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Fahy L, Rowe S, Nehme Z, Stub D, Zentner D, James P, Pflaumer A, Connell V, Semsarian C, Ingles J, La Gerche A, Paratz ED. Prevalence of atrial septal defects and patent foramen ovale in a cohort of sudden cardiac death patients undergoing autopsy. J Cardiol 2024; 83:390-393. [PMID: 37734655 DOI: 10.1016/j.jjcc.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 09/08/2023] [Accepted: 09/13/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Patent foramen ovale (PFO) and atrial septal defects (ASD) have been described in up to 30 % of subjects in autopsy series but contemporary data are scarce. It is important to confirm the prevalence of ASD/PFO in the general population given the potential associated stroke risk and the increasing availability of intervention via PFO closure. METHODS A state-wide prospective out-of-hospital cardiac arrest registry (OHCA) identified all patients aged 1 to 50 years who experienced OHCA in Victoria, Australia from April 2019 to April 2022 and subsequently underwent autopsy with a cardiac cause of death identified. Autopsy was performed including visual description of any ASD and identification of probe patency of foramen ovale. RESULTS A total of 517 patients underwent autopsy in the setting of sudden cardiac death; 36 patients (6.9 %) had a probe-patent foramen ovale, 2 patients (0.4 %) had secundum ASD, and 2 patients (0.4 %) had both a PFO and ASD (1 of whom had undergone percutaneous repair of both lesions). Twelve patients (2.3 %) had a prior history of cerebrovascular accident either recorded on medical history or detected on neuropathological examination; however none of these patients had a PFO or ASD. CONCLUSIONS The combined rate of PFO and ASD in a cohort of 517 patients undergoing autopsy was 7.9 %. None of these patients had experienced a cerebrovascular accident. This rate of PFOs appears lower than earlier reports and raises the possibility that the relative risk of an associated stroke could be higher than previously estimated.
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Affiliation(s)
- Louise Fahy
- Baker Heart and Diabetes Institute, Prahran, VIC, Australia; Department of Cardiology, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia.
| | - Stephanie Rowe
- Baker Heart and Diabetes Institute, Prahran, VIC, Australia; Department of Cardiology, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Ziad Nehme
- Ambulance Victoria, Doncaster, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Dion Stub
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Cardiology, Alfred Hospital, Prahran, VIC, Australia
| | - Dominica Zentner
- Department of Cardiology, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Paul James
- Department of Cardiology, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Andreas Pflaumer
- Department of Cardiology, Royal Children's Hospital, Parkville, VIC, Australia; Murdoch Children's Research Institute and University of Melbourne, Parkville, VIC, Australia; Department of Population Genomics, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
| | - Vanessa Connell
- Department of Cardiology, Royal Children's Hospital, Parkville, VIC, Australia
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute and University of Sydney, Sydney, NSW, Australia
| | - Jodie Ingles
- Department of Population Genomics, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
| | - Andre La Gerche
- Baker Heart and Diabetes Institute, Prahran, VIC, Australia; Department of Cardiology, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia; Faculty of Medicine, Dentistry and Health Sciences, Melbourne University, Parkville, VIC, Australia
| | - Elizabeth D Paratz
- Baker Heart and Diabetes Institute, Prahran, VIC, Australia; Department of Cardiology, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia; Faculty of Medicine, Dentistry and Health Sciences, Melbourne University, Parkville, VIC, Australia
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Oleas Quezada JD, Coyago Iñiguez JA, Guerrero Cevallos ER. [Peripartum cardiomyopathy with biventricular failure plus pulmonary thromboembolism and atrial septal defect]. Hipertens Riesgo Vasc 2024:S1889-1837(24)00052-7. [PMID: 38632004 DOI: 10.1016/j.hipert.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 03/17/2024] [Accepted: 03/22/2024] [Indexed: 04/19/2024]
Abstract
This case report examines peripartum cardiomyopathy (PPCM), a rare variant of heart failure with reduced ejection fraction, which manifests at the end of labor or puerperium. The frequency of this pathology varies globally, and its association with risk factors such as genetic disorders, autoimmune diseases, viral infections, suggests a multifactorial etiology. Diagnostic criteria include: Heart failure secondary to left ventricular systolic dysfunction, manifested in the puerperium or at the end of pregnancy and lack of other identifiable causes of heart failure. The case presents a patient with no significant personal pathological history, who, 17 days post cesarean section developed acute symptoms, including abdominal pain, dry cough and dyspnea. Clinical findings revealed hypoxemia, alterations in blood tests and an echocardiogram that confirmed an atrial septal defect. Multidisciplinary management resulted in successful treatment and the patient was discharged without complications. This case highlights the importance of MCPP, a disease with high maternal mortality. The connection between atrial septal defect and PPCM, as well as the involvement of pulmonary thromboembolism.
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Jin Y, Zhao M, Guo Q, Zhao W, Lei M, Zhang Y, Zhang Y, Shen Y, Lin K, Yang Z, Chu J, Sun H, Luo Z. Association study of FLT4 and HYDIN single nucleotide polymorphisms with atrial septal defect susceptibility in the Han Chinese population of Southwest China. Ital J Pediatr 2024; 50:62. [PMID: 38581027 PMCID: PMC10998412 DOI: 10.1186/s13052-024-01630-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/18/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Atrial septal defect (ASD) is a common form of congenital heart disease. Although several genes related to ASD have been found, the genetic factors of ASD remain unclear. This study aimed to evaluate the correlation between 10 candidate single nucleotide polymorphisms (SNPs) and sporadic atrial septal defects. METHODS Based on the results of 34 individual whole exome sequences, 10 candidate SNPs were selected. In total, 489 ASD samples and 420 normal samples were collected. The 10 SNPs in the case group and the control group were identified through Snapshot genotyping technology. The χ2-test and unconditional regression model were used to evaluate the relationship between ASD and each candidate SNP. Haploview software was used to perform linkage disequilibrium and haplotype analysis. RESULTS The χ2 results showed that the FLT4 rs383985 (P = 0.003, OR = 1.115-1.773), HYDIN rs7198975 (P = 0.04621, OR = 1.003-1.461), and HYDIN rs1774266 (P = 0.04621, OR = 1.003-1.461) alleles were significantly different between the control group and the case group (P < 0.05). Only the association with the FLT4 polymorphism was statistically significant after adjustment for multiple comparisons. CONCLUSION These findings suggest that a possible molecular pathogenesis associated with sporadic ASD is worth exploring in future studies.
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Affiliation(s)
- Ye Jin
- Yunnan Fuwai Cardiovascular Hospital, 528 Shahe Road, 650032, Kunming, Yunnan, China
| | - Miao Zhao
- Yunnan Fuwai Cardiovascular Hospital, 528 Shahe Road, 650032, Kunming, Yunnan, China
| | - Qiuzhe Guo
- Yunnan Fuwai Cardiovascular Hospital, 528 Shahe Road, 650032, Kunming, Yunnan, China
| | - Wanyu Zhao
- Yunnan Fuwai Cardiovascular Hospital, 528 Shahe Road, 650032, Kunming, Yunnan, China
| | - Min Lei
- Yunnan Fuwai Cardiovascular Hospital, 528 Shahe Road, 650032, Kunming, Yunnan, China
| | - Yifei Zhang
- Yunnan Fuwai Cardiovascular Hospital, 528 Shahe Road, 650032, Kunming, Yunnan, China
| | - Yunhan Zhang
- Yunnan Fuwai Cardiovascular Hospital, 528 Shahe Road, 650032, Kunming, Yunnan, China
| | - Yan Shen
- Yunnan Fuwai Cardiovascular Hospital, 528 Shahe Road, 650032, Kunming, Yunnan, China
| | - Keqin Lin
- The Department of Medical Genetics, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, 935 Jiao ling Road, 650118, Kunming, Yunnan, China
| | - Zhaoqing Yang
- The Department of Medical Genetics, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, 935 Jiao ling Road, 650118, Kunming, Yunnan, China
| | - Jiayou Chu
- The Department of Medical Genetics, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, 935 Jiao ling Road, 650118, Kunming, Yunnan, China
| | - Hao Sun
- The Department of Medical Genetics, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, 935 Jiao ling Road, 650118, Kunming, Yunnan, China.
| | - Zhiling Luo
- Yunnan Fuwai Cardiovascular Hospital, 528 Shahe Road, 650032, Kunming, Yunnan, China.
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Farooq O, Ghani U, Friedman H, Akbar MS, Saudye H, Alam S, Khan MJ, Mutti S. Prevalence of Aortic Root Pathologies in Platypnea-Orthodeoxia Syndrome Secondary to Intra-Cardiac Shunts. Cardiol Res 2024; 15:125-128. [PMID: 38645826 PMCID: PMC11027782 DOI: 10.14740/cr1624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 03/18/2024] [Indexed: 04/23/2024] Open
Abstract
Background Atrial septal defects can allow right to left shunting of venous blood which presents clinically as platypnea-orthodeoxia syndrome. It is believed that concomitant presence of aortic root pathologies increases the likelihood of shunting. Methods The study included a review of 510 articles listed in PubMed of patients with platypnea-orthodeoxia syndrome. Case reports of patients with extra-cardiac etiologies of platypnea-orthodeoxia were excluded. Results We reviewed 191 case reports, and 98 cases (51.3%) had evidence of concomitant aortic root pathology. Furthermore, of the remaining 93 case reports, 69 ones excluded any mention of the nature of the aortic root altogether, further suggesting that this is an underreported number. Conclusions There is a high prevalence of aortic root pathologies in patients with platypnea-orthodeoxia syndrome secondary to intra-cardiac shunts. In patients with unexplained hypoxemia and incidental finding of aortic root pathology, it may be worthwhile to obtain postural oxygen saturation measurements to exclude intra-cardiac shunts as the potential cause.
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Affiliation(s)
- Omer Farooq
- Internal Medicine, Ascension St Francis Hospital, Evanston, IL 60202, USA
| | - Usman Ghani
- Northwest General Hospital and Research Center, Peshawar, Pakistan
| | - Harvey Friedman
- Pulmonary and Critical Care Medicine, Ascension St Francis Hospital, Evanston, IL 60202, USA
| | | | - Hammad Saudye
- Interventional Cardiology, Ascension St Francis Hospital, Evanston, IL 60202, USA
| | - Sundus Alam
- Gloucestershire Royal Hospital, Gloucester GL1 3NN, UK
| | | | - Sumeet Mutti
- Internal Medicine, Ascension St Francis Hospital, Evanston, IL 60202, USA
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Thomas CH, Zampi JD, Joynt MR. Sinus venosus atrial septal defect presenting with platypnea-orthodeoxia syndrome in the setting of COVID-19 infection. Cardiol Young 2024:1-3. [PMID: 38439641 DOI: 10.1017/s1047951124000416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
Platypnea-orthodeoxia syndrome is characterised by hypoxemia and dyspnoea while upright that resolves when supine, typically associated with an interatrial communication. We present a case of platypnea-orthodeoxia syndrome associated with a sinus venosus atrial septal defect in a patient with multiple possible aetiologies of hypoxemia, including COVID-19 infection. Cardiac catheterisation with provocative maneuvers confirmed the diagnosis and symptoms resolved following defect closure. We suggest that in patients with platypnea-orthodeoxia syndrome, it is useful to obtain haemodynamic data while supine and upright.
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Affiliation(s)
- Courtney H Thomas
- Congenital Heart Center at CS Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
| | - Jeffrey D Zampi
- Congenital Heart Center at CS Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
| | - Michael R Joynt
- Congenital Heart Center at CS Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
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Swandita G, Arso IA, Anggrahini DW, Hartopo AB, Cipta CE, Dinarti LK. The Risk Factors of Mitral Regurgitation Deterioration After Secundum Atrial Septal Defect Closure. Clin Med Insights Cardiol 2024; 18:11795468231221420. [PMID: 38449713 PMCID: PMC10916457 DOI: 10.1177/11795468231221420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/20/2023] [Indexed: 03/08/2024]
Abstract
Background Association between secundum Atrial Septal Defect (ASD) and mitral valve (MV) disease has been recognized for decades. Secundum ASD closure can reduce mitral regurgitation (MR) degree. However, in some patients, deterioration of MR after ASD closure has been observed. We aimed to identify the risk factors of MR deterioration after ASD closure. Methods This was an observational retrospective cohort study. Data were collected from the registry and echocardiogram report. We evaluated all patients with ASD closure by surgery and transcatheterization without MR intervention from January 2012 until June 2021 at Dr. Sardjito General Hospital, Yogyakarta. We excluded patients with multiple ASD and ASD with severe MR requiring MV intervention. Risk factors for MR deterioration were evaluated using multivariate logistic regression. Results A total of 242 patients who underwent post-secundum ASD closure were included. In multivariate analysis, ASD closure by surgery, large left atrial (LA) diameter (>40 mm), low left ventricular ejection fraction (LVEF; <55%), and MV regurgitation degree were significant risk factors for MR worsening after ASD closure, with OR of 2.103 (95% CI 1.124-3.937); 2.871 (95% CI 1.032-7.985); 5.531 (95% CI 1.368-22.366); and 2.490 (95% CI 1.339-4.630) respectively. Conclusion ASD closure by surgery, large LA diameter (>40 mm), low LVEF (<55%), and MV regurgitation degree are independent significant risk factors for MR deterioration in post-secundum ASD closure patients. In adult ASD patients with reduced LV function, it is recommended to perform balloon testing and consider fenestrated closure, as low LVEF <55% has the highest risk of causing new or deteriorating MR.
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Affiliation(s)
- Garniswara Swandita
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada – Dr. Sardjito Hospital Yogyakarta, Indonesia
| | - Irsad Andi Arso
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada – Dr. Sardjito Hospital Yogyakarta, Indonesia
| | - Dyah Wulan Anggrahini
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada – Dr. Sardjito Hospital Yogyakarta, Indonesia
| | - Anggoro Budi Hartopo
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada – Dr. Sardjito Hospital Yogyakarta, Indonesia
| | - Cindy Elica Cipta
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada – Dr. Sardjito Hospital Yogyakarta, Indonesia
| | - Lucia Kris Dinarti
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada – Dr. Sardjito Hospital Yogyakarta, Indonesia
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Joseph SP, Mirza SU, Krupa J, Varghese SI, Kartha GB, George OK, George PV, Jose J, Thomson VS. Original Article--Clinical and Procedural Characteristics of Successful Transcatheter Device Closure of Ostium Secundum Atrial Septal Defect in Symptomatic Children Weighing <15 kg: A Retrospective Study Spanning One Decade From South India. J Saudi Heart Assoc 2024; 36:14-22. [PMID: 38566902 PMCID: PMC10984675 DOI: 10.37616/2212-5043.1365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 01/07/2024] [Accepted: 01/30/2024] [Indexed: 04/04/2024] Open
Abstract
Objectives This retrospective study sought to determine the feasibility of transcatheter atrial septal defect device closure in patients less than 15 kg, as well as to assess complication rates and the reasons for unsuccessful device closure. Background In general, the risks associated with transcatheter atrial septal defect device closure are believed and reported to be relatively low, but the evidence stems from trials involving adults and older children. Current guidelines do not recommend atrial defect closure in device closure in children <15 kg, due to limited data available for feasibility and safety of device closure in this group of patients. Methods Retrospective review of all patients who underwent elective transcatheter closure of ostium secundum atrial septal defect between September 2013 to February 2022. We excluded all children above 15 kg, as well as those with complex congenital heart defects. Major and minor complications were predefined and indications for referral were evaluated. Results We identified 81 patients meeting criteria with a median procedural age of 3 years (1 year-8 years), and median weight of 12 kg (4-15 kg). Successful device closure was achieved in 95.1% (77/81) and in 4.9% (4/81), the procedure was aborted. There was 1 major (1.2%) and 1 minor (1.2%) complication, total complication rate (2.4%). 100% of the referrals had right heart enlargement and exertional dyspnoea, 18.5% had recurrent lower respiratory tract infection and 9.9% had failure to thrive. Rate of resolution of residual shunt was 95.1%. at post-procedure day 1 and 98.8% at post-procedure 3 and 6 months respectively. Conclusions Percutaneous atrial septal defect closure can be done effectively and safely in symptomatic children weighing less than 15 kg in experienced centres. However, deferral for closure until the historically established timeline of around 4-5 years of age should be strongly considered in asymptomatic children.
