scholarly journals Analysis of Remifentanil-Based Fast-Track Anesthesia Combined with Dexmedetomidine for Transthoracic Device Closure of Atrial Septal Defect in Pediatric Patients

2021 ◽  
Vol 24 (2) ◽  
pp. E233-E238
Author(s):  
Ling-shan Yu ◽  
Yu-qing Lei ◽  
Jian-feng Liu ◽  
Jing Wang ◽  
Hua Cao ◽  
...  
Keyword(s):  
Atrial Septal Defect ◽  
Fast Track ◽  
Pediatric Patients ◽  
Septal Defect ◽  
Device Closure ◽  
Pain Scores ◽  
Postoperative Intensive Care ◽  
Significant Difference ◽  
Postoperative Intensive Care Unit ◽  
Asd Closure

Background: To investigate the safety and efficacy of remifentanil combined with dexmedetomidine in fast-track cardiac anesthesia (FTCA) for transthoracic device closure of atrial septal defect (ASD) in pediatric patients. Methods: A retrospective analysis was performed on 61 cases of children undergoing ASD closure through a small thoracic incision from January 2018 to January 2020. According to whether FTCA was administered, they were divided into group F (fast-track anesthesia, n = 31) and group R (routine anesthesia, n = 30). Results: There was no significant difference in general preoperative data, perioperative hemodynamics, or postoperative pain scores between the 2 groups (P > .05). The postoperative sedation score of group F was higher than that of group R 1 and 4 hours after extubation. Meanwhile, duration of mechanical ventilation and length of postoperative intensive care unit (ICU) stay of group F were significantly shorter than those of group R (P < .05). No serious anesthesia-related complications occurred. Conclusion: Remifentanil combined with dexmedetomidine in FTCA for transthoracic device closure of ASD in pediatric patients is safe and effective, is worthy of clinical promotion, and can benefit more children.

scholarly journals Transcatheter Atrial Septal Defect Closure in Children with and without Fluoroscopy: A Comparison

2019 ◽  
Vol 2019 ◽  
pp. 1-9 ◽  
Author(s):  
S. Ackermann ◽  
D. Quandt ◽  
N. Hagenbuch ◽  
O. Niesse ◽  
M. Christmann ◽  
...  
Keyword(s):  
Atrial Septal Defect ◽  
Septal Defect ◽  
Transoesophageal Echocardiography ◽  
Device Closure ◽  
Cardiac Catheterization Laboratory ◽  
Significant Difference ◽  
Group 2 ◽  
Asd Closure ◽  
Fluoroscopy Guidance ◽  
Group 1

Objective. The aim of this study was to compare feasibility, effectiveness, safety, and outcome of atrial septal defect (ASD) device closure in children with and without fluoroscopy guidance. Methods and Results. Children undergoing transcatheter ASD closure between 2002 and 2016 were included into this single center, retrospective study. Patients were analysed in two groups [1: intraprocedural fluoroscopy ± transoesophageal echocardiography (TOE) guidance; 2: TOE guidance alone]. Three-hundred-ninety-seven children were included, 238 (97 male) in group 1 and 159 (56 male) in group 2. Two-hundred-twenty-nine of 238 (96%) patients underwent successful fluoroscopy guided ASD closures versus 154/159 (97%) successful procedures with TOE guidance alone. Median weight (IQR) at intervention was 20kg (16.0-35.0) in group 1 versus 19.3kg (16.0-31.2) in group 2. Mean (SD) preinterventional ASD diameter was 12.4mm (4.4) in group 1 versus 12.2mm (3.9) in group 2. There was no significant difference in number of defects or characteristics of ASD rims. Median procedure time was shorter in group 2 [60min (47-86) versus 34min (28-44)]. Device-size-to-defect-ratio was similar in both groups [group 1: 1.07 versus group 2: 1.09]. There were less technical intraprocedural events in group 2 [10 (6.3%) versus 47 (20%)]. Intraprocedural complications were less frequent in group 2 [1 (0.6%) versus 8 (3.3%)]. Conclusion. Transcatheter ASD device closure with TOE guidance alone (i.e., without fluoroscopy) is as effective and safe as ASD closure with fluoroscopy guidance. As fluoroscopy remains an important adjunct to transoesophageal echocardiography, especially in complex defects and complications, procedures are always performed in a fully equipped cardiac catheterization laboratory.

