scholarly journals Impact of Right Ventricular Dilatation in Patients with Atrial Septal Defect

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Rie Nakayama ◽  
Yoichi Takaya ◽  
Teiji Akagi ◽  
Koji Nakagawa ◽  
Nobuhisa Watanabe ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Atrial Septal Defect ◽  
Exercise Capacity ◽  
Septal Defect ◽  
Adult Patients ◽  
Volume Index ◽  
End Diastolic Volume ◽  
The Mean ◽  
Asd Closure ◽  
The Relationship

Objective. The aim of this study was to examine the relationship between right ventricular (RV) volume and exercise capacity in adult patients with atrial septal defect (ASD) and to determine the degree of RV dilatation for transcatheter ASD closure. Background. RV dilatation is an indication of transcatheter ASD closure; however, few studies have reported the clinical significance of RV dilatation. Methods. We enrolled 82 consecutive patients (mean age, 49 ± 18 years; female, 68%) who underwent cardiac magnetic resonance imaging and symptom-limited cardiopulmonary exercise test before ASD closure. The relationship between RV volume and peak oxygen uptake (VO2) was evaluated. Results. The mean RV end-diastolic volume index was 108 ± 27 ml/m2 (range, 46 to 180 ml/m2). The mean peak VO2 was 24 ± 7 ml/min/kg (range, 14 to 48 ml/min/kg), and the mean predicted peak VO2 was 90 ± 23%. There were significant negative relationships of RV end-diastolic volume index with peak VO2 (r = −0.28, p<0.01) and predicted peak VO2 (r = −0.29, p<0.01). The cutoff value of RV end-diastolic volume index <80% of predicted peak VO2 was 120 ml/m2, with the sensitivity of 49% and the specificity of 89%. Conclusions. There was a relationship between RV dilatation and exercise capacity in adult patients with ASD. RV end-diastolic volume index ≥120 ml/m2 was related to the reduction in peak VO2. This criterion of RV dilatation may be valuable for the indication of transcatheter ASD closure.

Biventricular morphology in adults born with a ventricular septal defect

2018 ◽  
Vol 28 (12) ◽  
pp. 1379-1385 ◽  
Author(s):  
Marie Maagaard ◽  
Johan Heiberg ◽  
Filip Eckerström ◽  
Benjamin Asschenfeldt ◽  
Christian E. Rex ◽  
...  
Keyword(s):  
Ventricular Septal Defect ◽  
Right Ventricular ◽  
Septal Defect ◽  
Volume Index ◽  
Peak Exercise ◽  
Stroke Index ◽  
Healthy Controls ◽  
Ventricular Septal Defects ◽  
Septal Defects ◽  
End Diastolic Volume

AbstractVentricular septal defects – large, surgically closed or small, untreated – have demonstrated lower peak exercise capacity compared with healthy controls. The mechanisms behind these findings are not yet fully understood. Therefore, we evaluated biventricular morphology in adults with a ventricular septal defect using MRI. Adults with either childhood surgically closed or small, untreated ventricular septal defects and healthy controls underwent cine MRI for the evaluation of biventricular volumes and quantitative flow scans for measurement of stroke index. Scans were analysed post hoc in a blinded manner. In total, 20 operated patients (22±2 years) and 20 healthy controls (23±2 years) were included, along with 32 patients with small, unrepaired ventricular septal defects (26±6 years) and 28 controls (27±5 years). Operated patients demonstrated larger right ventricular end-diastolic volume index (103±20 ml/m2) compared with their controls (88±16 ml/m2), p=0.01. Heart rate and right ventricular stroke index did not differ between operated patients and controls. Patients with unrepaired ventricular septal defects revealed larger right ventricular end-diastolic volume index (105±17 ml/m2) compared with their controls (88±13 ml/m2), p<0.01. Furthermore, right ventricular stroke index was higher in unrepaired ventricular septal defects (53±12 ml/minute/m2) compared with controls (46±8 ml/minute/m2), p=0.02, with similar heart rates. Both patient groups’ right ventricles were visually characterised by abundant coarse trabeculation. Positive correlations were demonstrated between right ventricular end-diastolic volume indices and peak exercise capacity in patients. Left ventricle measurements displayed no differences between groups. In conclusion, altered right ventricular morphology was demonstrated in adults 20 years after surgical ventricular septal defect repair and in adults with small, untreated ventricular septal defects.

