scholarly journals Tricuspid Regurgitation in Ostium Secundum Atrial Septal Defects: Repair or Not?

2020 ◽  
Vol 23 (2) ◽  
pp. E239-E244 ◽  
Author(s):  
Chirag Sumithra Prasanna Kumar ◽  
Bineesh K Radhakrishnan ◽  
Remya Sudevan ◽  
Jayakumar Karunakaran
Keyword(s):  
Atrial Septal Defect ◽  
Tricuspid Regurgitation ◽  
Septal Defect ◽  
Pulmonary Artery Hypertension ◽  
Tricuspid Valve Repair ◽  
Secundum Atrial Septal Defect ◽  
Atrial Septal Defect Closure ◽  
Septal Defects ◽  
Atrial Septal Defects ◽  
Functional Tricuspid Regurgitation

Background: Longstanding ostium secundum atrial septal defects lead to functional tricuspid regurgitation. Significant functional tricuspid regurgitation associated with left heart valve disease is addressed at the time of primary left heart valve surgery. In contrast, there is no global recommendation for tricuspid regurgitation associated with atrial septal defects. This study assesses changes in tricuspid regurgitation after isolated atrial septal defect closure. Methods: Retrospectively, records were examined of 100 patients who underwent isolated ostium secundum atrial septal defect closure without tricuspid valve repair. Echocardiograms were done preoperatively and 3 days, 3 months, and 1 year after surgery. Data on tricuspid regurgitation status, right ventricle dimensions, and pulmonary artery hypertension status were collected and analyzed. Results: After surgical closure, echocardiography showed a regression of tricuspid regurgitation to mild or less in 76% of patients at 3 days, 89% at 3 months, and 93% at 1 year. Severe pulmonary artery hypertension (32% patients preoperatively) showed statistically significant regression: 14% at 3 days, 10% at 3 months, and 2% at 1 year. Preoperatively, the mean right ventricular internal diameter was 37.9 mm, which decreased to 34 ± 5.5 mm (mean ± standard deviation) at 3 days, 32.3 ± 5.3 mm at 3 months, and 31.3 ± 5.4 mm at 1 year. It was also noted that regression favored patients who were <25 years old. Conclusion: Tricuspid valve repair may not be required in patients with ostium secundum atrial septal defect with functional tricuspid regurgitation.

scholarly journals Predictive Model for Secundum Atrial Septal Defect Closure with Pulmonary Artery Hypertension in Adult: When to Close

2018 ◽  
Vol 21 (2) ◽  
pp. 108
Author(s):  
Supomo Supomo ◽  
Adika Zhulhi Arjana ◽  
Handy Darmawan
Keyword(s):  
Pulmonary Artery ◽  
Atrial Septal Defect ◽  
Predictive Model ◽  
Multiple Regression ◽  
Septal Defect ◽  
Pulmonary Artery Hypertension ◽  
Defect Closure ◽  
Secundum Atrial Septal Defect ◽  
Atrial Septal Defect Closure ◽  
Significant Difference

Background: Secundum atrial septal defect (SASD) closure is contraindicated in the presence of severe pulmonary artery hypertension (PAH). However, there is no consensus on the threshold of severe PAH, in terms of mean pulmonary artery pressure (mPAP), which would contraindicate for defect closure surgery in adults. Furthermore, PAH can persist, or even increase in severity, after the closure. The aim of this study was to produce a predictive model correlating mPAP in adult SASD patients with PAH after defect closure surgery. Methods: Between January 2014 and March 2017, 29 consecutive adult SASD patients who had PAH and underwent defect closure surgery were included in the study. Age, right atrium (RA) dimension, right ventricle (RV) dimension, and mPAP before surgery were analyzed using multiple regression to produce the model.Results: Multiple regression produced the following model: mPAP prediction = (0.24)(Age) + (0.06)(mPAP before surgery) + (0.17)(RA dimension) + (0.47)(RV dimension) – 13.79 (P = .0008). The mPAP prediction was compared to mPAP of the patients six to nine months after surgery, and showed no significant difference (P = .9562). Conclusion: In adult SASD patients with PAH, our model can significantly predict the mPAP after the closure. If the predicted mPAP is within its normal range, the closure is indicated.

Adverse events within 1 year after surgical and percutaneous closure of atrial septal defects in preterm children

2019 ◽  
Vol 29 (5) ◽  
pp. 626-636 ◽  
Author(s):  
Gustaf Tanghöj ◽  
Petru Liuba ◽  
Gunnar Sjöberg ◽  
Annika Rydberg ◽  
Estelle Naumburg
Keyword(s):  
Adverse Events ◽  
Atrial Septal Defect ◽  
Septal Defect ◽  
Survival Curve ◽  
Percutaneous Closure ◽  
Defect Closure ◽  
Atrial Septal Defect Closure ◽  
Preterm Children ◽  
Septal Defects ◽  
Atrial Septal Defects