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Affiliation(s)
- Shobhit P. Joseph
- Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu,
India
| | - Shohiab U.R. Mirza
- Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu,
India
| | - Jesu Krupa
- Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu,
India
| | - Shruti I. Varghese
- Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu,
India
| | - Gayathri B. Kartha
- Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu,
India
| | - Oommen K. George
- Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu,
India
| | - Paul V. George
- Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu,
India
| | - John Jose
- Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu,
India
| | - Viji S. Thomson
- Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu,
India
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Venkatesh P, Garg R. Multimodality Imaging in the Diagnosis of Unroofed Coronary Sinus in the Adult. CASE (Phila) 2024; 8:74-82. [PMID: 38524994 PMCID: PMC10954671 DOI: 10.1016/j.case.2023.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
•Unroofed CS is a rare cause of atrial-level shunting and right heart dilatation. •Unroofed CS is commonly diagnosed in adulthood. •TTE is the primary modality to recognize and diagnose unroofed CS. •CCT and/or magnetic resonance imaging should be done as complementary studies before CS repair.
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Affiliation(s)
| | - Ruchira Garg
- Cedars-Sinai Smidt Heart Institute, Los Angeles, California
- Guerin Children’s, Los Angeles, California
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Dehn AM, Pærregaard MM, Sellmer A, Dannesbo S, Blixenkrone-Møller E, Sillesen AS, Raja AA, Iversen KK, Bundgaard H, Christensen AH, Hjortdal V. Electrocardiographic Characteristics in 438 Neonates with Atrial Septal Defects. Pediatr Cardiol 2024; 45:580-587. [PMID: 37914855 PMCID: PMC10891263 DOI: 10.1007/s00246-023-03324-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/05/2023] [Indexed: 11/03/2023]
Abstract
Arrhythmias and electrocardiographic (ECG) abnormalities are common among patients with atrial septal defects (ASDs). We studied a large cohort of neonates with ASDs to investigate whether ECG abnormalities are present at this early stage or develop later, secondary to hemodynamic changes. We analyzed the echocardiograms and ECGs from the Copenhagen Baby Heart Study, a population-based cohort study. We compared ECG characteristics of 438 neonates with secundum ASDs to 1314 matched controls. In subgroup analyses, we investigated whether electrocardiographic characteristics were associated with age at examination. Neonates with ASDs (median age, 11 days; males, 51%) had longer P-wave durations (58 vs. 56 ms, p < 0.001), PR intervals (100 vs. 96 ms, p < 0.001), and a more rightward-shifted QRS axis (116 vs. 114 degrees, p = 0.032) compared to controls (median age, 10 days; males, 51%). There were no differences between cases and controls in the P-wave area, amplitude, or axis. Subgroup analyses showed that the differences in P-wave duration and PR interval were present in neonates examined in the first week after birth. The difference in the QRS axis was not found in neonates examined this early but was found in neonates examined at age two to four weeks. In conclusion, ASDs are associated with ECG changes from the neonatal phase. The P-wave duration and PR interval are longer in neonates with ASDs when compared to controls as early as the first week after birth, indicating that these changes are not purely secondary, but that neonates with an ASD have altered cardiac electrical activity.ClinicalTrials.gov Identifier NCT02753348 (April 27, 2016).
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Affiliation(s)
- Anna Maria Dehn
- Department of Cardiothoracic Surgery, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Maria Munk Pærregaard
- Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anna Sellmer
- Department of Cardiothoracic Surgery, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Sofie Dannesbo
- Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Anne-Sophie Sillesen
- Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anna Axelsson Raja
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kasper Karmark Iversen
- Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Alex Hørby Christensen
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Vibeke Hjortdal
- Department of Cardiothoracic Surgery, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
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Olejnik P, Tittel P, Venczelova Z, Kardos M, Tomko J, Bartova M, Masura J. Long-term follow-up of percutaneous secundum-type atrial septal defect closure using Amplatzer Septal Occluder since 1995: a single-centre study. Cardiol Young 2024; 34:643-646. [PMID: 37694546 DOI: 10.1017/s1047951123003190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
INTRODUCTION The goal of this single-centre study was to evaluate long-term results of percutaneous closure of secundum-type atrial septal defect using Amplatzer Septal Occluder with the follow-up to 25 years. METHODS A retrospective analysis of patients who underwent percutaneous closure of secundum-type atrial septal defect between September 1995 and October 2012 in our institution was performed. All procedures were performed after fulfilling strict indication criteria. More than 5 years follow-up was reached in 651/803 patients (81%) with median follow-up time of 12 (5-25) years. RESULTS The mean stretched defect diameter was 14,0 ± 5,2 mm. Early reintervention due to moderate or severe residual atrial septal defect had to be performed in 3/803 patients (0,03%). The incidence of long-term moderate or severe residual atrial septal defect was 0,0%. The complete closure rate at 10-year follow-up was 98,5%, as trivial residual shunts persisted in 8/508 patients (1,5%). A significant rate of the echocardiographic right ventricular end-diastolic diameter post-procedural normalisation (p < 0,05) was encountered. The rate of major complications was 0,5%. One device embolisation, one thrombus formation at the occluder surface, and one cardiac erosion in periprocedural or short post-procedural course were experienced. Only one late complication of infective endocarditis at the region of implanted occluder and the aortic valve was detected. The survival rate of all followed patients was 100%. CONCLUSIONS Percutaneous closure of secundum-type atrial septal defect using Amplatzer Septal Occluder is a safe and effective procedure accounting for a very low incidence of major complications in the long-term follow-up.
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Affiliation(s)
- Peter Olejnik
- National Institute of Cardiovascular Diseases, Pediatric Cardiac Center, Bratislava, Slovakia
- Department of Pediatric Cardiology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Peter Tittel
- National Institute of Cardiovascular Diseases, Pediatric Cardiac Center, Bratislava, Slovakia
| | - Zuzana Venczelova
- National Institute of Cardiovascular Diseases, Pediatric Cardiac Center, Bratislava, Slovakia
| | - Marek Kardos
- National Institute of Cardiovascular Diseases, Pediatric Cardiac Center, Bratislava, Slovakia
| | - Jaroslav Tomko
- National Institute of Cardiovascular Diseases, Pediatric Cardiac Center, Bratislava, Slovakia
- Department of Pediatric Cardiology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Maria Bartova
- National Institute of Cardiovascular Diseases, Pediatric Cardiac Center, Bratislava, Slovakia
- Department of Pediatric Cardiology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Jozef Masura
- National Institute of Cardiovascular Diseases, Pediatric Cardiac Center, Bratislava, Slovakia
- Department of Pediatric Cardiology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
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Delabays C, Correia P, Eeckhout E, Delabays A, Michel P. Comparison of atrial septal defect and patent foramen ovale in cryptogenic strokes. J Stroke Cerebrovasc Dis 2024:107664. [PMID: 38428550 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 02/12/2024] [Accepted: 02/24/2024] [Indexed: 03/03/2024] Open
Abstract
OBJECTIVES Paradoxical embolism from right-to-left shunt through atrial septal defect (ASD) and patent foramen ovale (PFO) is a well-accepted cause of "cryptogenic" strokes (CS). To better understand the pathogenic role of ASD, we compared ASD patients with CS having a high and low likelihood of being PFO-related. METHODS In the Acute Stroke Registry and Analysis of Lausanne, we calculated prevalence of PFO and ASD in CS patients undergoing echocardiography, and calculated odds ratios (OR) when compared to non-CS. Using the Risk of Paradoxical Embolism (RoPE) score, we divided CS PFO patients in high (HL-PFO, RoPE 8-10) and low-likelihood (LL-PFO, RoPE 0-4) PFO-related stroke. We then performed univariate comparison of epidemiological, clinical and radiological variables of ASD patients with both PFO groups. RESULTS Among all CS, prevalence of ASD and PFO were 1.3% and 36.8% respectively. When compared to non-CS, ASD and PFO were associated with CS (OR of 5.2, CI= 1.6-16.6, and 2.8, CI= 2.1-3.8). Compared with HL-PFO, ASD patients were older, more often female, had more cardiovascular risk factors and silent strokes. Compared with LL-PFO, ASD patients were younger, more often female, and had less risk factors. No differences were found for clinical and radiological characteristics and clinical outcome. CONCLUSION ASD is a rare stroke risk factor for CS. Since characteristics of such patients lie in-between high and low-likelihood paradoxical PFO-strokes, a thorough work-up for other stroke mechanisms is warranted. Individual evaluation of the likelihood of the ASD being causative for stroke may be preferable over routine ASD closure.
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Affiliation(s)
- Constant Delabays
- Stroke Center, Neurology Service, Department of Clinical Neurosciences, of the Lausanne University Hospital, Lausanne, Switzerland.
| | - Pamela Correia
- Stroke Center, Neurology Service, Department of Clinical Neurosciences, of the Lausanne University Hospital, Lausanne, Switzerland.
| | - Eric Eeckhout
- Cardiology Service, Department Heart-Vessel of the Lausanne University Hospital, Lausanne, Switzerland.
| | - Alain Delabays
- Cardiology Service, Department Heart-Vessel of the Lausanne University Hospital, Lausanne, Switzerland.
| | - Patrik Michel
- Stroke Center, Neurology Service, Department of Clinical Neurosciences, of the Lausanne University Hospital, Lausanne, Switzerland.
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Valdeolmillos E, Sakhi H, Tortigue M, Audié M, Isorni MA, Lecerf F, Sitbon O, Montani D, Jais X, Savale L, Humbert M, Azarine A, Hascoët S. 4D flow cardiac MRI to assess pulmonary blood flow in patients with pulmonary arterial hypertension associated with congenital heart disease. Diagn Interv Imaging 2024:S2211-5684(24)00034-2. [PMID: 38368175 DOI: 10.1016/j.diii.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/25/2024] [Accepted: 01/30/2024] [Indexed: 02/19/2024]
Abstract
PURPOSE The purpose of this study was to evaluate the accuracy of four-dimensional flow cardiac magnetic resonance imaging (4D flow MRI) compared to right heart catheterization in measuring pulmonary flow (Qp), systemic flow (Qs) and pulmonary-to-systemic flow ratio (Qp/Qs) in patients with pulmonary arterial hypertension associated with congenital heart disease (PAH-CHD). MATERIALS AND METHODS The study was registered on Clinical-trial.gov (NCT03928002). Sixty-four patients with PAH-CHD who underwent 4D flow MRI were included. There were 16 men and 48 women with a mean age of 45.3 ± 13.7 (standard deviation [SD]) years (age range: 21-77 years). Fifty patients (50/64; 78%) presented with pre-tricuspid shunt. Qp (L/min), Qs (L/min) and Qp/Qs were measured invasively using direct Fick method during right heart catheterization and compared with measurements assessed by 4D flow MRI within a 24-48-hour window. RESULTS The average mean pulmonary artery pressure was 51 ± 17 (SD) mm Hg with median pulmonary vascular resistance of 8.8 Wood units (Q1, Q3: 5.3, 11.7). A strong linear correlation was found between Qp measurements obtained with 4D flow MRI and those obtained with the Fick method (r = 0.96; P < 0.001). Bland Altman analysis indicated a mean difference of 0.15 ± 0.48 (SD) L/min between Qp estimated by 4D flow MRI and by right heart catheterization. A strong correlation was found between Qs and Qp/Qs measured by 4D flow MRI and those obtained with the direct Fick method (r = 0.85 and r = 0.92; P < 0.001 for both). CONCLUSION Qp as measured by 4D flow MRI shows a strong correlation with measurements derived from the direct Fick method. Further investigation is needed to develop less complex and standardized methods for measuring essential PAH parameters, such as pulmonary arterial pressures and pulmonary vascular resistance.
