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Background: Atrial septal defect (ASD) closure has become an established therapy. Novel echocardiographic methods have been developed to quantify global as well as regional ventricular function and are used for diagnostic and prognostic evaluation of various cardiovascular diseases. Objective: To assess the impact of transcatheter closure of secundum atrial septal defects on the left and right ventricular function using conventional and newer echo-Doppler modalities. Patients and methods: This study included 40 subjects with secundum ASD. Cases were assessed by transesophageal echo pre ASD closure to detect suitability for transcatheter ASD closure, then selected patients were evaluated by transthoracic echo-Doppler using conventional and recent modalities before closure, one month and three months after closure. Results: Post ASD closure there were increase in the Left ventricle (LV) dimensions and volumes, increase in LVEF, and reduction of LV-GLS compared to pre closure. The RV volumes, RV-GLS and RVEF were decreased post closure. Both LV Tei index and RV Tei index showed significant reduction post ASD closure. Conclusion: Transcatheter closure of secundum atrial septal defect leads to structural and functional changes in both ventricles in the form of: (a) reduction in RV dimensions and volumes with apparent deterioration of the RV systolic function, (b) increase in dimensions and volumes of the LV with apparent improvement of LV systolic function, and (c) apparent improvement of both left and right ventricular diastolic function post ASD closure. [ABSTRACT FROM AUTHOR]

Secundum atrial septal defects (sASDs) are common congenital cardiac defects mostly treated using a transcatheter approach. However, small children (<15 kg) are still undergoing surgical sASD closure in many centres. Although both options have been proved to have excellent results in children, comparative data of the two techniques are missing for patients ≤ 15 kg. The medical records of children ≤ 15 kg who underwent sASD surgical (group A) and transcatheter (group B) closure between 2010 and 2023 were reviewed retrospectively. Twenty-five children in group A and twenty-two in group B were included (mean weight 8.9 kg in group A and 10.3 kg in group B). The main indications for closure were right heart enlargement and failure to thrive. Major complications occurred in two patients in group A and none in group B. Minor complications occurred in eight patients in group A and one in group B. At last follow-up, symptoms resolved completely or improved significantly for all infants, with the exception of failure to thrive in the sub-population of children with extra-cardiac comorbidities. sASD closure can be performed safely in symptomatic infants ≤ 15 kg, even in the presence of comorbidity, and should not be postponed. However, in patients with extra-cardiac comorbidities, the only indication of growth retardation must be carefully evaluated. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the procedural and short-term results of percutaneous atrial septal defect (ASD) closure in adults. Methodology: We retrospectively analysed 149 consecutive patients with a secundum ASD who underwent percutaneous closure from September 2011 to January 2021. Procedural and short-term results, including arrhythmia, device embolisation and residual shunt, were assessed at 2 days and 4 weeks and 6 months after percutaneous closure of atrial septal defect. Results: The patients were 14 to 77 (37.7 ± 15.0) years old and 101 (67.8%) were female. Maximum defect size was 18.0 ± 6.3 mm measured on transoesophageal echocardiography. The device diameter used in patients who underwent closure was 21.9 ± 6.9 mm (6-38 mm). Percutaneous closure procedure success rate was 93.3%. In our study, the rates of device embolisation, arrhythmia and residual shunt were 3.6%, 1.4%, and 2.2%, respectively. Conclusion: Transcatheter closure of ASDs in adults was feasible in our centre with good short-term outcome. The procedure should be performed in experienced centres by cardiologists specialised in the treatment of structural heart diseases due to potentially severe complications. [ABSTRACT FROM AUTHOR]

The ideal follow-up of neonates who have a secundum atrial septal defect (ASD), muscular ventricular septal defect (VSD), or patent ductus arteriosus (PDA) remains uncertain. Newborns with findings limited to a secundum ASD, muscular VSD, and/or PDA on their neonatal hospitalization discharge echocardiogram and at least one outpatient follow-up echocardiogram performed between 9-1-17 and 9-1-21 were evaluated and patient follow-up assessed through 9-1-23. 95 infants met inclusion criteria. 43 infants had a secundum ASD, 41 had a muscular VSD, and 54 had a PDA at newborn hospital discharge. 39/95 had more than one intracardiac shunt. 56 were discharged from care, 26 were still in follow-up and 13 were lost to recommended follow-up. No patients received intervention during the follow-up period of 2 to 6 years. Of the 43 infants with a secundum ASD, 16 (37.2%) had demonstrated closure of the ASD, and 13 (30.2%) were discharged from care with an ASD < 3.5 mm in diameter. 3/43 infants with secundum ASD had a defect with a diameter of more than 5 mm at their last echocardiogram. No infant discharged from their neonatal hospitalization with a secundum ASD, muscular VSD, or PDA needed any intervention from 2 to 6 years of follow-up. Ongoing follow-up with echocardiography of those infants with a secundum ASD is of greater value than of those with muscular VSD or PDA. [ABSTRACT FROM AUTHOR]

