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

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

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.

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 < 0.001). RA dimensions and volumes decreased significantly 1 week, and 3 months after ASD closure (p < 0.001). RA peak systolic strain, and strain rate increased significantly 1 week, and 3 months after ASD closure (p < 0.001). LA dimensions and volumes increased significantly 1 week, and 3 months after ASD closure (P < 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).

Totally Thoracoscopic Versus Open Surgery for Closure of Atrial Septal Defect: Propensity-Score Matched Comparison

2014 ◽  
Vol 17 (4) ◽  
pp. 227 ◽  
Author(s):  
Zhe Zheng ◽  
Hua Kun ◽  
Xu Xuezeng ◽  
Chen Yunge ◽  
Ma Zengshan ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Propensity Score ◽  
Atrial Septal Defect ◽  
Open Surgery ◽  
Septal Defect ◽  
Thoracoscopic Surgery ◽  
Median Sternotomy ◽  
Robotic Assistance ◽  
Thoracoscopic Approach ◽  
Significant Difference

<p>The purpose of this study is to compare early clinical outcomes of surgical repair for isolated atrial septal defect (ASD) with a totally thoracoscopic approach without robotic assistance versus a conventional open procedure.</p><p>Between September 2010 and June 2012, 254 consecutive patients with isolated ASD underwent totally thoracoscopic surgery without robotic assistance in seven institutions participating in the nationwide multi-centered registry in China. During the same period, these patients were matched using propensity score methodology with 254 patients who had accepted conventional open surgery through a median sternotomy. The early in-hospital results between the two groups were analyzed and compared.</p><p>The patient age was 26.8 � 14.0 years and weight was 52.9 � 16.9 kg in the totally thoracoscopic group. The totally thoracoscopic surgery required longer aortic clamp time (32.1 � 17.3 minutes versus 28.3 � 16.7 minutes, <i>P</i> = .01); shorter length of stay in the intensive care unit (25.3 � 12.2 hours versus 34.8 � 24.4 hours, <i>P</i> = .001); shorter length of stay in hospital (6.5 � 6.3 days versus 7.9 � 6.4 days, <i>P</i> = .008); and shorter mechanical ventilation time (8.3 � 5.0 hours versus 11.4 � 14.8 hours, <i>P</i> = .04). The cardiopulmonary bypass (CPB) time (62.7 � 29.3 minutes versus 61.5 � 28.0 minutes, <i>P</i> = .64) showed no significant difference between the two groups. The totally thoracoscopic group had significantly less postoperative chest tube drainage (322.1 � 213.7 mL versus 462.8 � 398.4 mL, <i>P</i> = .001). The intraoperative (35.4% versus 38.6%, <i>P</i> = .46) and postoperative blood products usage (20.9% versus 21.3%, <i>P</i> = .91) showed no significant difference between the two groups.</p><p>There also was no significant difference in mortality and major in-hospital complications between the two groups. The early outcomes for treatment of isolated ASD were similar between the totally thoracoscopic group conventional open operation performed through median sternotomy, despite a longer aortic clamp time in the totally thoracoscopic group.</p>

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.

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.

Transareolar Video-Assisted Approach to the Atrial Septal Defect and Tricuspid Valve

2017 ◽  
Vol 12 (3) ◽  
pp. 217-220
Author(s):  
Tadashi Kitamura ◽  
Shinzo Torii ◽  
Tetsuya Horai ◽  
Koichi Sughimoto ◽  
Kensuke Kobayashi ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Atrial Septal Defect ◽  
Septal Defect ◽  
Defect Closure ◽  
Atrial Septal Defect Closure ◽  
Aortic Cannulation ◽  
Tricuspid Annuloplasty ◽  
Endoscopic Assistance ◽  
Asd Closure ◽  
Transareolar Approach

Minimally invasive atrial septal defect closure and tricuspid annuloplasty in female patients are normally performed through a right submammary anterior minithoracotomy approach. However, when the aortic root is located higher, the direction of aortic cannulation becomes not ideal through the submammary incision. In such cases, transareolar approach is useful. Through this approach, aortic cannulation and tricuspid operation can be performed with endoscopic assistance, and ASD closure can be performed under direct vision.

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.

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