Repair of Atrial Septal Defect Using Pedicled Right Atrial Wall Flap — A Retrospective Observational Study of a Novel Surgical Technique in a Tertiary Care Hospital in Eastern India

Introduction : In our institute, we have used the pedicled right atrial wall flap as an alternative to a free patch to close Atrial Septal Defect (ASD) in a series of patients. We hereby, report its results. Methods : Between January, 2016 and September, 2018, 24 patients (mean age 25.2 ± 12.43 years; range 5 years to 51 years), underwent closure of ASD with pedicled right atrial wall flap. All the patients who underwent this procedure had ostium secundum type of ASD without any other Intra-cardiac anomaly. Results : The intraoperative and postoperative period was uneventful in all the patients. The mean aortic crossclamp (X- clamp) time was 13 ± 2.99 minutes (Mean ± SD) and the mean duration for Cardiopulmonary Bypass (CPB) was 46.5 ± 10.23 minutes (Mean ± SD). There was no mortality. All the patients were discharged either on 3rd or 4th postoperative day. The pre-discharge and latest follow-up Transthoracic Echocardiographic Evaluation was found satisfactory in all the patients. None of them revealed any residual shunt, peri-flap Thrombosis, Flap dehiscence or shrinkage, or Cardiac Dysfunction. Conclusions : The Pedicled Right Atrial Wall Flap can be safely used as an alternative for pericardial patch for ASD closure. It is a novel technique with several advantages.

Mid-term Safety and Efficacy of Transcatheter Closure of Ostium Secundum Atrial Septal Defect under Transthoracic Echocardiographic Guidance in Children Weighing Less than 15 Kg

Background: Transcatheter device closure of ostium secundum atrial septal defect is a safe & effective intervention in older children, & is usually done under transesophageal echocardiography guidance. However, the procedure under transthoracic echocardiography guidance, especially in smaller children, is done only at few centers, the data of which is scarce. Methods: A prospective study was undertaken to assess the mid-term efficacy and outcome of transcatheter device closure of ostium secundum atrial septal defect under transthoracic echocardiographic guidance, in children <15 Kg. Results: Eighty three children with ostium secundum atrial septal defect were included in the study. Median age of the study population was 3.5 years (1.9-5.6 years), and median weight of 11.6 Kg (7.6 - 14.9 Kg). The primary and secondary procedural success rates were 94% and 96.4% respectively. Post procedure patients were followed up for 12-30 months. Device related major complications were encountered in 4 (4.8%) cases. The total occlusion rates of the defect at 24 hours, 1 month and 3 months post procedure were 94%, 98.8% and 100% respectively. Conclusion: The transcatheter device closure of ostium secundum atrial septal defect under transthoracic echocardiography guidance, in children <15 Kg, has a high short and mid-term safety and efficacy.

Functional and clinical importance of a large sized ostium secundum defect in a middle aged female cadaver: a case report / 대한해부학회지

Atrial septal defect (ASD) is one of the common congenital anomalies of the heart in humans. Its complications depend on the size of the defect and can manifest at any age. The common symptoms of ASD include dyspnea and fatigue. Most of the ASDs are associated with morbidity and mortality, Earlier the treatment, it is better to the patient. I saw a large ostium secundum defect in the heart of an adult female cadaver during dissection classes for undergraduate medical students. The interatrial septum had large defect at the region where fossa ovalis should have been located. It was about 1.25 inches in diameter and oval in shape. This type of large septal defect might result in cyanosis, stroke or death of the patient at any age.

Tromboembolismo pulmonar y comunicación interauricular tipo osteum secundum / Pulmonary embolism and interatrial osteum secundum

Se presenta el caso de una paciente de 45 años, de edad con antecedente de Cardiopatía Congénita Acianógena: comunicación interauricular (CIA) tipo Osteum Secundum (OS), quien de manera ambulatoria consultó para la realización de la evaluación Cardiovascular en preoperatorio de colecistectomía. En Rayos X y Angiotomografia de tórax, se evidenció tromboembolismo pulmonar (TEP). Paciente refiere disnea leve, inspiratoria, habitualmente asociada a leves esfuerzos por más de tres meses, negando otro síntoma pertinente. La ausencia de Enfermedad Tromboembólica venosa (ETV) del tipo Trombosis venosa profunda(TVP) y de factores de riesgo para un Síndrome de Hipercoagulabilidad, excepto el hábito tabáquico, aunado al antecedente de CIA tipo Osteum secundum y la falta de correlación clínica-imagenológica convergen para que la presentación de este caso clínico pudiendo ser mortal sea una condición rara, dado que durante la hospitalización se confirmaron los diagnósticos de TEP Crónico, Hipertensión pulmonar severa (HPS), en ausencia de criterios para Embolismo paradójico (EP), complicación descrita en este tipo de cardiopatía cuando hay hipertensión pulmonar asociada. Los métodos de imagen fueron esenciales para el correcto diagnóstico y el manejo terapéutico de la paciente, la cual evoluciona satisfactoriamente(AU)

