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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]

Congenital heart disease (CHD) is the most common congenital birth defect with an incidence of 1 in 100. Current survival to adulthood is expected in 9 out of 10 children with severe CHD as the diagnostic, interventional, and surgical success improves. The adult CHD (ACHD) population is increasingly diverse, reflecting the broad spectrum of CHD and evolution of surgical techniques to improve survival. Similarly, transcatheter interventions have seen exponential growth and creativity to reduce the need for repeat sternotomies. This article focuses on newer data and evolving techniques for transcatheter interventions specific to certain ACHD populations. [ABSTRACT FROM AUTHOR]

IntroductionRight ventricular (RV) fibrosis represents both adaptive and maladaptive responses to the overloaded RV condition. Its role in pulmonary hypertension (PH) associated with secundum atrial septal defect (ASD), which is the most common adult congenital heart disease (CHD), remains poorly understood.MethodsWe enrolled 65 participants aged ≥18 years old with uncorrected secundum ASD who had undergone clinically indicated right heart catheterization (RHC), divided into the non-PH group (n = 7), PH group (n = 42), and Eisenmenger syndrome (ES) group (n = 16). We conducted cardiovascular magnetic resonance (CMR) studies with late gadolinium enhancement (LGE) imaging, native T1 mapping, and extracellular volume (ECV) measurement to evaluate the extent and clinical correlates of RV fibrosis.ResultsLGE was present in 94% of the population and 86% of the non-PH group, mostly located at the right ventricular insertion point (RVIP) regions. LGE in the septal and inferior RV region was predominantly observed in the ES group compared to the other groups (p = 0.031 and p

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]

Device closure has become the preferred procedure for treating oval fossa defects in the last two decades. More recently, transcatheter sinus venosus defect (SVD) closure has emerged as an alternative to surgery. Transcatheter stenting aims to overcome potential late surgical complications such as stenosis of the superior vena cava (SVC) and right upper pulmonary vein (RUPV), as well as sinus node dysfunction. Balloon interrogation of the cavoatrial junction is able to identify patients who are suitable candidates for nonsurgical closure. Successful closure is possible when the balloon seals the SVD and redirects the RUPV towards the left atrium. Oval fossa (secundum) defects can coexist in approximately 9–16% of patients with SVD. Among a group of 80 patients who underwent transcatheter closure of SVD, five adult patients aged between 22 and 52 years also required device closure of an associated oval fossa defect. The procedure involved simultaneous balloon interrogation of both the SVD and oval fossa defect, with continuous monitoring of the RUPV using bilateral femoral venous sheaths. Covered stent exclusion of the SVD was performed with concurrent device closure of the oval fossa defect using 12–36 mm atrial septal occluders. During the procedure, two patients required protective balloon inflation in the RUPV while expanding the covered stent. In one patient, a higher small accessory RUPV was intentionally left to drain into the SVC through the struts of a bare stent anchoring the covered stent in the upper SVC. In another patient, a second overlapping covered stent was used to address residual flows from a fabric tear that became apparent after balloon deflation. There were no vascular complications and only one patient exhibited an insignificant 6 mm residual flow from the caudal edge of the SVD during a follow-up of 5 to 72 months. In conclusion, the closure of both SVD and associated oval fossa defects can be successfully performed in a single procedure, with comparable procedural times and favourable mid-term outcomes. [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

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]

Objective: The aim of this study was to use tissue Doppler imaging to evaluate the left atrial systolic and the left ventricular (LV) diastolic function as well as the left atrial ejection force in children who underwent transcatheter closure of a secundum atrial septal defect (ASD). Methods: Tissue Doppler measurements of the left atrial ejection force, the mitral valve, and left atrial volume were performed before the ASD closure procedure, and on the 1st day, 10th day, and 1st and 3rd months after the procedure in 56 patients and in 28 healthy controls. Results: There was a significant decrease in the septal and lateral a' velocities on the first day (p