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Affiliation(s)
- Estibaliz Valdeolmillos
- Department of Congenital Heart Diseases, Centre de Référence Malformations Cardiaques Congénitales Complexes M3C, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint-Joseph, Faculté de Médecine, Université Paris Saclay, 92350 Le Plessis-Robinson, France; Université Paris-Saclay, Faculté de Médecine, 94270 Le Kremin-Bicêtre, France; Inserm UMR-S 999, Hôpital Marie Lannelongue, 92350 Le Plessis-Robinson, France.
| | - Hichem Sakhi
- Department of Congenital Heart Diseases, Centre de Référence Malformations Cardiaques Congénitales Complexes M3C, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint-Joseph, Faculté de Médecine, Université Paris Saclay, 92350 Le Plessis-Robinson, France; Department of Cardiology, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint-Joseph, Faculté de Médecine, Université Paris Saclay, 92350 Le Plessis-Robinson, France; Department of Radiology, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint-Joseph, Université Paris-Saclay, 92350 Le Plessis-Robinson, France
| | - Marine Tortigue
- Department of Congenital Heart Diseases, Centre de Référence Malformations Cardiaques Congénitales Complexes M3C, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint-Joseph, Faculté de Médecine, Université Paris Saclay, 92350 Le Plessis-Robinson, France
| | - Marion Audié
- Department of Congenital Heart Diseases, Centre de Référence Malformations Cardiaques Congénitales Complexes M3C, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint-Joseph, Faculté de Médecine, Université Paris Saclay, 92350 Le Plessis-Robinson, France
| | - Marc-Antoine Isorni
- Department of Radiology, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint-Joseph, Université Paris-Saclay, 92350 Le Plessis-Robinson, France
| | - Florence Lecerf
- Research and Innovation Department, Marie Lannelongue Hospital, Paris Saclay University, 92350 Le Plessis-Robinson, France
| | - Olivier Sitbon
- Université Paris-Saclay, Faculté de Médecine, 94270 Le Kremin-Bicêtre, France; Inserm UMR-S 999, Hôpital Marie Lannelongue, 92350 Le Plessis-Robinson, France; Department of Respiratory and Intensive Care Medicine, Reference Centre for Pulmonary Hypertension, Hôpital Bicêtre, 94270 Le Kremlin-Bicêtre, France
| | - David Montani
- Université Paris-Saclay, Faculté de Médecine, 94270 Le Kremin-Bicêtre, France; Inserm UMR-S 999, Hôpital Marie Lannelongue, 92350 Le Plessis-Robinson, France; Department of Respiratory and Intensive Care Medicine, Reference Centre for Pulmonary Hypertension, Hôpital Bicêtre, 94270 Le Kremlin-Bicêtre, France
| | - Xavier Jais
- Université Paris-Saclay, Faculté de Médecine, 94270 Le Kremin-Bicêtre, France; Inserm UMR-S 999, Hôpital Marie Lannelongue, 92350 Le Plessis-Robinson, France; Department of Respiratory and Intensive Care Medicine, Reference Centre for Pulmonary Hypertension, Hôpital Bicêtre, 94270 Le Kremlin-Bicêtre, France
| | - Laurent Savale
- Université Paris-Saclay, Faculté de Médecine, 94270 Le Kremin-Bicêtre, France; Inserm UMR-S 999, Hôpital Marie Lannelongue, 92350 Le Plessis-Robinson, France; Department of Respiratory and Intensive Care Medicine, Reference Centre for Pulmonary Hypertension, Hôpital Bicêtre, 94270 Le Kremlin-Bicêtre, France
| | - Marc Humbert
- Université Paris-Saclay, Faculté de Médecine, 94270 Le Kremin-Bicêtre, France; Inserm UMR-S 999, Hôpital Marie Lannelongue, 92350 Le Plessis-Robinson, France; Department of Respiratory and Intensive Care Medicine, Reference Centre for Pulmonary Hypertension, Hôpital Bicêtre, 94270 Le Kremlin-Bicêtre, France
| | - Arshid Azarine
- Université Paris-Saclay, Faculté de Médecine, 94270 Le Kremin-Bicêtre, France; Inserm UMR-S 999, Hôpital Marie Lannelongue, 92350 Le Plessis-Robinson, France; Department of Radiology, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint-Joseph, Université Paris-Saclay, 92350 Le Plessis-Robinson, France
| | - Sébastien Hascoët
- Department of Congenital Heart Diseases, Centre de Référence Malformations Cardiaques Congénitales Complexes M3C, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint-Joseph, Faculté de Médecine, Université Paris Saclay, 92350 Le Plessis-Robinson, France; Université Paris-Saclay, Faculté de Médecine, 94270 Le Kremin-Bicêtre, France; Inserm UMR-S 999, Hôpital Marie Lannelongue, 92350 Le Plessis-Robinson, France
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Kauling RM, Pelosi C, Cuypers JAAE, van den Bosch AE, Hirsch A, Carvalho JG, Bowen DJ, Kardys I, Bogers AJJC, Helbing WA, Roos-Hesselink JW. Long term outcome after surgical ASD-closure at young age: Longitudinal follow-up up to 50 years after surgery. Int J Cardiol 2024; 397:131616. [PMID: 38030038 DOI: 10.1016/j.ijcard.2023.131616] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 11/10/2023] [Accepted: 11/23/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVES To describe the clinical outcome and quality of life up to 50 years after surgical atrial septal defect (ASD) closure at young age. Primary outcome is defined as MACE (all-cause mortality, cardiac re-interventions, ischemic stroke, endocarditis, heart failure and symptomatic arrhythmia). METHODS Single-center, longitudinal cohort-study evaluating 135 consecutive patients who underwent ASD-closure before the age of 15 years between 1968 and 1980. Participants were invited for extensive cardiac evaluation and assessment of quality-of-life every 10 years. RESULTS Eighty patients (86%) of 93 eligible survivors were included in this study (mean age 52 ± 5 years (range 41-63), 40% male). Median follow-up since surgery was 45 years (range 40-51). Cumulative survival after 50 years was 86% and comparable to the normal Dutch population. Cumulative event-free survival after 45 and 50-years was 59% and 46% respectively (re-intervention in 6, symptomatic arrhythmia in 25, and pacemaker implantation in 10 patients). Right ventricular ejection fraction on CMR was diminished in 6%. Exercise capacity was normal in 77%. There was no pulmonary hypertension. NT-proBNP was elevated in 61%. Quality of life was comparable with the general population. No predictors for late events were identified. CONCLUSION Long-term survival after surgical ASD-closure in childhood is good and not statistically different at 50 years compared to the normal Dutch population. Re-intervention rate is low, there is no pulmonary hypertension. Right ventricular function was diminished in 6%, exercise capacity was good and stable over time with quality of life comparable to the general population. However, supraventricular tachycardia is common.
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Affiliation(s)
- Robert M Kauling
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), Amsterdam, the Netherlands.
| | - Chiara Pelosi
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Judith A A E Cuypers
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), Amsterdam, the Netherlands
| | - Annemien E van den Bosch
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), Amsterdam, the Netherlands
| | - Alexander Hirsch
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - João G Carvalho
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Radiology, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Daniel J Bowen
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Isabella Kardys
- Clinical Epidemiology and Innovation Unit, Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Wim A Helbing
- Department of Pediatrics, division of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Jolien W Roos-Hesselink
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), Amsterdam, the Netherlands
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Liu Y, Wang H, Lan L, Shao J. A commentary regarding the article 'A meta-analysis of atrial septal defect closure in patients with severe pulmonary hypertension: Is there a room for poking holes amidst debate?'. Curr Probl Cardiol 2024; 49:102188. [PMID: 37952793 DOI: 10.1016/j.cpcardiol.2023.102188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 11/09/2023] [Indexed: 11/14/2023]
Abstract
Atrial septal defects (ASD) are a common congenital heart defect. The majority of patient with ASDs often follow an uncomplicated course of events. However, a proportion of patients with ASDs, may have their condition complicated by pulmonary hypertension (PH), with a subsequent significant impact on management, morbidity, and mortality. The presence of PH influences the suitability for defect closure. Suitability for ASD closure when PVR is between 2.3 and 4.6 WU (PVRi 4-8 WU/m2) is not straightforward and clinical decision-making is individualized. Considerations include, whether to intervene with a complete defect closure, fenestrated closure or the 'treat and repair' strategy. However, it is difficult to determine the outcomes for ASD closure in patients with moderately-to-severely elevated PVR. A "treat and repair strategy" might be an option. In addition, the patient should be carefully selected by the observation of PVR change through vasoreactivity and balloon occlusion tests, and then closure should be considered. For patients with a predictable poor prognosis, research on the risk assessment of ASD closure in patients with PAH will be needed for a more individualized treatment plan.
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Affiliation(s)
- Yongqi Liu
- Department of Respiratory and Critical Care Medicine, Chengdu Second People's Hospital, Chengdu, Sichuan 610017, China
| | - Hong Wang
- Department of Cardio-Thoracic Surgery, Chengdu Second People's Hospital, Chengdu, Sichuan 610017, China.
| | - Lin Lan
- Department of Neurology, West China Hospital of Sichuan University, Sichuan, Chengdu 610041, China
| | - Jie Shao
- Department of Emergency, Chengdu Second People's Hospital, Chengdu, Sichuan 610017, China
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15
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Rigatelli G, Zuin M. Differences and similarities in interatrial shunts management. Eur J Intern Med 2024; 120:25-28. [PMID: 38072687 DOI: 10.1016/j.ejim.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 11/11/2023] [Accepted: 12/05/2023] [Indexed: 02/06/2024]
Abstract
Atrial septal defects (ASD) and Patent foramen ovale (PFO) represent the most common congenital heart diseases (CHD) adulthood. These two clinical entities, having different embryological origin, as well as clinical manifestations, clinical course and treatment must be carefully distinguished. Right heart failure and pulmonary hypertension are considered the major determinants of morbidity and mortality in ASD. Conversely, new pathophysiology concepts have been raised in the management of PFO as left atrium cardiopathy. New diagnostic tools, including cardiac magnetic resonance and intracardiac echocardiography have joint transthoracic and transesophageal echocardiography in the diagnostic definition of both ASD and PFO as well as in guiding their percutaneous closure. Moreover, several innovations have been developed in the field of percutaneous ASD and PFO closure devices including new evidence supporting the safety and efficacy of device-based closure. Aim of the present review is to present review we provided and update overview on ASD and PFO, focusing on the novel concepts regarding their pathophysiological and therapeutic aspects.
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Affiliation(s)
- Gianluca Rigatelli
- Interventional Cardiology Unit, Ospedali Riuniti Padova Sud, Monselice, Padova, Italy.
| | - Marco Zuin
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
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Muroke V, Jalanko M, Haukka J, Anttila V, Pätilä T, Sinisalo J. Long-term outcome after surgical correction of sinus venosus defect in a nationwide register-based cohort study. Int J Cardiol 2024; 395:131433. [PMID: 37827284 DOI: 10.1016/j.ijcard.2023.131433] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 09/12/2023] [Accepted: 10/08/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVES Long-term results after sinus venosus defect (SVD) closure are sparse and many studies lack a proper control cohort. This nationwide cohort evaluated the long-term outcome after SVD surgery. METHODS The study enrolled every surgical SVD correction from the nationwide hospital discharge registry (FHDR) and surgical registries of two tertiary centers. Patients with more complex congenital heart defects were excluded. Surgeries were performed from 1969 to 2019. Five sex and birth-year-matched controls per SVD patient were gathered from the general population. RESULTS In total, 182 surgical SVD corrections were performed during the study period. The median age at the time of surgery was 8.3 years (range 0.06-75.7), and the majority (77.5%, n = 141) were under 18 years old. The median follow-up period was 18 years (range 0.1-53). There was no significant difference in mortality during the follow-up (logrank p = 0.62, MRR 0.78, 95% CI: 0.30-2.0). However, SVD patients had elevated risk for new-onset atrial fibrillation (RR 4.9, 95% CI: 2.2-10.9), heart failure (RR 4.0, 95% CI: 1.2-13.2), ischemic heart disease (4.3, 95% CI, 1.5-11.7), migraine (RR 3.6, 95% CI: 1.5-9.1) and sick sinus syndrome, II- or III-degree AV-block or pacemaker implantation (RR 11.3, 95% CI: 2.9-43.8). CONCLUSION Young patients with SVD have an excellent survival prognosis after the surgery. Risk for sick sinus syndrome or conduction disorders, atrial fibrillation, and heart failure remains elevated in the long-term follow-up.
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Affiliation(s)
- V Muroke
- Department of Cardiology, Helsinki University Hospital, Finland.
| | - M Jalanko
- Department of Cardiology, Helsinki University Hospital, Finland
| | - J Haukka
- Department of Public Health, University of Helsinki, Finland
| | - V Anttila
- Department of Cardiothoracic Surgery, Turku University Hospital, Finland
| | - T Pätilä
- Department of Cardiac Surgery, New Children's Hospital, Helsinki University Hospital, University of Helsinki, Finland
| | - J Sinisalo
- Department of Cardiology, Helsinki University Hospital, Finland
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Luo G, Li Z, Ge W, Ji Z, Qiao S, Pan S. Residual networks models detection of atrial septal defect from chest radiographs. Radiol Med 2024; 129:48-55. [PMID: 38082195 PMCID: PMC10808252 DOI: 10.1007/s11547-023-01744-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 10/19/2023] [Indexed: 01/25/2024]
Abstract
OBJECT The purpose of this study was to explore a machine learning-based residual networks (ResNets) model to detect atrial septal defect (ASD) on chest radiographs. METHODS This retrospective study included chest radiographs consecutively collected at our hospital from June 2017 to May 2022. Qualified chest radiographs were obtained from patients who had finished echocardiography. These chest radiographs were labeled as positive or negative for ASD based on the echocardiographic reports and were divided into training, validation, and test dataset. Six ResNets models were employed to examine and compare by using the training dataset and was tuned using the validation dataset. The area under the curve, recall, precision and F1-score were taken as the evaluation metrics for classification result in the test dataset. Visualizing regions of interest for the ResNets models using heat maps. RESULTS This study included a total of 2105 chest radiographs of children with ASD (mean age 4.14 ± 2.73 years, 54% male), patients were randomly assigned to training, validation, and test dataset with an 8:1:1 ratio. Healthy children's images were supplemented to three datasets in a 1:1 ratio with ASD patients. Following the training, ResNet-10t and ResNet-18D have a better estimation performance, with precision, recall, accuracy, F1-score, and the area under the curve being (0.92, 0.93), (0.91, 0.91), (0.90, 0.90), (0.91, 0.91) and (0.97, 0.96), respectively. Compared to ResNet-18D, ResNet-10t was more focused on the distribution of the heat map of the interest region for most chest radiographs from ASD patients. CONCLUSION The ResNets model is feasible for identifying ASD through children's chest radiographs. ResNet-10t stands out as the preferable estimation model, providing exceptional performance and clear interpretability.
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Affiliation(s)
- Gang Luo
- Heart Center, Women and Children's Hospital, Qingdao University, 6, Tongfu Road, Qingdao, 266034, China
| | - Zhixin Li
- Heart Center, Women and Children's Hospital, Qingdao University, 6, Tongfu Road, Qingdao, 266034, China
| | - Wen Ge
- Department of Radiology, Women and Children's Hospital, Qingdao University, Qingdao, 266034, China
| | - Zhixian Ji
- Heart Center, Women and Children's Hospital, Qingdao University, 6, Tongfu Road, Qingdao, 266034, China
| | - Sibo Qiao
- The School of Computer Science and Technology, China University of Petroleum, Qingdao, 266580, China
| | - Silin Pan
- Heart Center, Women and Children's Hospital, Qingdao University, 6, Tongfu Road, Qingdao, 266034, China.
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Thuan PQ, Chuong PTV, Thang HD, Nhiem DL, Nam NH, Dinh NH. Successful surgical management of large pulmonary artery thrombosis in a patient with primary severe mitral regurgitation and complex congenital heart disease: A case report. Int J Surg Case Rep 2024; 114:109159. [PMID: 38109800 PMCID: PMC10767183 DOI: 10.1016/j.ijscr.2023.109159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/06/2023] [Accepted: 12/08/2023] [Indexed: 12/20/2023] Open
Abstract
INTRODUCTION Pulmonary artery thrombosis presents a rare and formidable challenge, especially in individuals with untreated complex congenital heart diseases and concurrent valvular abnormalities. PRESENTATION OF CASE This case details a distinctive instance of pulmonary artery thrombosis in a patient with untreated congenital atrial septal defect, severe pulmonary hypertension, pulmonary aneurysm, valvular heart disease, and triple-positive antiphospholipid antibodies. Collaborative decision-making by a heart team guided the diagnostic and therapeutic processes, resulting in surgical interventions encompassing pulmonary thrombectomy, mitral and tricuspid regurgitation repair, and atrial septal defect closure. DISCUSSION The case underscores the nuanced management of pulmonary artery thrombosis within the realm of congenital heart disease, highlighting the imperative role of a multidisciplinary approach in achieving accurate diagnoses and timely interventions. The multifaceted treatment strategy implemented further accentuates the need for continual monitoring and personalized interventions in intricate clinical scenarios. CONCLUSION In conclusion, this case emphasizes the complexity of addressing pulmonary artery thrombosis in the context of congenital heart disease. The collaborative efforts of a multidisciplinary team proved pivotal in navigating diagnostic uncertainties and formulating a tailored treatment plan. Ongoing monitoring and personalized strategies remain crucial for optimizing outcomes in such intricate cases.