A 45-year-old woman came to the office with mild shortness of breath for the past 3 months and the chest X-ray (CXR) and CT showed chronic pulmonary embolism (PE). She had a past medical history of non-cyanotic congenital ostium secundum atrial septal defect, severe pulmonary hypertension and active smoking status. The uncommon clinical presentation in this patient could have been fatal without the appropriate diagnose and treatment(AU)

Clinical evaluation of ostium secundum ASD treatment via one -stop hybrid and classical surgical procedures / 中国基层医药

Objective To investigate clinical effect and safety of ostium secundum atrial septal defect(ASD) treatment via one -stop hybrid and classical surgical procedures.Methods 45 patients were diagnosed ostium secun-dum simple ASD by ultrasound cardiogram and clinical manifestation,they were divided into one -stop hybrid proce-dure group (n =20)and classical surgical procedure (n =25).Age,gender,weight,post operation hospital day,on -pump time,blood transfusion amount,drainage flow,incision length and incidence of complication between the two groups were compared.Results Age and weight had no difference between the two groups(t =0.40 and 1.64,P >0.05),but the proportion of female cases in one -stop hybrid procedure group was higher than post operation(χ2 =9.45,P 0.05).And one -stop hybrid procedure group was off -pump without blood transfusion.Conclusion One -stop hybrid procedure was simple,could make a quick recovery post operation and was an ideal method for ostium secundum ASD treatment.

A survey of the indications for early closure of ostium secundum atrial septal defects and subsequent progress of children in whom this has been undertaken.

Objectives: Closure of isolated secundum atrial septal defect (ASD) is generally recommended at the age of 4 to 5 years. However, there are children with isolated secundum ASDs in whom early closure is performed. The aim of this study is to describe the conditions that led to the decision for early closure and to determine whether these conditions were resolved by means of closure of the defect. Methods: The records of 16 patients who underwent surgical closure of isolated ASD before 24 month of life from 2001 to 2010 at Southampton University Hospital were scrutinised to collect data. Results: There were eight patients with recurrent respiratory tract infections and failure to thrive, three with only recurrent respiratory tract infection, two with evidence of high pulmonary pressures and one with heart failure. Two patients were asymptomatic but had large defects with significant right sided volume overloading. All patients survived surgery and most of them had an uneventful postoperative period. All patients showed clear improvement of their symptoms during the follow up period. Two patients continued to fail to thrive despite closure of ASD but both had other problems to account for the failure to thrive. Conclusion: All symptomatic patients with ostium secundum ASD improved following closure of the ASD before two years of age. Co-existing chromosomal or non cardiac anomalies can be associated with a continued tendency to a poor weight gain after ASD closure.

Clinical Course of the Ostium Secundum Atrial Septal Defect(ASD) and Its Rate of Spontaneous Closure

PURPOSE: To know the natural course of the ostium secundum ASD including its rate of spontaneous closure. METHODS: We studied 259 cases who were diagnosed as ostium secundum ASD by 2D-echocardiography at Department of Pediatrics, Kyungpook National University Hospital between Jan. 1985 and Dec. 1994. According to the age at diagnosis, we divided them into two groups, group I (those diagnosed before 1 month of age: 59 cases) and group II (those diagnosed after 1 month of age: 200 cases) RESULTS: Mean age at first diagnosis was 2.6+/-4.6 years and mean defect size(diameter by 2D-echocardiography) was 9.9+/-8.0 mm. Cardiac murmur was the main reason to refer the patients to hospital, being in 50 cases(87%) in group I, 179 cases(90%) in group II. Defect sizes were significantly small in group I compared with group II (5.3+/-3.4 mm vs 11.1+/-6.9 mm, p<0.05). Symptoms corresponding to congestive heart failure were present in 16 cases of group I (27%)( isolated ASD: 8 cases, ASD accompanying with PDA: 5 cases, ASD accompanying with VSD: 2 cases, ASD accompanying both PDA and VSD : 1 case) and in 27 cases of group II(13.5%) (isolated ASD: 17 cases, ASD accompanying with VSD: 4 cases, ASD accompanying with PDA: 4 cases, ASD accompanying both PDA and VSD: 2 cases). Of total 139 cases, spontaneous closure of ostium secundum ASD was documented in 14 cases(10.1%) by follow up 2D-echocardiography. The rate of spontaneous closure was significantly high in group I compared with group II (6 cases: 37.5% vs 8 cases: 6.5%, p<0.05) Comparing with those cases without closure, there were no significant differences in defect size in group I but significant differences in group II(p<0.05), being 5.63 2.62 mm in cases with spontaneous closure and 12.82 7.09 mm in those cases without closure. Of the 9 cases with atrial septal septal aneurysm, 2D- echocardiographic follow ups were possible in 5 cases with spontaneous closure in 2 (40%). CONCLUSIONS: Spontaneous closure was documented in 10.1% of all the patients with ostium secundum ASD. Especially the closure rate was significantly high in those cases their diagnosis was made before 1 month of age and with atrial septal aneurysm.