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British Heart Journal Aug 1985The results of cross sectional echocardiography, intracardiac contrast echocardiography, and balloon sizing techniques and conventional haemodynamic assessment were...
The results of cross sectional echocardiography, intracardiac contrast echocardiography, and balloon sizing techniques and conventional haemodynamic assessment were correlated in 40 consecutive patients evaluated for an isolated left to right shunt at atrial level. Echo free areas along the septum were identified in 23 of 25 patients with a secundum defect, but not in two with a fenestrated defect, and in the upper atrial septum in three of four patients with a sinus venosus defect. No false positive results occurred in 11 patients with a probe patent foramen ovale. Saline contrast injection into the left atrium showed significant left to right shunting in all patients with atrial septal defect; inferior vena caval injection produced right to left shunting in 15 of 29 patients and a negative contrast effect in eight of 29 patients with an atrial septal defect, although neither correlated quantitatively with defect diameter or magnitude of the left to right shunt. Echocardiographic assessment of defect size as small, moderate, or large showed a highly significant correlation with balloon measurement of defect diameter, although some overlap between the groups was evident. In contrast, the correlation between defect diameter and pulmonary to systemic blood flow ratio was poor, mainly because of highly variable shunting in patients with an anatomically large defect. Cross sectional echocardiography has high sensitivity and specificity in the diagnosis of the non-fenestrated atrial septal defect and provides quantitative information about defect diameter. Contrast studies do not add to the diagnostic value of imaging from the subcostal position. The poor correlation between defect size and the measured shunt suggests that the latter may not be the best criterion for surgical management and that size could be an important factor likely to influence both the long term prognosis and the decision for closure.
Topics: Adolescent; Child; Child, Preschool; Echocardiography; Female; Heart Atria; Heart Septal Defects, Atrial; Heart Septum; Hemodynamics; Humans; Infant; Male; Sodium Chloride
PubMed: 4015929
DOI: 10.1136/hrt.54.2.193 -
American Journal of Physiology. Heart... Nov 2020In patients with heart failure, atrial septal defect (ASD) closure has a risk of inducing life-threatening acute pulmonary edema. The objective of this study was to...
In patients with heart failure, atrial septal defect (ASD) closure has a risk of inducing life-threatening acute pulmonary edema. The objective of this study was to develop a novel framework for quantitative prediction of hemodynamics after ASD closure. The generalized circulatory equilibrium comprises right and left cardiac output (CO) curves and pulmonary and systemic venous return surfaces. We incorporated ASD into the framework of circulatory equilibrium by representing ASD shunt flow (Q) by the difference between pulmonary flow (Q) and systemic flow (Q). To examine the accuracy of prediction, we created ASD in six dogs. Four weeks after ASD creation, we measured left atrial pressure (P), right atrial pressure (P), Q, and Qs before and after ASD balloon occlusion. We then predicted postocclusion hemodynamics from measured preocclusion hemodynamics. Finally, we numerically simulated hemodynamics under various ASD diameters while changing left and right ventricular function. Predicted postocclusion P, P, and Q from preocclusion hemodynamics matched well with those measured [P: coefficient of determination () = 0.96, standard error of estimate (SEE) = 0.89 mmHg, P: = 0.98, SEE = 0.26 mmHg, Q: = 0.97, SEE = 5.6 mL·min·kg]. A simulation study demonstrated that ASD closure increases the risk of pulmonary edema in patients with impaired left ventricular function and normal right ventricular function, indicating the importance of evaluation for the balance between right and left ventricular function. ASD shunt incorporated into the generalized circulatory equilibrium accurately predicted hemodynamics after ASD closure, which would facilitate safety management of ASD closure. We developed a framework to predict the impact of atrial septal defect (ASD) closure on hemodynamics by incorporating ASD shunt flow into the framework of circulatory equilibrium. The proposed framework accurately predicted hemodynamics after ASD closure. Patient-specific prediction of hemodynamics may be useful for safety management of ASD closure.
Topics: Animals; Cardiac Surgical Procedures; Dogs; Heart Septal Defects, Atrial; Hemodynamics; Models, Cardiovascular; Postoperative Complications
PubMed: 32886004
DOI: 10.1152/ajpheart.00098.2020 -
Indian Heart Journal 2018Percutaneous closure of patent foramen ovale (PFO) and atrial septal defect (ASD) is routinely performed under general anesthesia or deep sedation and use of...
OBJECTIVE
Percutaneous closure of patent foramen ovale (PFO) and atrial septal defect (ASD) is routinely performed under general anesthesia or deep sedation and use of transesophageal (TEE) or intracardiac echocardiography, incurring longer duration and higher cost. We have used a simplified, economical, fluoroscopy-only guided approach with local anesthesia, and herein report our data.
METHODS
The study includes 112 procedures in 110 patients with PFO (n=75) or ASD (n=35), with use of an Amplatzer occluder, heparin and prophylactic antibiotics. Balloon sizing guided ASD-device selection. All patients received aspirin and clopidogrel for 6 months, when they all underwent TEE.
