Sufficient versus deficient rims during percutaneous closure of ostium secundum type atrial septal defect: A systematic review and meta-analysis

Background: The aim of this meta-analysis was to compare the efficacy and adverse events of percutaneous occlusion among patients with sufficient and deficient rims. Methods: A systematic review of all articles published in the Pubmed, MEDLINE and Google Scholar databases was performed. Odds ratio (OR) and 95% CI were used as a measure of effect of the combination of studies. I2 with 95% CI was estimated to assess study heterogeneity. For the meta-analysis, a random effects model was used. Results: The systematic search identified ten studies which included 4355 patients; 2661 of those had sufficient rim and the remaining 1694 patients showed some rim deficiency. Implant failure rate was 4.13% CI 95% 3.53e4.72%. Compared to frequency of failures in the group with a deficient rim (5.43% CI 95% 4.35e6.50%), implant failure in patients with a sufficient rim was significantly lower (3.30% CI 95% 2.62e3.97%), OR 2.27 CI 1.34e3.83 (p 0.002). The combined adverse events were 5.19% CI 95% 4.22e6.35% vs 2.7% CI 95% 2.08e3.31% in the deficient vs sufficient rim groups respectively (OR 2.21 CI 0.93e5.29; p 0.07). Implant failures and adverse events were more frequent in patients with posterior inferior rim deficiency. Conclusion: Patients presenting a posteroinferior rim deficiency are associated to both, an increased incidence of closure failure and a combined adverse events occurrence. More studies on posterior rim deficiency are necessary to ensure the feasibility and safety of the percutaneous approach.

Adult Congenital Heart Disease: Report from a Public Reference Hospital in Northeastern Brazil

ABSTRACT Introduction: The increasing worldwide number of adults with congenital heart disease (CHD) demands greater attention from health professionals. The purpose of this report is to describe the clinical demographic profile, frequency, and invasive treatment status of adults with CHD in a public reference hospital in northeastern Brazil. Methods: This is a retrospective cross-sectional study including 704 patients attended between August 2016 and August 2020. Data were collected from virtual database. Results: Patients' age varied from 17 to 81 years (mean 32±14; median 27 years); 294 (41.8%) patients were male, and 410 (58,2%) were female; 230 (32,7%) had diagnosis from age 18 and up. Cardiac complexity categories were "simple defects" (134 [19%] patients), "moderate complexity" (503 [71.5%]), and "great complexity" (67 [9.5%]). Atrial septal defect (ASD) was diagnosed in 216 (30.7%) patients, ventricular septal defect (VSD) in 101 (14.3%), tetralogy of Fallot in 93 (13.2%), and other CHD in 294 (41.8%). New York Heart Association (NYHA) functional classes were I (401 [57%]), II (203 [28.8%]), III (76 [10.8%]), and IV (24 [3.4%]). Complications were arrhythmias (173 [24%]) and severe pulmonary hypertension (69 [9.8%]). Invasive treatments were corrective surgery (364 (51.6%]), reoperation (28 [4.0%]), palliation (11 [1.6%]), interventional catheterization (12 [1.7%]), surgery plus interventional catheterization (5 [0.7%]), and preoperation (91 [12.9%]). Treatment was not required in 102 (14,5%) patients, and 91 (12.9%) were inoperable. Conclusion: The leading diagnosis was ASD. Frequency of unrepaired patients was high, mainly ASD, due to late diagnosis, which favored complications and denotes a matter of great concern.

Efficacy of echocardiography-guided alone versus fluoroscopy-guided percutaneous closure of atrial septal defect: A systematic review and meta-analysis / 中国胸心血管外科临床杂志