Objectives: Atrial septal defect (ASD) is one of the congenital diseases of the heart, which causes large cases of ASD requiring therapeutic interventions. In the event of a large defect of the atrial wall of the heart, the amount of blood shunted from the left atrium is noticeable and the amount of pulmonary blood flow increases, which can be associated with several symptoms and complications such as respiratory distress, recurrent infections, pulmonary artery hypertension, and large cavities. The right side of the heart is accompanied with failure, thus this abnormality needs treatment. The closure of secondum ASD as one of the congenital heart diseases can be conducted by transcatheter or open-heart surgery. Given the above-mentioned explanations, the present study was conducted to compare the two above-mentioned methods. Materials and Methods: In general, 60 patients treated with open-heart surgery (n=30) and transcatheter (n=30) were evaluated in this study. The two groups were compared in terms of success rate, hospitalization time, hospitalization costs, and complications such as infection, bleeding, arrhythmia, cardiac block, endocarditis, and the need for post-operative re-intervention. Results: Both groups were effectively treated with either of these two methods. The mean age of surgical patients was significantly (P=0.003) lower than those treated with transcatheter. Although the group treated with open-heart surgery had higher amounts of bleeding, arrhythmia, infection, heart block, hospitalization costs, and re-intervention, these differences were not statistically significant. During the study, none of the patients had endocarditis and none died as well. Finally, patients treated with transcatheter had a mean (standard deviation) duration of the hospitalization of 4.3 (±1.39) days, which was significantly lower (P<0.001) than the surgical method 11.1 (±4.6). Conclusions: Both trans-catheterization and open-heart surgery treatments are effective in treating patients with secondary ASD although the use of the transcatheter method is less risky and more cost-effective due to the findings in comparison with the open-heart surgery method. However, care should be taken in choosing the patient for this therapeutic intervention. In addition, patients treated with trans-catheterization had a shorter duration of hospitalization, which could be important in terms of family relocation to other family members and the system of treatment. Eventually, due to the high rate of bleeding from patients of young age in both groups, preclinical tests should be performed before the surgery in this age group in order to improve therapeutic techniques. [ABSTRACT FROM AUTHOR]

Atrial arrhythmias are common in patients with atrial septal defects (ASD) but the effects of percutaneous closure on atrial arrhythmia prevalence is unclear. We investigated the effects of ASD device closure and the impact of age at time of closure on prevalent atrial arrythmia. Meta-analysis of studies reporting atrial arrhythmia prevalence in adult patients before and after percutaneous closure was performed. Primary outcomes were prevalence of 'all atrial arrhythmia' and atrial fibrillation alone post closure. Sub-group analysis examined the effects of closure according to age in patients; <40 years, ≥40 and ≥ 60 years. 25 studies were included. Meta-analysis of all studies demonstrated no reduction in all atrial arrhythmia or atrial fibrillation prevalence post-closure (OR 0.855, 95% CI 0.672 to 1.087, P =.201 and OR 0.818, 95% CI 0.645 to 1.038, P =.099, respectively). A weak reduction in all atrial arrhythmia and atrial fibrillation was seen in patients ≥40 years (OR 0.77, 95% CI 0.616 to 0.979, P =.032 and OR 0.760, 95% CI 0.6 to 0.964, P =.024, respectively) but not ≥60 years (OR 0.822, 95% CI 0.593 to 1.141, P =.242 and OR 0.83, 95% CI 0.598 to 1.152, P =.266, respectively). No data were available in patients <40 years. This, and other limitations, prevents conclusive assessment of the effect of age on arrhythmia prevalence. Overall, percutaneous ASD closure is not associated with a reduction in atrial arrhythmia prevalence in this meta-analysis. A weak benefit is seen in patients ≥40 years of age, not present in patients ≥60 years. • Atrial arrhythmias are common in adults with atrial septal defects. • The effect of percutaneous ASD closure on atrial arrhythmia prevalence is unclear. • This meta-analysis showed no effect on atrial arrhythmias with device closure. • A weak beneficial effect was seen in those ≥40 years, but not in those ≥60 years. • Atrial ablation at time of closure may be of benefit in selected patients. [ABSTRACT FROM AUTHOR]

