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Journal of Cardiothoracic Surgery Jun 2019Extralobar sequestration is a rare congenital malformation of lung tissue, which can be combined with other foregut and cardiac abnormalities. Our case is the first to...
BACKGROUND
Extralobar sequestration is a rare congenital malformation of lung tissue, which can be combined with other foregut and cardiac abnormalities. Our case is the first to report extralobar sequestration, absence of pericardium and atrial septal defect in the same patient.
CASE PRESENTATION
A 22-year-old female with atrial septal defect came for her recent atypical symptom of intermittent palpitation and shortness of breath. Her computed tomography showed a cystic mass located in left superior anterior mediastinum near the pulmonary trunk. With specious of cystic teratoma prior to video-assisted thoracoscopic surgery, she finally was diagnosed as extralobar sequestration, while incidentally found with congenital absence of pericardium during surgery.
CONCLUSIONS
Extralobar sequestration, absence of pericardium and atrial septal defect can occur in the same patient. The preoperative diagnostic rate of extralobar sequestration and asymptomatic absence of pericardium remains low attributed to atypical imaging features. A cardiac magnetic resonance imaging is highly recommended if necessary. Regular follow-up is essential to asymptomatic absence of pericardium and atrial septal defect patients. To patients with extralobar sequestration, an operation could be performed.
Topics: Abnormalities, Multiple; Bronchopulmonary Sequestration; Diagnosis, Differential; Female; Heart Septal Defects, Atrial; Humans; Magnetic Resonance Imaging; Mediastinal Neoplasms; Pericardium; Teratoma; Thoracic Surgery, Video-Assisted; Tomography, X-Ray Computed; Young Adult
PubMed: 31221172
DOI: 10.1186/s13019-019-0932-9 -
Turk Kardiyoloji Dernegi Arsivi : Turk... Apr 2015The aim of this study was to evaluate acute cardiac remodeling after transcatheter closure of atrial septal defect (ASD) in adult patients.
OBJECTIVE
The aim of this study was to evaluate acute cardiac remodeling after transcatheter closure of atrial septal defect (ASD) in adult patients.
METHODS
This study included 19 patients (40.0 ± 13.51 mean age) with secundum ASD who underwent successful transcatheter closure. All patients received routine transthoracic echocardiography, including tissue Doppler left ventricle (LV) and right ventricle (RV) myocardial performance indices (MPI), mitral annular plane systolic excursion (MAPSE) and tricuspid annular plane systolic excursion (TAPSE) before ASD closure, on first day, and at first and third months after closure.
RESULTS
Left ventricle end-diastolic diameter (LVEDD) increased (37 ± 4 mm to 44 ± 5 mm, p<0.001); RVEDD decreased markedly after closure (40 ± 4 mm to 32 ± 5 mm, p<0.001); and differences existed in LV and RV adaptation. While MAPSE (1.87 ± 0.22 cm to 2.01 ± 0.23 cm, p<0.001) and LVMPI improved soon after procedure (0.44 ± 0.04 to 0.36 ± 0.03, p<0.001), RVMPI worsened until the first month post-procedure (0.25 ± 0.02 to 0.31 ± 0.03, p<0.001), but recovered by the third month follow-up visit (0.31 ± 0.03 to 0.27 ± 0.02, p<0.001). TAPSE remained unchanged (2.49 ± 0.46 cm to 2.51 ± 0.32 cm, p=0.078).
CONCLUSION
Closure of ASD using the Amplatzer Septal Occluder device led to a decrease in RV size and an increase in LV size. In the early period, while LV function improved, RV function deteriorated, probably due to RV functional and anatomical differences.
Topics: Adult; Cohort Studies; Echocardiography, Doppler; Female; Heart Septal Defects, Atrial; Heart Ventricles; Humans; Male; Middle Aged; Percutaneous Coronary Intervention; Ventricular Remodeling
PubMed: 25905996
DOI: 10.5543/tkda.2015.57106 -
Postgraduate Medical Journal Dec 1993This study examines the clinical and surgical outcome of a group of 55 patients (mean age 33 years) with secundum atrial septal defect who underwent surgical repair of...