RESULTS
All PFOs but one (98.7%) and all (100%) ASDs were successfully closed with only one complication (local pseudoaneurysm). At the 6-month TEE, there was no residual shunt in PFO patients, but 2 ASD patients had residual shunts. During long-term (4.3-year) follow-up, no stroke recurrence in PFO patients, and no other problems were encountered. Among 54 patients suffering from migraine, symptom relief or resolution was reported by 45 (83.3%) patients.
CONCLUSION
Percutaneous placement of an Amplatzer occluder was safe and effective with use of local anesthesia and fluoroscopy alone. There were no recurrent strokes over >4 years. Migraine relief was reported by >80% of patients.
Topics: Cardiac Catheterization; Cardiac Surgical Procedures; Echocardiography, Transesophageal; Female; Fluoroscopy; Follow-Up Studies; Foramen Ovale, Patent; Forecasting; Heart Septal Defects, Atrial; Humans; Male; Middle Aged; Septal Occluder Device; Surgery, Computer-Assisted; Treatment Outcome
PubMed: 29455783
DOI: 10.1016/j.ihj.2017.07.020 -
BMJ Open May 2019Intrathoracic shunt quantification is a major factor for appropriate clinical management of heart and pulmonary diseases. Intracardiac shunts quantified by pulmonary to...
Validation of intracardiac shunt using thoracic bioimpedance and inert gas rebreathing in adults before and after percutaneous closure of atrial septal defect in a cardiology research unit: study protocol.
INTRODUCTION
Intrathoracic shunt quantification is a major factor for appropriate clinical management of heart and pulmonary diseases. Intracardiac shunts quantified by pulmonary to systemic output ratio (Qp/Qs) are generally assessed by Doppler echocardiography, MRI or catheterisation. Recently, some authors have suggested the concomitant use of thoracic bioimpedance (TB) and inert gas rebreathing (IGR) techniques for shunt quantification. The purpose of this study is to validate the use of this approach under conditions where shunt fraction is directly quantified such as in patients with isolated atrial septal defect (ASD).
METHODS AND ANALYSIS
This trial is a prospective, observational single-centre, non-blinded study of adults seen for percutaneous closure of ASD. Qp/Qs ratio will be directly measured by Doppler echocardiography and direct Fick. IGR and TB will be used simultaneously to measure the cardiac output before and after closure: the ratio of outputs measured by IGR and TB reflecting the shunt fraction. The primary outcome will be the comparison of shunt values measured by TB-IGR and Doppler echocardiography.
ETHICS AND DISSEMINATION
The study has been approved by an independent Research Ethics Committee (2017-A03149-44 Fr) and registered as an official clinical trial. The results will be published in a peer-reviewed journal.
TRIAL REGISTRATION NUMBER
NCT03437148; Pre-results.
Topics: Breath Tests; Cardiac Output; Cardiography, Impedance; Echocardiography, Doppler; Heart Septal Defects, Atrial; Humans; Noble Gases; Oxygen Consumption; Treatment Outcome
PubMed: 31133575
DOI: 10.1136/bmjopen-2018-024389 -
BMC Cardiovascular Disorders Nov 2022Cardiac epicardium hemangiomas are exceedingly rare; however, they can cause significant hemodynamic impairment and large pericardial effusions. On rare occasion,...
BACKGROUND
Cardiac epicardium hemangiomas are exceedingly rare; however, they can cause significant hemodynamic impairment and large pericardial effusions. On rare occasion, cardiac tumors coexist with malformations of the heart.
CASE PRESENTATION
We present the case of a 10-month-old female infant with a rare cardiac surface hemangioma coexisting with malformations of the heart. It revealed an atrial septal defect (ASD) coexisting with an abnormal occupying lesion with high echogenicity. It was 35*12*9 mm in size and was found in the anterior atrioventricular junction to the posterior atrioventricular junction at the bottom of the ventricular septum by transthoracic echocardiography. We performed surgical treatment of the atrial septal defect and performed biopsy with the occupying lesion. The histopathological examination reported a benign tumor as hemangioma. As far as we know, this is the first case in which cardiac surface hemangioma was found to coexist with an atrial septal defect.
CONCLUSIONS
Cardiac epicardium hemangiomas is a rare solid tumor of the heart. If the mass is impossible to resect and does not cause hemodynamic impairment, only mass biopsy is possible.
Topics: Infant; Humans; Female; Heart Septal Defects, Atrial; Heart Neoplasms; Echocardiography; Hemangioma; Pericardium
PubMed: 36371149
DOI: 10.1186/s12872-022-02919-9 -
Methodist DeBakey Cardiovascular Journal 2018Spontaneous closure of an atrial septal defect (ASD) is well described in pediatric cardiology but may be less familiar to adult internists and cardiologists. We report... (Review)
Review
Spontaneous closure of an atrial septal defect (ASD) is well described in pediatric cardiology but may be less familiar to adult internists and cardiologists. We report a moderately sized 6-mm ASD that closed spontaneously without intervention. A literature review found that a smaller defect size and an early age of diagnosis are the most important predictors of closure. Possible mechanisms of a spontaneous ASD closure include adaptive endothelial migration, limited myocardial proliferation, and fibroblast migration with extracellular matrix deposition.