Percutaneous closure of secundum atrial septal defect (sASD) in children with interrupted inferior vena cava is challenging, especially in case of deficient aortic rim. Trans-jugular access is generally preferred in this scenario. Patients with situs inversus and sASD also carry technical difficulties for transcatheter closure because of the orientation of the atrial septum. We report a successful case of percutaneous closure of a sASD with deficient aortic rim using an occlutech figulla flex II ASD device through the left internal jugular vein in a child with situs inversus, dextrocardia, and interrupted IVC. This case was facilitated by the absence of left-sided hub of the Occlutech device to provide stable opening of the device into the left atrium, whereas the ball-connection of the delivery system allowed an angle of almost 180 degrees between the device and the atrial septum. [ABSTRACT FROM AUTHOR]

Objective: Ostium secundum defect is the common cause of RA enlargement. The aim in this study is to evaluate P wave dispersion in children to the size of atrial septal defect. Method: Forty--one children with isolated secundum atrial septal defect (and 41 age-matched controls evaluated. Using the same 12 lead ECG device in resting position, P maximum and P dispersion measured. Results: Mean P dispersion in atrial septal defect children is prolonged compare to the controls (P dispersion: 29.1±10.1 vs. 25.3±5.5 ms, P=0.009). And children with right atrial dilation had significantly longer P maximum (101.2±14.1 vs. 81.7±12.3 ms, P<0.001) and larger P dispersion (35.0±11.4 vs. 26.5±8.3 ms, P=0.003) compared to those without right atrial dilation. Conclusion: Children with moderate to large sized ASD are valuable to have prolonged. Atrial conduction time in the form of P duration and P dispersion. Also, it's a good tool for diagnosing ASD in places where echocardiography imaging is not available. We can also differentiate between small ASD and large one based on P dispersion. [ABSTRACT FROM AUTHOR]

While percutaneous catheter closure proves an effective treatment for secundum atrial septal defect (ASD2), some child patients require surgical closure. We assessed the risks associated with isolated surgical ASD2 closure by reviewing the outcomes of 120 children operated on between 1999 and 2011 (mean age 4.6 ± 3.9 years, mean weight 17 ± 12 kg). Direct sutures were performed in 4% and patch closures in 96%. The mean cardiopulmonary bypass duration was 38 ± 14 min, aortic cross-clamp time 19 ± 9 min, intensive care unit length of stay 1.6 ± 1.1 days, hospital stay 11.2 ± 5.1 days. There were no complications in 60 patients (50%) and major complications in 8 (6.7%), with 1 patient (0.8%) dying of pneumonia-induced sepsis, 2 (1.7%) requiring revision surgery, 3 (2.5%) requiring invasive treatment (2 pericardial drainage, 1 successful resuscitation), and 2 (1.7%) presenting thromboembolisms (1 cerebral stroke, 1 cardiac thrombus). In hospital minor complications occurred in 22 patients: 17 pericardial effusions (15%), 15 infections requiring treatment (12.5%), 1 sternal instability (0.8%), 4 anemias requiring transfusion (3.3%), 7 pulmonary atelectasis (6%), and 2 post-extubation glottis edema (1.7%). At early outpatient follow-up, complications occurred in 21 patients: 16 (13.3%) pericardial effusions, 4 (3.3%) infections requiring treatment, and 3 (2.5%) keloid scarring. No complications occurred during long-term follow-up. In line with published data, mortality was low (0.8%), yet major complications (6.7%) were more common in these cases than those following percutaneous ASD2 closure. Minor complications were frequent (43%) with no long-term sequelae. [ABSTRACT FROM AUTHOR]

The purpose of this study was to test the hypothesis that the incidence of crochetage on the R wave in inferior limb leads can be used for the diagnosis of pediatric secundum atrial septal defect (ASD). Two hundred fifty-six children with secundum ASD (case cohort) and 256 age- and gender-matched children without heart disease (control cohort) were included in the study. Statistical analyses were performed to test the relationship between the ASD and the crochetage on the R wave with a single lead and three leads, respectively. The impact of incomplete right bundle branch block (IRBBB) and ASD diameter (≥ 5 and < 5 mm) on ASD diagnosis were also explored. Crochetage on the R wave was observed in all three inferior limb leads on 28.13% (72/256, 28 with IRBBB) of subjects with secundum ASD, while it was seen in only 2.73% (7/256, one with IRBBB) of control subjects (P < 0.001). Subgroup analysis showed that the incidence of R wave crochetage correlated with ASD size in both the single inferior limb lead (26.14%, 23/88 on ASD ≥ 5 mm vs. 10.71%, 18/168 on ASD < 5 mm; P = 0.001) and all three inferior limb leads (44.32%, 39/88 on ASD ≥ 5 mm vs. 19.64%, 33/168 on ASD < 5 mm; P < 0.001). Our findings suggest that crochetage on the R wave in inferior limb leads can serve as an independent marker for ASD diagnosis. [ABSTRACT FROM AUTHOR]

