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Journal of the American Heart... Jan 2024The increasing prevalence of atrial fibrillation (AF) in adults with congenital heart disease raises significant questions regarding its management. The unique... (Review)
Review
The increasing prevalence of atrial fibrillation (AF) in adults with congenital heart disease raises significant questions regarding its management. The unique underlying anatomic and physiological background further adds to the difficulty in eliminating the AF burden in these patients. Herein, we provide an overview of the current knowledge on the pathophysiology and risk factors for AF in adult congenital heart disease, with a special focus on the existing challenges in AF ablation. Emerging imaging modalities and ablation techniques might have a role to play. Evidence regarding the safety and efficacy of AF ablation in adult congenital heart disease is summarized, especially for patients with an atrial septal defect, Ebstein anomaly of the tricuspid valve, tetralogy of Fallot, and Fontan circulation. Finally, any remaining gaps in knowledge and potential areas of future research are highlighted.
Topics: Humans; Adult; Heart Defects, Congenital; Atrial Fibrillation; Heart Septal Defects, Atrial; Catheter Ablation; Ebstein Anomaly
PubMed: 38193287
DOI: 10.1161/JAHA.123.032102 -
The Journal of Invasive Cardiology May 2024A 37-year-old man was referred to our medical center with a diagnosis of Eisenmenger syndrome due to an atrial septal defect (ASD). At admission he had central cyanosis,...
A 37-year-old man was referred to our medical center with a diagnosis of Eisenmenger syndrome due to an atrial septal defect (ASD). At admission he had central cyanosis, acrocyanosis, and progressive effort dyspnea; his symptoms improved during lying position.
PubMed: 38787924
DOI: 10.25270/jic/24.00153 -
Sultan Qaboos University Medical Journal Dec 2023This review provides an update on the morphology of the sinus venosus defect. It was earlier believed that a 'common wall' separated the right pulmonary veins from the... (Review)
Review
This review provides an update on the morphology of the sinus venosus defect. It was earlier believed that a 'common wall' separated the right pulmonary veins from the superior caval vein. In the sinus venosus defects, this wall was absent. Current evidence shows that the superior rim of the oval fossa, rather than forming a second septum or representing a common wall, is an infolding between the walls of the caval veins and the right pulmonary veins. The sinus venosus defect is caused by the anomalous connection of one or more pulmonary veins to a systemic vein. However, the pulmonary vein(s) retain their left atrial connections, leading to a veno-venous bridge that allows interatrial shunting outside the oval fossa. True atrial septal defects are located within the oval fossa or in the anteo-inferior buttress, while sinus venosus defects, ostium defects and coronary sinus defects are morphologically distinct from them.
Topics: Humans; Vena Cava, Superior; Heart Septal Defects, Atrial; Pulmonary Veins; Heart Atria
PubMed: 38161764
DOI: 10.18295/squmj.12.2023.075 -
Birth Defects Research Nov 2023This study examined risk for developmental disabilities in preschool-aged children with a congenital heart defect (CHD) at the population level.
BACKGROUND
This study examined risk for developmental disabilities in preschool-aged children with a congenital heart defect (CHD) at the population level.
METHODS
Statewide birth, birth defects, and preschool developmental disability records were integrated. The final sample included 1,966,585 children (51.0% male). Children were grouped by type(s) of CHD: critical CHD, noncritical CHD, atrial septal defect, or no major birth defects (groups were mutually exclusive).
RESULTS
Children with a CHD (any type) were at increased risk for developmental disability (any type) (RR 2.08, 95% CI 2.03-2.14, P < .001). Children in the critical CHD, noncritical CHD, and atrial septal defect groups were at increased risk for developmental delay, intellectual disability, language impairment, other health impairment, and any disability. Children in the atrial septal defect group were at increased risk for autism spectrum disorder and speech impairment. For all CHD groups, risk was greatest for other health impairment and intellectual disability.
CONCLUSIONS
Increased risk for developmental disabilities was identified for children with less severe CHDs as well as for children with more severe (critical) CHDs. All children with CHDs should be closely monitored so that appropriate interventions can be initiated as early as possible to maximize learning outcomes.
Topics: Humans; Male; Child; Child, Preschool; Female; Developmental Disabilities; Intellectual Disability; Autism Spectrum Disorder; Heart Defects, Congenital; Heart Septal Defects, Atrial
PubMed: 37681320
DOI: 10.1002/bdr2.2246 -
European Heart Journal Sep 2023Transcatheter closure of patent foramen ovale (PFO) is the recommended stroke prevention treatment in patients ≤60 years with cryptogenic ischemic stroke and PFO....
AIMS
Transcatheter closure of patent foramen ovale (PFO) is the recommended stroke prevention treatment in patients ≤60 years with cryptogenic ischemic stroke and PFO. Atrial fibrillation or flutter (AF) is a known potential procedure-related complication, but long-term risk of developing AF remains unknown. This paper studied the long-term risk of developing AF following PFO closure.