@#Objective     To systematically evaluate the safety and efficacy of percutaneous closure of atrial septal defect (ASD) guided by echocardiography alone versus fluoroscopy. Methods     The databases of PubMed, The Cochrane Library, EMbase, VIP, Wanfang Data and CNKI from January 2000 to October 2021 were searched by computer for relevant research literature. Two reviewers independently screened the literature, extracted the data and evaluated the quality according to the inclusion and exclusion criteria. Meta-analysis was performed using RevMan 5.4 software. Results     A total of 19 cohort studies and 1 randomized controlled study were collected, including 2 825 patients. The Newcastle-Ottawa Scale score for cohort studies was≥7 points. Meta-analysis showed that there was no statistical difference in the operative success rate (RR=1.01, 95%CI 1.00 to 1.02, P=0.17), incidence of occluder displacement/shedding (RR=0.77, 95%CI 0.26 to 2.27, P=0.63), incidence of arrhythmia (RR=0.50, 95%CI 0.21 to 1.14, P=0.10), incidence of pericardial effusion (RR=0.98, 95%CI 0.32 to 2.98, P=0.97), operative time (MD=–0.23, 95%CI –7.56 to 7.10, P=0.95) or cost (SMD=–0.39, 95%CI –1.09 to 0.30, P=0.27) between the two groups. The echocardiography group reduced the incidence of total postoperative complications (RR=0.42, 95%CI 0.30 to 0.60, P<0.001) and residual shunt (RR=0.70, 95%CI 0.50 to 0.98, P=0.04), and shortened length of hospital stay (MD=–0.43, 95%CI –0.77 to 0.09, P=0.01). Conclusion     Compared with traditional fluoroscopy-guided percutaneous closure of ASD, echocardiography guidance alone is equivalent in terms of operative success rate, major postoperative complications, operative time and total cost, but it reduces the incidence of total postoperative complications and residual shunt, and has a shorter length of hospital stay.

Atrial septal defect with atrial fibrillation treated by one-stop radiofrequency ablation and transthoracic closure under total endoscopy: A case report / 中国胸心血管外科临床杂志

@#Surgical treatment of atrial septal defect (ASD) mainly includes occlusion or repair under cardiopulmonary bypass. Surgical treatment of atrial fibrillation includes transcatheter radiofrequency ablation or Maze surgery under cardiopulmonary bypass. There are many treatments for ASD patients combined with atrial fibrillation, but each has its own advantages and disadvantages. We reported an ASD patient combined with atrial fibrillation treated by totally endoscopic "one-stop" radiofrequency ablation and simultaneous transthoracic ASD occlusion of atrial fibrillation, with good postoperative results.

Presentación inusual del síndrome de Lutembacher / Unusual presentation of Lutembacher’s syndrome

Resumen Introducción: El síndrome de Lutembacher corresponde a la asociación de un defecto interauricular (congénito o iatrogénico) e insuficiencia o estenosis mitral (congénita o adquirida). La etiología reumática es la causa más frecuente del compromiso mitral. Tiene una prevalencia reportada de 0.001 por cada 1.000.000 habitantes. Caso clínico: Paciente femenina de 6 años con cuadro de 10 meses de palpitaciones asociadas a dolor torácico. Se realizó un electrogardiograma en el que se evidenció bloqueo incompleto de la rama derecha del haz de His y prolongación del intervalo PR, además de un ecocardiograma en el que se visualizó una comunicación interauricular tipo ostium secundum no restrictiva de 28 mm, con cortocircuito de izquierda a derecha, dilatación del ventrículo derecho, prolapso de válvula mitral, valvas engrosadas e insuficiencia mitral moderada a grave. Se realizó plastia de válvula mitral y cierre quirúrgico de la comunicación interauricular, sin complicaciones. Durante el seguimiento se encuentra asintomática desde el punto de vista cardiovascular, en manejo farmacológico. Conclusiones: La asociación Lutembacher tiene una prevalencia de 0.001/1.000.000 habitantes; la mayoría tiene etiología reumática. La paciente no tiene historia de fiebre reumática y sería la paciente más joven reportada en la literatura con síndrome de Lutembacher.