The aim of this study was to define characteristics of those patients who are referred for device closure of an Atrial septal defect (ASD), but identified to “crossover” surgery. All patients who underwent surgical and device (Amplatzer or Helex occluder) closures of secundum ASDs from 2001 to 2010 were reviewed and organized into three groups: surgical closure, device closure, and “crossover” group. 369 patients underwent ASD closure (265 device, 104 surgical). 42 of the 265 patients referred for device closure “crossed over” to the surgical group at various stages of the catheterization procedure. The device group had defect size measuring 14.2 mm (mean) and an ASD index (Defect Size (mm)/BSA) of 14.0 compared to the corresponding values in the surgical group (20.1 mm, ASD index 25.9) (P < 0.001) and in the “crossover” group (20.7 mm, 22.6 ASD index) (P < 0.001). 79 patients in the device group had a deficient rim, and 86% were located in the retroaortic region. 33 patients in the “crossover” group had deficient rims with 70% deficiency in the posterior/inferior rim. The device group with deficient rims had an ASD index of 14.7 compared with the crossover group ASD index of 23.8 (P < 0.001). Comparing the device and “crossover” groups, an ASD index greater than 23.7 had a 90% specificity in “crossing over” to surgery. The crossover and surgical groups had statistically larger ASD defect size indexes compared with the device group. Deficient rim in the posterior/inferior rim is associated with a large ASD size index which is a predictive factor for crossing over to surgery. Catheterization did not negatively impact surgical results in the “crossover” group. [ABSTRACT FROM AUTHOR]

Introduction: We evaluated chest pain alongside other midterm subjective and objective complications of the transcatheter closure of atrial septal defects (ASDs) and patent foramen ovales (PFOs) with various closure devices. Methods: This cross-sectional study, performed from March 2010 to October 2015 in Rajaie Cardiovascular, Medical, and Research Center, evaluated 313 patients (mean age = 29.12 ± 10 years, 32.9% male) for probable complications associated with the transcatheter occlusion of secundum ASDs (n = 289, mean age = 30.5 ± 11.4 years, 28% male) or PFOs (n = 24, mean age = 42.8 ± 10.2 years). ASD closure was performed under sedation and transesophageal echocardiography (TEE) guidance. Duration of follow-up was 12 ± 3 months (mean follow-up = 11.52 months). Results: Among the subjective complications, chest pain was the most frequent complaint during the follow-up period and although it was common (7.3%), a clear cardiac etiology was rare. Thirteen (4.2%) patients reported palpitation during the follow-up period, and 4 had documented arrhythmias--including atrial flutter, atrial fibrillation, and 2:1 atrioventricular block. Migraine with or without aura occurred in 1.6% of the patients. Objective complications comprising tamponade, device embolization, and thrombus formation occurred in 6 (1.9%) patients. There was no procedure-related mortality in our patients. Conclusion: Transcatheter closure of PFOs and secundum-type ASDs in our adult patients using ASD septal occluders was associated with a high degree of success, minimal procedural subjective and objective complication rates, and excellent short- and midterm results. Although chest pain was common after the first month following ASD closure, there was no cardiac death or aortic erosion in 11.52 months follow up. [ABSTRACT FROM AUTHOR]

Objective: To find out correlation of age and defect size of isolated secundum atrial septal defect with pulmonary artery pressure measured by cardiac catheterization. Methodology: It was a cross-sectional study conducted at Cardiology department, Lady Reading Hospital, Peshawar from January 2012 to December 2016. Eligible patients were included in the study through cardiology out patient department. Patients with other causes of raised PAP were excluded. Diagnosis was made by transthoracic echocardiography while size of defect was measured with trans-esophageal echocardiography. Pulmonary artery pressures (PAP) were measured with right heart catheterization. The data was analyzed by SPSS 20. Correlation of age and ASD size with PAP groups were examined by Pearson correlation (2-tailed) and R value was calculated.Results:A total of 104 consecutive patients were included with 65.4 % of females. Mean age and defect size were 23.25 ± 12.2 years and 23.36 ± 5.81 mm, respectively. Average systolic and mean PAP were 37.88±12.3 and 24.48 ± 8.19 mmHg, respectively with 49 (47.1%) patients had raised PAP. Age and size were positively correlated with systolic (R=0.220 & 0.198) and mean PAP (R=0.288 & 0.218) respectively , with most significant results in second and third decade of life and defect size of>20mm(p <0.002). Conclusion:Age and ASD size were positively correlated with pulmonary artery pressure. Moreover PAP can be predicted by the age of patients with ASD secundum. [ABSTRACT FROM AUTHOR]

