scholarly journals Atrial septal defect patients with greater shunts show susceptibility for ventricular arrhythmias

2020 ◽  
Vol 4 (Issue 3) ◽  
Author(s):  
Osman Can Yontar
Keyword(s):  
Ventricular Arrhythmia ◽  
Atrial Septal Defect ◽  
Septal Defect ◽  
Ventricular Repolarization ◽  
Systolic Pulmonary Artery Pressure ◽  
T Wave ◽  
Dispersion Of Repolarization ◽  
Increased Risk ◽  
Shunt Group ◽  
Ventricular Arrhythmogenesis

Objective: Ventricular arrhythmia episodes are not infrequent in patients with atrial septal defect (ASD). Disturbance in cardiac volume and pressures may lead to enlargement and fibrosis in heart. An interatrial volume displacement through septal defect, briefly interatrial shunt, is the major reason for this complication. Prolongation of the interval between the peak and end of the T wave (Tpeak to Tend, Tp-e) on the 12-lead electrocardiogram (ECG), is utilized as a marker of ventricular arrhythmogenesis during last years. The aim of this study was to assess if there is an impact of shunt ratio on ventricular repolarization in patients with ASD by using Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio. Methods: Patient records of Samsun Training and Research Hospital were retrospectively analyzed. Electrocardiograms of 133 patients, who were diagnosed as ASD between January 2016 and December 2019 were obtained and scanned. ECG intervals were measured. Shunt ratios, right ventricle diameters and volumes were also acquired. Patients were grouped into two by their calculated shunt ratio, ratio of ≥2.0 is accepted as a high shunt group and <2.0 as a low shunt group. Results: Both groups’ baseline characteristics were similar. Right ventricular dimensions and systolic pulmonary artery pressure were higher in high shunt group. Furthermore, ASD patients with higher shunt ratio had significantly higher ECG measurements than controls, Tp-e: 103.0 (22.1) vs 76.2 (10.2); Tp-e/QT: 0.25 (0.03) vs 0.21 (0.02); Tp-e/QTc: 0.22 (0.03)  vs, 0.17 (0.02); for all p<0.001). Of all ECG parameters; Tp-e (r=0.631, p<0.001), Tp-e/QT (r=0.531, p<0.001) and Tp-e/QTc (r=0.614, p<0.001) had moderate correlation with shunt ratio. Conclusion: T wave peak-to-end interval is a measure of transmural dispersion of repolarization and accepted as a surrogate for increased ventricular arrhythmogenesis risk. Our findings show that ASD patients whose shunt ratio are ≥2.0 show increased risk for arrhythmias. Key words: atrial septal defect, electrocardiogram, ventricular arrhythmia, risk, ventricular repolarization

Atrial septal aneurysms in childhood: prevalence, classification, and concurrent abnormalities

2013 ◽  
Vol 24 (3) ◽  
pp. 453-458 ◽  
Author(s):  
Andreas Giannopoulos ◽  
Christoforos Gavras ◽  
Stavroula Sarioglou ◽  
Fotini Agathagelou ◽  
Irene Kassapoglou ◽  
...  
Keyword(s):  
Atrial Septal Defect ◽  
Patent Foramen Ovale ◽  
Septal Defect ◽  
Interatrial Septum ◽  
Paediatric Population ◽  
Point Of View ◽  
Atrial Septal Aneurysm ◽  
Foramen Ovale ◽  
Increased Risk

AbstractObjectives: This study sought to investigate the prevalence of atrial septal aneurysms in the paediatric population and to define coexisting abnormalities and their incidence. Background: Few papers refer to the prevalence of atrial septal aneurysms in childhood. Methods: We enrolled a total of 4522 children aged more than 12 months who underwent a transthoracic echocardiography. Atrial septal aneurysm was defined as a protrusion of the interatrial septum or part of it >15 mm beyond the plane of the atrial septum or phasic excursion of the interatrial septum during the cardiorespiratory cycle of at least 15 mm in total amplitude and a diameter of the base of the aneurysm of at least 15 mm. Results: Atrial septal aneurysms were found in 47 children (1.04%). They involved almost the entire septum in 14 patients (28.89%) and were limited to the fossa ovalis in 33 (71.11%). An atrial septal aneurysm was an isolated structural defect in 17 (35.56%). In 30 (64.44%) patients, it was associated with interatrial shunting – atrial septal defect and patent foramen ovale. At the echo follow-up after a year, no changes were recorded. Conclusions: Prevalence of atrial septal aneurysms is almost 1%. The most common abnormalities associated are interatrial shunts, that is, a patent foramen ovale and an atrial septal defect. From a medical point of view, it is suggested that no action is to be taken during childhood, as a child with an atrial septal aneurysm is not at increased risk compared with a child without one. Follow-up is scheduled on an individual basis.