Secundum atrial septal defect (ASD) is one of the most common congenital heart diseases (CHDs). This study aims to evaluate the feasibility and accuracy of automatic detection of ASD in children based on color Doppler echocardiographic images using convolutional neural networks. In this study, we propose a fully automatic detection system for ASD, which includes three stages. The first stage is used to identify four target echocardiographic views (that is, the subcostal view focusing on the atrium septum, the apical four-chamber view, the low parasternal four-chamber view, and the parasternal short-axis view). These four echocardiographic views are most useful for the diagnosis of ASD clinically. The second stage aims to segment the target cardiac structure and detect candidates for ASD. The third stage is to infer the final detection by utilizing the segmentation and detection results of the second stage. The proposed ASD detection system was developed and validated using a training set of 4,031 cases containing 370,057 echocardiographic images and an independent test set of 229 cases containing 203,619 images, of which 105 cases with ASD and 124 cases with intact atrial septum. Experimental results showed that the proposed ASD detection system achieved accuracy, recall, precision, specificity, and F1 score of 0.8833, 0.8545, 0.8577, 0.9136, and 0.8546, respectively on the image-level averages of the four most clinically useful echocardiographic views. The proposed system can automatically and accurately identify ASD, laying a good foundation for the subsequent artificial intelligence diagnosis of CHDs.

Introduction: Right ventricular (RV) fibrosis represents both adaptive and maladaptive responses to the overloaded RV condition. Its role in pulmonary hypertension (PH) associated with secundum atrial septal defect (ASD), which is the most common adult congenital heart disease (CHD), remains poorly understood., Methods: We enrolled 65 participants aged ≥18 years old with uncorrected secundum ASD who had undergone clinically indicated right heart catheterization (RHC), divided into the non-PH group ( n  = 7), PH group ( n  = 42), and Eisenmenger syndrome (ES) group ( n  = 16). We conducted cardiovascular magnetic resonance (CMR) studies with late gadolinium enhancement (LGE) imaging, native T1 mapping, and extracellular volume (ECV) measurement to evaluate the extent and clinical correlates of RV fibrosis., Results: LGE was present in 94% of the population and 86% of the non-PH group, mostly located at the right ventricular insertion point (RVIP) regions. LGE in the septal and inferior RV region was predominantly observed in the ES group compared to the other groups ( p  = 0.031 and p  < 0.001, respectively). The mean LGE scores in the ES and PH groups were significantly higher than those in the non-PH group (3.38 ± 0.96 vs. 2.74 ± 1.04 vs. 1.57 ± 0.79; p  = 0.001). The ES and PH groups had significantly higher degrees of interstitial RV fibrosis compared to those in the non-PH group, indicated by native T1 (1,199.9 ± 68.9 ms vs. 1,131.4 ± 47.8 ms vs. 1,105.4 ± 44.0 ms; p  < 0.001) and ECV (43.6 ± 6.6% vs. 39.5 ± 4.9% vs. 39.4 ± 5.8%; p  = 0.037). Additionally, native T1 significantly correlated with pulmonary vascular resistance ( r  = 0.708, p  < 0.001), RV ejection fraction ( r  = -0.468, p  < 0.001) and peripheral oxygen saturation ( r  = -0.410, p  = 0.001)., Conclusion: In patients with uncorrected secundum ASD, RV fibrosis may occur before the development of PH and progressively intensify alongside the progression of PH severity. A higher degree of RV fibrosis, derived from CMR imaging, correlates with worse hemodynamics, RV dysfunction, and poorer clinical conditions., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Ginting Munte, Elen, Lelya, Rudiktyo, Prakoso and Lilyasari.)

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]