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Affiliation(s)
- Phan Quang Thuan
- Department of Adult Cardiovascular Surgery, University Medical Center HCMC, Viet Nam
| | - Pham Tran Viet Chuong
- Department of Adult Cardiovascular Surgery, University Medical Center HCMC, Viet Nam
| | - Ho Duc Thang
- Department of Adult Cardiovascular Surgery, University Medical Center HCMC, Viet Nam
| | - Dinh Long Nhiem
- Department of Adult Cardiovascular Surgery, University Medical Center HCMC, Viet Nam
| | - Nguyen Hoai Nam
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Viet Nam.
| | - Nguyen Hoang Dinh
- Department of Adult Cardiovascular Surgery, University Medical Center HCMC, Viet Nam; Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Viet Nam.
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Abdul Jabbar A, Jaradat M, Hasan M, Yoo JW, Jenkins JS, Crittendon I, Lucas VS, Ramee S, Collins T. Systematic review of multiple versus single device closure of Secundum atrial septal defects in adults. Cardiovasc Revasc Med 2024; 58:90-97. [PMID: 37596193 DOI: 10.1016/j.carrev.2023.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/24/2023] [Accepted: 07/31/2023] [Indexed: 08/20/2023]
Abstract
INTRODUCTION Multiple device closure (MDC) strategy has been used in treating of complex Atrial septal defects (ASDs) in adults. The safety profile of MDC compared to conventional single device closure (SDC) is unknown in this population. This report represents the first review examining the outcomes of single versus multiple device ASD closure in adults with ostium secundum defects. METHODS Literature databases and manual search from their inception until June 30th, 2017 followed the Preferred Reporting Items of Systemic Review and Meta-Analysis (PRISMA) guideline. Main outcomes are 1) overall complication incidence, 2) arrhythmia incidence, 3) residual shunt rate. Each outcome profile was pooled by MDC and SDC, respectively and chi-square analysis was applied to examine statistical significance between MDC and SDC strategies (two-sided and p < .050). RESULTS A total of 1806 + studies were initially screened, and 20 studies were finally selected (MDC group, 147 patients; SDC group, 1706 patients). There was no difference in overall complication incidence (χ2 = 1.269; p = .259) and arrhythmia incidence (χ2 = 0.325; p = .568) between MDC and SDC. There was no difference in residual shunt rate between the SDC (4.10 %; 70/1706) and MDC groups (6.80 %; 10/147; χ2 = 2.387; p = .122). CONCLUSIONS The outcomes of percutaneous multiple ASD closure (MDC) seem to be safe and effective as compared to conventional single ASD (SDC) closure in terms of device - related complications and technical success of the procedure. Prospective registry data and randomized trials are needed to determine the long-term outcomes of percutaneous ASD closure using MDC.
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Affiliation(s)
- Ali Abdul Jabbar
- Section of Interventional Cardiology, Cardiology Department, John Ochsner Heart and vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, United States of America; The Tampa Bay Heart Institue at HCA Florida Northside Hospital, University of South Florida Morsani College of Medicine, HCA West FL Division GME Program, St. Petersburg, FL, United States of America
| | - Mohammad Jaradat
- Department of Internal Medicine, University of Nevada School of Medicine, Las Vegas, NV, United States of America
| | - Mohanad Hasan
- Section of Interventional Cardiology, Cardiology Department, John Ochsner Heart and vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, United States of America
| | - Ji Won Yoo
- Department of Internal Medicine, University of Nevada School of Medicine, Las Vegas, NV, United States of America
| | - J Stephen Jenkins
- Section of Interventional Cardiology, Cardiology Department, John Ochsner Heart and vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, United States of America
| | - Ivory Crittendon
- Section of Pediatric Cardiology, Cardiology Department, John Ochsner Heart and vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, United States of America
| | - Victor S Lucas
- Section of Pediatric Cardiology, Cardiology Department, John Ochsner Heart and vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, United States of America
| | - Stephen Ramee
- Section of Interventional Cardiology, Cardiology Department, John Ochsner Heart and vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, United States of America
| | - Tyrone Collins
- Section of Interventional Cardiology, Cardiology Department, John Ochsner Heart and vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, United States of America; Section of Pediatric Cardiology, Cardiology Department, John Ochsner Heart and vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, United States of America.
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20
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Prakoso R, Ariani R, Mendel B, Lilyasari O. Transoesophageal echocardiography-guided balloon-assisted percutaneous closure of a large secundum atrial septal defect in a pregnant woman: a case report. Eur Heart J Case Rep 2024; 8:ytae014. [PMID: 38274706 PMCID: PMC10810588 DOI: 10.1093/ehjcr/ytae014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 12/18/2023] [Accepted: 01/04/2024] [Indexed: 01/27/2024]
Abstract
Background According to the 2018 European Society of Cardiology guidelines, atrial septal defect (ASD) closure can be performed during pregnancy but is rarely indicated. In this case, we demonstrate the viability of percutaneous balloon-assisted ASD closure without fluoroscopy in a pregnant woman. Case summary A 23-year-old G3P2A0 woman who was 20 weeks pregnant had primary complaints of breathlessness [New York Heart Association functional class (NYHA fc) III and IV] for 1 week prior to admission. A transthoracic echocardiography showed a dilatation of the right atrium (RA), a dilated right ventricle, a dilated main pulmonary artery (28.1 mm), and an oval-shaped 22 × 33 mm-sized secundum ASD with a left-to-right shunt. Despite optimal pharmacological treatment, the NYHA fc persisted. Under transoesophageal echocardiography monitoring, we introduced a 40 mm Cera™ ASD Occluder (Lifetech, China) via the delivery sheath. The device was deployed in the usual position; however, despite numerous placement adjustments, the left atrium disc kept getting dislodged to the RA and could not engage correctly. Therefore, we decided to use a balloon-assisted approach using a sizing balloon of No. 34 mm. The device was successfully positioned, and a wiggle test was conducted to make sure that the device remained stable. The patient was able to give birth to the child normally several months later. Discussion Despite the fact that pregnant women with ASD receive a very low dose of radiation, it is nevertheless recommended to avoid radiation because this demographic is particularly vulnerable to it. It is possible to treat a large ASD in pregnant women with a successful balloon-assisted approach.
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Affiliation(s)
- Radityo Prakoso
- Division of Pediatric Cardiology and Congenital Heart Disease, Department of Cardiology and Vascular Medicine, National Cardiovascular Centre Harapan Kita, Universitas Indonesia, Letjen S. Parman St No.Kav. 87, Slipi, Palmerah, West Jakarta City, 11420 Jakarta, Indonesia
| | - Rina Ariani
- Division of Non-invasive Diagnostic and Cardiovascular Imaging, Department of Cardiology and Vascular Medicine, National Cardiovascular Centre Harapan Kita, Universitas Indonesia, Letjen S. Parman St No.Kav. 87, Slipi, Palmerah, West Jakarta City, 11420 Jakarta, Indonesia
| | - Brian Mendel
- Division of Pediatric Cardiology and Congenital Heart Disease, Department of Cardiology and Vascular Medicine, National Cardiovascular Centre Harapan Kita, Universitas Indonesia, Letjen S. Parman St No.Kav. 87, Slipi, Palmerah, West Jakarta City, 11420 Jakarta, Indonesia
- Department of Cardiology and Vascular Medicine, Sultan Sulaiman Government Hospital, Serdang Bedagai, Negara 58 No. 315, Firdaus, Sei Rampah, Serdang Bedagai City, 20995 North Sumatera, Indonesia
| | - Oktavia Lilyasari
- Division of Pediatric Cardiology and Congenital Heart Disease, Department of Cardiology and Vascular Medicine, National Cardiovascular Centre Harapan Kita, Universitas Indonesia, Letjen S. Parman St No.Kav. 87, Slipi, Palmerah, West Jakarta City, 11420 Jakarta, Indonesia
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21
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Sandeep B, Li H, Huang X, Xiao Z. An editorial regarding the article 'A meta-analysis of atrial septal defect closure in patients with severe pulmonary hypertension: is there a room for poking holes amidst debate?'. Curr Probl Cardiol 2024; 49:102172. [PMID: 37907187 DOI: 10.1016/j.cpcardiol.2023.102172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 10/28/2023] [Indexed: 11/02/2023]
Abstract
Pulmonary arterial hypertension (PAH) related to an atrial septal defect (ASD) poses a challenge to transcatheter closure of an ASD. In patients with untreated ASDs, chronic pulmonary over-circulation due to shunt flow can cause pulmonary vascular remodeling and increased pulmonary vascular resistance. PAH is one of the difficult situations to treat. Complex pathophysiology, association of the multiple comorbidities make clinical scenario challenging. The closure of ASD in patients with PAH improves PAH severity and cardiac functional capacity and reduces atrial arrhythmias. However, some patients show remaining PAH or aggravation of PAH post-ASD closure. PAH is a strong predictor of mortality in older patients who undergo ASD closure. Hence, the decision to opt for ASD closure should be carefully considered in high-risk patients with PAH. As per the American Heart Association/American College of Cardiology 2018 guidelines, ASD with elevated pulmonary artery pressure (PAP) and pulmonary vascular resistance (PVR) more than two-thirds systemic is considered to be a contraindication for closure. However, it is difficult to determine the outcomes for ASD closure in patients with moderately-to-severely elevated PVR. A "treat and repair strategy" might be an option. In addition, the patient should be carefully selected by the observation of PVR change through vasoreactivity and balloon occlusion tests, and then closure should be considered. For patients with a predictable poor prognosis, research on the risk assessment of ASD closure in patients with PAH will be needed for a more individualized treatment plan.
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Affiliation(s)
- Bhushan Sandeep
- Department of Cardio-Thoracic Surgery, Chengdu Second People's Hospital, Chengdu, Sichuan 610017, China.
| | - Hong Li
- Department of Anesthesiology, No. 363 Hospital, Chengdu, Sichuan 610017, China
| | - Xin Huang
- Department of Anesthesiology, West China Hospital of Sichuan University, Sichuan, Chengdu 610041, China
| | - Zongwei Xiao
- Department of Cardio-Thoracic Surgery, Chengdu Second People's Hospital, Chengdu, Sichuan 610017, China
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22
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Liu X, Gao Y, Wang Z, Shi R, Qian WL, Shen MT, Sun YS, Yang ZG. Effect of concomitant atrial septal defect on left ventricular function in adult patients with unrepaired Ebstein's anomaly: a cardiovascular magnetic resonance imaging study. J Cardiovasc Magn Reson 2023; 25:75. [PMID: 38057914 PMCID: PMC10702047 DOI: 10.1186/s12968-023-00976-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 11/10/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Due to the heterogeneity of anatomic anomalies in Ebstein's anomaly (EA), particularly in the subset of patients with atrial septal defect (ASD), hemodynamic changes, which ultimately cause left ventricular (LV) deterioration remain unclear. The current study aimed to investigate the effect of concomitant ASD on LV function using cardiovascular magnetic resonance (CMR) imaging in patients with EA. METHODS This study included 31 EA patients with ASD, 76 EA patients without ASD, 35 patients with simple ASD and 40 healthy controls. Left/right ventricular (RV, the RV was defined as a summation of the functional RV and atrialized RV in EA patients) volumes and functional parameters, LV strain parameters, and echocardiogram indices were compared among the four groups. Associations between variables were evaluated via Spearman or Pearson correlation analyses. The association between risk factors and LV ejection fraction (EF) was determined via multivariate linear regression analysis. RESULTS Both EA patients and ASD patients had a higher RV/LV end-diastolic volume (RVEDV/LVEDV) as well as lower LV and RV ejection fractions (LVEF/RVEF) compared to healthy controls (all p < 0.05). Moreover, the EA patients with ASD had a significantly higher RVEDV/LVEDV and a lower LVEF and RVEF than those without ASD (all p < 0.05). Multivariate linear regression analysis revealed that the presence of ASD was independently associated with LVEF (β = - 0.337, p < 0.001). The RVEDV/LVEDV index was associated with LVEF (r = - 0.361, p < 0.001). Furthermore, the LV longitudinal peak diastolic strain rate (PDSR) was lower in EA patients with ASD than those without ASD, patients with simple ASD, and healthy controls (p < 0.05). CONCLUSION Concomitant ASD is an important risk factor of LV dysfunction in patients with EA, and diastolic dysfunction is likely the predominate mechanism related to LV dysfunction.
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Affiliation(s)
- Xi Liu
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital and Institute, 52# Fu Cheng Road, Hai Dian District, Beijing, 100142, China
| | - Yue Gao
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Zhen Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital and Institute, 52# Fu Cheng Road, Hai Dian District, Beijing, 100142, China
| | - Rui Shi
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Wen-Lei Qian
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Meng-Ting Shen
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Ying-Shi Sun
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital and Institute, 52# Fu Cheng Road, Hai Dian District, Beijing, 100142, China.
| | - Zhi-Gang Yang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
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23
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Muroke V, Jalanko M, Haukka J, Pätilä T, Hartikainen J, Tahvanainen A, Ukkonen H, Ylitalo K, Anttila V, Pihkala J, Sinisalo J. Atrial septal defect patients have an elevated risk for infective endocarditis. SCAND CARDIOVASC J 2023; 57:2215490. [PMID: 37264780 DOI: 10.1080/14017431.2023.2215490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Background. It has been unclear whether simple atrial septal defect (ASD) is an independent risk factor for infective endocarditis (IE). This study aimed to untangle the risk of endocarditis in a large nationwide cohort. Methods. We acquired data from the Finnish hospital discharge register on all individuals with ASD diagnosis from 1969 to 2019. Patients with complex congenital cardiac abnormalities were ruled out. Five individualized controls from the general population were matched to the ASD patient's birth year, sex, and residence at the index date. All the patients with ICD-8, -9, or -10 diagnosis codes for IE were gathered from the hospital discharge registry. Results. Altogether, 8322 patients with ASD and 39,237 individualized controls were enrolled in the study. Median follow-up was 21.6 years (IQR 11.8-36.9) from the first hospital contact. In total, 24 (16 male) cases of infective endocarditis among ASD patients and 10 (8 male) cases among controls were diagnosed during the follow-up. The incidence of endocarditis was 0.11 per 1000 person-years in the patients with ASD and 0.011 per 1000 person-years in the controls. The adjusted risk ratio for endocarditis was 13.51 (95% CI: 6.20-29.46) in patients with ASD compared to the control cohort. Patients with ASD and endocarditis had higher long-term mortality than individualized control patients (MRR 2.25, 95% CI: 1.23-4.11). Conclusions. The incidence of IE in patients with ASD was higher than in the general population. Mortality associated with IE was higher in patients with ASD compared to controls.
