Cyanotic Ostium Secundum Atrial Septal Defect without Pulmonary Hypertension and Clinical Signs of Heart Disease

Uncorrected atrial septal defect undergoes right ventricle chronic volume overload which may lead to pulmonary hypertension and Eisenmenger Syndrome. The soluble suppression of tumorigenicity-2 is a left ventricle strain biomarker; however, its role in right ventricle strain is unclear. This study aimed to investigate the implication of serum soluble suppression of tumorigenicity-2 in adult uncorrected atrial septal defect. This was a cross-sectional study. We enrolled 81 adult uncorrected secundum atrial septal defect patients. Clinical and hemodynamic data were collected. Serum samples were withdrawn from the pulmonary artery during right heart catheterization. Serum soluble suppression of tumorigenicity-2 and NT-proBNP levels were measured. Subjects were divided into three groups based on clinical and hemodynamic severity. The correlation of soluble suppression of tumorigenicity-2 with patients' data and comparison among groups were analyzed. A p value <0.05 was considered statistically significant. Results showed that, there were significant correlations between serum soluble suppression of tumorigenicity-2 and mean pulmonary artery pressure ( r = 0.203, p = 0.035) and right ventricle end-diastolic diameter ( r = 0.203, p <0.05). Median serum soluble suppression of tumorigenicity-2 level was incrementally increased from group I (atrial septal defect and no-pulmonary hypertension), group II (left-to-right atrial septal defect and pulmonary hypertension), to group III (Eisenmenger Syndrome): (17.4 ng/mL, 21.8 ng/mL, and 29.4 ng/mL, respectively). A post-hoc analysis showed that serum soluble suppression of tumorigenicity-2 level was significantly different between groups I and III ( p = 0.01). Serum N terminal pro brain natriuretic peptide (NT-proBNP) level was consistently associated with worse clinical and hemodynamic parameters. No correlation was found between serum soluble suppression of tumorigenicity-2 and NT-proBNP level. In conclusion, serum soluble suppression of tumorigenicity-2 level had significant positive correlation with mean pulmonary artery pressure and right ventricle end-diastolic diameter in uncorrected secundum atrial septal defect patients. Higher serum soluble suppression of tumorigenicity-2 level was associated with the presence of pulmonary hypertension and Eisenmenger Syndrome in uncorrected secundum atrial septal defect patients.

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Echocardiographic correlates of severe pulmonary hypertension in adult patients with ostium secundum atrial septal defect

Echocardiography ◽

10.1111/echo.13358 ◽

2016 ◽

Vol 33 (12) ◽

pp. 1891-1896 ◽

Cited By ~ 5

Author(s):

Jorge Cossío-Aranda ◽

Karina Del Valle Zamora ◽

Navin C. Nanda ◽

Anezi Uzendu ◽

Candace Keirns ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Atrial Septal Defect ◽

Septal Defect ◽

Adult Patients ◽

Severe Pulmonary Hypertension ◽

Secundum Atrial Septal Defect

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Familial recurrence of congenital heart disease in patients with ostium secundum atrial septal defect

European Heart Journal ◽

10.1093/eurheartj/ehi378 ◽

2005 ◽

Vol 26 (20) ◽

pp. 2179-2184 ◽

Cited By ~ 20

Author(s):

Salvatore Caputo ◽

Giovanbattista Capozzi ◽

Maria Giovanna Russo ◽

Teresa Esposito ◽

Lucia Martina ◽

...

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Atrial Septal Defect ◽

Congenital Heart ◽

Septal Defect ◽

Secundum Atrial Septal Defect

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Spinal Anesthesia in Patient with Congestive Heart Failure due to Congenital Atrial Septal Defect, and Pulmonary Hypertension Undergoing Cesarean Section Procedure: A Case Report

Journal of Anesthesiology and Clinical Research ◽

10.37275/jacr.v1i2.244 ◽

2020 ◽

Vol 1 (2) ◽

pp. 95-102

Author(s):