This study was conducted to investigate the combined use of fenestrated atrial septal occluder (F-ASO) and targeted medical therapy (TMT) in patients with secundum atrial septal defect (ASD) and severe pulmonary arterial hypertension (PAH). Treatment of patients with ASD and severe PAH is still challenging. After ethical approval was obtained, 56 consecutive patients with ASD with severe PAH were included (7 men, 49 women; median age 50.5 years; mean ASD size 26.9 ± 4.6 mm). After 3 months of TMT, transcatheter closure was performed using F-ASO in patients with ratios of pulmonary to systemic blood flow ≥1.5. TMT was continued post-operatively together with 6 months of dual-antiplatelet therapy. The hemodynamic variables during baseline, TMT alone, and combined treatment with F-ASO were compared. After only TMT, systolic pulmonary arterial pressure (−14.5 mm Hg; p < 0.001), pulmonary vascular resistance (−3.9 Wood units; p < 0.001), and exercise capacity (+72.0 m; p < 0.001) improved. Ratio of pulmonary to systemic blood flow increased by 0.9 (p < 0.001), with adverse cardiac remodeling (right ventricular dimension +3.5 mm; p < 0.001). Closure with F-ASO (median size 34.0 mm) led to further decrease in systolic pulmonary artery pressure (−6.0 mm Hg; p < 0.001). Follow-up (median duration 10 months) revealed further improvement in exercise capacity (+60.5 m; p < 0.001), with favorable cardiac remodeling (right ventricular dimension −9.9 mm; p < 0.001). In addition, all fenestrations were stable (p = 0.699), with negligible shunt (median ratio of pulmonary to systemic blood flow 1.1) and no complications. One year later, pulmonary artery pressure was normalized in 8 of 19 patients, and PAH recurred in 5 patients after discontinuation of TMT. In patients with ASD and severe PAH, combination of F-ASO and TMT was a safe and effective procedure. Compared with TMT alone, the combined treatment further improved exercise capacity, with favorable cardiac remodeling. [ABSTRACT FROM AUTHOR]

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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]

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.

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]

Objective To investigate the changes of surface electrocardiogram in patients with secundum atrial septal defect(ASD) and its relationship with pulmonary hypertension. MethodsSeventy-four patients with secundum ASD were recruited in the study. The incidence of abnormal electrocardiogram and related risk factors were analyzed. According to the results of echocardiography, the patients were categorized into two subgroups: the normal pulmonary artery pressure(NPAP) and the pulmonary artery hypertension(PAH) groups. The differences of surface electrocardiogram between the two groups were compared. ResultsThe incidence of crochetage R wave, incomplete right bundle branch block(IRBBB) and ST-T changes in the electrocardiogram of ASD patients were 67.6%(50/74), 58.1%(43/74) and 56.8%(42/74), respectively. Older age was significantly associated with IRBBB(OR=1.044, 95%CI=1.009-1.080, P=0.012), whereas atrial defect area was significantly associated with crochetage R wave and ST-T changes(OR=0.139, 95%CI=0.011-1.774, P=0.041; OR=0.221, 95%CI=0.073-0.666, P=0.027). The mean age of patients in PAH group was older than that of NPAP group(P<0.05), and the incidence of complete right bundle branch block and ST-T changes in PAH group were significantly increased(P<0.05). ConclusionSurface electrocardiogram plays an important role in the diagnosis of secundum ASD with or without pulmonary hypertension. [ABSTRACT FROM AUTHOR]

Abstract Objective Transcatheter closure is usually contraindicated in secundum atrial septal defect with no rim to right pulmonary vein. The morphology of an atrial septal defect is special in these patients, and the off-label use of a duct occluder might make transcatheter closure possible with the assistance of a personalized heart model. However, the related data are absent. This study was performed to investigate the off-label use of a duct occluder in the transcatheter closure of an atrial septal defect with no right pulmonary vein rim. Methods Seven consecutive patients with an atrial septal defect (2 male/5 female; 40.1 ± 15.2 years) with no right pulmonary vein rim were referred for attempted transcatheter closure, and a personalized heart model was produced on the basis of multislice computed tomography images. With the elastic heart model, in vitro trial occlusion was performed with a duct occluder for preoperative evaluation, and the results were compared with postoperative outcomes. Results A single atrial septal defect was identified in 6 patients, and a double atrial septal defect was identified in another patient (1 atrial septal defect with no right pulmonary vein rim and 1 with sufficient surrounding rims). The size of the atrial septal defect was 13.4 ± 2.2 mm, and the in vitro balloon-stretched diameter was 20.2 ± 3.2 mm in the heart model. In vitro trial occlusion was achieved in all patients, and subsequent in vivo transcatheter closure was performed successfully with the duct occluder of the same size (24.3 ± 3.1 mm). During follow-up (1.57 ± 0.84 years), mild pericardial effusion was identified in 2 patients and disappeared within 3 months. No other complications occurred. Conclusions By using a personalized heart model, the off-label use of a duct occluder is feasible and safe in the transcatheter closure of an atrial septal defect with no right pulmonary vein rim. Further research is required to evaluate the long-term outcomes. [ABSTRACT FROM AUTHOR]