METHODS AND RESULTS
A Danish nationwide cohort study was conducted. During 2008-2020, this study identified a PFO closure cohort, a PFO diagnosis cohort without PFO closure, and a general population comparison cohort matched 10:1 to the PFO closure cohort on age and sex. The outcome was first-time AF diagnosis. Risk of AF and multivariable-adjusted hazard ratio (HR) of the association between PFO closure or PFO diagnosis and AF were calculated. A total of 817 patients with PFO closure, 1224 with PFO diagnosis, and 8170 matched individuals were identified. The 5 year risk of AF was 7.8% [95% confidence interval (CI): 5.5-10] in the PFO closure cohort, 3.1% (95% CI: 2.0-4.2) in the PFO diagnosis cohort, and 1.2% (95% CI: 0.8-1.6) in the matched cohort. The HR of AF comparing PFO closure with PFO diagnosis was 2.3 (95% CI: 1.3-4.0) within the first 3 months and 0.7 (95% CI: 0.3-1.7) thereafter. The HR of AF comparing PFO closure with the matched cohort was 51 (95% CI: 21-125) within the first 3 months and 2.5 (95% CI: 1.2-5.0) thereafter.
CONCLUSION
Patent foramen ovale closure was not associated with any substantial increased long-term risk of developing AF beyond the well-known procedure-related short-term risk.
Topics: Humans; Atrial Fibrillation; Stroke; Foramen Ovale, Patent; Cohort Studies; Secondary Prevention; Cardiac Catheterization; Denmark; Treatment Outcome; Recurrence; Septal Occluder Device
PubMed: 37279491
DOI: 10.1093/eurheartj/ehad305 -
Interventional Cardiology Clinics Jan 2024Transcatheter structural heart interventions are expanding into more complex spaces including mitral transcatheter edge-to-edge repair, left atrial appendage occlusion,... (Review)
Review
Transcatheter structural heart interventions are expanding into more complex spaces including mitral transcatheter edge-to-edge repair, left atrial appendage occlusion, tricuspid transcatheter edge-to-edge repair, mitral/tricuspid valve-in-valve, and perivalvular leak closures. Transesophageal echocardiography (TEE), with concomitant fluoroscopy, has remained the gold standard for many of these interventions. Although three-dimensional intracardiac echocardiography has been used, applications were often limited to guidance for more "simple" procedures such as patent foramen ovale/atrial septal defect closure and/or intraprocedural adjunctive imaging guidance. However, patients with an excessive risk for general anesthesia or contraindications to TEE, including esophageal/gastric disease, cervical/thoracic spinal disease, or coagulopathies, have limited options.
Topics: Humans; Cardiac Catheterization; Echocardiography, Three-Dimensional; Echocardiography, Transesophageal; Cardiac Surgical Procedures; Foramen Ovale, Patent
PubMed: 37980061
DOI: 10.1016/j.iccl.2023.08.005 -
Cardiology in the Young Aug 2023Congenitally corrected transposition of great arteries is a rare anomaly which are responsible for 0.5% of all CHDs and can be associated with other congenital cardiac...
Congenitally corrected transposition of great arteries is a rare anomaly which are responsible for 0.5% of all CHDs and can be associated with other congenital cardiac abnormalities. Association of congenitally corrected transposition of great arteries and isolated atrial septal defect is a very rare condition, and management of this association is challenging. In this paper, we describe three patients with congenitally corrected transposition of great arteries and isolated atrial septal defect who were admitted to our clinic and all of them underwent percutaneous closure of defect. From 2017 to 2020, we visited three patients with congenitally corrected transposition of great arteries and isolated atrial septal defect. Our patients' ages ranged from 28 to 38 years. All of them underwent percutaneous atrial septal defect device closure without any complications. Patients were discharged from hospital in good condition with a daily dose of Aspirin 80 mg and Plavix 75 mg. For all of them, follow-up echocardiography was performed the day after the procedure at 1, 3, and 6 months later and showed the function of the right-sided left ventricle improvement and the severity of the mitral regurgitation was reduced. Furthermore, clinical evaluation also indicated functional class improvement. Although the cases of percutaneous transcatheter closure are few and cannot be regarded as strong evidence to recommend this procedure, the outcomes are promising and can demonstrate that this approach is practical.
Topics: Humans; Adult; Congenitally Corrected Transposition of the Great Arteries; Transposition of Great Vessels; Heart Defects, Congenital; Heart Septal Defects, Atrial; Arteries
PubMed: 36776113
DOI: 10.1017/S1047951123000070 -
CVIR Endovascular Nov 2023Although the candy-plug technique has been reported to be useful for the treatment of post-dissection aortic aneurysm, the stent graft needs be to customized to...