This study examines the clinical and surgical outcome of a group of 55 patients (mean age 33 years) with secundum atrial septal defect who underwent surgical repair of this defect between 1981 and 1990. A group of 25 of these patients underwent late echocardiographic follow-up. Fifty-two patients underwent repair by direct suturing and three by patch closure. Surgical mortality was nil. There was one late death of a 58 year old who died from cardiac failure 4 years after surgery. Late postoperative morbidity consisted of two patients; one, age 63 at the time of surgery, required mitral and tricuspid valve replacement 6 years later and one, age 77 at surgery, developed cardiac failure 3 years later. Atrial fibrillation persisted in the six patients who had the rhythm before surgery and developed postoperatively in two patients aged 54 and 58. Two patients aged 49 and 57 developed immediate postoperative sinus node dysfunction requiring permanent pacing. The mean age at surgery of those six patients who suffered cardiac morbidity was 60 years. The patients with preoperative angiographic evidence of mitral valve prolapse were significantly older (P < 0.001) and had higher mean pulmonary artery pressures (P < 0.001) than patients with normal valves. There was no significant relationship between shunt size and mitral valve prolapse. Echocardiographic follow-up showed persistent mitral valve prolapse in all nine patients who developed the condition preoperatively. Five patients developed mitral valve prolapse with mitral regurgitation postoperatively, one of whom needed subsequent mitral and tricuspid valve replacement. These five patient were on average older (mean age 54) but the group was too small to prove significance. The follow-up data illustrate the current low mortality and morbidity associated with surgical closure of atrial septal defects. Late postoperative echocardiography had revealed not only that mitral valve prolapse persists in those patients who developed the condition pre-operatively but that new cases of mitral valve prolapse with mitral regurgitation can occur after atrial septal defect closure.
Topics: Adult; Aged; Follow-Up Studies; Heart Septal Defects, Atrial; Humans; Middle Aged; Mitral Valve Insufficiency; Mitral Valve Prolapse; Prospective Studies; Treatment Outcome; Ultrasonography
PubMed: 8121863
DOI: 10.1136/pgmj.69.818.912 -
Acta Veterinaria Scandinavica Mar 2014A 3-week-old female white Bengal Tiger cub (Panthera tigris tigris) presented with acute onset tachypnoea, cyanosis and hypothermia. The cub was severely hypoxaemic with...
A 3-week-old female white Bengal Tiger cub (Panthera tigris tigris) presented with acute onset tachypnoea, cyanosis and hypothermia. The cub was severely hypoxaemic with a mixed acid-base disturbance. Echocardiography revealed severe pulmonic stenosis, right ventricular hypertrophy, high membranous ventricular septal defect and an overriding aorta. Additionally, an atrial septal defect was found on necropsy, resulting in the final diagnosis of Tetralogy of Fallot with an atrial septal defect (a subclass of Pentalogy of Fallot). This report is the first to encompass arterial blood gas analysis, thoracic radiographs, echocardiography and necropsy findings in a white Bengal Tiger cub diagnosed with Tetralogy of Fallot with an atrial septal defect.
Topics: Animals; Animals, Newborn; Blood Gas Analysis; Echocardiography; Fatal Outcome; Female; Heart Septal Defects, Atrial; Radiography; Tetralogy of Fallot; Tigers
PubMed: 24594084
DOI: 10.1186/1751-0147-56-12 -
The American Journal of Case Reports Jul 2019BACKGROUND Catheter ablation for atrial fibrillation is an important therapeutic intervention. One of the most frequent complications of this procedure is vascular...
BACKGROUND Catheter ablation for atrial fibrillation is an important therapeutic intervention. One of the most frequent complications of this procedure is vascular issues including arteriovenous fistula. Iatrogenic atrial septal defect (IASD) has been reported as a complication of transseptal puncture; however, no data are available demonstrating any coexistent of arteriovenous fistula with IASD. CASE REPORT A 61-year-old female patient was admitted to our center for catheter ablation for persistent atrial fibrillation. Her past medical history was significant for cryoballoon ablation for atrial fibrillation in 2015, which was subsequently complicated by hematoma and arteriovenous fistula at puncture site. After general surgery consultation, the patient was qualified for conservative treatment. To exclude left atrial thrombus before redo procedure, transesophageal echocardiography was performed which visualized the presence of 9-mm atrial septal defect with left-to-right shunting, detecting right-to-left shunting using Valsalva maneuver. No significant valvular abnormalities were identified. The next day, pulmonary vein isolation for atrial fibrillation was performed. One month later, a control transthoracic echocardiogram (TTE) revealed hemodynamic significant left-to-right shunting with Qp/Qs 2.0 and high probability of pulmonary hypertension. Vascular surgery for arteriovenous fistula was successfully performed in October 2018. Subsequent TTE, performed a month later, confirmed no left-to-right shunting and no signs of pulmonary hypertension or diminishment of the right atrium. CONCLUSIONS Vascular access during catheter ablation for atrial fibrillation may result in arteriovenous fistula. This condition might affect right atrium pressure leading to increased diameter of previous puncture site at the interatrial septum, causing IASD with significant shunting. In this group of patients, arteriovenous fistula should be treated as soon as possible.