Abstract Introduction: Lutembacher’s syndrome corresponds to the association of an atrial septal defect (congenital or iatrogenic) and mitral regurgitation or stenosis (congenital or acquired), with rheumatic etiology being the most-frequent cause of mitral regurgitation. It has a reported prevalence of 0.001 for every 1,000,000 inhabitants. Clinical case: Female patient six years of age with a 10-month condition of palpitations associated with chest pain. An electrocardiogram was performed with evidence of incomplete right His bundle branch block and PR interval prolongation; additionally, an echocardiogram showed 28-mm non-restrictive ostium secundum atrial septal defect, with left-to-right shunt, right ventricular dilation, mitral valve prolapse, thickened valves, and moderate-to-severe mitral regurgitation. Mitral valve plasty and surgical closure of the atrial septal defect were performed, without complications. During follow-up, she was asymptomatic from the cardiovascular point of view, under pharmacological management. Conclusions: Lutembacher’s association has a prevalence of 0.001/1´000.000 inhabitants; the majority with rheumatic etiology. Our patient has no history of rheumatic fever and would be the youngest patient reported in the literature with Lutembacher’s syndrome.

Alteration of Pulmonary Venous Flow Doppler Post Transcatheter Closure of Atrial Septal Defect

Background: Atrial septal defect is a common congenital heart anomaly results in hemodynamically significant right ventriclular volume overload and an increase in the pulmonary venous flow. Aim: Evaluate changes of pulmonary venous flow parameters after transcatheter closure of secundum atrial septal defect. Patients and Methods: 50 patients with atrial septal defect aged from 3.5 to 31 years were included in the study. Pulmonary venous flow Doppler and right ventricular function were evaluated before and after successful transcatheter closure by transthoracic and transesophageal echocardiography. Results: The defect size ranged from 15 to 37mm with a mean (24.96 ±7.52), Normal systolic and diastolic waves of pulmonary venous flow Doppler were replaced by a continuous antegrade wave (mean 60±13.6 cm/s) in all atrial septal defect patients. Post-closure, the normal pulmonary venous flow pattern was regained, two separate waves, with a significant decrease in mean peak Systolic wave velocity (44.54±8.12 cm/sec vs 69.61±12.37, P=0.000), the mean peak Diastolic Wave velocity (55.85±9.81 cm/sec vs 72.65±10.38, P=0.000) and a significant increase in the mean peak atrial reversal wave velocity (28.75±4.63cm/sec vs 21.18±3.64, P=0.000). In multivariate regression analysis, significant predictors of haemodynamic significant ASD were ASD size,(odds ratio 1.508, P=0.007, 95% CI 1.153,2.671) and ASD/IAS ratio (odds ratio 2.313, P=0.001, 95% CI 1.064,3.104). Conclusions: Atrial septal defect patients have characteristic pulmonary venous flow pattern: continuous antegrade wave with systolic predominance and decrease in atrial reversal wave, which return to normal after closure. These changes could be helpful echocardiographic tool in prediction of successful closure of the defect.

Two-dimensional Echocardiography in the Evaluation of Right Ventricular Systolic Function in Patients with Atrial Septal Defect before and after Closure

Background: Atrial septal defects lead to left to right shunt, the volume of the shunt is determined by RV/LV compliance, defect size, and LA/RA pressure. RV volume overload and pulmonary over circulation are caused by a simple ASD because the RV is more compliant than the LV. The aim of our study was to assess changes in RV systolic function before and after ASD closure either by surgery or transcatheter closure. Methods: This study was conducted on 70 patients diagnosed with ASD Secundum and had subdivided into two groups A (surgical closure) group, and B (percutaneous device closure) group. All patients had been assessed by transthoracic Echocardiography examination for RV systolic Function 24 h before ASD closure, and 6 months after closure. Results: There was a significant decrease in the right ventricle systolic function indices (TAPSE, FAC, Tissue Doppler S wave velocity, and global longitudinal free wall strain) after ASD closure either by surgery or by transcatheter device closure Conclusions: The right ventricle's size and function are affected by a large shunt caused by an ASD secudium. ASD and its consequent volume overload resulted in higher RV myocardial contraction, leading to an increase in strain values and RV systolic function indices, which were reduced and returned to normal values when the left-to-right shunt was eliminated, and the defect was closed.