Acute Changes in Left Ventricular End Diastolic Pressure following the Transcatheter Closure of an Atrial Septal Defect in Adults

2016 ◽  
Vol 19 (3) ◽  
pp. 145 ◽  
Author(s):  
Young Hwa Kong ◽  
Jinyoung Song ◽  
Kyung Hee Kim ◽  
June Huh ◽  
I-Seok Kang
Keyword(s):  
Elderly Patients ◽  
Atrial Septal Defect ◽  
Septal Defect ◽  
Transcatheter Closure ◽  
Diastolic Pressure ◽  
Left Ventricular Diastolic Function ◽  
Left Ventricular ◽  
Device Closure ◽  
Acute Changes ◽  
Asd Closure

<strong>Background:</strong> Acute changes in left ventricular diastolic function shortly after ASD closure in elderly patients have not been well known. We aimed to investigate acute changes in left ventricular end diastolic pressure (LVEDP) in elderly patients following transcatheter closure of atrial septal defect (ASD). <br /><strong>Methods:</strong> All 19 adults with ASDs who underwent transcatheter closure between June 2013 and December 2014 were enrolled. LVEDP was measured prior to device closure and compared with that immediately following device closure and 15 minutes after device closure. <br /><strong>Results:</strong> The median age of the patients was 48 years old. The baseline E/e’ and LVEDP values were 8.3 ± 2.8 and 13 ± 3 mmHg. The LVEDP value immediately following closure was 19 ± 4 mmHg, and 15 minutes after closure was 16 ± 4 mmHg. The median increase in the LVEDP value immediately following closure was 6 mmHg, which significantly differed from that prior to closure. The LVEDP 15 minutes after closure decreased but remained significantly higher than the value observed immediately after closure. No significant changes were observed with regard to E/e’ at either 1 day or 3 months following closure. The LVEDP value <br />15 minutes after device closure was significantly correlated with those observed before closure and immediately following closure; however, no significant correlations were observed with regard to patient age, Qp/Qs, E/e’ before closure, or E/e’ 3 months after device closure.<br /><strong>Conclusion:</strong> LVEDP in adults with ASDs significantly increases following device closure. LVEDP before closure predicts LVEDP following device closure.

scholarly journals Right Anterolateral Thoracotomy an Alternative to Median Sternotomy for Closure of Atrial Septal Defect: A Cosmetic Approach in Young Females

2015 ◽  
Vol 12 (1) ◽  
pp. 21-25
Author(s):  
Ravi Kumar Baral ◽  
Bhagawan Koirala
Keyword(s):  
Minimally Invasive ◽  
Atrial Septal Defect ◽  
Septal Defect ◽  
Demographic Data ◽  
Median Sternotomy ◽  
Young Females ◽  
Anterolateral Thoracotomy ◽  
Significant Difference ◽  
Asd Closure ◽  
Duration Of Operation

Background and Aims: Atrial septal defect operation is a safe and low-risk procedure. Cosmetic results have been an important issue, so right anterolateral thoracotomy approach has been used for repair. We present minimally invasive ASD closure via limited right anterolateral thoracotomy, as our early experience in road of minimally invasive cardiac surgery. Methods: This study was done in the Manmohan Cardiothoracic and Transplant Center in the time period of 2012 to 2013. The study included 70 patients aged 15 – 35 years old (22.1±5.5) admitted for surgical repair of their secundum atrial septal defects. The patients were randomly allocated into one of two groups according to the approach used in their operation. Right anterolateral thoracotomy(RALT) group included 35 patients operated via right anterolateral thoracotomy.and median sternotomy(MS) group included 35 patients operated via the median sternotomy. Result: Of 70 patients only 63 patients meet the criteria for analysis. There was no statistically significant difference between the 2 groups regarding their demographic data and duration of operation. Postoperative pleural/pericardial effusion and pneumothorax occurred in 2.1% of patients in MS and 6.6% in Right anterolateral thoracotomygroup (p= 0.001). Total in hospital pain score was high in sternotomy group than thoracotomy group, but did not reach statistically significant values. There was no operative or late mortality or morbidity in the early follow-up (range, 1 m to 2 years, mean 1.34 yrs). Conclusion: RALT is a safe and effective alternative approach to MS incision for ASD closure. DOI: http://dx.doi.org/10.3126/njh.v12i1.12340 Nepalese Heart Journal Vol.12(1) 2015: 21-25

Echocardiographic Evaluation of Changes in Cardiac Hemodynamics, Loading Conditions, and Atrial Function after Transcatheter Closure of Atrial Septal Defect

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohamed Abdelfattah Shoeir ◽  
Ghada Elshahed ◽  
Yasmin Abdelrazek Esmail ◽  
Dina Adel Ezz Eldin
Keyword(s):  
Atrial Septal Defect ◽  
Strain Rate ◽  
Septal Defect ◽  
Atrial Function ◽  
Loading Conditions ◽  
Systolic Strain ◽  
Peak Systolic Strain ◽  
Strain And Strain Rate ◽  
Significant Difference ◽  
Asd Closure