Analysis of T wave changes by activation recovery interval in patients with atrial septal defect

2000 ◽  
Vol 74 (2-3) ◽  
pp. 115-124 ◽  
Author(s):  
Naomi Izumida ◽  
Yuh Asano ◽  
Hiroko Wakimoto ◽  
Mitsunori Nishiyama ◽  
Shouzaburoh Doi ◽  
...  
Keyword(s):  
Atrial Septal Defect ◽  
Septal Defect ◽  
Recovery Interval ◽  
T Wave

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.

Association ofCx43rs2071166 polymorphism with an increased risk for atrial septal defect

2017 ◽  
Vol 28 (3) ◽  
pp. 397-402 ◽  
Author(s):  
Ruoyi Gu ◽  
Wei Sheng ◽  
Xiaojing Ma ◽  
Guoying Huang
Keyword(s):  
Confidence Interval ◽  
Atrial Septal Defect ◽  
Odds Ratio ◽  
Septal Defect ◽  
Healthy Controls ◽  
Nucleotide Polymorphism ◽  
Chain Reaction ◽  
Single Nucleotide ◽  
Increased Risk ◽  
Polymerase Chain

AbstractAtrial septal defect is one of the most common CHD. The pathogenesis of atrial septal defect still remains unknown.Cx43is the most prevalent connexin in the mammalian heart during development. Its genetic variants can cause several CHD. The aim of our study was to investigate the association of genetic variations of theCx43with sporadic atrial septal defect. A total of 450 paediatric patients were recruited, including 150 cases with atrial septal defect and 300 healthy controls. The promoter region ofCx43was analysed by sequencing after polymerase chain reaction. All data were analysed by using the Statistic Package for Social Science 19.0 software. The frequency of the single nucleotide polymorphism rs2071166 was significantly higher in atrial septal defect cases than in healthy controls. The CC genotype at rs2071166 site inCx43was correlated with an increased risk for atrial septal defect (p<0.0001, odds ratio=3.891, 95% confidence interval 1.948–7.772) and the C allele was positively correlated with atrial septal defect (p=0.007, odds ratio=1.567, 95% confidence interval 1.129–2.175). In conclusion, our results confirmed that rs2071166 inCx43may be relevant with an increased atrial septal defect risk.

Association between polymorphisms inIL27and risk for CHD in a Chinese population

2015 ◽  
Vol 26 (2) ◽  
pp. 237-243 ◽  
Author(s):  
Danyan Zhang ◽  
Mingfu Ma ◽  
Yuyou Yang ◽  
Ling Wan ◽  
Zhixi Yang ◽  
...  
Keyword(s):  
Ventricular Septal Defect ◽  
Atrial Septal Defect ◽  
Chinese Population ◽  
Septal Defect ◽  
Fragment Length Polymorphism ◽  
Chd Risk ◽  
Increased Risk ◽  
Polymerase Chain ◽  
Maternal Tolerance ◽  
Control Study

AbstractBackgroundIL-27, a member of the IL-12 family, has been involved in maternal tolerance to the foetus and successful pregnancy. Growing evidences indicate that IL-27 plays a crucial role in pregnancy.AimWe carried out the present study in order to investigate whether polymorphisms in theIL27are associated with the risk for CHDs, including atrial septal defect and ventricular septal defect.Patients and methodsWe conducted this case–control study among 247 atrial septal defect patients, 150 ventricular septal defect patients, and 368 healthy controls in a Chinese population using polymerase chain reaction-restriction fragment length polymorphism assay.ResultsSignificantly increased risk for atrial septal defect (p=0.001, OR=1.490, 95% CI=1.178–1.887) and ventricular septal defect (p=0.004, OR=1.502, 95% CI=1.139–1.976) was observed to be associated with the allele G of rs153109. In a dominant model, we have also observed that increased susceptibilities for atrial septal defect (p<0.01, OR=1.89, 95% CI=1.35–2.63) and ventricular septal defect (p<0.01, OR=2.50, 95% CI=1.67–3.85) were statistically associated with rs153109; however, no association was found between CHD risk and rs17855750 in theIL27gene.ConclusionThe 153109 of theIL27gene may be associated with the susceptibility to CHD, including atrial septal defect and ventricular septal defect.