Objective: The characteristic rSR' pattern in lead V1 on electrocardiogram (ECG) has been described in association with atrial septal defect (ASD) and right ventricular dilation. We aimed to determine if temporal ECG changes can guide a more discriminate and cost-effective screening during follow-up of isolated secundum ASD. Methods: Our study population included all pediatric patients followed at the Stollery Children's Hospital with a secundum ASD, not associated with other significant heart disease, between 2004 and 2010. We collected clinical as well as serial echocardiographic and ECG data. Results: We identified 141 patients with ASD, 95% were asymptomatic and 88% referred for a murmur. Moderate-to-large (>5 mm) ASDs were present in 52%. The prevalence of an rSR' pattern was 26% in the overall cohort and 54% in the large ASD group. During median follow-up of 28.7 months, 37 patients underwent surgical or transcatheter closure. Among patients with rSR' on ECG, 78% had moderate-to-large ASD size. In that group, the presence versus the absence of rSR' correlated with lower positive predictive value (PPV) for spontaneous closure (7% vs. 36%; P = 0.01) and higher PPV for device or surgical closure (71% vs. 38%; P = 0.02). Conclusion: We observed a lower prevalence of rSR' pattern in patients with isolated ASD than previously reported. However, an rSR' pattern had incremental value in predicting the need for surgical or device intervention for closure in moderate.large groups. This can be used to tailor patient echocardiographic screening and caregiver counseling.

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.

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 : The characteristic rSR' pattern in lead V1 on electrocardiogram (ECG) has been described in association with atrial septal defect (ASD) and right ventricular dilation. We aimed to determine if temporal ECG changes can guide a more discriminate and cost-effective screening during follow-up of isolated secundum ASD. Methods : Our study population included all pediatric patients followed at the Stollery Children's Hospital with a secundum ASD, not associated with other significant heart disease, between 2004 and 2010. We collected clinical as well as serial echocardiographic and ECG data. Results : We identified 141 patients with ASD, 95% were asymptomatic and 88% referred for a murmur. Moderate-to-large (>5 mm) ASDs were present in 52%. The prevalence of an rSR' pattern was 26% in the overall cohort and 54% in the large ASD group. During median follow-up of 28.7 months, 37 patients underwent surgical or transcatheter closure. Among patients with rSR' on ECG, 78% had moderate-to-large ASD size. In that group, the presence versus the absence of rSR' correlated with lower positive predictive value (PPV) for spontaneous closure (7% vs. 36%; P = 0.01) and higher PPV for device or surgical closure (71% vs. 38%; P = 0.02). Conclusion : We observed a lower prevalence of rSR' pattern in patients with isolated ASD than previously reported. However, an rSR' pattern had incremental value in predicting the need for surgical or device intervention for closure in moderate-large groups. This can be used to tailor patient echocardiographic screening and caregiver counseling. [ABSTRACT FROM AUTHOR]

Although late complications of percutaneous closure of atrial septal defect (ASD), including cardiac erosion and thrombosis, are rare, they are the most lethal. Data are still lacking regarding the usefulness of new imagining modalities, such as three-dimensional echocardiography (3DE), for the detection of these complications. Here, we report the case of a 57-year-old woman in whom cardiac erosion was very well visualized by 3D transesophageal echocardiography (3D TEE) after percutaneous ASD closure. [ABSTRACT FROM AUTHOR]