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Affiliation(s)
- Valtteri Muroke
- Department of Cardiology, Helsinki University Hospital, Helsinki, Finland
| | - Mikko Jalanko
- Department of Cardiology, Helsinki University Hospital, Helsinki, Finland
| | - Jari Haukka
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Tommi Pätilä
- Department of Cardiac Surgery, New Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | | | - Anna Tahvanainen
- Department of Cardiology, Tampere University Hospital, Tampere, Finland
| | | | - Kari Ylitalo
- Department of Cardiology, Oulu University Hospital, Oulu, Finland
| | - Vesa Anttila
- Department of Cardiology, New Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Jaana Pihkala
- Department of Cardiothoracic Surgery, Turku University Hospital, Turku, Finland
| | - Juha Sinisalo
- Department of Cardiology, Helsinki University Hospital, Helsinki, Finland
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24
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Korsholm K, Jensen JM, Nielsen-Kudsk JE. Left atrial appendage occlusion guided by intracardiac echocardiography in a patient with a 34 mm atrial septal defect occluder: a case report. Eur Heart J Case Rep 2023; 7:ytad571. [PMID: 38046651 PMCID: PMC10691873 DOI: 10.1093/ehjcr/ytad571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/29/2023] [Accepted: 11/14/2023] [Indexed: 12/05/2023]
Abstract
Background Intracardiac echocardiography (ICE)-guided left atrial appendage occlusion (LAAO) is increasingly common. Patients with previous atrial septal defect closure constitute a significant challenge for transseptal access. Case summary A 49-year-old man with persistent atrial fibrillation, hypertension, and reduced left ventricular function was considered for LAAO after a life-threatening intrathoracic bleeding while on oral anticoagulation. Percutaneous atrial septal defect closure was performed 15 years before with a 34 mm Amplatzer Septal Occluder. Preprocedural cardiac computed tomography demonstrated the atrial septal occluder device with a small native interatrial septum at the inferior margin. The left atrial appendage landing zone measured 17 × 22 mm. The LAAO was performed under local analgesia. A steerable sheath was used to guide the transseptal puncture, and the ICE probe was traced along a guidewire across the atrial septum. A 12-F Amulet delivery sheath was advanced through the same transseptal hole. Under ICE and fluoroscopy guidance, a 25 mm Amplatzer Amulet was deployed. Follow-up imaging showed a well-positioned device with a small peridevice leak at the disc. Discussion This case report illustrates the feasibility of LAAO performed with ICE guidance from the left atrium in a patient with a large Amplatzer Septal Occluder with a small native interatrial septum. It demonstrates that prior atrial septal defect closure should not be considered as a contraindication for LAAO but warrants careful preprocedural planning.
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Affiliation(s)
- Kasper Korsholm
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark
| | - Jesper Møller Jensen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark
| | - Jens Erik Nielsen-Kudsk
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark
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25
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Hascoet S, Baruteau AE, Jalal Z, Demkow M, de Winter R, Gaio G, Clerc JM, Sabiniewicz R, Eberli F, Santoro G, Dauphin C, Schubert S, Smolka G, Lutz M, Moreno R, Pan M, Gutierrez-Larraya F, Godart F, Carminati M, Ovaert C, Batteux C, Guerin P, Thambo JB, Ewert P. Safety and efficacy of the Amplatzer™ Trevisio™ intravascular delivery system: Post-approval study results. Arch Cardiovasc Dis 2023; 116:580-589. [PMID: 37951755 DOI: 10.1016/j.acvd.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND The Amplatzer™ Trevisio™ Intravascular Delivery System (Trevisio DS; Abbott Laboratories, Chicago, IL, USA) facilitates the delivery of Amplatzer™ Occluders and features an ultraflexible tip, which improves assessment of occluder position before release. AIMS To assess the safety and efficacy of the Trevisio DS for transcatheter closure of patent foramen ovale and atrial septal defect. METHODS The Amplatzer™ Trevisio™ Intravascular Delivery System Post-Approval Study was a prospective, postmarket, single-arm, multicentre, observational study of the Trevisio DS. Enrolled patients were indicated for transcatheter closure of patent foramen ovale or atrial septal defect. In all procedures, the Trevisio DS was used to deliver Amplatzer™ Occluders. Technical success was defined as successful deployment and release of at least one occluder. Device- or procedure-related serious adverse events were tracked until discharge or day 7, whichever occurred earlier. RESULTS The study enrolled 144 patients with patent foramen ovale and 107 patients with atrial septal defect at 22 European sites; 53 patients with atrial septal defect (49.6%) were aged<18years. The rate of technical success was 98.4% (97.2% for atrial septal defect, 99.3% for patent foramen ovale). There was one serious adverse event (0.4%), an acute periprocedural device embolization that occurred after occluder release in a patient with atrial septal defect; the device was retrieved percutaneously. This was determined by the implanter to be unrelated to the performance of the Trevisio DS. CONCLUSIONS The Trevisio DS exhibited a high rate of technical success and an excellent safety profile during transcatheter closure of patent foramen ovale and atrial septal defect.
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Affiliation(s)
- Sebastien Hascoet
- Hôpital Marie-Lannelongue, Groupe Hospitalier Paris Saint-Joseph, Faculté de Médecine Paris-Saclay, Université Paris-Saclay, Centre Constitutif Réseau Maladies Rares Cardiopathies Congénitales Complexes (M3C), BME Lab, 92350 Le Plessis-Robinson, France.
| | - Alban-Elouen Baruteau
- Nantes Université, CHU de Nantes, Department of Paediatric Cardiology and Paediatric Cardiac Surgery, FHU PRECICARE, 44000 Nantes, France; Nantes Université, CHU de Nantes, Inserm, CIC FEA 1413, 44000 Nantes, France; Nantes Université, CHU de Nantes, CNRS, Inserm, l'Institut du Thorax, 44000 Nantes, France
| | - Zakaria Jalal
- Department of Paediatric and Adult Congenital Cardiology, CHU de Bordeaux, 33000 Bordeaux, France; Centre Constitutif Réseau Maladies Rares Cardiopathies Congénitales Complexes (M3C), 92350 Le Plessis-Robinson, France; Electrophysiology and Heart Modelling Institute, IHU Liryc, Fondation Bordeaux Université, 33000 Bordeaux, France
| | - Marcin Demkow
- The Cardinal Stefan Wyszynski Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland
| | - Robbert de Winter
- Amsterdam Academic Medical Centre (AMC), 1105 AZ Amsterdam, The Netherlands
| | | | | | | | | | | | | | - Stephan Schubert
- Deutsches Herzzentrum Berlin, 13353 Berlin, Germany; Herz-und Diabetes Zentrum NRW, University Clinic of Ruhr-University Bochum, 32545 Bad Oeynhausen, Germany
| | | | - Matthias Lutz
- Universitätsklinikum Schleswig-Holstein Campus Kiel, 24105 Kiel, Germany
| | - Raul Moreno
- Hospital Universitario de la Paz, 28046 Madrid, Spain
| | - Manuel Pan
- Hospital Universitario Reina Sofia, 14004 Cordoba, Spain
| | | | | | | | | | - Clement Batteux
- Hôpital Marie-Lannelongue, Groupe Hospitalier Paris Saint-Joseph, Faculté de Médecine Paris-Saclay, Université Paris-Saclay, Centre Constitutif Réseau Maladies Rares Cardiopathies Congénitales Complexes (M3C), BME Lab, 92350 Le Plessis-Robinson, France
| | | | - Jean-Benoit Thambo
- Centre Constitutif Réseau Maladies Rares Cardiopathies Congénitales Complexes (M3C), 92350 Le Plessis-Robinson, France; Electrophysiology and Heart Modelling Institute, IHU Liryc, Fondation Bordeaux Université, 33000 Bordeaux, France
| | - Peter Ewert
- Deutsches Herzzentrum München des Freistaates Bayern, 80636 München, Germany
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26
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Muroke V, Jalanko M, Haukka J, Hartikainen J, Tahvanainen A, Ukkonen H, Ylitalo K, Pihkala J, Sinisalo J. Outcome of transcatheter atrial septal defect closure in a nationwide cohort. Ann Med 2023; 55:615-623. [PMID: 36786506 PMCID: PMC9930864 DOI: 10.1080/07853890.2023.2178669] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Transcatheter (TC) atrial septal defect (ASD) closure has been the mainstay of therapy for secundum-type ASDs for over 20 years. AIMS This nationwide cohort evaluated the long-term outcome of transcatheter-closed ASDs. METHODS The study enrolled every transcatheter ASD closure performed in Finland from 1999 to 2019. Five age, sex, and municipality-matched controls per ASD patient were gathered from the general population. The median follow-up period was 5.9 years (range 0-20.8). We used the hospital discharge register to gather all hospital visits and diagnoses. Closure complications and echocardiographic changes were collected from the electronic health records. RESULTS Transcatheter ASD closure was performed in 1000 patients (68.5% females) during the study period. The median (range) age at the time of the procedure was 37.9 (1.8-87.5) years. ASD patients had an increased risk for new-onset atrial fibrillation (RR 2.45, 95% CI: 1.84-3.25), migraine (RR 3.61, 95% CI: 2.54-5.14), ischemic heart disease (RR 1.73, 95% CI: 1.23-2.45), ventricular fibrillation/tachycardia (RR 3.54 (95% CI: 1.48-8.43) and AV conduction disorder (RR 3.60, 95% CI: 1.94-6.70) compared to the control cohort. Stroke risk was not increased (RR 1.36, 95% CI: 0.91-2.03). Adverse events occurred in 6.3% (n = 63) of the patients, including four erosions and ten device embolizations. CONCLUSION After TC closure of ASD, patients had a higher risk of new-onset atrial fibrillation and migraine than controls without ASD. As novel findings, we found an increased risk for ischemic heart disease, AV conduction disorders, and ventricular fibrillation/tachycardia.Key messagesEven though patients have an excellent overall prognosis after percutaneous ASD closure, the increased incidence of major comorbidities like atrial fibrillation and heart failure prompts more thorough lifelong follow-up.This study's novel findings revealed the increased risk for ischemic heart disease, AV conduction disorders, or ventricular tachycardia/fibrillation during the follow-up.Major complications after the closure are rare; erosion is seen in 0.4% of the patients and embolization in 1.0% of the patients.
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Affiliation(s)
- V Muroke
- Department of Cardiology, Helsinki University Hospital, Helsinki, Finland
| | - M Jalanko
- Department of Cardiology, Helsinki University Hospital, Helsinki, Finland
| | - J Haukka
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - J Hartikainen
- Department of Cardiology, Kuopio University Hospital, Kuopio, Finland
| | - A Tahvanainen
- Department of Cardiology, Tampere University Hospital, Tampere, Finland
| | - H Ukkonen
- Heart Centre, Turku University Hospital, Turku, Finland
| | - K Ylitalo
- Department of Cardiology, Oulu University Hospital, Oulu, Finland
| | - J Pihkala
- Department of Cardiology, New Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - J Sinisalo
- Department of Cardiology, Helsinki University Hospital, Helsinki, Finland
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27
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Kong MW, Li YJ, Li J, Pei ZY, Xie YY, He GX. Down syndrome child with multiple heart diseases: A case report. World J Cardiol 2023; 15:615-622. [PMID: 38058402 PMCID: PMC10696207 DOI: 10.4330/wjc.v15.i11.615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 09/27/2023] [Accepted: 10/27/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Down syndrome, also known as trisomy 21 syndrome, is commonly associated with congenital heart disease, and can often result in early formation of pulmonary hypertension. The development of pulmonary hypertension can result from factors such as intracardiac and macrovascular shunts, and upper airway obstruction or hypoplasia of lung tissue. Individuals with Down syndrome and congenital heart disease have a significantly lower average life expectancy, with surgical intervention being the most viable treatment option to improve longevity. CASE SUMMARY We report the case of a 13-year-old boy with Down syndrome presenting with atrial septal defect and patent ductus arteriosus along with severe pulmonary hypertension. The electrocardiogram shows sinus rhythm and right ventricular hypertrophy. The echocardiogram shows an atrial septal defect with interrupted echo in the interatrial septum, measuring 0.813 cm in length. The patient was initially refused to be offered surgical treatment by many hospitals due to the high surgical risk and pulmonary artery resistance. After discussing the patient's diagnosis and treatment options, we ultimately recommended surgical treatment. However, the patient and their family declined this recommendation and chose to be discharged. During the follow-up period of 6 mo, there were no significant improvements or deteriorations in the patient's condition. CONCLUSION In conclusion, this case highlights the challenges faced by individuals with Down syndrome and congenital heart disease complicated by severe pulmonary hypertension. Timely intervention and a multidisciplinary approach are crucial for improving prognosis and life expectancy. Further research is needed to enhance our understanding and develop effective interventions for this population.
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Affiliation(s)
- Mo-Wei Kong
- Department of Cardiology, Guiqian International General Hospital, Guiyang 550018, Guizhou Province, China
| | - Yi-Jing Li
- Department of Cardiology, Guiqian International General Hospital, Guiyang 550018, Guizhou Province, China
| | - Jun Li
- Department of Cardiology, Guiqian International General Hospital, Guiyang 550018, Guizhou Province, China.
| | - Zhen-Ying Pei
- Department of Cardiology, Guiqian International General Hospital, Guiyang 550018, Guizhou Province, China
| | - Yu-Yu Xie
- Department of Dermatology, Guiqian International General Hospital, Guiyang 550018, Guizhou Province, China
| | - Guo-Xiang He
- Department of Cardiology, Guiqian International General Hospital, Guiyang 550018, Guizhou Province, China
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Mendez-Ruiz A, Dangl M, Peñalver J, Colombo R. Migration of an Atrial Septal Defect Occluder in a Pregnant Patient. CASE (Phila) 2023; 7:445-448. [PMID: 38028387 PMCID: PMC10679532 DOI: 10.1016/j.case.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
•Delayed migration of ASDO is a rare complication. •Evidence of ASDO migration in pregnant patients is lacking. •TTE provides safe and rapid imaging to assess hemodynamics and ASDO location in pregnancy. •Treatment includes surgery, transcatheter retrieval, and conservative strategies.