scholarly journals Pregnancy outcome in women with atrial septal defect: associated with in vitro fertilisation and pre-eclampsia

Open Heart ◽  
2019 ◽  
Vol 6 (2) ◽  
pp. e001148
Author(s):  
Sebastian Udholm ◽  
Louise Udholm ◽  
Camilla Nyboe ◽  
Ulrik Schiøler Kesmodel ◽  
Vibeke Elisabeth Hjortdal
Keyword(s):  
Atrial Septal Defect ◽  
Septal Defect ◽  
Reference Group ◽  
Reference Sample ◽  
Perinatal Outcomes ◽  
Population Based ◽  
In Vitro Fertilisation ◽  
Maternal Characteristics ◽  
Increased Risk

ObjectiveTo investigate in vitro fertilisation (IVF) in women with atrial septal defect (ASD), and to examine the maternal characteristics and outcome of pregnancy, as well as the fetal outcome of infants born by women with ASD.MethodsWe used population-based registries in this nationwide cohort study, including Danish individuals born before 1994 who received an ASD diagnosis between 1959 and 2014. Patients were compared with a random reference sample (ratio of 10 citizens per patient) matched by sex and age. The Danish Medical Birth Register (DMBR) contains data on all pregnancies and births in Denmark from 1977 to present. Risk of IVF treatment as well as maternal, pregnancy and fetal outcomes were compared.ResultsA total of 2277 Danish patients had a validated ASD diagnosis. Of these, 310 women were identified in the DMBR. Women with ASD had an increased risk of receiving IVF treatment (HR 3.14, 95% CI 2.1 to 4.7, p<0.0001), and a higher proportion of patients received IVF treatment when compared with the reference cohort (10.6% vs 3.2%; p<0.001). Furthermore, patients had more multiple births. Looking at singleton pregnancies (n=519), pre-eclampsia occurred more frequently in patients with ASD during pregnancy (6.7% vs 2.3%; p<0.001). Infants from mothers with ASD were found to have perinatal outcomes comparable to those of infants from the reference group.ConclusionWomen with ASD had an increased risk of and received more IVF treatment than the reference group. The outcome of pregnancy in these patients were generally uneventful, however, we did confirm that pre-eclampsia occurred more frequently.

Left atrial pressure is associated with iatrogenic atrial septal defect after mitral valve clip

Heart ◽  
2018 ◽  
Vol 105 (11) ◽  
pp. 864-872 ◽  
Author(s):  
Hiroki Ikenaga ◽  
Atsushi Hayashi ◽  
Takafumi Nagaura ◽  
Satoshi Yamaguchi ◽  
Jun Yoshida ◽  
...  
Keyword(s):  
New York ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Atrial Septal Defect ◽  
Septal Defect ◽  
Heart Association ◽  
Functional Class ◽  
Systolic Pulmonary Artery Pressure ◽  
New York Heart Association ◽  
Iatrogenic Atrial Septal Defect

ObjectivesMitral valve (MV) clip procedure requires interatrial trans-septal puncture to access the left atrium (LA). Iatrogenic atrial septal defect (iASD) is not uncommon and may remain for a while. However, haemodynamic and echocardiographic determinants of persistent iASD are not well investigated. We sought to find haemodynamic and echocardiographic determinants of iASD after MV clip.MethodsA total of 131 patients with grades 3 to 4+ mitral regurgitation who underwent MitraClip and completed invasive haemodynamic measurement, baseline, 1 month and approximately 12 months of transthoracic echocardiography (TTE) follow-up were retrospectively reviewed.ResultsTTE at 1 month showed persistent iASD in 57% (1M-iASD). Mean LA pressure after clip was significantly higher in patients with 1M-iASD than patients without 1M-iASD (17±6 mm Hg vs 15±5 mm Hg, p=0.01). Among patients with 1M-iASD, 24 patients (35%) had persistent iASD at 12 months (12M-iASD). Mean LA pressure after clip was significantly higher in patients with 12M-iASD than patients without 12M-iASD (19±6 mm Hg vs 16±6 mm Hg, p=0.04). Patients with 12M-iASD did not significantly differ from patients without 12M-iASD in terms of right heart enlargement, estimated systolic pulmonary artery pressure, New York Heart Association functional class and brain natriuretic peptide at 12 months. Logistic regression analysis, however, showed that mean LA pressure after clip was significantly associated with persistent iASD at 12 months in patients with 1M-iASD even after adjustment for cardiac index after clip and the prevalence of mitral regurgitation ≥3+ at 12 months (OR 1.10 per 1 mm Hg, 95% CI 1.01 to 1.21, p=0.04).ConclusionsElevated LA pressure after MV clip was associated with persistent iASD.