Role of cardiac rehabilitation in patient with pulmonary hypertension on functional capacity and quality of life

Patients with pulmonary hypertension (PH) continue to develop significant exertional symptoms and reduced quality of life despite receiving pharmacological therapy. Guidelines highlighted the importance of rehabilitation as part of management in PH. However, the cardiac rehabilitation program is still underused. We present a case of functional capacity improvement in patients with surgically corrected secundum atrial septal defect (ASD) with PH who underwent cardiac rehabilitation program. A 30-year-old female with a previous history of surgically corrected ASD went to our rehabilitation program in our hospital. She had a 3-weeks program of rehabilitation, and there were improvements in symptoms, clinical parameters, and quality of life after completion of the cardiac rehabilitation program. Rehabilitation can be an adjuvant for pharmacological therapy for PH that has been proven to improve the quality of life in patients with PH.

Prevalence of Mitral Valve Regurge with or without Prolapse and Left Atrial Volume among Patients with Secundum Type Atrial Septal Defect

Background: An atrial septal defect (ASD) is a persistent interatrial communication. It is distinct from a patent foramen ovale wherein there is a flap with intermittent communication. The aim of this work was to assess prevalence of mitral valve regurge or prolapse and left atrial volume in patients with secundum type ASD. Methods: This prospective study was carried out at the cardiovascular department, Tanta University Hospitals on 140 patients either adult or children who were diagnosed as atrial septal defect by 2-D echocardiography. They were subjected to detailed history, detailed clinical examination, chest x-ray and echocardiography (2-D echo & Doppler). Results: 95% of patients were trivial or mild mitral regurgitation, 3.6% were moderate and 1.4% were severe. Cause of mitral valve regurgitation was 2.86% prolapse, 1.43% rheumatic and 0.71 dysplastic. Left atrial enlargement was found in 2.1% of patients. Mean LA diameter was 34.68 ± 3.9 mm, mean LA volume was 45.75 ± 3.44 ml and mean LA volume index was 24.14 ± 2.97 ml/m2. 1.43% of patients have history of rheumatic fever. 51.4% of patients presented with fatigue, 45.7% presented with palpitation, 41.4% of the patients presented with exertional dyspnea and 22.8% presented with tachypnea. Conclusions: The prevalence of mitral regurgitation is low in secundum ASD. Mitral regurgitation associated with secundum atrial septal defect could exist as a coexistent lesion, its recognition is important and most of them could be repaired with satisfactory results. Also, the left atrial volume was not affected except in sever mitral regurgitation.

Results of percutaneous closure with device in congenital heart disease of the atrial septal defect type / Resultados del cierre percutáneo con dispositivo en la cardiopatía congénita de tipo comunicación interauricular

Congenital Interatrial Septal Defects (TEA) are among the most common Congenital Heart Diseases in the population, where Atrial Septal Defect stands out, which is produced by a left-right short circuit that provides greater survival and less morbidity and mortality. The objective was to determine the results of Percutaneous Closure with a Device in Congenital Heart Disease of the Atrial Communication type at the Carlos Andrade Marín Specialty Hospital (Quito) in the Hemodynamics service from January 2009 to July 2019. It is a retrospective descriptive cross-sectional study . With a population of 122 cases from the AS400 registry. Thus, it was determined: there is a female predominance in a ratio of 2:1, the ranges for defect intervention were 5.5 mm to 35 mm, post-procedure pulmonary artery pressures (systolic 18-25 mmHg and diastolic 6-10 mmHg) in 95% of patients, ventricular overload in 76% in pre-procedure patients. Concluding that 96% of our population has a significant post-procedure improvement.

Los defectos del tabique interauricular congénitos (TEA) se encuentran entre las cardiopatías congénitas más comunes en la población donde resalta la comunicación interauricular que es producido por un cortocircuito izquierda derecha que brinda mayor sobrevida y menor morbimortalidad. El objetivo fue determinar los resultados del cierre percutáneo con dispositivo en la cardiopatía congénita de tipo comunicación interauricular en el hospital de especialidades Carlos Andrade Marín (Quito) en el servicio de hemodinamia en el período enero 2009 a julio 2019. Es un estudio transversal descriptivo retrospectivo. Con una población 122 casos del registro de AS400. Encontramos un predominio en sexo femenino en una proporción de 2:1, los rangos para intervención del defecto fueron de 5,5 mm a 35 mm, las presiones de la arteria pulmonar pos-procedimiento (sistólica de 18-25 mmHg y diastólica de 6-10 mmHg) en un 95% de los pacientes, sobrecarga ventricular en un 76% en los pacientes pre-procedimiento. Concluyendo que el 96% de nuestra población tiene una mejoría significativa post-procedimiento.