Topics: Arteriovenous Fistula; Atrial Fibrillation; Catheter Ablation; Cryosurgery; Echocardiography, Transesophageal; Female; Heart Septal Defects, Atrial; Humans; Iatrogenic Disease; Middle Aged; Postoperative Complications; Vascular Surgical Procedures
PubMed: 31280280
DOI: 10.12659/AJCR.916205 -
Medicina (Kaunas, Lithuania) Jul 2022Atrial septal defect is one of the most common congenital heart diseases in adults. The defect often leads to volume overload in the right heart coupled with the...
Atrial septal defect is one of the most common congenital heart diseases in adults. The defect often leads to volume overload in the right heart coupled with the potential risk of right heart failure and pulmonary arterial hypertension. These conditions lead to worsening in quality of life, decrease in physical capacity, and even to fatal outcomes. The main strategy for treatment of atrial septal defect is a transcatheter or surgical closure of the defect, but in patients with severe pulmonary arterial hypertension, it is recommended to manage pulmonary arterial hypertension and after that treat the defect invasively. This strategy is called "treat and repair" strategy. We present an illustrative case report of management and treatment of atrial septal defect, complicated with severe pulmonary arterial hypertension. In this case, surgical closure of the defect was contraindicated because of the high pulmonary vascular resistance. Therefore, the "treat and repair" strategy was approached. After specific medical treatment of pulmonary arterial hypertension, surgical closure of the defect was chosen and proven successful.
Topics: Adult; Heart Septal Defects, Atrial; Humans; Hypertension, Pulmonary; Pulmonary Arterial Hypertension; Quality of Life; Treatment Outcome
PubMed: 35888611
DOI: 10.3390/medicina58070892 -
Thorax Sep 1972Surgical closure of an atrial septal defect was performed on 104 patients over the age of 40 at the Brompton Hospital. The hospital mortality was 9·6%, reducing to...
Surgical closure of an atrial septal defect was performed on 104 patients over the age of 40 at the Brompton Hospital. The hospital mortality was 9·6%, reducing to 2·7% in the last six years. There were five late deaths. A moderate increase in preoperative pulmonary artery systolic pressure did not influence mortality. Twenty-five per cent of patients in preoperative atrial fibrillation have been maintained in sinus rhythm an average of five years following operation. Seven per cent of patients in sinus rhythm preoperatively left hospital in atrial fibrillation. Another 7% developed atrial fibrillation an average of seven years after operation. At late follow-up 75 patients were symptom-free and leading normal lives. It is concluded that patients in this age group with atrial septal defect benefit from surgical closure of the defect.
Topics: Adult; Age Factors; Aged; Atrial Fibrillation; Blood Pressure; Delusions; Female; Follow-Up Studies; Hallucinations; Heart Failure; Heart Septal Defects, Atrial; Hemorrhage; Humans; Male; Middle Aged; Postoperative Complications; Pulmonary Artery; Thromboembolism; Vascular Resistance; Ventricular Fibrillation
PubMed: 5083725
DOI: 10.1136/thx.27.5.577 -
BMC Cardiovascular Disorders Jun 2024Atrial septal defects (ASD) are the most common type of adult congenital heart disease (ACHD) associated with a high risk developing of pulmonary arterial hypertension...
BACKGROUND
Atrial septal defects (ASD) are the most common type of adult congenital heart disease (ACHD) associated with a high risk developing of pulmonary arterial hypertension (PAH). ASD closure is not recommended in patients with PAH and Pulmonary Vascular Resistance (PVR) ≥ 5 Wood Unit (WU). Noninvasive methods have been proposed to measure PVR; however, their accuracy remains low. Right Ventricle (RV) - Pulmonary Artery (PA) coupling is defined as the ability of the RV to adapt to high-resistance conditions. Tricuspid Annular Plane Systolic Excursion (TAPSE)/estimated pulmonary artery systolic pressure (ePASP) calculation using echocardiography is a noninvasive technique that has been proposed as a surrogate equation to evaluate RV-PA coupling. Currently, no research has demonstrated a relationship between RV-PA coupling and PVR in patients with ASD.