Symptomatic pulmonary arterial hypertension (PAH) in patients with isolated atrial septal defect (ASD) is rare during infancy. We report a case of isolated ASD with severe PAH in an infant who developed airway obstruction as cardiomegaly progressed. The patient presented with recurrent severe respiratory insufficiency and failure to thrive before the repair of the ASD. Echocardiography confirmed volume overload on the right side of heart and severe PAH (tricuspid regurgitation [TR] with a peak pressure gradient of 55 to 60 mmHg). The chest radiographs demonstrated severe collapse of both lung fields, and a computed tomography scan showed narrowing of the main bronchus because of an intrinsic cause, as well as a dilated pulmonary artery compressing the main bronchus on the left and the intermediate bronchus on the right. ASD patch closure was performed when the infant was 8 months old. After the repair of the ASD, echocardiography showed improvement of PAH (TR with a peak pressure gradient of 22 to 26 mmHg), and the patient has not developed recurrent respiratory infections while showing successful catch-up growth. In infants with symptomatic isolated ASD, especially in those with respiratory insufficiency associated with severe PAH, extrinsic airway compression should be considered. Correcting any congenital heart diseases in these patients may improve their symptoms.

A 20-year-old female had undergone definitive surgical repair for pulmonary atresia with intact ventricular septum soon after birth. She was referred to our institution with the chief complaint of clubbing fingers. A thorough examination revealed platypnea- orthodeoxia syndrome due to an interatrial right-to-left shunt through a secundum atrial septal defect. Percutaneous closure with an Amplatzer Septal Occluder resulted in resolution of the syndrome. [ABSTRACT FROM AUTHOR]

Amaç: Kliniğimizde iki yıl boyunca transkateter yolla atriyal septal defekt kapatılması işlemi yapılan hastalarla ilgili klinik deneyimlerimizin paylaşılması ve sonuçlarının değerlendirilmesi amaçlandı. Gereç ve yöntemler: Çalışmaya, sekundum atriyal septal defekt nedeniyle transkateter yolla kapatma işlemi uygulanan, ortalama yaşı 8 olan 5 yaş 3 ay-16 yaş 24 hasta 16 kız, 8 erkek , retrospektif olarak dahil edildi. Bulgular: Kapatma işlemi hastaların 22’sinde % 92 başarılı bir şekilde gerçekleştirildi ve takiplerde cihaz erezyonu, aritmi, tromboz veya rezidüel şant gibi herhangi bir komplikasyon gelişmedi. Bir hastada işlem sırasında cihaz embolizasyonu oldu, cerrahiye verilen hastada cihaz çıkartıldı ve defekt başarılı bir şekilde kapatıldı. İki hastada % 8 işlem başarısız oldu. Atriyal septal defekt kapatma cihazı olarak Amplatzer septal okluder kullanıldı. Kapatma işlemi yapılan hastalara altı ay süre ile antiagregan dozda asetilsalisilik asit tedavisi verildi. Sonuç: Sekundum atriyal septal defektlerin perkütan yolla tıkayıcı cihazlarla kapatılması etkili, güvenli ve başarı oranı yüksek, komplikasyon gelişme ihtimali düşük bir tedavi şeklidir. Son yıllarda cerrahi tedavinin yerini almıştır

The aim of the study was to estimate the possible association of pregnant women with paroxysmal supraventricular tachycardia (PSVT) with the possible risk for adverse birth outcomes, particularly different congenital abnormalities (CAs) in their children. Prospectively and medically recorded PSVT was evaluated in 103 pregnant women who later had offspring with CA (case group) and 149 pregnant women who later delivered newborn infants without CA (control group) and matched to cases in the population-based data set of the Hungarian Case-Control Surveillance System of Congenital Abnormalities, 1980-1996. Of 252 pregnant women with PSVT, 115 (45.6%) had the onset of this condition before the study pregnancy, that is, their PSVT was a chronic condition, while the rest (N = 137) of PSVT was considered as new onset in the study pregnancy. The comparison of occurrence of PSVT in pregnant women who had offspring with different CA groups and in control mothers showed a higher risk for cardiovascular CAs (adjusted OR with 95% CI: 2.1, 1.1-3.8) explained mainly by secundum atrial septal defect. This association was confirmed in pregnant women with PSVT in the second and/or third gestational month, that is, critical period of cardiovascular CAs. In conclusion PSVT in pregnant women associates with a higher risk of secundum atrial septal defect in their children. © 2015 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]