Abstract Background The changes in loading conditions, atrial function, and the different echocardiographic parameters before and after transcatheter atrial septal defect (ASD) closure are still under study. So we felt the need to evaluate the echocardiographic changes that occur and detect the timing after closure at which the right-sided heart hemodynamics, and measurements are back to normal. Objectives To evaluate the changes in cardiac hemodynamics, loading conditions, and atrial function after percutaneous closure of ASD using echocardiography. Patients and Methods The study included 30 patients referred to percutaneous closure of ASD in Ain Shams University hospital we performed echocardiography before, 1 week, and 3 months after closure. Results The study showed that RV dimensions and volumes decreased significantly 1 week, and 3 months after ASD closure (p &lt; 0.001). RA dimensions and volumes decreased significantly 1 week, and 3 months after ASD closure (p &lt; 0.001). RA peak systolic strain, and strain rate increased significantly 1 week, and 3 months after ASD closure (p &lt; 0.001). LA dimensions and volumes increased significantly 1 week, and 3 months after ASD closure (P &lt; 0.001). LA peak systolic strain showed no significant difference before, 1week, and 3 months after ASD closure (P = 0.063), and strain rate showed no significant difference before, 1week, and 3 months after ASD closure (P = 0.207). Conclusion In our study, we have concluded that RV dimensions and volumes decreased significantly 1 week, and 3 months after ASD closure. RA dimensions and volumes decreased significantly 1 week, and 3 months after ASD closure. RA peak systolic strain, and strain rate increased significantly 1 week, and 3 months after ASD closure, as a result of improvement of the RA wall velocity, due to relief of the volume overload after closure of the shunt. LA peak systolic strain, and strain rate showed no significant difference before, 1week, and 3 months after ASD closure. Abbreviations list ASD (atrial septal defect), RV (right ventricle), RA (right atrium), LA (left atrium).

Percutaneous device closure of atrial septal defect and patent foramen ovale

2010 ◽  
pp. 632-652
Author(s):  
Patrick A. Calvert ◽  
Bushra S. Rana ◽  
David Hildick-Smith
Keyword(s):  
Atrial Septal Defect ◽  
Patent Foramen Ovale ◽  
Septal Defect ◽  
Interventional Procedure ◽  
Structural Heart Disease ◽  
Foramen Ovale ◽  
Device Closure ◽  
The United Kingdom ◽  
Clinical Benefits ◽  
Asd Closure

Structural heart disease interventions look set to form an increasing proportion of the interventional cardiologist’s workload. Device closure of atrial septal connections, both patent foramen ovale (PFO) and atrial septal defect (ASD), are the most commonly performed adult structural interventional procedure in the United Kingdom, with 793 PFO and 573 ASD closure procedures performed in adults in 2007. Device closure of ASDs and PFOs are elegant procedures which combine technical and imaging skills with a detailed understanding of cardiac anatomy. More importantly, they also provide tangible clinical benefits to patients.

P4358The role of the “halo sign” for the accurate quantification of atrial septal defect size by 3D TEE

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C Aggeli ◽  
I Dimitroglou ◽  
S Kastellanos ◽  
M Drakopoulou ◽  
K Moldovan ◽  
...  
Keyword(s):  
Atrial Septal Defect ◽  
Septal Defect ◽  
Transoesophageal Echocardiography ◽  
Closure Device ◽  
Halo Sign ◽  
Complex Anatomy ◽  
Significant Difference ◽  
Study Population ◽  
Asd Closure ◽  
Device Size