scholarly journals Comparison of Cardiopulmonary Exercise Capacity in Patients with Atrial Septal Defect Treated with Minimally Invasive Cardiac Surgery or Transcatheter Closure

2020 ◽  
Vol 25 (8) ◽  
pp. 3879
Author(s):  
Hicaz Zencirkiran Agus ◽  
Serkan Kahraman ◽  
Mehmet Erturk ◽  
Burak Onan ◽  
Ali Kemal Kalkan ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Minimally Invasive ◽  
Atrial Septal Defect ◽  
Exercise Capacity ◽  
Septal Defect ◽  
Transcatheter Closure ◽  
Minimally Invasive Cardiac Surgery ◽  
Cardiopulmonary Exercise ◽  
Cardiopulmonary Exercise Capacity ◽  
Asd Closure

Aim. The main aim of our study was to compare the results of transcatheter atrial septal defect (ASD) closure versus minimally invasive cardiac surgery (MICS) focusing on cardiopulmonary exercise capacity and echocardiographic findings preoperatively and 1 month after defect closure.Material and methods. 54 patients with ASD and finally 43 patients who were followed up were included in the study. 21 patients were in MICS (robotic or endoscopic approach) and 22 patients were in transcatheter closure arm. All patients investigated in detail by transesophageal echocardiography and underwent cardiopulmonary exercise test (CPET). At the end of first month, CPET and transthorasic echocardiography were reperformed.Results. There was significant improvement of physical capacity after 1 month following the transcatheter closure procedure documented by exercise time and VO 2 max. Tricuspid annular plane systolic excursion (TAPSE) and tricuspid lateral annular systolic velocity (Tri S) were not changed. In surgery group right heart diameters declined significantly; but VO 2 max, TAPSE and Tri S significantly decreased.Conclusion. Cardiopulmonary exercise function is increased in transcatheter closure group 1 month after closure and contrary not in MICS group. This may be caused by long recovery time of the right ventricle after surgery. Device closure of ASD is preferable to surgical closure if the anatomy is suitable. However, MICS for ASD closure is safe, with short recovery period and less scarring.

P1800The benefit of atrial septal defect closure in patients with borderline shunt

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Komar ◽  
T Przewlocki ◽  
B Sobien ◽  
P Prochownik ◽  
U Gancarczyk ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Atrial Septal Defect ◽  
Septal Defect ◽  
Transcatheter Closure ◽  
Color Doppler ◽  
Percutaneous Treatment ◽  
Right Atrial ◽  
P Value ◽  
Atrial Septal Defect Closure ◽  
Asd Closure

Abstract Objective Closure of atrial septal defect in patients with borderline shunt is controversial. The aim of the study was to evaluate the outcomes of transcatheter closure of secundum atrial septal defect (ASD) in the patients with the borderline shunt. Methods 215 pts (126 F,89 M) with a mean age of 31.9±18.2 (16–58) years with a small ASD who underwent transcatheter closure were analyzed. All patients had an isolated secundum ASD with pulmonary to systemic blood flow Qp:Qs ratio≤1.5, mean 1.2±0.6 (1.1–1.5). A symptom-limited treadmill exercise test with respiratory gas exchange analysis, transthoracic color Doppler echocardiographic study and Quality of life (QoL) (using the SF36 questionnaire (SF36q)) were repeated in all pts before and 36 months after the procedure. Results The device was successfully implanted in all pts (procedure time 19.1±5.2 (8–38) minutes, fluoroscopy time 8.1±4.4 (6–13) minutes). There were no major complications. The defect echo diameter was 7.7±3.9 (5 - 15) mm. The diameter of the implanted devices ranged from 6 to 18 mm. After 36 months of ASD closure, all the pts showed a significant improvement of exercise capacity. 7 QoL parameters (except mental health) improved at 36 months of follow-up compared with baseline. The mean SF36q scale increased in 168 (78.1%) pts of mean 40.2±20.1 (9–72). The right ventricular dimension decreased in 173 pts (80.4%) (Table 1). Table 1 Parameter Before ASD closure 36 months after ASD closure p value Time of exercise (min) 12.1±5.2 18.6±4.3 <0.001 VO2 peak (ml/kg/min) 10.2±4.7 14.8±4.2 <0.001 SF36q scale 0–100 37.3±22.3 79±29.5 <0.001 Right atrial area (cm2) 20.1±1.7 14.7±1.5 <0.001 Right ventricular area (cm2) 18.1±1.4 12.2±1.5 <0.001 Conclusions ASD closure in patients with borderline shunt resulted in a significant and long-term clinical and hemodynamic improvement after percutaneous treatment.