Objective: We prospectively investigated the neoendothelialization of transcatheter secundum atrial septal defect (ASD) closure in children receiving one of three different occluders. Methods: Transcatheter ASD closure was performed for 44 children. The patients were divided into three groups: group I: Amplatzer, group II: Lifetech CeraFlex, and group III: Occlutech Figulla Flex II septal occluder. The data were prospectively analyzed. Markers of the three phases of wound healing were studied in all patients before and on the 1st and 10th days and 1st month post intervention. Results: The mean age of children was 7.08±3.51 years, and the mean weight was 26.07±15.07 kg. The mean ASD diameter was 12.65±3.50 mm. Groups I, II, and III comprised 34.1%, 31.8%, and 34.1% patients, respectively. No significant differences were observed between the groups regarding patient number, age, defect size, device diameter, or total septum/device ratio (p>0.05). Inflammatory and proliferative phase marker levels increased following the procedure (p<0.05). However, scar formation markers did not change after 1 month. No significant differences in neoendothelializaton were observed among the different occluders (p>0.05). Conclusion: All three devices were composed of nitinol with different surface coating techniques. Although the different manufacturing features were claimed to facilitate of neoendothelialization, no differences were observed among the three devices 1 month following the procedure. [ABSTRACT FROM AUTHOR]

Objective: We aimed to evaluate our clinical experience and short-term results of percutaneous closure of secundum type atrial septal defects (ASD) in adults. Methods: We studied 71 patients (49 female, 22 male, mean age 35±14 years) undergoing percutaneous closure of ASD between January 2010-October 2012 in our clinic. All procedures were performed under sedoanalgesia without balloon sizing. Clinical characteristics of patients, properties of percutaneous closure intervention, complications and short-term results are evaluated. Results: Defect diameter measured by transesophageal echocardiographic examination was 19.8±6.4 mm. Device size used for percutaneous closure was 24.7±6.7 mm. Procedure was successfully performed in 67 patients (94%). Four patients were referred for surgery because of procedural failure. During procedure, a patient developed transient 2nd degree AV block, and another developed device thrombosis. Residual shunt was detected in three patients at first day control echocardiographic examination. In the follow-up of 13±8 months, no residual shunt, embolic or arrhythmic complications were observed. Conclusion: Percutaneous closure of secundum ASD is a safe and effective method with high success and low complication rates in experienced centers. [ABSTRACT FROM AUTHOR]

Inferior sinus venosus defects (SVDs) are rare imperfections located in the inferior portion of the atrial septum, leading to an overriding inferior vena cava (IVC) and an interatrial connection. These defects have increased risk of anomalous pulmonary venous return (PAPVR) and often are confused with secundum atrial septal defects (ASDs) with inferior extension. The authors sought to review their experience with inferior SVDs and to establish at their institution an echocardiographic definition that differentiates inferior SVDs from secundum ASDs with inferior extension. The study identified 161 patients 1.5 to 32 years of age who had undergone repair of a secundum ASD with inferior extension or inferior SVD over the preceding 10 years. All surgical notes, preoperative transthoracic echocardiograms (TTEs), and preoperative transesophageal echocardiograms (TEEs) were reviewed. Based on the surgical notes, 147 patients were classified as having a secundum ASD (147/161, 91 %) and 14 patients (9 %) as having an inferior SVD. The study identified PAPVR in 7 % (1/14) of the patients with inferior SVDs and 3.5 % (5/14) of the patients with secundum ASDs. Surgical diagnosis and preoperative TTE correlated for 143 (89 %) of the 161 patients. Using a strict anatomic and echocardiographic definition with a blinded observer, the majority of the defects (14/18, 78 %) were reclassified correctly after review of their TTE images, and 100 % of the defects were correctly reclassified after TEE image review. Accurate diagnosis of inferior SVDs remains challenging. The data from this study demonstrate that use of a strict anatomic and echocardiographic definition (a defect that originates in the mouth of the IVC and continues into the inferoposterior border of the left atrium, leaving no residual atrial septal tissue at the inferior margin) allows for accurate differentiation between secundum ASDs with inferior extension and inferior SVDs. This differentiation is extremely important in planning for surgical versus device closure of these rare defects. [ABSTRACT FROM AUTHOR]

Percutaneous closure of secundum atrial defects has become an accepted treatment in part because it is minimally invasive and relatively low risk. Despite recent advances in implantation technique and device improvements, complications occur. Here, we report a case of device embolization during percutaneous repair of an atrial septal defect ( ASD) with multiple fenestrations. We highlight the value of using live/real time three-dimensional transesophageal echocardiography to help plan the percutaneous procedure and detect complications. [ABSTRACT FROM AUTHOR]