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Affiliation(s)
- Alan Mendez-Ruiz
- Department of Internal Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida
| | - Michael Dangl
- Department of Internal Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida
| | - Jorge Peñalver
- Department of Medicine, Cardiovascular Disease Division, Jackson Memorial Hospital, Miami, Florida
| | - Rosario Colombo
- Department of Medicine, Cardiovascular Disease Division, Jackson Memorial Hospital, Miami, Florida
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Yamazaki Y, Numasawa Y, Mase T, Arai M, Maeda T, Shinoda Y, Watabe K, Ono S, Hashimoto R, Yokokura S, Haginiwa S, Kojima H, Tanaka M, Koizumi K. A case of atrial septal defect with right-to-left shunting without pulmonary hypertension. J Cardiol Cases 2023; 28:224-227. [PMID: 38024117 PMCID: PMC10658296 DOI: 10.1016/j.jccase.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 07/18/2023] [Accepted: 07/21/2023] [Indexed: 12/01/2023] Open
Abstract
We report a case of a 54-year-old man with atrial septal defect who presented with oxygen desaturation on pulse oximetry. Cardiac magnetic resonance imaging and transesophageal echocardiography showed right-to-left shunting through an atrial septal defect, which was confirmed by superior vena cavography and suggested Eisenmenger syndrome. However, cardiac catheterization revealed a normal pulmonary arterial pressure. Simultaneous measurement of interatrial pressure identified two transient interatrial pressure gradient points, where the right atrial pressure was higher than the left atrial pressure. The patient was finally diagnosed with atrial septal defect without pulmonary hypertension. Right-to-left shunting was primarily caused by a transient interatrial pressure gradient due to a time delay in both initial atrial contraction and completion of passive ventricular filling between the right and left sides of the heart. Surgical closure of the atrial septal defect was performed, and hypoxemia improved. This is the first report of right-to-left shunting without pulmonary hypertension caused by a transient interatrial pressure gradient due to a time delay between the right and left cardiac cycles. Precise assessment of the simultaneous interatrial pressure in addition to diagnostic imaging played a pivotal role in clarifying the etiology of this rare condition. Learning objective Atrial septal defect with right-to-left shunting without Eisenmenger syndrome is a rare condition. We identified transient interatrial pressure gradients associated with a time delay in both initial atrial contraction and completion of the passive ventricular filling phase, which we considered as the primary mechanism underpinning right-to-left shunting. Simultaneous measurement of interatrial pressure played a pivotal role in elucidating the hemodynamics and abnormal shunt flow mechanism.
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Affiliation(s)
- Yusuke Yamazaki
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
| | - Yohei Numasawa
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
| | - Taro Mase
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
| | - Miona Arai
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
| | - Takashi Maeda
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
| | - Yuhei Shinoda
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
| | - Kosuke Watabe
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
| | - Shoya Ono
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
| | - Ryota Hashimoto
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
| | - Souichi Yokokura
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
| | - Sho Haginiwa
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
| | - Hidenori Kojima
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
| | - Makoto Tanaka
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
| | - Kiyoshi Koizumi
- Department of Cardiovascular Surgery, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
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Chen J, Xie Y, Li Y, Chen X, Fu M, Liu Y, Zhang Z. Assessment of degradability and endothelialization of modified poly L-lactic acid (PLLA) atrial septal defect (ASD) occluders over time in vivo. J Cardiothorac Surg 2023; 18:283. [PMID: 37817186 PMCID: PMC10566106 DOI: 10.1186/s13019-023-02401-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 09/30/2023] [Indexed: 10/12/2023] Open
Abstract
OBJECTIVE To evaluate the fiber-degradation and endothelialization of a modified poly L-lactic acid (PLLA) atrial septal defect (ASD) occluder for a long time in vivo. METHODS A total of 57 New Zealand rabbits were selected to establish the vasculature implantation model, which would be used to characterize the mechanical properties and pathological reaction of PLLA filaments (a raw polymer of ASD occluder). In total, 27 Experimental piglets were used to create the ASD model for the catheter implantation of PLLA ASD occluders. Then, X-ray imaging, transthoracic echocardiography, histopathology, and scanning electron microscope (SEM) were performed in the experimental animals at 3, 6, 12, and 24 months after implantation. RESULTS In the rabbit models, the fibrocystic grade was 0 and the inflammatory response was grade 2 at 6 months after vasculature implantation of the PLLA filaments. The mass loss of PLLA filaments increased appreciably with the increasing duration of implantation, but their mechanical strength was decreased without broken. In the porcine models, the cardiac gross anatomy showed that all PLLA ASD occluders were stable in the interatrial septum without any vegetation or thrombus formation. At 24 months, the occluders had been embedded into endogenous host tissue nearly. Pathological observations suggested that the occluders degraded gradually without complications at different periods. SEM showed that the occluders were endothelialized completely and essentially became an integral part of the body over time. CONCLUSION In the animal model, the modified PLLA ASD occluders exhibited good degradability and endothelialization in this long-term follow-up study.
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Affiliation(s)
- Jun Chen
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, Guangdong, China
- Department of Pediatric Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, No. 106 Zhongshan Second Road, Yuexiu District, Guangzhou, 510100, Guangdong, China
- Danzhou People's Hospital, Danzhou, 571700, Hainan, China
| | - Yumei Xie
- Department of Pediatric Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, No. 106 Zhongshan Second Road, Yuexiu District, Guangzhou, 510100, Guangdong, China
| | - Yifan Li
- Department of Pediatric Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, No. 106 Zhongshan Second Road, Yuexiu District, Guangzhou, 510100, Guangdong, China
| | - Xianmiao Chen
- Lifetech Scientific (Shenzhen) Co., Ltd., Shenzhen, 518057, Guangdong, China
| | - Mingjuan Fu
- Lifetech Scientific (Shenzhen) Co., Ltd., Shenzhen, 518057, Guangdong, China
| | - Yanfen Liu
- Lifetech Scientific (Shenzhen) Co., Ltd., Shenzhen, 518057, Guangdong, China
| | - Zhiwei Zhang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, Guangdong, China.
- Department of Pediatric Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, No. 106 Zhongshan Second Road, Yuexiu District, Guangzhou, 510100, Guangdong, China.
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Khattab MN, Alhalabi MM, Alkounsol K, Othman M, Hujair N. Lutembacher's Syndrome Accompanied by Partial Anomalies of Pulmonary Veins in a 70-Year-Old Male: A Case of Congenital Heart Disease in the Elderly. Eur J Case Rep Intern Med 2023; 10:004089. [PMID: 37920223 PMCID: PMC10619523 DOI: 10.12890/2023_004089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 09/04/2023] [Indexed: 11/04/2023] Open
Abstract
Lutembacher's syndrome is a rare disease defined as the combination of atrial septal defect and mitral stenosis, which relieves the progression of symptoms resulting from mitral stenosis. We present a case of a previously asymptomatic 70-year-old man having Lutembacher's syndrome with sinus venosus type of interatrial defect associated with partial anomalous pulmonary venous drainage. Our patient's only complaint was of mild exertional dyspnea, which started six months prior to referral. Clinical suspicion of the combination of defects arose during transthoracic echocardiography. The patient underwent transesophageal echocardiography and multi-slice computed tomography for defect confirmation. The combination of Lutembacher's syndrome with this complex deformity of pulmonary venous drainage has rarely been described. Such complex congenital defects with multifaceted physiological repercussions can go largely undiagnosed for the patients affected for most of their lifetimes. LEARNING POINTS Despite the complexity of Lutembacher's syndrome, including the involvement of several deformities and pathological mechanisms of mitral stenosis, sinus venosus type of interatrial defects with partial anomalous return in the pulmonary veins, the multiplicity of mechanisms involved contribute to altered hemodynamics.Multiple intersecting mechanisms can further contribute to delaying congenital heart disease presentation. Congenital heart disease remains a plausible differential in the evaluation of elderly patients presenting with exertional dyspnea.Adult congenital heart defects can have very late onset for presentation, especially with physiological processes that paradoxically reduce the severity and progression of symptoms.
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Affiliation(s)
| | | | - Karam Alkounsol
- Department of Cardiology, Al Bassel Heart institute, Damascus, Syria
| | - Majed Othman
- Department of Cardiac Surgery, Al Bassel Heart institute, Damascus, Syria
| | - Nizar Hujair
- Department of Cardiology, Al Bassel Heart institute, Damascus, Syria
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Samarawickrama T, Wijesinghe N, Karunarathna S, Biyanwila A. Scimitar syndrome with large atrial septal defect and a rare partial anomalous venous drainage in an adult: a case report. Eur Heart J Case Rep 2023; 7:ytad453. [PMID: 37811155 PMCID: PMC10552381 DOI: 10.1093/ehjcr/ytad453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 08/23/2023] [Accepted: 09/07/2023] [Indexed: 10/10/2023]
Abstract
Background Scimitar syndrome is a very rare congenital cardio-pulmonary disease with anomalous right pulmonary vein draining either partially or completely into the inferior vena cava. It is called Scimitar syndrome due to the classical appearance in the chest X-ray, which resembles the curved blade of Turkish sword 'Scimitar'. It commonly associates with atrial septal defect (ASD), hypoplasia of the right lung, dextroposition of the heart, and pulmonary hypertension (PHT). Case summary A 67-year-old lady, diagnosed with atrial fibrillation and moderate PHT 3 years ago, presented with worsening bilateral ankle oedema and New York Heart Association class III shortness of breath. Chest X-ray showed the Scimitar appearance. The trans-thoracic and trans-oesophageal echocardiograms revealed a 46 mm ASD and a partial anomalous pulmonary venous drainage (PAPVD) of the right upper pulmonary vein (RUPV) into the right atrium at the junction of the atria. Three-dimensional reconstruction of the computed tomographic pulmonary angiogram confirmed Scimitar syndrome of the right lower pulmonary vein (RLPV). We managed her conservatively on her wish. After 13 months, she succumbed due to a massive stroke. Discussion We describe a very rare case of an elderly lady who has Scimitar syndrome with an ASD and evidence of PAPVD of the RUPV; thus, we intend to provide an antecedent for further cases, for prompt and accurate diagnosis and timely interventions in order to prevent life-threatening complications.
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Affiliation(s)
- Thisara Samarawickrama
- Department of Clinical Medicine, Faculty of Medicine, General Sir John Kotelawala Defence University, Kandawala Road, Ratmalana, Colombo 10390, Sri Lanka
- University Hospital, General Sir John Kotelawala Defence University, Boralesgamuwa, Colombo 10290, Sri Lanka
| | - Namal Wijesinghe
- Department of Clinical Medicine, Faculty of Medicine, General Sir John Kotelawala Defence University, Kandawala Road, Ratmalana, Colombo 10390, Sri Lanka
- University Hospital, General Sir John Kotelawala Defence University, Boralesgamuwa, Colombo 10290, Sri Lanka
| | - Subash Karunarathna
- University Hospital, General Sir John Kotelawala Defence University, Boralesgamuwa, Colombo 10290, Sri Lanka
| | - Anjali Biyanwila
- University Hospital, General Sir John Kotelawala Defence University, Boralesgamuwa, Colombo 10290, Sri Lanka
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Maagaard M, Boutrup N, Udholm S, Ahlstrup M, Nielsen-Kudsk JE, Ringgaard S, Hjortdal V. Adults with small, unrepaired atrial septal defects have reduced cardiac index during exercise. Cardiol Young 2023; 33:1981-1991. [PMID: 36468329 DOI: 10.1017/s1047951122003742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Small, unrepaired atrial septal defects are considered a benign lesion with good prognosis. Recently, clinical and register-based studies discovered increased long-term mortality and morbidity. The nature of these findings is not fully understood. Therefore, MRI was performed to evaluate cardiac function at rest and during exercise. METHODS Adults with open or spontaneously closed atrial septal defects and healthy, matched controls underwent MRI for evaluation of cardiac chamber volume. Quantitative flow scans measured blood flow in the ascending aorta and the proximal pulmonary artery at rest and during increasing supine exercise. RESULTS In total, 15 open defects (39 ± 11 years) and 15 matched controls (38 ± 12 years) were included, along with 20 spontaneously closed (36 ± 13 years) and 20 controls (36 ± 11 years). Cardiac chamber volumes and flow measurements at rest were comparable between groups, as were heart rates and workloads during exercise. At maximal exercise, open defects reached 31% lower cardiac index and had 38% higher retrograde flow in the pulmonary artery than their controls, p < 0.01. Shunt ratio remained unchanged during exercise, 1.2 ± 0.2. Closed defects reached 18% lower cardiac index, p = 0.02, with comparable pulmonary retrograde flow. Maximal cardiac index was inversely correlated with increasing age for patients only. CONCLUSION Adults with a small, open or spontaneously closed atrial septal defects exhibit markedly lower exercise capacity compared with healthy peers. Moreover, open defects exhibit higher retrograde flows with increasing exercise. Finally, increasing age is related to poorer results in patients but not healthy controls. Longitudinal studies are necessary in order to determine potential accelerated worsening of physical capacity along with age-related changes in patients.
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Affiliation(s)
- Marie Maagaard
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nicolai Boutrup
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Sebastian Udholm
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Mathias Ahlstrup
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Vibeke Hjortdal
- Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
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Ignatius R, Stephen T, Varun C. Pulmonary valve infective endocarditis in an adult patient with atrial septal defect presenting with multiple pulmonary emboli - A case report. J Cardiol Cases 2023; 28:109-112. [PMID: 37671258 PMCID: PMC10477041 DOI: 10.1016/j.jccase.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 04/18/2023] [Accepted: 04/21/2023] [Indexed: 09/07/2023] Open
Abstract
Isolated pulmonary valve (PV) infective endocarditis (IE) is a rare entity accounting for <2 % of all cases of IE. Risk of PV IE in patients with atrial septal defect (ASD) is considered negligible and there have only been a few cases reported to date. We describe a case of a 51-year-old woman with an ostium secundum ASD with associated PV endocarditis, who presented with multiple pulmonary septic emboli. Initially we tried antibiotic therapy and later she underwent successful surgery with ASD closure, vegetectomy, and PV repair. We want to draw attention to the possibility of IE of PV in a patient with ASD and report successful management with surgery and good recovery following treatment. Learning objective In this study, we highlight the importance of keeping a strong clinical suspicion of infective endocarditis (IE) in patients presenting with fever and a pulmonary focus, especially in the setting of congenital heart disease (including even atrial septal defect). We also discuss the possible indications for surgical management in patients with pulmonary valve IE.
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Affiliation(s)
- Remil Ignatius
- Department of Cardiac Surgery, Medical Trust Hospital, Ernakulam, Kerala, India
| | - Thomas Stephen
- Department of Cardiac Surgery, Medical Trust Hospital, Ernakulam, Kerala, India
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Abstract
PURPOSE OF REVIEW The goal of this paper is to review currently available devices for closure of atrial septal defects (ASDs) and ventricular septal defects (VSDs). RECENT FINDINGS Favorable results from the ASSURED trial resulted in FDA approval for the most recently developed device for transcatheter ASD closure in the United States. Further studies are required to assist in the development or approval of safe devices for transcatheter perimembranous VSD closure in pediatric patients. Device closure is the less invasive and preferred management option for many ASDs, with multiple studies demonstrating lower complication rates, shorter hospital stays, and lower mortality than surgical repair. Complex ASDs that make device closure more difficult include large defects, rim deficiencies, fenestrated defects, multiple defects, and the presence of pulmonary arterial hypertension. Device closure has also become an accepted alternative to surgery for some types of ventricular septal defects VSDs, though challenges and limitations remain. Future innovations including novel devices and techniques are needed to further expand on the types of defects that can be safely closed via transcatheter approach.