P4166Efficacy and safety of novel biodegradable device for closure of atrial septal defect: from preclinical study to first-in-man experience

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
Y F Li ◽  
Y M Xie ◽  
Z F Xie ◽  
S S Wang ◽  
B N Li ◽  
...  
Keyword(s):  
Atrial Septal Defect ◽  
Septal Defect ◽  
Preclinical Study ◽  
Closure Device ◽  
Swine Model ◽  
Procedure Time ◽  
Short Term ◽  
The Mean ◽  
Asd Closure

Abstract Background closure of atrial septal defect (ASD) has emerged as the treatment of choice for the majority of defect. The biodegradable ASD closure device is a novel, absorbable device made of poly-L_latic acid (PLLA). This study evaluates the feasibility, safety and effectiveness of PLLA biodegradable ASD closure device in a swine model and for the first time in human. Objective The study reports on the 24- and 36- month follow-up results of PLLA device implanted in a swine model and the first-in- man experience with 6-month follow-up. Method Preclinical study was done in a swine ASD model. In a clinical setting, 5 pediatric patients with a secundum ASD who a clinically left-to-right shunt were enrolled in our center. Percutaneous ASD closure procedure with PLLA device was performed with fluoroscopic and transcatheter echocardiography (TTE) guidance. Procedure results and clinical outcomes at 1 day, 30 days, 3 months and 6 months after closure procedure were analyzed. Results 24- and 36-month follow-up results of preclinical study demonstrated that the PLLA device exhibited good endothelialization and degradability in a swine model. In clinical study, device implantation was successfully achieved in all of 5 patients (median age, 3.6 years; range, 3.1–6.5 years). The mean ASD size was (13.4±2.4)mm (range, 10–16mm). The mean pulmonary-to-systemic blood flow ratio (Qp:Qs) was (1.7±0.2):1 with a range of 1.5:1 to 2.0:1. The mean procedure time and the mean fluoroscopy time were (36.2±11.3) and (6.4±1.0)minutes, respectively. There was no evidence of short-term complications related to the device or the delivery system. No device dislodgement, significant aortic valve or mitral valve regurgitation, new onset cardiac arrhythmia, or other adverse events were reported. Characteristics and procedure data of the 5 patients who underwent ASD closure procedure with PLLA device Patient No. Age Weight Gender Defect size Qp:Qs Mean Pulmonary Pressure Device size (mm) Sheath (Fr) Procedure time Fluoroscopy time Immediate residual shunt (years) (kg) (mm) (mmHg) (mm) (Fr) (min) (min) 1 4.9 23.5 Male 17 1.7:1 22 24 12 52 7.6 None 2 3.1 10.0 Male 14 2.0:1 19 20 12 26 5.4 None 3 6.5 21.0 Male 15 1.8:1 22 20 12 31 6.0 None 4 3.2 14.5 Female 12 1.5:1 13 18 10 44 7.3 None 5 3.6 12.5 Male 10 1.5:1 17 14 10 28 5.5 None Conclusion This study is the first to demonstrate the feasibility, safety and effectiveness of PLLA biodegradable device in human, with no evidence of short-term complications and a high rate of early shunt closure. Acknowledgement/Funding National Key R&D Program of China (Grant Number: 2016 YFC1100305)

Stroke in patients with secundum atrial septal defect and sequelae after transcatheter closure

Heart ◽  
2021 ◽  
pp. heartjnl-2021-319050
Author(s):  
Stephen J Dolgner ◽  
Zachary Louis Steinberg ◽  
Thomas K Jones ◽  
Mark Reisman ◽  
Jonathan Buber
Keyword(s):  
Risk Factors ◽  
Atrial Septal Defect ◽  
Septal Defect ◽  
Lifestyle Changes ◽  
Adult Patients ◽  
Atrial Arrhythmias ◽  
Secundum Atrial Septal Defect ◽  
Eustachian Valve ◽  
Increased Risk ◽  
Asd Closure