The Amplatzer septal occluder is commonly used to close secundum atrial septal defects (ASDs). Recently, the manufacturer's recommendations have been modified with regard to contraindications for its use. These changes primarily focus on evaluation of the aortic rim (anterio-superior rim) with transesophageal echocardiography (TEE) and intracardiac echocardiography (ICE). In this editorial, we will review systematically all of the sequential views in TEE and ICE that are required for thorough assessment of the aortic rim and provide explanation of what constitutes deficiency of the aortic rim as seen on ICE. [ABSTRACT FROM AUTHOR]

Abstract: Background: The relation between pulmonary venous flow (PVF) pattern and degree of left-to-right interatrial shunting (IAS) in patients with secundum atrial septal defect (ASD) is unknown. Methods: Fifty consecutive ASD patients (14 males, 36±17years) received transthoracic echocardiography (TTE) before and 1day after transcatheter closure and their results were compared to 40 controls. The ratio of pulmonary-to-systemic flows (Qp/Qs) was assessed by TTE and invasive oximetry. Results: Pre-closure PV systolic (PVs), diastolic (PVd) velocities and velocity-time integral (PV-VTI) increased, time from onset of ECG Q-wave to the peak PV diastolic wave (Q-PVd) shortened and atrial reversal (PVar) velocity significantly decreased as compared to normals. These findings normalized after closure. Patients with large IAS (defined as invasive Qp/Qs≥2) had higher PVs, PVd and PV-VTI, shorter Q-PVd but lower PVar (all p<0.01) than those with small IAS. Invasive Qp/Qs ratios correlated with PVs, PVd, PV-VTI, Q-PVd and TTE-derived Qp/Qs ratios, ASD sizes and RV end-diastolic dimensions (all p<0.05). PV-VTI (β=0.49) and ASD size (β=0.48) remained independent predictors of large IAS after multivariate analysis. The corresponding sensitivity, specificity and AUC were 89%, 82% and 0.90 respectively for a PV-VTI of 30cm (p<0.001). Conclusion: ASD patients with significant IAS have distinguishable PVF features. Doppler evaluation of PV-VTI is a novel additional tool for assessing the magnitude of shunting in these patients non-invasively. [Copyright &y& Elsevier]

Introduction: Mitral regurgitation associated with secundum atrial septal defect is not uncommon. We reported our experiences and also reviewed its etiologies and managements in the literatures. Patients and Methods: Mitral regurgitation was found in 13% (12 patients) of all patients with secundum atrial septal defect (93 patients) who were operated on during 9-year period at Yala Hospital. The etiologies were as follows : rheumatic valve 3, prolapsed anterior leaflet 2, congenital abnormality 2, specific pathology complex 4, and chronic infective endocarditis 1. All patients underwent closure of secundum atrial septal defect with mitral valve repair. Results: There was one death and one serious post-operative complication. On follow-up, the echocardiograms showed no mitral regurgitation in 10 patients and mild mitral regurgitation in 1 patient. Conclusion: Mitral regurgitation associated with secundum atrial septal defect could exist as an co-existent lesion or as the result of hemodynamic change occurred in secundum atrial septal defect. Its recognisation is important and most of them could be repaired with satisfactory results. [ABSTRACT FROM AUTHOR]

We report a case of a 33-year-old man with Down syndrome and ruptured sinus of Valsalva aneurysm (SOVA) plus large ostium secundum atrial septal defect (ASD) with attenuated inferior rim. He underwent successful transcatheter closure of both defects at two separate procedures with transesophageal echocardiography (TEE) guidance. The combination of these two procedures has not been previously reported. Transgastric echocardiographic views which mimic transthoracic subcostal echocardiographic views provide high quality useful images of the anatomy, hemodynamics, and device placement. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To study the gene mutations of homeobox transcription factor(CSX/NKX2.5) associated with a Chinese family with secundum atrial septal defect(ASD). Methods: Polymerase chain reaction and DNA sequencing were used to check all the members in the family with ASD, and single strand conformation polymorphism analysis(SSCP) was used to check 126 normal control people for detecting the mutations of CSX/NKX2.5 gene. Results: Three mutations, G270A(Glu32Lys), G378A(Glu68Lys)andG390A(Glu72Lys) were identified in CSX/NKX2.5 gene of ASD patients. However, the other members in the family with ASD and the control did not have such gene mutations. Conclusion: These mutations of CSX/NKX2.5 gene, which were identified in a Chinese family, may be one of the secundum ASD etiologic causes. [Copyright &y& Elsevier]

A quadricuspid aortic valve (QAV) is a rare congenital heart defect, previously described as an incidental finding at the time of surgery or postmortem, which is now being increasingly detected by 2D transthoracic or transesophageal echocardiogram. With advances in echocardiography, secondary cardiac anomalies are also being described in association with QAV. Herein we describe a patient with QAV with a secundum atrial septal defect. [ABSTRACT FROM AUTHOR]