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.

The surgical effects of total endoscopy and right thoracic small-incision for atrial septal defect repair: A retrospective cohort study / 中国胸心血管外科临床杂志

@#Objective    To compare the surgical effects of total endoscopy and right thoracic small-incision for atrial septal defect repair. Methods    The clinical data of 60 patients undergoing atrial septal defect repair in our hospital in 2019 under cardiopulmonary bypass (CPB) were collected. The patients were divided into two groups according to different surgical methods: a right thoracic small-incision group (n=31), including 11 males and 20 females, aged 44.5±11.5 years; a thoracoscopic surgery group (n=29), including 12 males and 17 females, aged 46.5±12.7 years. The clinical data were compared between the two groups. Results    The baseline data of the patients were not statistically different (P>0.05). The surgeries were successfully completed in the two groups of patients. The volume of chest drainage in 24 h after the surgery (59.1±43.9 mL vs. 91.0±72.9 mL, P=0.046), red blood cell input (78.0±63.9 mL vs. 121.0±88.7 mL, P=0.036), length of postoperative hospital stay (5.5±2.1 d vs. 7.2±2.1 d, P=0.003), postoperative complications rate (6.9%vs. 22.6%, P=0.029) in the thoracoscopic surgery group were significantly better than those in the right thoracic small-incision group. There was no significant difference in the CPB time, aorta blocking time, operation time, mechanical ventilation time, ICU retention time or postoperative pain score between the two groups (P>0.05). Conclusion    The two techniques are safe and effective. Patients undergoing thoracoscopic repair of atrial septal defect have small trauma, short postoperative hospital stay, mild pain, beautiful incision, and no bone damage, which is worthy of clinical promotion.

Complicaciones a corto plazo del cierre percutáneo de comunicación interauricular / Short-term complications of percutaneous atrial septal defect closure

Resumen Introducción: El cierre percutáneo de la comunicación interauricular ostium secundum ha pasado a ser una alternativa a la cirugía convencional. En ese caso, los dispositivos de autocentrado son los más usados entre los cardiólogos intervencionistas. El tipo y la tasa de complicaciones difieren para los distintos dispositivos. Objetivo: Reportar las complicaciones a corto plazo del cierre percutáneo de la comunicación interauricular ostium secundum. Método: Entre abril de 2001 y diciembre de 2017, 129 pacientes (media de edad: 26 años; desviación estándar: 20,39 años) fueron sometidos a cierre percutáneo de comunicación interauricular ostium secundum. Las complicaciones fueron identificadas y clasificadas como mayores y menores. Resultados: 14 pacientes experimentaron complicaciones menores durante la hospitalización y en el primer año de seguimiento (10.85 %), y uno tuvo una complicación mayor que requirió cirugía electiva 4 meses después para la remoción del dispositivo mal posicionado. Entre los que presentaron complicaciones menores, dos tuvieron shunt residual leve, cinco presentaron arritmias interoperatorias, uno refirió dolor torácico y seis tuvieron migraña posimplante. Conclusiones: Esta serie de pacientes muestra que el cierre percutáneo de la comunicación interauricular ostium secundum es un procedimiento seguro y efectivo en casos bien seleccionados. Con el fin de reducir la tasa de complicaciones, están indicados el diagnóstico y el tratamiento tempranos, así como la observación de los criterios de selección de acuerdo con la morfología de la comunicación interauricular ostium secundum. La profilaxis antiagregante con clopidogrel para todos los pacientes requiere mayor investigación.

