ABSTRACT
Secondary atrial septal defect is one of the most common congenital heart diseases, and treatment is required in cases of large defects. The aim of this study was to assess the short-term results of secundum atrial septal defect closure by two surgery [right thoracotomy] and intervention [transcatheter Amplatzer septal occluder]. This is a descriptive study on 25 patients treated by one of the two above-mentioned methods at our center between 2004 and 2007. The patients underwent clinical and diagnostic examinations both before and after treatment such as chest X-ray, electrocardiography, echocardiography, catheterization, and angiography. The outcome and results were thereafter assessed and compared. The study population was comprised of 20 [80%] females and 5 [20%] males. The patients were divided into two groups: 17 [68%] patients were treated by intervention and 8 [32%] by right thoracotomy. The intervention group had a mean age of 12 years [ +/- 6years] and the surgery group 11 years [ +/- 4 years]. The average size of the defect was approximately 15 mm, which was similar in both groups. The average duration of hospital stay in the intervention group was significantly shorter than that of the surgery group, and the average cost of treatment in the intervention group was slightly less than the surgery group. One of the patients in the surgery group needed blood transfusion, and one of the patients in the intervention group suffered from Amplatzer embolization to the left ventricle, necessitating the extraction of the device through open heart surgery. One of the patients in the surgery group had a residual defect in the atrial septum, which was not significant. In light of the results of this study, it seems that in appropriately selected patients, the closure of the atrial septal defect via the interventional method is comparable to surgery
ABSTRACT
Pulmonary arteriovenous fistula [PAVF] is a rare cyanotic disease. Until 1942 when the first surgery was performed for PAVF, there was not any treatment option available for this disease. In 1977, the first embolotherapy for PAVF was carried out and today, this procedure is the treatment of choice for PAVF. There has been no report of PAVF patients from Iran so far. In a retrospective study, all PAVF cases who had been hospitalized since the inauguration of the center were identified, and data regarding demographic information, symptoms, signs, complications, paraclinical studies, treatment complications and results, and long-term follow-up were gathered and analyzed. Our patients comprised 11 cases and had a lower mean age [16 years] compared with previous large studies. We found that the lower referral rate of non-Tehranian adult patients to our center, as compared to non-Tehranian pediatric patients, might have been responsible for the observed difference. Other statistically significant differences were lower prevalence of chronic headaches [9%] and higher rate of polycythemia [70%] in our patients compared with other studies. The first PAVF surgery had been performed in 1991 and the first embolotherapy in 2001 at our center. After 2001, no PAVF patient had been referred for fistula surgery. PAVF is a rare and interesting disease. Embolization has opened new horizons into the treatment of PAVF