A 27-year-old woman had a history of migraine with aura (MWA) since aged 13 years with mostly two attacks per year. After transcutaneous closure of a secundum atrial septal defect (ASD) she suffered from almost daily recurring migraine attacks with prolonged aura symptoms. Exacerbation and new appearance of migraine attacks with aura after transcutaneous closure of ASD have been described previously. [ABSTRACT FROM AUTHOR]

Objective: To discuss the initial experience with the use of a new double disc occluding device, the Amplatzer septal occluder in transcatheter occlusion of secundum atrial septal defects (ASD).Methods: Transvenous sizing of secundum ASD was performed in five children under general anaesthesia using transoesophageal echocardiographic and fluoroscopic guidance. An Amplatzer septal occluder equal to or minimally larger than the stretched diameter of the ASD was used for transcatheter occlusion of the defect in three suitable patients. Pulmonary balloon valvuloplasty with a 18 mm x 3 cm Mansfield balloon catheter was carried out in one patient with associated pulmonary valvar stenosis in the same procedure setting.Results: Stretched diameters of the defects in the three patients ranged from 14 to 17 mm. Devices of sizes 14, 17 and 17 were deployed through 7F and 8F sheaths, respectively. The upper and lower rims of interatrial septum were more than 8 mm in all patients. All patients had successful occlusion with complete obliteration of the atrial left to right shunting. Simultaneous pulmonary balloon valvuloplasty for the valvar stenosis reduced pressure gradient from 53 mmHg to 22 mmHg across the valve prior to septal occlusion in one patient. No intraprocedural or short-term complication was encountered.Conclusions: The design of the Amplatzer septal occluder permits ease in loading, delivery, deployment and stable seating of the device. This initial experience shows that Amplatzer device occlusion is feasible, relatively safe and effective and appears to be a viable alternative to surgical closure of secundum atrial septal defects in properly selected patients. [ABSTRACT FROM AUTHOR]

Objective: To investigate the safety, efficacy, and clinical application of a new self centering device ("angel wings") for closure of secundum atrial septal defects (ASD II) and persistent foramen ovale in all age groups.Design: Multicentre, prospective, nonrandomised study.Patients: Inclusion Criteria: defects with an occlusive diameter of < or = 20 mm and a surrounding rim of > 4 mm; body weight > 10 kg; and an indication for surgical closure of secundum atrial septal defect. Additionally, there were compassionate indications for closure in patients with persistent foramen ovale.Interventions: Defects were closed by a transcatheter device consisting of two square frames made of superelastic nitinol wire. The frames are covered by elastic polyester fabric, which is sewn together at a central circle. All procedures, except for three interventions that were carried out under sedation, were performed under general anaesthesia using transoesophageal echocardiography and fluoroscopy to monitor intervention.Results: Closure was attempted in 75 (71%) of 105 patients. An ASD II was present in 35 children and 15 adults. A persistent foramen ovale was present in 25 adults with suspected paradoxical embolism. Transcatheter closure was unsuccessful in three children and crossover to surgery was required. Residual shunts were found in 20 patients (27%) immediately after the procedure. A transient atrioventricular third degree block occurred in three patients (4%) and the right atrial disk was not fully deployed in three. A minor shunt (< 3 mm) was present in only three (4%) of 72 patients during follow up of 1-17 months. Blood clots on the right atrial disks in two patients (one required lysis) were seen during follow up transoesophageal echocardiography. Serious complications demanding surgical removal of the device occurred in three patients. One patient had haemopericardial tamponade because of an aortic lesion. Left atrial thrombus formation due to an unfolded right atrial disk was found in a second patient and dislodgement of the left atrial disk resulted in a large residual shunt in a third.Conclusions: Percutaneous closure of a central ASD with a diameter < or = 20 mm in paediatric and adult patients is feasible and effective with this new device. It is a promising alternative to surgical closure. Modifications of the design, however, seem to be mandatory as 4% of patients developed serious complications. [ABSTRACT FROM AUTHOR]

Background: Device closure of an isolated secundum type atrial septal defect (ASD) has been used as an alternative method for open surgical closure with comparable success and lower morbidity. In this study we evaluated the procedural success and mid-term follow-up results of percutaneous closure of secundum ASD with an AmplatzerTMSeptal Occluder(ASO) device or a Figula ASD occluder device. Method: From June 2001 to January 2009, 74 consecutive patients were scheduled for percutaneous device closure in two centers in Tehran, Iran. All patients had a stretched defect diameter of 30mm or less. After using a sizing balloon to measure the stop-flow diameter, device implantation was performed under the guidance of a trans-esophageal echocardiography (TEE).The size was generally 1 - 2 mm larger than the stretched diameter. Patients were followed for an average of 11 ±4 months. Results: The median stretched diameter of the defect was 20.7±4.8 mm (range: 8-30 mm).A total of 73 devices were used in this study. Device closure was successful in 72 (97.2%) out of 74 patients. Repositioning of the device was required in one patient. Major complications(including significant residual shunt and device embolization) occurred in 3 (4%) patients. There was no procedure-related mortality in our patients. Mild-to-moderate residual shunt was detectable in 10 (13.7%) patients immediately following the procedure and in 5 (6.7%) patients 24 hours after the procedure. None had residual flow across the device at the end of the follow-up period. Conclusion: Device closure of ASD has a safety profile comparable to open surgical repair and can effectively close the defect with excellent procedural and mid-term results. [ABSTRACT FROM AUTHOR]