Abstract Introduction: Percutaneous closure of ostium secundum atrial septal defects has become an alternative to conventional surgery. Self-centering devices are the ones most used by interventional cardiologists in these cases. The type and rate of complications varies according to the various devices. Objective: To report the short-term complications of percutaneous closure of ostium secundum atrial septal defects. Method: Between April 2001 and December 2017, 129 patients (mean age: 26; standard deviation: 20.39 years) underwent percutaneous closure of ostium secundum atrial septal defects. Complications were identified and classified as major or minor. Two types of devices were used: the Amplatzer™ Septal Occluder in 98 patients, and the Figulla® Septal Occluder in 31 patients. Results: 14 patients had minor complications during hospitalization and the first year of follow up (10.85%), and one had a major complication which required elective surgery four months later to remove the misaligned device. Of those who experienced minor complications, two had mild residual shunting, five had intraoperative arrhythmias, one reported chest pain, and six had post-implant migraines. Conclusions: This series of patients shows that percutaneous closure of ostium secundum atrial septal defects is a safe and effective procedure in carefully selected cases. Early diagnosis and treatment are needed to decrease the rate of complications, along with adherence to the selection criteria according to the morphology of the ostium secundum atrial septal defect. Antiplatelet prophylaxis with clopidogrel for all patients requires further study.

Recent clinical development of minimally invasive closure for atrial septal defect / 中国胸心血管外科临床杂志

@#Atrial septal defect (ASD) is a congenital heart disease that causes blood communication between the left and right ventricles due to partial atrial septal tissue defects, accounting for about 13% of all heart malformations. Secondary ASD is the most common type of ASD and can generally be treated with minimally invasive closure. At present, the commonly used minimally invasive methods in clinical practice mainly include X-ray-guided percutaneous occlusion, transesophageal ultrasound-guided transthoracic occlusion and ultrasound-guided percutaneous occlusion. This review focuses on the basic research process of occluder materials, and advantages and disadvantages of three different surgical methods.

Major cardiac defects in cattle in southern Brazil: retrospective study of necropsies over 20 years (2000-2019) / Principais defeitos cardíacos em bovinos no sul do Brasil: estudo retrospectivo de necropsias em 20 anos (2000-2019)

ABSTRACT: Cardiac malformations are reported to be relatively rare in bovine species, with ventricular septal defects being the most common abnormality observed predominantly in young calves. This report aims to describe the cardiac malformations observed in bovids and review the literature related to those malformations in this species. The necropsy reports of 1,783 bovids were reviewed, and 0.4% were diagnosed with a cardiac congenital defect. The most common cardiac congenital malformation detected in this study was ventricular septal defect, observed alone or associated with other anomalies (in one case, as part of tetralogy of Fallot); followed by atrial septal defect, also alone or with other cardiac malformations. Secondary findings in the lungs and liver were observed in 75% of all cases. Histologic cardiac lesions were identified in 25% of all cases, characterized mainly by fibrosis. Other congenital malformations in different organs were observed in 25% of the cases. Considering the importance of cardiac congenital malformations observed in this study, these conditions should be considered as a differential diagnosis for calves who died with no specific clinical signs. Furthermore, macroscopic evaluation is crucial for the diagnosis of cardiac congenital malformations.

RESUMO: Malformações cardíacas são descritas como relativamente raras para bovinos, e defeitos do septo interventricular são as anomalias mais observadas em bezerros. O objetivo deste artigo é descrever os casos de malformações cardíacas observadas em bovinos e uma revisão de literatura sobre estas malformações nesta espécie. Os relatórios de necropsia de 1.783 bovinos foram revisados, e 0,4% destes foram diagnosticados com defeitos cardíacos congênitos. A malformação cardíaca congênita mais diagnosticada neste estudo foi defeito do septo interventricular, observado sozinho ou associado a outras anomalias (em um caso de tetralogia de Fallot); seguida de defeito no septo interatrial, também observado sozinho ou juntamente com outras malformações cardíacas. Lesões secundárias nos pulmões e fígado foram observadas em 75% dos casos. As alterações histológicas no coração, visualizadas em 25% dos casos, foram caracterizadas principalmente por fibrose. Outras malformações congênitas em diferentes órgãos foram identificadas em 25% dos casos. Considerando a importância de malformações cardíacas congênitas observadas neste estudo, estas condições devem ser consideradas como diagnósticos diferenciais para bezerros que morrem sem sinais clínicos específicos. Adicionalmente, a avaliação macroscópica é fundamental para o diagnóstico de malformações cardíacas congênitas.