METHODS
The study participants were consecutive eligible patients with ASD who underwent right heart catheterization (RHC) and echocardiography at Hasan Sadikin General Hospital, Bandung. Both the procedures were performed on the same day. RV-PA Coupling, defined as TAPSE/ePASP > 0.31, was assessed using echocardiography. The PVR was calculated during RHC using the indirect Fick method.
RESULTS
There were 58 patients with ASD underwent RHC and echocardiography. Among them, 18 had RV/PA Coupling and 40 had RV/PA Uncoupling. The PVR values were significantly different between the two groups (p = 0.000). Correlation test between TAPSE/ePASP with PVR showed moderate negative correlation (r= -0.502, p = 0.001). TAPSE/ePASP ≤ 0.34 is the cutoff point to predict PVR > 5 WU with sensitivity of 91.7% and specificity 63.6%.
CONCLUSION
This study showed a moderate negative correlation between TAPSE/ePASP and PVR. TAPSE/ePASP ≤ 0.34 could predict PVR > 5 WU with good sensitivity.
Topics: Humans; Heart Septal Defects, Atrial; Pulmonary Artery; Male; Vascular Resistance; Female; Ventricular Function, Right; Adult; Middle Aged; Cardiac Catheterization; Arterial Pressure; Pulmonary Arterial Hypertension; Predictive Value of Tests
PubMed: 38853261
DOI: 10.1186/s12872-024-03935-7 -
The Journal of Veterinary Medical... Aug 2018A 14-month-old, female mini rex was referred for a detailed examination because of exercise intolerance with associated dyspnea. The thoracic radiograph demonstrated...
A 14-month-old, female mini rex was referred for a detailed examination because of exercise intolerance with associated dyspnea. The thoracic radiograph demonstrated severe cardiac enlargement and elevation of the trachea. The echocardiography revealed dilatations of the right-side heart and pulmonary artery, and the color flow Doppler echocardiography demonstrated an atrial septum defect with left to right shunt, resulting in a disturbed flow. The rabbit died 19 days after the initial presentation, and a necropsy was performed. At the necropsy, a defect, 5 mm in diameter, was detected in the atrial septum. Based on the location of the defect, an ostium secundum type atrial septal defect was diagnosed. This is the first clinical report of atrial septal defect in rabbits.
Topics: Animals; Echocardiography; Female; Heart Septal Defects, Atrial; Rabbits
PubMed: 29973434
DOI: 10.1292/jvms.18-0215 -
The New England Journal of Medicine Aug 1995The surgical closure of an atrial septal defect is frequently recommended for patients over 40 years of age. However, the prognosis for such patients with unrepaired... (Comparative Study)
Comparative Study
BACKGROUND
The surgical closure of an atrial septal defect is frequently recommended for patients over 40 years of age. However, the prognosis for such patients with unrepaired defects is largely unknown, and the outcome for patients operated on after the fourth decade of life has not yet been compared with that for medically treated patients in a controlled follow-up study.
METHODS
In a retrospective study, we examined the clinical course of 179 consecutive patients with isolated atrial septal defects diagnosed after the age of 40. The 84 patients (47 percent) who underwent surgical repair were compared with the 95 patients (53 percent) who were treated medically. The mean (+/-SD) follow-up period was 8.9 +/- 5.2 years (range, 1 to 26).
RESULTS
Multivariate analysis revealed that surgical closure of the defect significantly reduced mortality from all causes (relative risk, 0.31; 95 percent confidence interval, 0.11 to 0.85). The adjusted 10-year survival rate of surgically treated patients was 95 percent, as compared with 84 percent for the medically treated patients. In addition, surgical treatment prevented functional deterioration, as measured by the New York Heart Association class (relative risk, 0.21; 95 percent confidence interval, 0.08 to 0.55). However, the incidence of new atrial arrhythmias or of cerebrovascular insults in the two groups was not significantly different.
CONCLUSIONS
The surgical repair of an atrial septal defect in patients over 40 years of age, as compared with medical therapy, increases long-term survival and limits the deterioration of function due to heart failure. However, surgically treated patients should be followed closely for the onset of atrial arrhythmias so as to reduce the risk of thromboembolic complications.
Topics: Adult; Aged; Cardiovascular Diseases; Digitalis Glycosides; Diuretics; Female; Heart Septal Defects, Atrial; Humans; Incidence; Male; Middle Aged; Multivariate Analysis; Nitrates; Postoperative Complications; Proportional Hazards Models; Retrospective Studies; Risk; Severity of Illness Index; Survival Analysis
PubMed: 7623878
DOI: 10.1056/NEJM199508243330801