Abstract
Atrial septal defects (ASDs) represent the most common congenital heart defect diagnosed in adulthood. Although considered a simple defect, challenges in optimal diagnostic and treatment ...options still exist due to great heterogeneity in terms of anatomy and time-related complications primarily arrhythmias, thromboembolism, right heart failure and, in a subset of patients, pulmonary arterial hypertension (PAH). Atrial septal defects call for tertiary expertise where all options may be considered, namely catheter vs. surgical closure, consideration of pre-closure ablation for patients with atrial tachycardia and suitability for closure or/and targeted therapy for patients with PAH. This review serves to update the clinician on the latest evidence, the nuances of optimal diagnostics, treatment options, and long-term follow-up care for patients with an ASD.
Background: Transesophageal echocardiography (TEE) has been used for percutaneous atrial septal defect (ASD) closure, with intracardiac echocardiography (ICE) guidance recently being ...introduced.Methods and Results: The Japanese Structural Heart Disease Registry was established by the Japanese Association of Cardiovascular Intervention and Therapeutics. This study analyzed data from the Registry for 2,859 consecutive cases undergoing percutaneous ASD closure between January 2015 and December 2020. ASD closure was performed under ICE guidance (n=519; 18.2%), TEE guidance (n=1,428; 49.9%), or TEE plus ICE guidance (“Both”; n=900 cases; 31.5%). The success rates were similar in the TEE, ICE, and both groups (99.0%, 99.2%, vs. 98.0%, respectively; P=0.054), as were complication rates (1.2%, 0.5%, vs. 2.1%, respectively; P=0.24). In the TEE and Both groups, 92.4% and 79.6% of patients required general anesthesia, compared with only 2.9% of patients in the ICE group (P<0.001). Fluoroscopic time was longer in the ICE and Both groups than in the TEE group (median interquartile range 19 14–28 and 21 13–30 vs. 12 8–19 min, respectively; P<0.001). Rim deficiency and larger defect diameter were inversely related, whereas hospital volume was positively related to ICE guidance.Conclusions: Percutaneous transcatheter ASD closure was as feasible under ICE as under TEE guidance. ICE guidance is used for less challenging cases in high-volume centers in Japan.
Background. Surgical therapy for closure of atrial septal defect with cardiopulmonary bypass is the gold standard. Transcatheter closure has become an alternative for the treatment of atrial septal ...defect because 80-90% of atrial septal defects can be resolved without surgery. The success of transcatheter closure of atrial septal defect is almost 80% of all patients with atrial septal defect. Objective. To analyze the differences in the results of transcatheter and surgical closure of atrial septal defects Method. The type of research is observational analytic with a cross-sectional design. The sample is medical record data from pediatric patients with atrial septal defect who underwent transcatheter and surgical closure of the atrial septal defect between January 1, 2019 and June 30, 2023 at Dr. Soetomo Surabaya. All subjects with incomplete data will be excluded. Results. The total research subjects were 81 subjects, divided into 2 groups: transcatheter 41/81 (50.6%) and surgical 40/81 (49.6%). Transcatheter and surgical procedures had similar success rates (100% vs 92.5%, p=1.116). Transcatheter procedures had a longer ICU stay (0.07 day vs 3 days, p<0.001) and longer hospital stay (4,8 days vs 7,3 days, p<0.001) than surgical procedures. The total procedure cost of transcatheter procedures was also cheaper than surgical procedures (61 million vs 91 million, p<0.001). Complications of transcatheter procedures were also lower than surgical procedures (12.2% vs 52.5%, p<0.001). Conclusion. Transcatheter closure of atrial septal defects showed excellent result, shorter ICU and hospital stay, lower costs, and fewer complications.
With an increase in number of patients undergoing percutaneous treatment of severe mitral regurgitation with MitraClip placement, the consequences of transseptal puncture resulting in iatrogenic ...atrial septal defects (iASDs) are being increasingly realized. Closure of iASDs following MitraClip therapy is not routinely performed, and no guidelines currently exist in managing this condition. While immediate hemodynamic and clinical compromise secondary to acute hypoxemia related to iASDs should be acutely managed with defect closure, the prevalence and consequences of long‐term iASDs are still unclear. Some studies have cited a potential improvement in hemodynamic outcomes as a result of iASDs; while others report potential inferior and even fatal outcomes. In this state‐of‐the‐art clinical review, we present the readers with the current data on the prevalence, outcomes, and potential management options of iASDs after MitraClip placement.
Atrial septal defects are the second most common congenital heart defects. Transthoracic echocardiogram is the imaging modality of choice to diagnose atrial septal defects in the pediatric population ...and delineate the anatomic type of atrial septal defect. This imaging modality not only allows diagnosis but also permits evaluation of concomitant congenital cardiac defects and secondary physiological changes. Clinicians and sonographers must have a thorough understanding of the appropriate echocardiographic views to completely assess an atrial septal defect and neighboring intracardiac structures. This information is essential to determine if a patient is a candidate for a catheterization based intervention or if the patient would be a better candidate for surgical intervention.