scholarly journals Risk factors for adverse events within one year after atrial septal closure in children: a retrospective follow-up study

2019 ◽  
Vol 30 (3) ◽  
pp. 303-312 ◽  
Author(s):  
Gustaf Tanghöj ◽  
Petru Liuba ◽  
Gunnar Sjöberg ◽  
Estelle Naumburg
Keyword(s):  
Risk Factors ◽  
Adverse Events ◽  
Atrial Septal Defect ◽  
Septal Defect ◽  
Conditional Logistic Regression ◽  
Septal Defects ◽  
Atrial Septal Defects ◽  
Increased Risk ◽  
One Year

AbstractIntroduction:Secundum atrial septal defect is one of the most common congenital heart defects. Previous paediatric studies have mainly addressed echocardiographic and few clinical factors among children associated with adverse events. The aim of this study was to identify neonatal and other clinical risk factors associated with adverse events up to one year after closure of atrial septal defect.Methods:This retrospective case–control study includes children born in Sweden between 2000 and 2014 that were treated surgically or percutaneously for an atrial septal defect. Conditional logistic regression was used to evaluate the association between major and minor adverse events and potential risk factors, adjusting for confounding factors including prematurity, neonatal sepsis, neonatal general ventilatory support, symptomatic atrial septal defects, and pulmonary hypertension.Results:Overall, 396 children with 400 atrial septal defect closures were included. The median body weight at closure was 14.5 (3.5–110) kg, and the median age was 3.0 (0.1–17.8) years. Overall, 110 minor adverse events and 68 major events were recorded in 87 and 49 children, respectively. Only symptomatic atrial septal defects were associated with both minor (odds ratio (OR) = 2.18, confidence interval (CI) 95% 1.05–8.06) and major (OR = 2.80 CI 95% 1.23–6.37) adverse events.Conclusion:There was no association between the investigated neonatal comorbidities and major or minor events after atrial septal defect closure. Patients with symptomatic atrial septal defects had a two to four times increased risk of having a major event, suggesting careful management and follow-up of these children prior to and after closure.

scholarly journals Global changes of ventricular repolarization in arrhythmogenic right ventricular dysplasia

2018 ◽  
Vol 5 (4) ◽  
pp. 35-43
Author(s):  
N. A. Arteyeva ◽  
I. A. Zemskov ◽  
T. A. Kurilenko ◽  
E. A. Parmon
Keyword(s):  
Right Ventricular ◽  
Arrhythmogenic Right Ventricular Dysplasia ◽  
Ventricular Repolarization ◽  
Lateral Part ◽  
Ecg Changes ◽  
T Wave ◽  
Wave Inversion ◽  
Dispersion Of Repolarization ◽  
Right Ventricular Dysplasia ◽  
The Right

Background.In arrhythmogenic right ventricular dysplasia (ARVD), repolarization disorders precede structural heart changes.Objective.The aim of this work was to evaluate repolarization changes in ARVD patients with various degree of electrocardiographic (ECG) changes.Design and methods. The standard ECG and vectorcardiograms (VCG) of patients with a confirmed ARVD diagnosis (N = 22, 13 men 51 ± 16 years and 9 women 50 ± 12 years), observed in the Medical Centre of V.A. Almazov, were analyzed. The degree of ECG changes was assessed by the number of precordial leads with negative T-wave, the global dispersion of repolarization — on the basis of the maximum interval between the peak and the end of T-wave, the spatial repolarization sequence — by T-vector direction, the action potential duration (APD) — on the basis of Q-Tpeak and Q-Tend intervals.Results.At no T-wave inversion in precordial leads, the latest repolarization took place in the posterior regions of ventricular base, at T-wave inversion only in the right precordial leads — in the lateral part of the right ventricle, at T-wave inversion in all precordial leads — in the antero-apical parts of the ventricles. Depending on the degree of ECG changes, the duration of repolarization increased in such a way that the shorter APD increased more than the longer ones; the global dispersion of repolarization was not increased.Conclusion.In ARVD, the increase of repolarization ECG changes is a result of inhomogeneous APD prolongation and the changes in ventricular repolarization sequence (up to it’s inversion), not accompanied with a growth of global dispersion of repolarization.

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