The unnatural history of an atrial septal defect: Longitudinal 35 year follow up after surgical closure at young age

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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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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Late Surgical Closure of Secundum Type Atrial Septal Defect

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849239600400309 ◽

1996 ◽

Vol 4 (3) ◽

pp. 164-167

Author(s):

Binali Mavitaş ◽

S Fehmi Katircioğlu ◽

Birol Yamak ◽

Ahmet Saritaş ◽

Gürkan Uzunonat ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Congestive Heart Failure ◽

Pulmonary Hypertension ◽

Atrial Septal Defect ◽

Septal Defect ◽

Surgical Closure ◽

Long Term Follow Up

Between 1968 and 1995, a total of 153 patients who were between 35 and 63 years of age (mean 49.8 years), underwent surgery for secundum type atrial septal defect. There were 78 (50.9%) males and 75 females (49.1 %). Mean left-to-right shunt ratio was calculated as 2.49. Mean pulmonary artery pressure was 50.15 mm Hg. Three patients died within 30 days of surgery, giving a hospital mortality of 1.96%. Long-term follow-up was available in 135 cases (90%). Total follow-up was 967.3 patient-years and ranged from 3 months to 11.3 years (mean 7.16 years). There were no late deaths reported. Four patients were readmitted with atrial fibrillation and 2 with pericardial effusion. In our experience, surgical closure of atrial septal defect in adults was found to be successful, safe, and with low morbidity in patients with pulmonary hypertension and congestive heart failure.

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Outcome of patients after surgical closure of ventricular septal defect at young age: longitudinal follow-up of 22?34 years

European Heart Journal ◽

10.1016/j.ehj.2004.04.012 ◽

2004 ◽

Vol 25 (12) ◽

pp. 1057-1062 ◽

Cited By ~ 123

Author(s):

J ROOSHESSELINK

Keyword(s):

Ventricular Septal Defect ◽

Septal Defect ◽

Young Age ◽

Surgical Closure

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Enlarged right ventricular size at 11 years’ follow-up after closure of secundum-type atrial septal defect in children

Cardiology in the Young ◽

10.1017/s1047951112000480 ◽

2012 ◽

Vol 23 (1) ◽

pp. 7-13 ◽

Cited By ~ 8

Author(s):

Wilfred B. de Koning ◽

Lennie M. van Osch-Gevers ◽

Danielle Robbers-Visser ◽

Ron T. van Domburg ◽

Ad J.J.C. Bogers ◽

...

Keyword(s):

Right Ventricular ◽

Atrial Septal Defect ◽

Exercise Testing ◽

Septal Defect ◽

Systolic Volume ◽

Surgical Closure ◽

End Systolic Volume ◽

The Mean ◽

Ventricular Dimensions

AbstractBackgroundThe fate of right ventricular dimensions after surgical closure of secundum-type atrial septal defects remains unclear. The objectives of this study were to assess ventricular dimensions, exercise capability, and arrhythmias of patients operated for secundum-type atrial septal defect and compare the results with those in healthy references.MethodsA total of 78 consecutive patients underwent surgical closure for a secundum-type atrial septal defect between 1990 and 1995. In all, 42 patients were included and underwent a cross-sectional evaluation including echocardiography, magnetic resonance imaging, exercise testing, and 24-hour ambulatory electrocardiography. Patients were matched with healthy controls for gender, body surface area, and age.ResultsThe mean age at surgery was 4.6 plus or minus 2.8 years, and the mean age at follow-up was 16 plus or minus 3 years. There were no residual intracardiac lesions. The mean right ventricular end-systolic volume was significantly larger in patients (142 ± 26 millilitres) than in references (137 ± 28 millilitres; p = 0.04). In 25% of the patients, right ventricular end-systolic volume was larger than the 95th percentile for references. No relevant arrhythmias were detected. Exercise testing did not reveal differences with healthy references: maximal power (169 ± 43 Watt patients versus 172 ± 53 controls; p = 0.8), maximal oxygen uptake (38 ± 8 versus 41 ± 13 millilitres per minute per kilogram; p = 0.1).CommentAfter surgical closure of secundum-type atrial septal defect, right ventricular end-systolic volume is increased. These findings have no impact on rhythm status or exercise capacity at this stage of follow-up, but may have implications for the timing of surgery or the technique of closure if confirmed in longer follow-up.