•Atrial septal defects are the second most common congenital heart defect•Echocardiography in pediatric patient is typically the only imaging modality needed to diagnose patients with atrial septal defects•Echocardiography allows diagnosis of associated congenital defects
Up to 90% of adults with untreated atrial septal defect will be symptomatic by 4
decade, and 30-49% will develop heart failure. 8-10% of these patients have pulmonary arterial hypertension with a ...female predominance regardless of age. We aimed to demonstrate that fenestrated closure can be safely performed in patients with decompensated heart failure and atrial septal defect-associated pulmonary arterial hypertension with improved outcome.
Transcatheter fenestrated atrial septal defect closures (Occlutech GmbH, Jena, Germany) were performed on a compassionate-use basis in 5 consecutive adult patients with atrial septal defect-associated pulmonary arterial hypertension and severe heart failure with prohibitive surgical mortality risks. Change in systemic oxygen saturation, 6-minute walk test, NYHA class, echocardiographic and haemodynamic parameters were used as parameters of outcome.
All patients were female, mean age 48.8 ± 13.5 years, followed up for a median of 29 months (max 64 months). Significant improvements observed in the 6-minute walk test, and oxygen saturation comparing day 0 time point to all other follow-up time points data (
= 1.32, SE = 0.28,
(22.7) = -4.77,
= 0.0001); and in the haemodynamic data (including pulmonary vascular resistance and pulmonary pressure) (
= -0.60, SE = 0.22,
(40.2) = 2.74,
= .009). All patients showed improved right ventricular size and function along with NYHA class. There were no procedure-related complications.
Fenestrated atrial septal defect closure is feasible in adults with decompensated heart failure and atrial septal defect-associated pulmonary arterial hypertension. It results in sustained haemodynamic and functional improvement.
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.
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).
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).
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.
Introduction: Atrial septal defect (ASD) is one of the most common congenital heart diseases and often diagnosed in adulthood. ASD represents a spectrum of disease with symptoms that vary from ...asymptomatic to right-sided cardiac volume overload, pulmonary arterial hypertension and atrial arrhythmias depending on the size of the defect, size of the shunt and associated anomalies. We reported a patient with large ostium primum ASD who underwent surgical closure with a pericardial patch. Case Description: A 18 years old man came with chief complaint of abnormal ECG results of the screening examination of police candidates from Bhayangkara Hospital Manado. The patient had no complaints during admission. The patient could still carry out daily activities without any obstacles. The patient also could do high intensity sport without complaints of shortness of breath, heavy chest, or headaches. .Electrocardiogram (ECG) examination showed sinus rhythm, heart rate 74 beats per minute, left anterior fascicular block (LAFB), complete right bundle branch block (RBBB) and fragmented QRS at inferior leads. Transthoracic and transesophageal echocardiography revealed large ostium primum ASD L-R shunt. Open heart ASD surgical closure with pericardial patch was done with good results and no residual shunt. Conclusion: Large ostium primum ASD are associated with significant systemic-to-pulmonary shunts that results in desaturation requiring surgical closure. Large shunt of ASD patients who have a dilated right heart are associated with increased age-related morbidity and mortality. ASD with right heart dilatation should be considered for closure once the diagnosis is established regardless of the patient's age.
Atrial septal defects (ASD) are congenital cardiac anomalies, characterized by abnormal communication between the atria. These are commonly diagnosed in childhood and occasionally remain asymptomatic ...and undetected until the later stages of life. In ASD, there is communication between atria. Until the 4 th decade of life, the majority of ASD are asymptomatic. Some exhibit the signs of exhaustion, syncope, exercise intolerance, and dyspnea with effort. Eisenmenger syndrome, paradoxical embolism, and atrial arrhythmias are among the problems that some people may later on develop. We describe a particular case of a 70-year-old male who arrived with a transient ischemic attack where he had left-sided upper limb weakness due to a paradoxical embolism due to ASD.
Background: Transcatheter mitral valve repair with the MitraClip system has been established in selected high-risk patients. The MitraClip procedure results in a relatively large iatrogenic atrial ...septal defect (iASD). This study aimed to investigate the prevalence and clinical course of iASD requiring transcatheter closure following the MitraClip procedure.Methods and Results: This study was conducted at all 59 institutions that perform transcatheter mitral valve repair with the MitraClip system in Japan. The data of patients on whom transcatheter iASD closure was performed were collected. Of the 2,722 patients who underwent the MitraClip procedure, 30 (1%) required transcatheter iASD closure. The maximum iASD size was 9±4 mm (range, 3–18 mm). The common clinical course of transcatheter iASD closure was hypoxemia with right-to-left shunt or right-sided heart failure with left-to-right shunt. Of the 30 patients, 22 (73%) required transcatheter closure within 24 h following the MitraClip procedure, including 12 with hypoxemia and 5 with right-sided heart failure complicated with cardiogenic shock. Of the 5 patients, 2 required mechanical circulatory support devices. Twenty-one patients immediately underwent transcatheter iASD closure, and hemodynamic deteriorations were resolved; however, 1 patient died without having undergone transcatheter closure.Conclusions: Transcatheter iASD closure was required in 1% of patients who underwent the MitraClip procedure. Many of these patients immediately underwent transcatheter iASD closure because of hypoxemia with right-to-left shunt or right-sided heart failure with left-to-right shunt.