Topics: Adolescent; Adolescent Development; Age Factors; Child Development; Child, Preschool; Coronary Circulation; Echocardiography, Doppler, Color; Echocardiography, Transesophageal; Female; Heart Septal Defects, Atrial; Heart Septal Defects, Ventricular; Hemodynamics; Humans; Infant, Newborn; Remission, Spontaneous; Time Factors
PubMed: 29623173
DOI: 10.14797/mdcj-14-1-60 -
Frontiers in Endocrinology 2023Paraganglioma is a rare neuroendocrine tumor and is highly associated with hereditary susceptibility genes, often occurring as part of a genetic syndrome. The genetic...
BACKGROUND
Paraganglioma is a rare neuroendocrine tumor and is highly associated with hereditary susceptibility genes, often occurring as part of a genetic syndrome. The genetic heterogeneity of paraganglioma poses challenges in diagnosis, counseling, and clinical management.
CASE SUMMARY
We present the case of a 60-year-old woman with hypertension, atrial septal defect, and polycythemia, who experienced paroxysmal palpitations, sweating, headache, abdominal pain, nausea, and vomiting. Her blood pressure was severely unstable. Blood laboratory tests revealed elevated catecholamine levels, contrast-enhanced CT of her whole abdomen showed a round retroperitoneal mass with soft tissue density, and somatostatin receptor imaging (68Ga PET-CT) indicated a retroperitoneal mass with abnormally increased expression of somatostatin receptor. It is interesting to note that whole exome sequencing (WES) analyses on both blood and tumor samples revealed a novel mutation, specifically the c.2501A > G; p.Tyr834Cys variant, which has never been reported. The patient was diagnosed with paraganglioma and underwent successful Da Vinci robot-assisted laparoscopic resection of the retroperitoneal tumor. During a 3-month follow-up period, her blood pressure stabilized, and her symptoms significantly improved.
CONCLUSION
This case reveals that the mutation may be the primary driver of paraganglioma complicated by atrial septal defect and polycythemia. Additionally, the utilization of Da Vinci robot-assisted laparoscopic surgery contributed to a favorable prognosis for the patient.
Topics: Humans; Female; Middle Aged; Paraganglioma; Polycythemia; Heart Septal Defects, Atrial
PubMed: 37576964
DOI: 10.3389/fendo.2023.1180091 -
Journal of the American College of... Nov 1992The purpose of this study is to determine the early and late results of the surgical repair of atrial septal defect in adults.
OBJECTIVES
The purpose of this study is to determine the early and late results of the surgical repair of atrial septal defect in adults.
BACKGROUND
Progressively limiting, untreated atrial septal defect can lead to the early death of middle-aged adults. Recently it has been suggested that the closure of atrial septal defects might be accomplished with interventional cardiac techniques. Although the long-term results of the transcatheter closure are as yet unknown, the outcome of surgical therapy has been shown to be beneficial for almost 40 years.
METHODS
Between 1971 and 1991, 166 consecutive patients underwent surgical repair of a secundum or sinus venosus atrial septal defect, or both, at the Brigham and Women's Hospital, Boston. There were 120 women and 46 men in this group; the mean age was 44 years and 58 (35%) of the patients were > or = 50 years old. The average pulmonary to systemic flow ratio was 3.0, and 57 patients had a peak systolic pulmonary artery pressure > 30 mm Hg.
RESULTS
There were two operative deaths (early mortality rate 1.2%), and 13% of the patients had a perioperative complication. One hundred fifty-three of the 164 survivors were followed up for a mean of 90 months (range 2 to 247). There were eight late deaths (late mortality rate 4.9%) and a late morbidity rate of 12.4% (in most cases due to arrhythmias). The 5- and 10-year survival rates are 98% and 94%, respectively, and the probability of event-free survival (with no morbidity or mortality) at 5 years is 97% and at 10 years is 92%.
CONCLUSIONS
The results indicate that the surgical correction of atrial septal defect in adults is safe and efficacious as confirmed by 20 years of follow-up.
Topics: Adult; Age Factors; Arrhythmias, Cardiac; Boston; Cause of Death; Female; Follow-Up Studies; Heart Septal Defects, Atrial; Humans; Incidence; Life Tables; Male; Middle Aged; Postoperative Complications; Reoperation; Sex Factors; Survival Rate; Time Factors; Treatment Outcome
PubMed: 1401616
DOI: 10.1016/0735-1097(92)90372-t -
JACC. Cardiovascular Interventions Jan 2016
Topics: Cardiac Catheterization; Heart Septal Defects, Atrial; Humans; Septal Occluder Device
PubMed: 26762916
DOI: 10.1016/j.jcin.2015.11.011 -
JACC. Cardiovascular Interventions Nov 2017
Topics: Adult; Follow-Up Studies; Foramen Ovale, Patent; Heart Septal Defects, Atrial; Humans; Tricuspid Valve Insufficiency
PubMed: 29055757
DOI: 10.1016/j.jcin.2017.07.014