Anugerah Ade Periambudi ◽

Rizal Zainal ◽

Mayang Indah Lestari

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Pulmonary Hypertension ◽

Heart Disease ◽

Case Report ◽

Atrial Septal Defect ◽

Spinal Anesthesia ◽

Congenital Heart ◽

Septal Defect ◽

Shortness Of Breath

Introduction. In patients suffering from heart disease, pregnancy is a risk factor for mortality. Heart disease in pregnant women can be in form of rheumatic heart disease, cardiomyopathy, or congenital heart disease. This case report is about the successful spinal anesthesia technique in cesarean section (C-section) patients with congestive heart failure due to congenital atrial septal defect, and pulmonary hypertension (PH). Case presentation. A pregnant woman, 24 years old, planned to have an emergency C-section. She complained about shortness of breath for 2 days before admission. Three months ago, the patient started to feel shortness of breath during activity and also complained her legs swelled. She has a history of congenital heart i.e. atrial septal defect (ASD), but not routinely been treated. Her examination showed tachypnea, murmur, bibasilar fine crackles lung sound, and pretibial pitting edema. Echocardiography showed ASD with pulmonary hypertension. Spinal Anesthesia using 0.5% isobaric bupivacaine 7.5 mg and fentanyl 25 µcg was given before surgery. Drugs was injected in L3-L4 level with the upper target was as high as T6. the head position is raised 30 degrees. Procedure went well and the APGAR score was 8/9, Patient was admitted to the ICU for one day and discharged from hospital at the 5 days of hospital care. Conclusion. Spinal single-shot spinal anesthesia with small doses of bupivacaine and adjuvant can be used as an alternative technique in emergency C-section for patients with congestive heart failure due to congenital atrial septal defect, and pulmonary hypertension.

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Diameter and shunt act as an alleviator of pulmonary hypertension: an echocardiography assessment of patients with ostium secundum atrial septal defect

European Heart Journal ◽

10.1093/eurheartj/ehab724.0143 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

N E Z Espinola-Zavaleta ◽

N E A V Antonio-Villa ◽

E C G Guerra ◽

E A R Alexanderson-Rosas ◽

G B C Bracamontes-Castelo ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Atrial Septal Defect ◽

Interaction Effect ◽

Septal Defect ◽

Continuous Wave ◽

Systolic Pressure ◽

Volume Overload ◽

Secundum Atrial Septal Defect ◽

Triple Interaction ◽

Chronic Volume Overload

Abstract Background Ostium-secundum atrial septal defect (OS-ASD) increases pulmonary arterial systolic pressure (PSAP) and eventually leads to pulmonary hypertension (PH). Nevertheless, whether the characteristics of OS-ASD could serve as an alleviator within chronic-volume overload in the right atrium (RA) is unclear. Aims To evaluate a potential interaction of OS-ASD diameter and the shunt (Qp/Qs ratio) on PSAP values in patients with secondary PH. Methods We designed a cross-sectional study of 63 adult patients with OS-ASD. A conventional transthoracic echocardiography was performed using Vivid 9X-clear equipment (GE Vingmed Ultrasound, Horten, Norway) to evaluate the OS-ASD diameter and the Qp/Qs ratio. The PSAP was calculated by tricuspid regurgitation velocity with continuous-wave Doppler in the apical four-chamber view. Polynomic adjusted correlations were performed between the RA volume and the PSAP; we evaluated a double and triple interaction-effect of the OS-ASD diameter and Qp/Qs ratio, respectively adjusted for age, sex and body surface area. Results In our study population, 78% (n=49) were female, with a mean age of 41.8 (±15) years. 44% (n=28) with mild-PH, 38% (n=24) with moderate-PH and 17% (n=11) with severe-PH. Mean echocardiographic parameters were: RA volume 58.8 (±26.4) mL, PSAP of 55.9 (±20.7) mmHg, OS-ASD diameter 30.1 (±7.8) mm and Qp/Qs 2.9 (±0.9). We observed a cubic relationship between RA volume and PSAP (r=0.354, p=0.006; Figure 1A). ASD-Diameter had a negative interaction effect (β=−0.0231 95% CI: −0.043 to −0.003, p=0.03) of the relationship between RA volume and PSAP (Figure 1B). Furthermore, the addition of Qp/Qs ratio displayed a positive triple interaction effect (β=0.021 95% CI: 0.001–0.043, p=0.048) on the previously mentioned variables (Figure 1C) after adjusting for covariates. Conclusions The increase in OS-ASD diameter and shunt decreases PSAP values. Our results could indicate that OS-ASD could potentially ameliorate chronic-volume overload in patients with secondary PH. FUNDunding Acknowledgement Type of funding sources: None. Figure 1

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Severe pulmonary hypertension and reduced right ventricle systolic function associated with maternal mortality in pregnant uncorrected congenital heart diseases

Pulmonary Circulation ◽

10.1177/2045894019884516 ◽

2019 ◽

Vol 9 (4) ◽

pp. 204589401988451 ◽

Cited By ~ 3

Author(s):

Anggoro B. Hartopo ◽

Dyah W. Anggrahini ◽

Detty S. Nurdiati ◽

Noriaki Emoto ◽

Lucia K. Dinarti

Keyword(s):