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Transcatheter closure of atrial septal defect in a patient with Noonan syndrome after corrective surgery

Vojnosanitetski pregled ◽

10.2298/vsp1506557m ◽

2015 ◽

Vol 72 (6) ◽

pp. 557-560 ◽

Cited By ~ 2

Author(s):

Ljupco Mangovski ◽

Mihajlo Farkic ◽

Ljiljana Jovovic

Keyword(s):

Cardiac Surgery ◽

Atrial Septal Defect ◽

Noonan Syndrome ◽

Septal Defect ◽

Transcatheter Closure ◽

Late Complication ◽

Surgical Closure ◽

Patient Reported ◽

History Of ◽

Asd Closure

Introduction. Transcatheter atrial septal defect (ASD) closure is considered to be a gold standard for patients with the suitable anatomy as compared to cardiac surgery. Reocurrence of ASD after surgical closure is a very rare late complication which can be successfully managed with transcatheter procedure. Case report. We reported a female patient with Noonan syndrome who presented with hemodinamically significant ASD 37 years after the corrective cardiac surgery. Due to numerous comorbidities which included severe kyphoscoliosis, pectus excavatum and multiple surgeries we decided to perform transcatheter closure of ASD. The procedure itself was very challenging due to the patient?s short stature and heart?s orientation in the chest, but was performed successfully. The subsequent follow-up was uneventful and the patient reported improvement in the symptoms. Conclusion. Transcatheter closure of ASD in a patient with Noonan syndrome with the history of surgically corrected ASD can be performed successfully, despite challenging chest anatomy.

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Recent Experience and Follow-Up After Surgical Closure of Secundum Atrial Septal Defect in 120 Children

Pediatric Cardiology ◽

10.1007/s00246-018-1914-8 ◽

2018 ◽

Vol 39 (7) ◽

pp. 1440-1444

Author(s):

Geoffroy de Beco ◽

Natasha Mambour ◽

Christophe Vô ◽

Laetitia Vanhoutte ◽

Stéphane Moniotte ◽

...

Keyword(s):

Atrial Septal Defect ◽

Septal Defect ◽

Recent Experience ◽

Secundum Atrial Septal Defect ◽

Surgical Closure

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Very late (>5 years) thrombus formation on an atrial septal defect device: a case report

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20204923 ◽

2020 ◽

Vol 8 (11) ◽

pp. 4149

Author(s):

Sudheer Venkata Bolinera ◽

Srinivas Soma ◽

Sanivarapu Srinivasa Reddy ◽

Vijaya Pamidimukkala ◽

Michael Naronha ◽

...

Keyword(s):

Atrial Septal Defect ◽

Septal Defect ◽

Thrombus Formation ◽

Device Closure ◽

Atrial Septal Defect Closure ◽

Septal Occluder Device ◽

Occluder Device ◽

History Of

Though percutaneous transcatheter atrial septal defect closure with newer generation occluder devices is a standard treatment at present, these devices have significant long-term risks (>1 year) associated with such as thrombus formation. Here, we present a case of 28 year-old patient presented with few symptoms and had a history of ASD device closure using amplatzer septal occluder device five years back. The patient was found to have a large thrombus (30×33 mm) attached to the device which was managed using anticoagulants and patients was advised for regular echocardiographic follow-up.

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Changes of Cardiac Rhythm after Closure of Secundum Atrial Septal Defect in Children

Journal of Advances in Medicine and Medical Research ◽

10.9734/jammr/2020/v32i1030523 ◽

2020 ◽

pp. 84-96

Author(s):

Esraa A. Sorour ◽

Elatafy E. Elatafy ◽

Wael N. Lotfy ◽

Amr M. Zoair

Keyword(s):

Risk Factors ◽

Atrial Septal Defect ◽

Pediatric Patients ◽

Septal Defect ◽

Hemodynamic Instability ◽

Right Atrial ◽

Surgical Closure ◽

Septal Defects ◽

Atrial Septal Defects

Background: Arrhythmias may complicate congenital heart diseases, such as secundum atrial septal defects. We aimed at following up the rhythm changes in children after closure of ostiumsecundum atrial septal defects. Methods: The current study was conducted in the Pediatric Cardiology Unit, Tanta University, on 60 pediatric patients who had undergone either trans-catheter or surgical closure of secundum atrial septal defects. Complete history taking and full clinical assessment were done. Echocardiographic assessment was performed to detect any residual defects, and assess chamber dimensions, and cardiac functions. Electrocardiographic assessment including Holter monitoring was performed within two months after the procedure, after six months, and after one year. Arrhythmias were classified into major and minor types. All results were statistically analyzed and tabulated. Results: There were no significant differences between the pre-closure rhythm and the rhythm after closure of the defects throughout the follow-up. The percentage of patients with major arrhythmias has increased from 6.7% of the total sample to 13.3%, 11.6%, and 11.6% in the early, midterm and late follow up respectively. The significant risk factors for postoperative arrhythmias were; pre-closure arrhythmia, right atrial dilatation, and serious hemodynamic instability in the early follow up. Conclusions: We concluded that arrhythmias were common before and after atrial septal defect closure, without significant differences. Pre-closure arrhythmia, right atrial dilatation, and serious hemodynamic instability are considered important risk factors of arrhythmias after secundum atrial septal defect’s closure in pediatric patients.

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