right Heart ◽  
Eccentricity Index ◽  
Mean Pulmonary Arterial Pressure ◽  
Pulmonary Arterial

Background: Secundum type atrial septal defect (ASD) is the most common adult congenital heart disease. Hemodynamically, ASD result in a left-to-right shunt that causes right heart volume overload. This condition affects interventricular septal position and shape. Left ventricular (LV) eccentricity index (EI) suggests right ventricle (RV) overload when this ratio is >1.0. The aim of this study was to assess correlation between LV EI and mean pulmonary arterial pressure (mPAP) in secundum type ASD patients. Methods: We conducted a cross sectional study from ASD patients registry data. We enrolled subjects with secundum type ASD from the complete registry data. The LV EI was calculated from transthoracal echocardiography. The mPAP was measured by right heart catheterization as a gold standart. The correlation was performed by Spearman correlation test. Results: There were 40 adult secundum type ASD patients participated. The mean LV EI in enddiastolic was 1.55±0.39 and LV EI in end-systolic was 1.75±0.58. The median value of mPAP was 29 (12-99) mmHg. There was a moderate strength, positive and significant correlation between LV EI in end-diastolic and mPAP (r=0.37, p=0.018). The correlation was more significant and stronger between LV EI in end-systolic and mPAP (r=0.52, p=0.001). Conclusion: There was sufficiently strong and significant correlation between LV EI in both end-diastolic and end-systolic phase with mPAP in adult secundum type ASD.

scholarly journals Delayed aorto-right atrial fistula following percutaneous closure of atrial septal defect

2014 ◽  
Vol 96 (5) ◽  
pp. e3-e4 ◽  
Author(s):  
M Bashir ◽  
H Abudhaise ◽  
H Mustafa ◽  
M Fok ◽  
A Bashir ◽  
...  
Keyword(s):  
Atrial Septal Defect ◽  
Septal Defect ◽  
Percutaneous Closure ◽  
Patch Repair ◽  
Right Atrial ◽  
Jude Medical ◽  
First Case ◽  
Surgical Device ◽  
The Uk ◽  
Pericardial Patch Repair

We present the case of a 27-year-old man who underwent percutaneous atrial septal defect (ASD) repair using the Amplatzer® (St Jude Medical, St Paul, MN, US) septal occluder (ASO). Six weeks later, he presented with heart failure and was found to have an aorto-right atrial fistulation. He required urgent surgical device explantation and repair of the existing ASD using a pericardial patch repair technique. This is the first case to be reported from the UK describing a delayed aorto-right atrial fistula following percutaneous closure using ASO.

scholarly journals Emergent surgical removal of a migrated atrial septal defect occluder: case report

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Bi Wen ◽  
Juan He
Keyword(s):  
Atrial Septal Defect ◽  
Septal Defect ◽  
Major Complication ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Percutaneous Closure ◽  
Surgical Removal ◽  
Device Implantation ◽  
Occluder Device ◽  
Asd Closure

Abstract Background Atrial septal defect (ASD) closure has been widely accepted and is now routinely performed using a percutaneous approach under especially echocardiographic guidance Transesophageal echocardiography (TEE). One major complication is dislocation of occluder device during or after the device implantation. Surgical removal may be required, especially when the device stuck in the left ventricular outflow tract (LVOT). Case introduction A 21-year-old female was admitted to our department for percutaneous closure of secundum ASD. Percutaneous closure under the guidance of TEE was recommended for the patients. During device implantation, the TEE showed dislocation of the 22 mm ASD occluder device, stucked into the LVOT and behind the anterior mitral leaflet, producing severe LVOT obstruction Fig. 1). We herein present a safe and quick technique for surgical removal of an ASD occlude device located in the LVOT. Conclusion This technique provides a safe method for surgical removal of malposition and migration ASD occluder device.

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