Congenital Heart Disease ◽

Pulmonary Hypertension ◽

Heart Disease ◽

Mortality Rate ◽

Right Ventricle ◽

Maternal Mortality ◽

Atrial Septal Defect ◽

Congenital Heart ◽

Septal Defect ◽

Systolic Function

Background Pregnant uncorrected congenital heart disease patients, especially those who already developed pulmonary hypertension, have increased risk for maternal mortality. The pulmonary hypertension severity and right ventricle function may be associated with higher maternal mortality. The study aimed to investigate the mortality rate of pregnant uncorrected congenital heart disease and the impact of pulmonary hypertension severity on mortality. Methods This is the sub study of COngenital HeARt Disease in adult and Pulmonary Hypertension Registry. The data of pregnant uncorrected congenital heart disease patients were analyzed from registry database. The maternal mortality was recorded. The data of demography, clinics, obstetrics, and transthoracic echocardiography were collected. The factors that influenced maternal mortality were analyzed. A statistical significance was determined when p value < 0.05. Results From 2012 until 2017, there were 78 pregnant congenital heart disease patients. Of them, 56 patients were eligible for analyses. The majority of congenital heart disease was atrial septal defect (91.1%). The maternal mortality rate was 10.7% (6 of 56). Pulmonary hypertension occurred in 48 patients, therefore the maternal mortality rate among congenital heart disease-pulmonary hypertension with majority of atrial septal defect was 12.5% (6 of 48). Among nonsurvivors, 100% suffered from severe pulmonary hypertension as compared to survivors (56.0%), p = 0.041. Most nonsurvivors were Eisenmenger syndrome (83.3%), significantly higher compared to survivors (22.0%), p = 0.006. Nonsurvivors had significantly worsened WHO functional class, reduced right ventricle systolic function, and right heart failure. The modes of maternal death were severe oxygen desaturation (66.7%) and respiratory failure and sepsis (33.3%). Most of the maternal deaths occurred within 24 h postpartum period. Conclusion Maternal mortality rate among pregnant uncorrected congenital heart disease with majority of atrial septal defect was 10.7% and among congenital heart disease-pulmonary hypertension with majority of atrial septal defect was 12.5%. Factors related with maternal mortality were severe pulmonary hypertension, Eisenmenger syndrome, and reduced right ventricle systolic function.

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Case report of an atrial septal defect with negative transthoracic echocardiography, a diagnostic challenge in a middle-aged female with marked dyspnoea

SAGE Open Medical Case Reports ◽

10.1177/2050313x211012506 ◽

2021 ◽

Vol 9 ◽

pp. 2050313X2110125

Author(s):

Chathuri Liyanapathirana ◽

Shashika Mihirani Arthanayake ◽

Sisil Widyaratne ◽

Saman Chandana ◽

Danajani Senevirathne

Keyword(s):

Pulmonary Hypertension ◽

Atrial Septal Defect ◽

Transesophageal Echocardiography ◽

Transthoracic Echocardiography ◽

Septal Defect ◽

Abrupt Onset ◽

Secundum Atrial Septal Defect ◽

Diagnostic Challenge ◽

Chest X Ray ◽

Prone Sleeping

A 39-year-old G3P3 female presented with abrupt onset dyspnoea of one month duration. She was markedly symptomatic when lying supine and resorted to prone sleeping. Chest X-ray reported as cardiomegaly. Transthoracic echocardiography was unremarkable twice. Computed tomography chest showed a dilated pulmonary artery. Transesophageal echocardiography identified a 12-mm ostium secundum atrial septal defect with mild pulmonary hypertension. The defect was closed with a cocoon device and rendered her symptom free. This case highlights the importance of timely organization of transesophageal echocardiography when transthoracic echocardiography is negative. It also illustrates marked dyspnoea could be a presentation of undiagnosed atrial septal defect with mild pulmonary hypertension.

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Atrial septal defect with right-to-left shunt in the absence of pulmonary hypertension

Cardiology in the Young ◽

10.1017/s1047951116002754 ◽

2017 ◽

Vol 27 (3) ◽

pp. 575-576

Author(s):

Devi A. Manuel ◽

Gopal C. Ghosh ◽

Anoop G. Alex

Keyword(s):

Pulmonary Hypertension ◽

Atrial Septal Defect ◽

Septal Defect ◽

Late Onset ◽

Transoesophageal Echocardiography ◽

Right Atrial ◽

Secundum Atrial Septal Defect ◽

Eustachian Valve

AbstractWe describe the case of a 27-year-old gentleman who developed late-onset clubbing and cyanosis. Transoesophageal echocardiography revealed a 27-mm ostium secundum atrial septal defect and a large, floppy Eustachian valve directing right atrial blood to the left side of the heart.

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