AbstractIntroduction:Atrial septal defect is the third most common CHD. A hemodynamically significant atrial septal defect causes volume overload of the right side of the heart. Preterm children may suffer from both pulmonary and cardiac comorbidities, including altered myocardial function. The aim of this study was to compare the rate of adverse events following atrial septal defect closure in preterm- and term-born children.Method:We performed a retrospective cohort study including children born in Sweden, who had a surgical or percutaneous atrial septal defect closure at the children’s hospitals in Lund and Stockholm, between 2000 and 2014, assessing time to the first event within 1 month or 1 year. We analysed differences in the number of and the time to events between the preterm and term cohort using the Kaplan–Meier survival curve, a generalised model applying zero-inflated Poisson distribution and Gary-Anderson’s method.Results:Overall, 413 children were included in the study. Of these, 93 (22.5%) were born prematurely. The total number of adverse events was 178 (110 minor and 68 major). There was no difference between the cohorts in the number of events, whether within 1 month or within a year, between major (p = 0.69) and minor (p = 0.84) events or frequencies of multiple events (p = 0.92).Conclusion:Despite earlier procedural age, larger atrial septal defects, and higher comorbidity than term children, preterm children appear to have comparable risk for complications during the first year after surgical or percutaneous closure.

Effects of reducing frame rate from 7.5 to 4 frames per second on radiation exposure in transcatheter atrial septal defect closure

2018 ◽  
Vol 28 (11) ◽  
pp. 1323-1328 ◽  
Author(s):  
Younes Boudjemline
Keyword(s):  
Atrial Septal Defect ◽  
Radiation Exposure ◽  
Septal Defect ◽  
Frame Rate ◽  
Atrial Septal Defect Closure ◽  
Dose Area Product ◽  
Air Kerma ◽  
Septal Defects ◽  
Atrial Septal Defects ◽  
Area Product

AbstractObjectivesThe aim of this study was to evaluate the reduction of frame rate from 7.5 to 4 frames per second on radiation exposure and to provide new standards of radiation exposure.BackgroundFrame rate is a large contributor to radiation exposure. The use of 4 frames per second for closure of atrial septal defects has been reported not to affect the level of radiation exposure.MethodsWe retrospectively reviewed radiation data from all patients referred to our catheterisation laboratory for closure of an atrial septal defect between January, 2015 and June, 2017. Fluoroscopic time, dose area product (μGy.m2), and total air kerma (mGy) were collected. These values were compared according to the frame rate used for closure of atrial septal defects.ResultsA total of 49 atrial septal defects were closed using 7.5 frames per second and 85 using 4 frames per second. Baseline characteristics were similar in both groups. Procedural success was similar in both groups (100 versus 98.8%). Median total air kerma and dose area product were statistically lower in the 4 frames per second group (4 versus 1.3 mGy [p=0.00012]), 43.7 versus 13.1 μGy.m2 [p<0.00001]). There was no increase in median procedure and fluoroscopic times (respectively, 10 and 1.1 min for 7.5 and 4 frames per second), or complications (4.1 versus 2.3%, p>0.05).ConclusionReduction of frame rate allows reducing significantly the radiation exposure while maintaining excellent clinical results in transcatheter closure of atrial septal defects. We recommend implementing this little change in every laboratory in order to achieve drastic reduction of radiation exposure to the patients and laboratory personnel.

Percutaneous management of coronary sinus atrial septal defect: two cases representing the spectrum for device closure and a review of the literature

2014 ◽  
Vol 24 (5) ◽  
pp. 797-806 ◽  
Author(s):  
Nefthi Sandeep ◽  
Michael C. Slack
Keyword(s):  
Atrial Septal Defect ◽  
Coronary Sinus ◽  
Septal Defect ◽  
Case Reports ◽  
Device Closure ◽  
Atrial Septal Defect Closure ◽  
Septal Defects ◽  
Atrial Septal Defects ◽  
Percutaneous Device ◽  
Percutaneous Device Closure

AbstractCoronary sinus atrial septal defects are the rarest defects of the atrial septum comprising <1% of the five different types of atrial septal defects. Despite the widespread adoption of percutaneous device closure of secundum atrial septal defects, the published experience with percutaneous device closure of coronary sinus atrial septal defects is limited to only a few isolated case reports because of uncertainty regarding safety and efficacy. Open-heart surgical repair remains the treatment of choice for coronary sinus atrial septal defects, although this may not be the only treatment option in selected cases. Herein we describe our own experience with two patients with different clinical presentations and our method of successful percutaneous coronary sinus atrial septal defect closure in each. We then present a review of the anatomic spectrum of coronary sinus atrial septal defects along with a review of contemporary surgical and percutaneous device treatment.