Changes of Cardiac Rhythm after Closure of Secundum Atrial Septal Defect in Children

Background: Arrhythmias may complicate congenital heart diseases, such as secundum atrial septal defects. We aimed at following up the rhythm changes in children after closure of ostiumsecundum atrial septal defects. Methods: The current study was conducted in the Pediatric Cardiology Unit, Tanta University, on 60 pediatric patients who had undergone either trans-catheter or surgical closure of secundum atrial septal defects. Complete history taking and full clinical assessment were done. Echocardiographic assessment was performed to detect any residual defects, and assess chamber dimensions, and cardiac functions. Electrocardiographic assessment including Holter monitoring was performed within two months afterthe procedure, after six months, and after one year. Arrhythmias were classified into major and minor types. All results were statistically analyzed and tabulated.Results: There were no significant differences between the pre-closure rhythm and the rhythm after closure of the defects throughout the follow-up. The percentage of patients with major arrhythmias has increased from 6.7% of the total sample to 13.3%, 11.6%, and 11.6% in the early, midterm and late follow up respectively. The significant risk factors for postoperative arrhythmias were; pre-closure arrhythmia, right atrial dilatation, and serious hemodynamic instability in the early follow up. Conclusions: We concluded that arrhythmiaswere common before and after atrial septal defect closure, without significant differences. Pre-closure arrhythmia, right atrial dilatation, and serious hemodynamic instability are considered important risk factors of arrhythmias after secundum atrial septal defect’s closure in pediatric patients

Percutaneous ASD Closure Requiring Emergency Surgical Removal of Embolized Cardiac Occluder Devices

Introduction: Atrial septal defect (ASD), ventricular septaldefect (VSD), patent ductus arteriosus (PDA) are mostcommon congenital acyanotic heart diseases. Surgery isthe gold standard treatment for these defects. Percutaneousdevice closure is now getting popular for closure of thesedefects (Ostium Secundum ASD, PDA, muscular VSD).Device dislodgement, migration and embolization is a causeof failure in this procedure. For this emergency surgicalretrieval of migrated device becomes necessary at times.Here two different scenarios of failed device closure of ASDare presented who required emergency surgical retrieval ofdevice.Case report: In the first case the device got embolized intothe main pulmonary artery which was retrieved surgicallyand his post-operative period was uneventful. In the secondcase the device got embolized into right ventricle. Surgicallythe device was retrieved but post operatively the patient wasfound to have CVA from which she recovered gradually anddischarged.Conclusion: Proper assessment of defect size and rim aroundthe defect is necessary. Devices of all sizes should be availablewith the team doing the procedure. During implantation incase of unsatisfactory device position it should be retrievedand elective surgical closure should be planned. Surgeonsshould be kept in backup in all catheter based procedure.

Cierre de la comunicación interauricular por cateterismo intervencionista con dispositivo Amplatzer en pediatría / Atrial Septal defect closure by interventional catheterization with Amplatzer device in Pediatrics