Abstract Introduction In patients undergoing percutaneous closure of secundum atrial septal defect (ASD), device selection is based on defect sizing by transoesophageal echocardiography (TEE) and in particular 3D measurement as well as 2D balloon-stretched derived measurements. We sought to investigate whether in patients with the presence of the “halo sign”, defined as increased tissue thickness at the edge of the ASD rims, there is an agreement between the aforementioned sizing methods with a view to avoid balloon sizing. Methods Consecutive patients referred to our department for single ASD closure without complex anatomy were included in our study. TEE was performed in all patients before and during the intervention. 3D datasets for ASD quantification as well as X-PLANE data sets for measurement of balloon-stretched 2D dimensions were acquired and analysed offline. During the analysis of 3D datasets, researchers were blinded to the 2D balloon-stretched measurements. Patients were stratified according to the presence of the halo sign and the correlation between 3D dimensions and balloon-derived diameter was calculated. Results Thirty-eight patients (14 males, 36.8%) with median age 46 [32–56] were included in our study. The “halo sign” was present in 16 patients (42.1%). In the whole study population, the median maximal and median minimal diameter measured by 3D TEE were 1.79cm [1.54–2.10] and 1.57cm [1.15–2.00] respectively while median circumference and area were 5.26cm [4.14–6.44] and 2.20cm2 [1.25–3.30] respectively. Median balloon-stretched diameter was 1.8cm [1.4–2.1]. In patients with the “halo sign” there was no significant difference between the medians of the ASD diameter calculated from 3D measurements and the 2D derived diameter (1.53cm; 1.6cm, p=0.170) whereas in patients with no “halo sign” there was significant difference (1.79cm; 2.0cm, p=0.001) (figure 1). The discrepancy between the aforementioned diameters was significantly lower in patients with the halo sign (0.04cm; 0.19cm, p=0.001). There was a good correlation between closure device size and 3D derived ASD circumference in the whole study population (R2=0.897) which was even higher in patients with the halo sign (R2=0.981). In this subgroup, the selected size of the closure device would not have differed significantly even without balloon sizing (p=0.414). Figure 1 Conclusion The ASD sizing by 3D echocardiography is accurate in patients with the “halo sign”. This study justifies further investigation concerning the reliability of 3D imaging in this population for the selection of the ASD device size with a view to avoid balloon sizing, decrease procedural time and thus simplify the procedure.

Percutaneous device closure of atrial septal defect and patent foramen ovale

2018 ◽  
pp. 641-656
Author(s):  
Patrick A. Calvert ◽  
Bushra S. Rana ◽  
Roland Hilling-Smith ◽  
David Hildick-Smith
Keyword(s):  
Atrial Septal Defect ◽  
Patent Foramen Ovale ◽  
Septal Defect ◽  
Structural Heart Disease ◽  
Foramen Ovale ◽  
Device Closure ◽  
Percutaneous Device ◽  
Clinical Benefits ◽  
Asd Closure ◽  
The Uk

Structural heart disease interventions look set to form an increasing proportion of the interventional cardiologist’s workload. Device closure of atrial septal connections, both patent foramen ovale (PFO) and atrial septal defect (ASD), are the most commonly performed adult structural interventional procedures in the UK, with 428 PFO and 545 ASD closure procedures performed in adults in 2014. Device closure of ASDs and PFOs are elegant procedures which combine technical and imaging skills with a detailed understanding of cardiac anatomy. More importantly, they also provide tangible clinical benefits to patients.

scholarly journals Right Anterolateral Thoracotomy an Alternative to Median Sternotomy for Closure of Atrial Septal Defect: A Cosmetic Approach in Young Females

2015 ◽  
Vol 12 (1) ◽  
Author(s):  
Ravi Kumar Baral ◽  
Bhagawan Koirala
Keyword(s):  
Minimally Invasive ◽  
Atrial Septal Defect ◽  
Septal Defect ◽  
Demographic Data ◽  
Median Sternotomy ◽  
Young Females ◽  
Anterolateral Thoracotomy ◽  
Significant Difference ◽  
Asd Closure ◽  
Duration Of Operation

Background and Aims: Atrial septal defect operation is a safe and low-risk procedure. Cosmetic results have been an important issue, so right anterolateral thoracotomy approach has been used for repair. We present minimally invasive ASD closure via limited right anterolateral thoracotomy, as our early experience in road of minimally invasive cardiac surgery. Methods: This study was done in the Manmohan Cardiothoracic and Transplant Center in the time period of 2012 to 2013. The study included 70 patients aged 15 – 35 years old (22.1±5.5) admitted for surgical repair of their secundum atrial septal defects. The patients were randomly allocated into one of two groups according to the approach used in their operation. Right anterolateral thoracotomy(RALT) group included 35 patients operated via right anterolateral thoracotomy.and median sternotomy(MS) group included 35 patients operated via the median sternotomy. Result: Of 70 patients only 63 patients meet the criteria for analysis. There was no statistically significant difference between the 2 groups regarding their demographic data and duration of operation. Postoperative pleural/pericardial effusion and pneumothorax occurred in 2.1% of patients in MS and 6.6% in Right anterolateral thoracotomygroup (p= 0.001). Total in hospital pain score was high in sternotomy group than thoracotomy group, but did not reach statistically significant values. There was no operative or late mortality or morbidity in the early follow-up (range, 1 m to 2 years, mean 1.34 yrs). Conclusion: RALT is a safe and effective alternative approach to MS incision for ASD closure.Nepalese Heart Journal | Jan 2015 | Volume 12 | No.1Page : 21-25

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