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Affiliation(s)
- Kathleen P Wood
- Division of Pediatric Cardiology, Duke University, Durham, USA
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Miura K, Yagi R, Miyama H, Kimura M, Kanazawa H, Hashimoto M, Kobayashi S, Nakahara S, Ishikawa T, Taguchi I, Sano M, Sato K, Fukuda K, Deo RC, MacRae CA, Itabashi Y, Katsumata Y, Goto S. Deep learning-based model detects atrial septal defects from electrocardiography: a cross-sectional multicenter hospital-based study. EClinicalMedicine 2023; 63:102141. [PMID: 37753448 PMCID: PMC10518511 DOI: 10.1016/j.eclinm.2023.102141] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 09/28/2023] Open
Abstract
Background Atrial septal defect (ASD) increases the risk of adverse cardiovascular outcomes. Despite the potential for risk mitigation through minimally invasive percutaneous closure, ASD remains underdiagnosed due to subtle symptoms and examination findings. To bridge this diagnostic gap, we propose a novel screening strategy aimed at early detection and enhanced diagnosis through the implementation of a convolutional neural network (CNN) to identify ASD from 12-lead electrocardiography (ECG). Methods ECGs were collected from patients with at least one recorded echocardiogram at 3 hospitals from 2 continents (Keio University Hospital from July 2011 to December 2020, Brigham and Women's Hospital from January 2015 to December 2020, and Dokkyo Medical University Saitama Medical Center from January 2010 and December 2021). ECGs from patients with a diagnosis of ASD were labeled as positive cases while the remainder were labeled as negative. ECGs after the closure of ASD were excluded. After randomly splitting the ECGs into 3 datasets (50% derivation, 20% validation, and 30% test) with no patient overlap, a CNN-based model was trained using the derivation datasets from 2 hospitals and was tested on held-out datasets along with an external validation on the 3rd hospital. All eligible ECGs were used for derivation and validation whereas the earliest ECG for each patient was used for the test and external validation. The discrimination of ASD was assessed by the area under the receiver operating characteristic curve (AUROC). Multiple subgroups were examined to identify any heterogeneity. Findings A total of 671,201 ECGs from 80,947 patients were collected from the 3 institutions. The AUROC for detecting ASD was 0.85-0.90 across the 3 hospitals. The subgroup analysis showed excellent performance across various characteristics Screening simulation using the model greatly increased sensitivity from 80.6% to 93.7% at specificity 33.6% when compared to using overt ECG abnormalities. Interpretation A CNN-based model using 12-lead ECG successfully identified the presence of ASD with excellent generalizability across institutions from 2 separate continents. Funding This work was supported by research grants from JST (JPMJPF2101), JSR corporation, Taiju Life Social Welfare Foundation, Kondou Kinen Medical Foundation, Research fund of Mitsukoshi health and welfare foundation, Tokai University School of Medicine Project Research and Internal Medicine Project Research, Secom Science and Technology Foundation, and Grants from AMED (JP23hma922012 and JP23ym0126813). This work was partially supported by One Brave Idea, co-funded by the American Heart Association and Verily with significant support from AstraZeneca and pillar support from Quest Diagnostics.
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Affiliation(s)
- Kotaro Miura
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
- Institute for Integrated Sports Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Ryuichiro Yagi
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
| | - Hiroshi Miyama
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Mai Kimura
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Hideaki Kanazawa
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Hashimoto
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Sayuki Kobayashi
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Shiro Nakahara
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Tetsuya Ishikawa
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Isao Taguchi
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Motoaki Sano
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Kazuki Sato
- Institute for Integrated Sports Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Rahul C. Deo
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
| | - Calum A. MacRae
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
| | - Yuji Itabashi
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Yoshinori Katsumata
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
- Institute for Integrated Sports Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Shinichi Goto
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
- Division of General Internal Medicine & Family Medicine, Department of General and Acute Medicine, Tokai University School of Medicine, Isehara, Japan
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Montella AP, Petrarcone CG, Giordano M, D'Andrea C, Oppido G. Intracardiac total anomalous pulmonary venous return or septum primum malposition? Complete repair in left atrial isomerism. Multimed Man Cardiothorac Surg 2023; 2023. [PMID: 37578040 DOI: 10.1510/mmcts.2023.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Total anomalous pulmonary venous return due to septum primum malposition is a poorly understood condition despite being very common in left atrial isomerism or polysplenia syndrome. Due to the leftward displacement of the septum primum, either the two right pulmonary veins or all four pulmonary veins can drain abnormally into the right atrium, despite their correct position. In other words, the four pulmonary veins (or the two right pulmonary veins), looking from outside the heart, return at the back of the atrium in the normal position. Nevertheless, from the inside of the heart, two or all four pulmonary veins drain into the right atrium due to the leftward displacement of the septum primum. As an example, we report a 5-month-old patient with severe malposition of the septum primum and consequent total anomalous pulmonary venous drainage into the right atrium. The patient underwent surgical correction with resection of the malpositioned septum primum and reconstruction of a normal interatrial septation with a pericardial patch.
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Affiliation(s)
- Antonio Pio Montella
- Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Monaldi Hospital, Via Leonardo Bianchi, 80131 Naples, Italy
| | - Caterina Golini Petrarcone
- Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Monaldi Hospital, Via Leonardo Bianchi, 80131 Naples, Italy
| | - Mario Giordano
- Pediatric Cardiology Division, University of Campania 'Luigi Vanvitelli', AORN 'Ospedali dei Colli', Monaldi Hospital, Naples, Italy
| | - Claudia D'Andrea
- Pediatric Cardiac Surgery and Congenital Unit, Monaldi Hospital. Via Leonardo Bianchi, 80131 Naples, Italy
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Elsayed YMH, Almarghany AA. Resolution of Trifascicular Heart Block with Effective Closure of Congenital Atrial Septal Defect Followed by Later Coronavirus Disease 2019-associated Cardiac Strain. J Innov Card Rhythm Manag 2023; 14:5533-5536. [PMID: 37650121 PMCID: PMC10464646 DOI: 10.19102/icrm.2023.14081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 04/13/2023] [Indexed: 09/01/2023] Open
Abstract
Heart block (HB) is one of the most serious arrhythmias. Higher degrees of HB-for example, trifascicular HB-result in a more intense patient condition. Atrial septal defects (ASDs) represent the most common congenital heart disease in adults. All ASDs generally result in a left-to-right shunt, commonly causing right-side enlargement and dilation and, to a lesser extent, left atrial enlargement. A 26-year-old woman presented to the physician outpatient clinic with a complicated ASD with trifascicular HB and severe mitral and tricuspid regurgitations. The trifascicular HB with valvular regurgitations resolved with congenital ASD closure; however, she was diagnosed with coronavirus disease 2019 (COVID-19)-associated cardiac strain 3 years later. Interventions included electrocardiography, oxygenation, echocardiography, and cardiovascular surgical repair. A dramatic electrocardiographic response and better clinical outcomes despite dilations of both atria were observed. Trifascicular HB is a newly recorded association after congenital ASDs in adults. The disappearance of trifascicular HB after surgical closure of the congenital ASD is an indicator of effective surgical repair. The occurrence of COVID-19 pneumonia later, with atrial dilations continuing after the infection, may be a constellation of risk factors for the observed cardiac strain.
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D'Angelo LA, Arora Y, Diaz MA, Carrillo RG, Guta C, Patton M. Endovascular approach to a complex thrombus in-transit through a patent foramen ovale. J Cardiol Cases 2023; 28:83-85. [PMID: 37521573 PMCID: PMC10382967 DOI: 10.1016/j.jccase.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 04/11/2023] [Accepted: 04/17/2023] [Indexed: 08/01/2023] Open
Abstract
Large atrial thrombi can be managed percutaneously. We present a case of a 76-year-old female patient who presented to our emergency room with an acute stroke and was managed with mechanical thrombectomy. Further work-up revealed a large complex thrombus in-transit trapped in a patent foramen ovale with a large mobile portion in the left atrium. Due to contraindications for thrombolysis and poor surgical candidacy, an endovascular approach was favored. The procedure was performed successfully, and the patient recovered uneventfully. Learning objective Endovascular approach with mechanical thrombectomy can be a treatment option for patients that present with large thrombus in-transit when other therapies are contraindicated.
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Affiliation(s)
| | - Yingyot Arora
- University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Miguel A. Diaz
- Heart Institute at Palmetto General Hospital, Hialeah, FL, USA
| | | | - Cosmin Guta
- Heart Institute at Palmetto General Hospital, Hialeah, FL, USA
| | - Marquand Patton
- Heart Institute at Palmetto General Hospital, Hialeah, FL, USA
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Bagaria V, Hiremath CS. Late systemic desaturation after transcatheter device closure of atrial septal defect. Cardiol Young 2023; 33:1223-1225. [PMID: 36533532 DOI: 10.1017/s1047951122003833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Transcatheter device closure has emerged as the preferred treatment for ostium secundum atrial septal defects with adequate margins, occasionally requiring surgical intervention to manage complications. We report a case of a young female patient who presented with systemic desaturation and exertional dyspnoea 5 years after device closure. Evaluation demonstrated anterior malposition of the septal occluder, with the right atrial rim of the device diverting the blood from the inferior vena cava to the left atrium. She underwent surgical extraction of the device and pericardial patch closure of the atrial septal defect.
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Affiliation(s)
- Vivek Bagaria
- Department of Cardiothoracic and Vascular Surgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore 560066, India
| | - Channabasavaraj S Hiremath
- Department of Cardiothoracic and Vascular Surgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore 560066, India
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41
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Moy-Trigilio KE, Keene BW, Barker P, Adin D. Myocardial Enhancement Following Agitated Saline Contrast Study in a Boxer Dog. CASE (Phila) 2023; 7:292-294. [PMID: 37546359 PMCID: PMC10403648 DOI: 10.1016/j.case.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
•Myocardial enhancement after agitated saline contrast study in a dog is described. •Suspect air microemboli can inadvertently be introduced into coronary vasculature. •Air microemboli are a theoretic risk of saline contrast echocardiography.
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Affiliation(s)
- Karen E. Moy-Trigilio
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - Bruce W. Keene
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina
| | - Piers Barker
- Duke Pediatric and Congenital Heart Center, Duke University Medical Center, Durham, North Carolina
| | - Darcy Adin
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
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Pana TA, Craigen F, Mohamed MO, Mamas MA, Myint PK. In-hospital outcomes of acute ischaemic stroke patients with atrial septal defect. A national inpatient sample study. Am J Cardiovasc Dis 2023; 13:183-191. [PMID: 37469530 PMCID: PMC10352813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/15/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND AND AIMS Atrial septal defects (ASD) are a well-recognised risk factor for acute ischaemic stroke (AIS). We aimed to delineate the relationship between ASD and in-hospital AIS outcomes (mortality, severe stroke (National Institutes of Health Stroke Scale (NIHSS) > 15), prolonged hospitalisation > 4 days and routine home discharge) in contemporary practice using data from the United States National Inpatient Sample. METHODS NIS admissions with a primary diagnosis of AIS between 2016-2018 were extracted. The NIHSS variable had 75% missing data, which were imputed using multiple imputations by chained equations. The relationship between ASD and the main outcomes was modelled using multivariable logistic regressions, adjusting for age, sex, comorbidities, stroke severity and revascularisation therapies. RESULTS 245,859 records representative of 1,229,295 AIS admissions were included, 35,840 (2.91%) of whom had ASD. ASD patients were younger (median age 63 years versus 72 years) and less likely to have traditional cardiovascular risk factors than their counterparts without ASD. ASD was independently associated with 58% lower odds of in-hospital mortality (hazard ratio (95% confidence interval) = 0.42 (0.33-0.54)), 18% lower odds of severe stroke (0.82 (0.71-0.94)), 20% higher odds of routine home discharge (1.20 (1.14-1.28)) and 28% higher odds of prolonged hospitalisation (1.28 (1.21-1.35)). CONCLUSIONS ASD was associated with better in-hospital outcomes, which were likely driven by younger age, lower prevalence of traditional cardiovascular risk factors, and lower stroke severity. Further research is warranted to clarify the ASD anatomical characteristics which are most strongly associated with these associations.
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Affiliation(s)
- Tiberiu Alexandru Pana
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele UniversityStoke-on-Trent, Keele, United Kingdom
- Aberdeen Cardiovascular and Diabetes Centre, School of Medicine, Medical Sciences and Nutrition, University of AberdeenAberdeen, United Kingdom
- Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of AberdeenAberdeen, United Kingdom
| | - Fiona Craigen
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele UniversityStoke-on-Trent, Keele, United Kingdom
- Aberdeen Cardiovascular and Diabetes Centre, School of Medicine, Medical Sciences and Nutrition, University of AberdeenAberdeen, United Kingdom
- Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of AberdeenAberdeen, United Kingdom
| | - Mohamed O Mohamed
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele UniversityStoke-on-Trent, Keele, United Kingdom
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele UniversityStoke-on-Trent, Keele, United Kingdom
| | - Phyo Kyaw Myint
- Aberdeen Cardiovascular and Diabetes Centre, School of Medicine, Medical Sciences and Nutrition, University of AberdeenAberdeen, United Kingdom
- Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of AberdeenAberdeen, United Kingdom
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Murni IK, Kato T, Wirawan MT, Arafuri N, Hermawan K, Hartopo AB, Anggrahini DW, Nugroho S, Noormanto N, Emoto N, Dinarti LK. An electrocardiographic score to predict pulmonary hypertension in children with atrial septal defect. BMC Pediatr 2023; 23:288. [PMID: 37301836 PMCID: PMC10257265 DOI: 10.1186/s12887-023-04102-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND In limited resource settings, identification of factors that predict the occurrence of pulmonary hypertension(PH) in children with atrial septal defect(ASD) is important to decide which patients should be prioritized for defect closure to prevent complication. Echocardiography and cardiac catheterization are not widely available in such settings. No scoring system has been proposed to predict PH among children with ASD. We aimed to develop a PH prediction score using electrocardiography parameters for children with ASD in Indonesia. METHODS A cross-sectional study reviewing medical record including ECG record was conducted among all children with newly diagnosed isolated ASD admitted to Dr Sardjito Hospital in Yogyakarta, Indonesia during 2016-2018. Diagnosis of ASD and PH was confirmed through echocardiography and/or cardiac catheterization. Spiegelhalter Knill-Jones approach was used to develop PH prediction score. Accuracy of prediction score was performed using a receiver operating characteristic (ROC) curve. RESULTS Of 144 children, 50(34.7%) had PH. Predictors of pulmonary hypertension were QRS axis ≥120°, P wave ≥ 3 mm at lead II, R without S at V1, Q wave at V1, right bundle branch block (RBBB), R wave at V1, V2 or aVR > normal limit and S wave at V6 or lead I > normal limit. ROC curve from prediction scores yielded an area under the curve (AUC) 0.908(95% CI 0.85-0.96). Using the cut-off value 3.5, this PH prediction score had sensitivity of 76%(61.8-86.9), specificity 96.8%(91.0-99.3), positive predictive value 92.7%(80.5-97.5), negative predictive value 88.4%(82.2-92.6), and positive likelihood ratio 23.8(7.7-73.3). CONCLUSIONS A presence of PH in children with ASD can be predicted by the simple electrocardiographic score including QRS axis ≥120°, P wave ≥3 mm at lead II, R without S at V1, Q wave at V1, RBBB, R wave at V1, V2 or aVR > normal limit and S wave at V6 or lead I > normal limit. A total score ≥ 3.5 shows a moderate sensitivity and high specificity to predict PH among children with ASD.