Incidence and Causes of 30-day Readmissions after Surgical Versus Percutaneous Secundum Atrial Septal Defect Closure: A United States Nationwide Analysis

2019 ◽  
Vol 3 (2) ◽  
pp. 113-120
Author(s):  
Mohammad K. Mojadidi ◽  
Ahmed N. Mahmoud ◽  
Dhruv Mahtta ◽  
Muhammad O. Zaman ◽  
Islam Y. Elgendy ◽  
...  
Keyword(s):  
United States ◽  
Atrial Septal Defect ◽  
Septal Defect ◽  
Defect Closure ◽  
Secundum Atrial Septal Defect ◽  
Atrial Septal Defect Closure

scholarly journals The role of three-dimensional transesophageal echocardiography in preoperative assessment of atrial septal defects

2015 ◽  
Vol 18 (1) ◽  
pp. 58 ◽  
Author(s):  
D. G. Tarasov ◽  
I. V. Tkachev ◽  
S. S. Kadrabulatova
Keyword(s):  
Atrial Septal Defect ◽  
Transesophageal Echocardiography ◽  
Septal Defect ◽  
Preoperative Evaluation ◽  
Three Dimensional ◽  
Maximum Diameter ◽  
Septal Defects ◽  
Atrial Septal Defects ◽  
Dimensional Echocardiography ◽  
Three Dimensional Echocardiography

An atrial septal defect is the most common congenital heart disease. Transcatheter defect closure has become widespread in recent times and the requirements for this procedure are rather strict. Two-dimensional echocardiography is limited in evaluating atrial septal defects because it provides planar images only. In order to preoperatively assess atrial septal defects, we applied three-dimensional transesophageal echocardiography and then compared the results with those of surgical operations. The maximum diameter, shape, area and localization of the atrial septal defect in 26 patients were estimated with three-dimensional echocardiography. It was found out that positive correlation existed between three-dimensional echocardiography findings and those measured during surgery. Three-dimensional echocardiography provides invaluable assistance in preoperative evaluation of atrial septal defects and in selection of treatment.

Closure of a secundum atrial septal defect in two infants with chronic lung disease using the Gore HELEX Septal Occluder

2015 ◽  
Vol 26 (1) ◽  
pp. 79-83 ◽  
Author(s):  
Matt E. Zussman ◽  
Grace Freire ◽  
Shawn D. Cupp ◽  
Gary E. Stapleton
Keyword(s):  
Atrial Septal Defect ◽  
Lung Disease ◽  
Premature Infants ◽  
Chronic Lung Disease ◽  
Septal Defect ◽  
Right Atrial ◽  
Secundum Atrial Septal Defect ◽  
Atrial Septal Defect Closure ◽  
Significant Clinical Improvement ◽  
Helex Septal Occluder

AbstractChildren with a secundum atrial septal defect are usually asymptomatic and are referred for elective closure after 3–4 years of age; however, in premature infants with chronic lung disease, bronchopulmonary dysplasia, or pulmonary hypertension, increased pulmonary blood flow secondary to a left-to-right atrial shunt, may exacerbate their condition. Closure of the atrial septal defect in these patients can result in significant clinical improvement. We report the cases of two premature infants with chronic lung disease, who underwent atrial septal defect closure with the Gore HELEX Septal Occluder and discuss the technical aspects of using the device in these patients and their clinical outcomes.

Transcatheter closure as standard treatment for most interatrial defects: experience in 200 patients treated with the Amplatzer ™ Septal Occluder

1999 ◽  
Vol 9 (5) ◽  
pp. 468-473 ◽  
Author(s):  
Felix Berger ◽  
Peter Ewert ◽  
Per G. Boöjrnstad ◽  
Ingo Dähnert ◽  
Gregor Krings ◽  
...  
Keyword(s):  
Atrial Septal Defect ◽  
Septal Defect ◽  
Transcatheter Closure ◽  
Paradoxical Embolism ◽  
Residual Shunt ◽  
Septal Defects ◽  
Atrial Septal Defects ◽  
Diagnostic Cardiac Catheterization ◽  
Long Term Follow Up

AbstractTo judge whether an Amplatzer™ Septal Occluder can be used as standard therapy instead of surgery for closure of atrial septal defects we report our experiences in 200 patients. Of these patients, 127 had an atrial septal defect with haemodynamically significant left-to-right shunt, 68 patients a persistent oval foramen after presumed paradoxical embolism, and 5 had a fenestration after Fontan-repair. Mean age was 29.8 years (0.8 to 77.7 years). Body weight ranged from 6.9 to 120.0 kg (mean 51.5 kg). After diagnostic cardiac catheterization, and balloon-sizing of the defect, we implanted Amplatzer™ Septal Occluders with stents of 4 to 28 mm diameter. Follow-up studies were obtained after 48hours, and one, six, and twelve months. Transcatheter closure of the atrial septal defect proved successful in all without any relevant residual shunts. In particular, complete closure was achieved in all patients after presumed paradoxical embolism. The mean period of follow-up is 9–5 months, with a range from 0.4 to 23.5 months, giving a total of 1898 patient months. The occlusion rate after three month was 98.1°. A trivial haemodynamically insignificant residual shunt remained in 1.9° of the patients. Fluoroscopy times ranged from 0 to 43.5 minutes, with a median of 8.7 minutes. The excellent results in the short and medium term in children and adults have resulted in using this device routinely at the present time for closure of central atrial septal defects up to a diameter of 28 mm. Final judgement, however, is only possible after long-term follow-up.

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