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
This study was conducted to assess the incidence of abnormalities of ventricular depolarization [late potentials] in children with sinus rhythm after open heart surgery and their relation to spontaneous ventricular tachycardia. Open heart surgery, particularly operations involving ventriculotomy, may predispose patients to the development of ventricular tachycardia [VT] or ventricular fibrillation [VF]. Previous studies on children with right bundle branch block [RBBB] have shown that late potentials may be a risk factor for developing VT or VF following open heart surgery. After corrective surgery for congenital heart defects, scars may create fractionation and delay of the electrical signals in the heart muscle, providing a substrate for arrhythmias and sudden cardiac death. To find normal values of signal averaged EKG [SA-EKG] indices in children and their changes following open heart surgery, we studied 20 normal children and 20 children with congenital heart disease [CHD] following total correction of heart defects without ventriculotomy. All patients were in normal sinus rhythm and did not have RBBB. The mean age was 8.8 +/- 2.6 years for the control group and 8.1 +/- 2.1 years for the operated patients. SA-EKG was performed for the operated group on the day before and on the 2nd and 4th days after operation. Noise level was less than 1 microvolt. The SA-EKG parameter values were as follows: control group: filtered QRS-duration 40Hz [F. QRS-d], 84.2 +/- 9.5 ms; high frequency low amplitude signals [HFLA], 18.9 +/- 9.5 ms; root mean square 40 [RMS 40], 181.0 +/- 89.4[micro]v; patients: F. QRS-d, 97.2 +/- 19.3*, 116.4:t21.2 * and 122.2 +/- 220A before operation, 2nd day post-op and 4th day post-op, respectively; HFLA, 205 +/- 22.3, 8.9 +/- 7.0*, and 15.4 +/- 16.4 ms, respectively; RMS 40, 146.4 +/- 110.9,92.1 +/- 65.9,and 112.8 +/- 60.3, respectively. Values marked with an asterisk are statistically significant. Except for a significant difference between the QRS duration of normal children and pre-op values of operated patients [p<0.05], there was no remarkable difference between the SA-EKG values pre- and postoperatively. This study in which there was no RBBB, contrary to previous studies, shows that SA-EKG indices are not a predictive value for VT or VF postoperatively. Increased thickness of the ventricular myocardium may be a reason for the increased QRS duration before operation