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Affiliation(s)
- Indah K Murni
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Dr. Sardjito Hospital, Yogyakarta, Indonesia.
- Centre for Child Health-Pediatric Research Office (CCH-PRO), Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
| | - Taichi Kato
- Department of Pediatrics/Developmental Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Muhammad Taufik Wirawan
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Nadya Arafuri
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Kristia Hermawan
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Anggoro Budi Hartopo
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Dyah Wulan Anggrahini
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Sasmito Nugroho
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Noormanto Noormanto
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Noriaki Emoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
- Laboratory of Clinical Pharmaceutical Science, Kobe Pharmaceutical University, Kobe, Japan
| | - Lucia Kris Dinarti
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Dr. Sardjito Hospital, Yogyakarta, Indonesia
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Qureshi AM, Gowda ST. A tale of two ASDs-Compliance matters. Catheter Cardiovasc Interv 2023; 101:1241-1242. [PMID: 37125612 DOI: 10.1002/ccd.30669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 04/03/2023] [Indexed: 05/02/2023]
Abstract
Key Points
Patients with secundum atrial septal defects (ASDs) who have pulmonary atresia with intact ventricular septum or critical pulmonary stenosis, exhibit different ASD physiology compared to patients with isolated secundum ASDs.
The indication and timing of secundum ASD closure in these patients should be made on a case‐by‐case basis.
Long‐term assessment of the physiological consequences of secundum ASD closure in this group of patients should be kept in mind, as these patients have right ventricles that represent a spectrum ranging from significantly restrictive right ventricles, to right ventricles with normal compliance.
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Affiliation(s)
- Athar M Qureshi
- Department of Pediatrics, The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Srinath T Gowda
- Department of Pediatrics, The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
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Wiafe YA, Amponsah GM, Asafu Adjaye Frimpong G, Owusu IK. Progressive Memory Decline in a Patient With Atrial Septal Defect: Case Report and Literature Review. Clin Med Insights Case Rep 2023; 16:11795476231176713. [PMID: 37255701 PMCID: PMC10225960 DOI: 10.1177/11795476231176713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 05/01/2023] [Indexed: 06/01/2023]
Abstract
Atrial septal defect (ASD) is a common congenital anomaly that increases the risk of heart failure as well as strokes which can lead to cognitive impairment. The risk of stroke is higher when pulmonary hypertension develops and there is reversal of shunt. Stroke in ASD may be due to paradoxical emboli from the right heart or a left ventricular thrombus which develops as a result of atrial fibrillation, a common arrhythmia in ASD. We present a case of a 32-year-old Ghanaian man with history of ASD who presented with progressive memory loss with magnetic resonance imaging scan of the brain showing multiple infarcts, microvascular disease, and cerebral atrophy.
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Affiliation(s)
- Yaw Amo Wiafe
- Department of Medical Diagnostics, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Gordon Manu Amponsah
- Department of Physiology, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - George Asafu Adjaye Frimpong
- Department of Radiology, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Isaac Kofi Owusu
- Department of Medicine, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Wu J, Huang X, Chen W, Tang Y, Chen X, Wang X, Jing B, Sun Y, Huang K, Gao Q, Liu X, Su M. Noninvasive right ventricular work in patients with atrial septal defects: a proof-of-concept study. Cardiovasc Ultrasound 2023; 21:10. [PMID: 37210542 DOI: 10.1186/s12947-023-00306-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 04/06/2023] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND Noninvasive right ventricular (RV) myocardial work (RVMW) determined by echocardiography is a novel indicator used to estimate RV systolic function. To date, the feasibility of using RVMW has not been verified in assessing RV function in patients with atrial septal defect (ASD). METHODS Noninvasive RVMW was analysed in 29 ASD patients (median age, 49 years; 21% male) and 29 age- and sex-matched individuals without cardiovascular disease. The ASD patients underwent echocardiography and right heart catheterization (RHC) within 24 h. RESULTS The RV global work index (RVGWI), RV global constructive work (RVGCW), and RV global wasted work (RVGWW) were significantly higher in the ASD patients than in the controls, while there was no significant difference in RV global work efficiency (RVGWE). RV global longitudinal strain (RV GLS), RVGWI, RVGCW, and RVGWW demonstrated significant correlations with RHC-derived stroke volume (SV) and SV index. The RVGWI (area under receiver operating characteristic curve [AUC] = 0.895), RVGCW (AUC = 0.922), and RVGWW (AUC = 0.870) could be considered good predictors of ASD and were superior to RV GLS (AUC = 0.656). CONCLUSION The RVGWI, RVGCW, and RVGWW could be used to assess RV systolic function and are correlated with RHC-derived SV and SV index in patients with ASD.
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Affiliation(s)
- Jian Wu
- Department of Ultrasonography, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- School of Medicine, Xiamen University, Xiamen, China
| | - Xinyi Huang
- Department of Ultrasonography, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Weibin Chen
- Department of Cardiology, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Yiruo Tang
- Department of Ultrasonography, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- School of Medicine, Xiamen University, Xiamen, China
| | - Xu Chen
- Department of Ultrasonography, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Xinyu Wang
- Department of Ultrasonography, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Bo Jing
- Department of Ultrasonography, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Yuanyuan Sun
- Department of Ultrasonography, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Kunhui Huang
- Department of Ultrasonography, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Qiumei Gao
- Department of Ultrasonography, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Xueming Liu
- Department of Cardiology, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.
| | - Maolong Su
- Department of Ultrasonography, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.
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Shin T, Shimamura S, Hirata S, Kodera C, Komai S, Tani H. Surgical repair of an unroofed coronary sinus in a dog. J Vet Cardiol 2023; 48:1-6. [PMID: 37269624 DOI: 10.1016/j.jvc.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 04/13/2023] [Accepted: 04/27/2023] [Indexed: 06/05/2023]
Abstract
A 5-year-old, 7.9 kg castrated male Miniature Dachsund presented with heart enlargement on radiography. The dog was asymptomatic. Echocardiography revealed a tubular structure running along the posterior wall of the left atrium and connecting to the right atrium on the caudal side of the left atrium and annulus, which was presumed to be a dilated coronary sinus. After confirming a shunt between the left atrium and coronary sinus by cardiovascular catheterization, an unroofed coronary sinus was diagnosed. Open-heart surgery using cardiopulmonary bypass was performed through left atriotomy. The defect between the left atrium and the coronary sinus was closed by suturing. The cardiac enlargement improved after surgery. The dog was still alive 1227 days after surgery without clinical signs.
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Affiliation(s)
- T Shin
- Shin Doubutsu Byouin, 3-14-29, Minamihorie, Nishi-ku, Osaka, Osaka, 550-0015, Japan
| | - S Shimamura
- Veterinary Medical Center, School of Veterinary Science, Department of Veterinary Science, Osaka Metropolitan University, 1-58, Izumisano, Osaka, 589-8531, Japan.
| | - S Hirata
- Veterinary Medical Center, School of Veterinary Science, Department of Veterinary Science, Osaka Metropolitan University, 1-58, Izumisano, Osaka, 589-8531, Japan
| | - C Kodera
- Veterinary Medical Center, School of Veterinary Science, Department of Veterinary Science, Osaka Metropolitan University, 1-58, Izumisano, Osaka, 589-8531, Japan
| | - S Komai
- Veterinary Medical Center, School of Veterinary Science, Department of Veterinary Science, Osaka Metropolitan University, 1-58, Izumisano, Osaka, 589-8531, Japan; Small Animal Internal Medicine, School of Veterinary Science, Department of Veterinary Science, Osaka Metropolitan University, 1-58, Izumisano, Osaka, 589-8531, Japan
| | - H Tani
- Veterinary Medical Center, School of Veterinary Science, Department of Veterinary Science, Osaka Metropolitan University, 1-58, Izumisano, Osaka, 589-8531, Japan; Small Animal Internal Medicine, School of Veterinary Science, Department of Veterinary Science, Osaka Metropolitan University, 1-58, Izumisano, Osaka, 589-8531, Japan
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Suryawan IGR, Ratri AK, Andrianto A, Ardiana M, Nugraha RA. Fibronectin enhances attachment of human adipose-derived mesenchymal stem cells into polytetrafluoroethylene patch during surgical closure of the atrial and ventricular septal defect. Ann Pediatr Cardiol 2023; 16:189-193. [PMID: 37876958 PMCID: PMC10593271 DOI: 10.4103/apc.apc_9_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 02/19/2023] [Accepted: 07/03/2023] [Indexed: 10/26/2023] Open
Abstract
Background Polytetrafluoroethylene (PTFE) patch is commonly used during surgical closure for atrial septal defect (ASD) and ventricular septal defect (VSD). However, this patch has several limitations such as its inability to grow or remodel, especially in children and young adults. To tackle these limitations, we have tried to use fibronectin and human adipose-derived mesenchymal stem cells (hAMSCs) in the PTFE patch. Objective To understand the impact of fibronectin to enhance hAMSCs cell-to-cell adherence and cell-to-patch surface attachment into PTFE patches used in the surgical closure of ASD or VSD. Materials and Methods The hAMSCs were plated and fixated with 15 mL methanol and cluster of differentiation (CD) 90+, CD105+, and CD45 - antibodies were labeled with fluorescein isothiocyanate, rinsed with phosphate-buffered saline, and analyzed under a fluorescence microscope. Fibronectin solution (0.1%) was used to soak patch scaffolds for approximately 2-h duration and then dried for 20 min in the treatment group. The samples were examined with a scanning electron microscope (SEM). Results SEM examination showed incomplete attachment of the cells even after 10 days in the control group at 1.14 ± 1.13. In contrast, the treatment group showed more cells attached to the patch surface at 31.25 ± 13.28 (P ≤ 0.0001). The observation at 5 days was 17.67 ± 20.21, at 7 days was 12.11 ± 10.94, and at 10 days was 18.83 ± 23.25. There was no significant statistical difference in mean cell per view among each treatment group (P = 0.802). Conclusion Our work demonstrates that fibronectin has a positive impact on hAMSC attachment seeded onto the PTFE patch. These properties, in combination with their developmental plasticity, have generated tremendous interest in regenerative medicine.
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Affiliation(s)
- I. Gde Rurus Suryawan
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Anudya Kartika Ratri
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Andrianto Andrianto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Meity Ardiana
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Ricardo Adrian Nugraha
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya, Indonesia
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Parekh P, Narasimhan S, Karim F, Ambrose M, Hiremath G. Early Infective Endocarditis Associated with an Amplatzer Atrial Septal Occluder Device in a 14-Year-Old Male. Pediatr Cardiol 2023; 44:1187-1189. [PMID: 37115239 DOI: 10.1007/s00246-023-03172-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 04/19/2023] [Indexed: 04/29/2023]
Abstract
Infective endocarditis (IE) associated with an ASD device, particularly in the early post-procedure period, is extremely rare. We report a case of infective endocarditis presenting with embolic complications and vegetations on the device that were only seen on transesophageal echocardiography, necessitating device removal.
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Affiliation(s)
- Punishi Parekh
- Division of Pediatric Cardiology, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, 2450 Riverside Ave, Minneapolis, MN, 55454, USA
| | - Shanti Narasimhan
- Division of Pediatric Cardiology, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, 2450 Riverside Ave, Minneapolis, MN, 55454, USA
| | - Farida Karim
- Division of Pediatric Cardiology, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, 2450 Riverside Ave, Minneapolis, MN, 55454, USA
| | - Matthew Ambrose
- Division of Pediatric Cardiology, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, 2450 Riverside Ave, Minneapolis, MN, 55454, USA
| | - Gurumurthy Hiremath
- Division of Pediatric Cardiology, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, 2450 Riverside Ave, Minneapolis, MN, 55454, USA.
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Coskun S, Adina KA, Tiryakioglu SK, Sahin T, Kilic T. Effect of percutaneous closure on atrium and appendage functions in patients with secundum atrial septal defects. Int J Cardiovasc Imaging 2023:10.1007/s10554-023-02843-9. [PMID: 37040061 DOI: 10.1007/s10554-023-02843-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 03/20/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND The study aimed to assess the impact of percutaneous transcatheter atrial septal defect (ASD) closure on atrium and atrial appandage functions among patients with ostium secundum ASDs. METHODS A total of 101 patients (34,7% male, 65,3% female, 37,6 ± 12) with the diagnosis of ostium secundum type ASD underwent transthorasic (TTE) and transesophageal echocardiography (TEE) before and six months after percutaneous transcatheter ASD closure. Pulmonary venous flow and atrial appendage flow velocities were obtained from the TEE recordings. The offline evaluation of the global and segmental atrial appendage strains were evaluated with speckle tracking echocardiography (STE) via EchoPac 6,3 (GE Vingmed, Horten, Norway). RESULTS Mean values of pulmonary artery pressure, right ventricular, left atrium, left ventricular end-diastolic and end-systolic diameters were significantly decreased 6 months after ASD closure. Statistically significant changes were documented in pulmonary venous and left atrial appendage flow velocities after ASD closure. Both left and right atrial appendage flow velocities and global strains of atrial appandages were improved after ASD closure. The mean left atrial appendage global strain value was - 11.45 ± 4.13% before the procedure, this value was - 16.82 ± 3.78% sixth months after the procedure (P < 0.001).The mean right atrial appendage global strain was - 13.31 ± 4.84% before the procedure and - 18.53 ± 4.69% sixth months after the procedure (P < 0.001). CONCLUSION Left and right atrial appendage flow velocities and global strains of left and right atrial appandage can be improved after transcatheter ASD closure. Percutaneous transcatheter closure of ASDs not only improves atrial and left ventricular dimensions but also have a positive impact on left and right atrial appandage functions.
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Affiliation(s)
- Senol Coskun
- Department of Cardiology, Bursa Acibadem Hospital, Bursa, Turkey
| | - Kurban Ali Adina
- Department of Cardiology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | | | - Tayfun Sahin
- Department of Cardiology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Teoman Kilic
- Department of Cardiology, Kocaeli University School of Medicine, Kocaeli, Turkey
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