BACKGROUND
Although the candy-plug technique has been reported to be useful for the treatment of post-dissection aortic aneurysm, the stent graft needs be to customized to accommodate the size of vascular occluders.
CASE PRESENTATION
We present a case of a persistent false lumen successfully treated with endovascular stent-graft and atrial septal defect occluder in a patient with Stanford Type B dissection. A covered stent graft was implanted into the false cavity through a distal rupture, and an atrial septal defect occluder was inserted into the covered stent to seal of the false cavity. Decreased aneurysmal diameter and false lumen thrombosis were noted by CT scan at 6-month follow-up.
CONCLUSIONS
Our case showed that combined use of a stent graft and atrial septal defect occluder is safe, technically feasible and effective in sealing of the false lumen in post-dissection aortic aneurysm patients with previously failed false lumen thrombosis.
PubMed: 38019332
DOI: 10.1186/s42155-023-00405-7 -
Journal of Clinical Medicine Oct 2023The GORE CARDIOFORM (GCO) septal occluder is an atrial septal defect/patent foramen ovale closure device with theoretical advantages over other commercialized devices...
BACKGROUND AND AIM
The GORE CARDIOFORM (GCO) septal occluder is an atrial septal defect/patent foramen ovale closure device with theoretical advantages over other commercialized devices thanks to its softness and anatomical compliance. Our aim was to evaluate the short- and medium-term electrocardiographic changes after percutaneous ASD closure with GCO in a pediatric population.
METHODS
We enrolled 39 patients with isolated ASD submitted to trans-catheter closure from January 2020 to June 2021. ECG was performed before, at 24 h and 6 months after the procedure. P wave dispersion, QTc and QTc dispersion were calculated. ECG Holter was recorded at 6 months after implantation.
RESULTS
Patients' age and body surface area (BSA) were 8.2 ± 4.2 years and 1.0 ± 0.3 m respectively. At the baseline, mean P wave dispersion was 40 ± 15 msec and decreased at 24 h ( < 0.002), without any further change at 6 months. At 24 h, PR conduction and QTc dispersion significantly improved ( = 0.018 and < 0.02 respectively), while the absolute QTc value considerably improved after 6 months. During mid-term follow-up, QTc dispersion remained stable without a significant change in PR conduction. The baseline cardiac frequency was 88.6 ± 12.6 bpm, followed by a slight reduction at 24 h, with a further amelioration at 6 months after the procedure (87.3 ± 14.2, = 0.9 and 81.0 ± 12.7, = 0.009, respectively). After device deployment, two patients developed transient, self-limited junctional rhythm. One of them needed a short course of Flecainide for atrial ectopic tachycardia. No tachy/brady-arrhythmias were recorded at the 6-month follow-up. ASD closure resulted in a marked decrease in right heart volumes and diameters at 6 months after percutaneous closure.
CONCLUSIONS
Percutaneous ASD closure with the GCO device results in significant, sudden improvement of intra-atrial, atrio-ventricular and intraventricular electrical homogeneity. This benefit persists unaltered over a medium-term follow-up. These electrical changes are associated with a documented positive right heart volumetric remodeling at mid-term follow-up.
PubMed: 37834978
DOI: 10.3390/jcm12196334 -
Nutrients Aug 2023Existing evidence supported that congenital heart defect (CHD) was associated with a combination of environmental and genetic factors. Based on this, this study aimed at...
Existing evidence supported that congenital heart defect (CHD) was associated with a combination of environmental and genetic factors. Based on this, this study aimed at assessing the association of maternal folic acid supplementation (FAS), genetic variations in offspring methylenetetrahydrofolate dehydrogenase (MTHFD)1 and MTHFD2 genes, and their interactions with CHD and its subtypes. A hospital-based case-control study, including 620 cases with CHD and 620 healthy children, was conducted. This study showed that the absence of FAS was significantly associated with an increased risk of total CHD and its subtypes, such as atrial septal defect (ASD). FAS during the first and second trimesters was associated with a significantly higher risk of CHD in offspring compared to FAS during the three months prior to conception. The polymorphisms of offspring MTHFD1 and MTHFD2 genes at rs2236222, rs11849530, and rs828858 were significantly associated with the risk of CHD. Additionally, a significantly positive interaction between maternal FAS and genetic variation at rs828858 was observed for the risk of CHD. These findings suggested that pregnant women should carefully consider the timing of FAS, and individuals with higher genetic risk may benefit from targeted folic acid supplementation as a preventive measure against CHD.
Topics: Pregnancy; Child; Female; Humans; Methylenetetrahydrofolate Dehydrogenase (NADP); Case-Control Studies; Heart Defects, Congenital; Family; Folic Acid; Minor Histocompatibility Antigens
PubMed: 37630697
DOI: 10.3390/nu15163502