ObjectiveTo evaluate the frequency of and risk factors for stroke as a presenting feature in adult patients with secundum atrial septal defect (ASD); rates of post-closure atrial fibrillation (AF) and stroke were also assessed.MethodsWe retrospectively reviewed adult patients who presented with an ASD between 2002 and 2018, excluding those with known atrial arrhythmias. Risk factors for stroke were identified using multivariable logistic regression. Post-closure stroke was evaluated using survival analysis stratified by the presence of post-procedure AF.ResultsOf 346 patients with ASD (median age 44 years), 34 (10%) presented with a history of stroke. Independent risk factors included elevated body mass index over 25 (OR: 18.2; 95% CI: 4.0 to 82.2; p<0.001), smoking (OR: 9.5; 95% CI: 3.8 to 23.9; p<0.001) and a prominent Eustachian valve (OR: 9.2; 95% CI: 3.4 to 25.2; p<0.001). A scoring system based on these three parameters provided robust stroke risk stratification. During a median follow-up of 12 months after closure, 12 patients (4%) experienced AF and 4 patients (1%) had a new stroke. AF was highly associated with development of stroke post-closure (p<0.001).ConclusionsIn this study population, the incidence of stroke prior to ASD closure among patients without atrial arrhythmias was 10%. Risk factors included obesity, smoking and prominent Eustachian valve anatomy. Lifestyle changes should be recommended for at-risk patients, and it may be reasonable to consider ASD closure in the absence of haemodynamic indications in patients at increased risk of stroke.

scholarly journals Preoperative Left Ventricle End Diastolic Volume Index as a Predictor for Low Cardiac Output Syndrome After Surgical Closure of Secundum Atrial Septal Defect With Small-Sized Left Ventricle

2021 ◽  
Vol 9 ◽  
Author(s):  
Budi Rahmat ◽  
Nurima Ulya Dwita ◽  
Putu Wisnu Arya Wardana ◽  
Oktavia Lilyasari
Keyword(s):  
Cardiac Output ◽  
Left Ventricle ◽  
Atrial Septal Defect ◽  
Septal Defect ◽  
Volume Index ◽  
Low Cardiac Output Syndrome ◽  
Low Cardiac Output ◽  
Cutoff Value ◽  
Surgical Closure ◽  
End Diastolic Volume

Introduction: Low cardiac output syndrome is one of the postoperative complications that are associated with significant morbidity and mortality after surgical closure of atrial septal defect (ASD) with small-sized left ventricle (LV). This study investigated whether preoperative left ventricular end-diastolic volume index (LVEDVi) could accurately predict low cardiac output syndrome (LCOS) after surgical closure of ASD with small-sized LV.Method: This retrospective cohort study involved adult ASD patients with small-sized LV from January 2018 to December 2019 in National Cardiovascular Center Harapan Kita. Preoperative MRI data to assess the left and right ventricle volume were collected. A bivariate analysis using independent Student's t-test was done. Diagnostic test using receiver operating characteristic (ROC) curve was also done to obtain the area under the curve (AUC) value. The best cutoff point was determined by Youden's index.Result: Fifty-seven subjects were involved in this study [age (mean ± SD) 32.56 ± 13.15 years; weight (mean ± SD) 48.82 ± 12.15 kg]. Subjects who had post-operative LCOS (n = 30) have significantly lower LVEDVi (45.0 ± 7.42 ml/m2 vs. 64.15 ± 13.37 ml/m2; p &lt; 0.001), LVEDV (64.6 ± 16.0 ml vs. 85.9 ± 20.7 ml; p &lt; 0.001), LVSV (38.97 ± 11.5 ml vs. 53.13 ± 7.5 ml; p &lt; 0.001), and LVSVi (27.28 ± 8.55 ml/m2 vs. 37.42 ± 5.35 ml/m2; p &lt; 0.001) compared to subjects who did not have post-operative LCOS (n = 27). ROC analysis showed that the best AUC was found on LVEDVi (AUC 95.3%; 95% confidence interval: 90.6–100%). The best cutoff value for LVEDVi to predict the occurrence of LCOS after surgical closure of ASD was 53.3 ml/m2 with a sensitivity of 86.7% and a specificity of 85.2%.Conclusion: This study showed that preoperative LVEDVi could predict LCOS after surgical closure of ASD with small-sized LV with a well-defined cutoff. The best cutoff value of LVEDVi to predict the occurrence of LCOS after surgical ASD closure was 53.5 ml/m2.

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

2012 ◽  
Vol 23 (1) ◽  
pp. 7-13 ◽  
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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