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 [ABSTRACT FROM AUTHOR]

Background: Right atrium (RA) enlargement in uncorrected atrial septal defect (ASD) is due to chronic volume overload. Several electrocardiogram (ECG) criteria had been proposed for screening RA enlargement. This study aimed to compare the accuracy of ECG criteria in detecting RA enlargement in adults with uncorrected ASD. Methods: This was a cross-sectional study involving 120 adults with uncorrected secundum ASD. The subjects underwent ECG examination, transthoracic echocardiography, and right heart catheterization. An RA enlargement was determined with RA volume index by transthoracic echocardiography. Various ECG and combined ECG criteria were evaluated. Statistical analysis was performed to analyze the sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV). Results: An RA enlargement was detected in 64.2% subjects. The P wave height > 2.5 mm in lead II criterion had the best specificity (100%) and PPV (100%), but low sensitivity (19%) and accuracy (48%). The combined 2 ECG criteria (QRS axis > 90°, R/S ratio > 1 in V1) had 82% sensitivity, 56% specificity, 73% accuracy, 77% PPV, and 63% NPV. The combined 3 ECG criteria (QRS axis > 90°, R/S ratio > 1 in V1, and P wave height > 1.5 mm in V2) had 35% sensitivity, 86% specificity, 53% accuracy, 82% PPV, and 43% NPV. Conclusions: The combined 2 ECG criteria (QRS axis > 90° and R/S ratio > 1 in V1) had increased sensitivity, better accuracy, and more balance of PPV and NPV as compared with P wave > 2.5 mm in II criterion and combined 3 ECG criteria to diagnose RA enlargement in adults with uncorrected ASD. [ABSTRACT FROM AUTHOR]

The article describes the case of a 76-year-old woman who suffered Amplatzer atrial septal occluder device embolization after she was presented with increasing dyspnea on exertion. She had a large ostium secundum atrial septal defect as well as severe right ventricular enlargement as revealed by echocardiography. Also discussed are inadequate septal rim and an undersized device as the most common reasons for Amplatzer atrial septal occluder device embolization.

Abstract: We greatly appreciated the letter to the Editor by Rana Olgunturk and Serdar Kula. We can say that his interpretation coincides with our interpretation and with the knowledge about patent ductus arteriosus (PDA) and secundum atrial septal defects. Although functional closure of PDA usually occurs in the first few hours of life in healthy infants born at term (about 15 h of life in healthy infants born at term), true anatomic closure, in which the ductus loses the ability to reopen, may take several weeks. Persistent, patency for up to 10 days after birth is encountered in premature infants. The male Italian newborn infant of the cited case report was referred at the age of 2 days to the Cardiology Unit for a cardiovascular check-up (in the text: “in a 3-day-old newborn infant” must be comprehended as “in a 2-day-old newborn infant”) and was mature. Interatrial septal shunts in newborns are frequently encountered. Since there are no definitive diagnostic criteria for both patent foramen ovale and secundum atrial septal defects, it is difficult to differentiate these two lesions by echocardiography, particularly in the early newborn period. Some authors, called these two lesions as “interatrial septal openings”. The diagnosis, in the case report cited, was made not only on the basis of the first observation but also on the basis of the persistence of abnormalities during the long-term follow-up and therefore the infant was referred to a pediatric heart surgical unit were the abnormalities were confirmed. [ABSTRACT FROM AUTHOR]

Abstract: One of the most common congenital anomalies of systemic veins is persistent left superior vena cava. Association of persistent left superior vena cava with other congenital cardiac diseases is common and frequently encountered during diagnostic studies. Contrast echocardiography has an important role in the diagnosis. Owing to the fact that cardiopulmonary by-pass procedure may be problematic in patients with persistent left superior vena cava, this anomaly should be detected before cardiac surgery and required measures should be taken. Our case is an association of persistent left superior vena cava detected in a patient to be operated for secundum atrial septal defect. We report the case owing to its low frequency and to emphasize the importance of detection before cardiac surgery. [Copyright &y& Elsevier]