Introducción: El cateterismo intervencionista corrige las cardiopatías complejas, donde el dispositivo Amplatzer es el más usado y está disponible en Cuba. Objetivo: Evaluar el cateterismo intervencionista con Amplatzer, en el cierre de la comunicación interauricular ostium secundum. Métodos: Estudio de evaluación, longitudinal y prospectivo en 92 pacientes. El cierre de la comunicación por cateterismo con Amplatzer, se realizó en el Cardiocentro Pediátrico William Soler (2010-2016). Se utilizaron variables demográficas, ecocardiográficas (transtorácicas y transesofágicas) antes, durante y al año del cateterismo. Se observaron las complicaciones. La evaluación clínica y ecocardiográfica se realizó al año poscateterismo. Los pacientes a quienes se les realizó el proceder en el 2016, se evaluaron a los 6 meses. Resultados: Se encontraron diferencias significativas en el sexo (p<0,05): femenino 64,1 por ciento con homogeneidad para la edad (p= 0,244): media 9,8 años ( 5 desviaciones estándar. Precateterismo: 28,3 por ciento eran desnutridos y 17,4 por ciento delgados; poscateterismo la desnutrición mejoró significativamente (p= 0,000): desnutridos 9,8 por ciento y delgados 8,7 por ciento. El diámetro medio del defecto por ecocardiografía transcateterismo fue significativo (p= 0,000). Transcateterismo: 98,9 por ciento con cierre de defecto, 16,3 por ciento con insuficiencia tricúspidea y 4,3 por ciento con insuficiencia mitral. Poscateterismo: 98,9 por ciento con Amplatzer bien colocado. Hubo complicaciones inmediatas en 8,7 por ciento (arritmias, derrame pericárdico y embolización). Al año se detectó cortocircuito residual pequeño (n= 1) e insuficiencias valvulares auriculoventriculares (n= 3). La evolución fue satisfactoria (n= 91). Conclusiones: La evolución del cierre de la comunicación interauricular ostium secundum con dispositivo Amplatzer es satisfactoria, con mejoras de la desnutrición(AU)

Introduction: The interventional catheterization corrects complex heart diseases, and the Amplatzer device is the most widely used and is available in Cuba. Objective: To assess the interventional catheterization with Amplatzer device in the ostium secundum atrial septal closure. Methods: Longitudinal and prospective evaluation study in 92 patients. The closure of the communication by Amplatzer catheterization was performed in the William Soler Pediatric Cardiocenter of (2010-2016). Demographic and echocardiographic (transthoracic and transesophageal) variables were used before, during, and at the year of the catheterization. Complications were observed. Clinical and echocardiographic assessment was made a year after catheterism. The patients who underwent the procedure in 2016 were evaluated at 6 months. Results: Significant differences were found in the sex (p< 0.05): Female 64.1 t percent with homogeneity of the age (p= 0.244): average 9.8 years ( 5 standard deviations. Pre-catheterism: 28.3 percent were malnourished and 17.4 percent thin; post-catheterism: malnutrition improved significantly (p= 0.000): 9.8 percent malnourished and 8.7 percent thin. The average diameter of the defect by transcatheter echocardiography was significant (p= 0.000). Transcatheter: 98.9 percent : with default closure, 16.3 percent with tricuspid insufficiency and 4.3 percent with mitral regurgitation. Post-catheterism: 98.9 percent with Amplatzer device correctly positioned. There were immediate complications in 8.7 percent (arrhythmia, pericardial effusion, and embolization). A year after, small residual short circuit was detected (n= 1), and atrioventricular valve regurgitation (n= 3). The evolution was satisfactory (n= 91). Conclusions: The evolution of ostium secundum atrial septal defect´s closure with Amplatzer device is satisfactory and improves malnutrition(AU)

Profile of Congenital Heart Disease in Children with Down’s Syndrome Attending an Early Intervention Center in a Teaching Hospital in South India

Background: Down’s syndrome is the most common chromosomal disorder and the association between Down’s syndrome and congenital heart disease (CHD) is well established. The spectrum of CHD in Down’s syndrome shows wide variations due to genetic, socioeconomic, and geographic factors. The incidence of CHD in Down’s syndrome is around 40–60% and contributes significantly to the morbidity and mortality in these children in the first 2 years of life. Objective: The objective of the study was to study the incidence and spectrum of CHD in children with Down’s syndrome attending special clinics. Materials and Methods: It is a prospective, observational, and monocentric study done over a period of 3 years (2016–2019). Echocardiogram was done to all children at the first visit. Results: Of the 120 children studied, 62 had CHD (52%) and ostium secundum atrial septal defect was the most common lesion (36%). Conclusions: The incidence of CHD in Down's syndrome in this study is 52%. Hence early cardiac screening is of paramount significance in all children with Down's syndrome.

Percutaneous transcatheter closure of atrial septal defect guided by transthoracic echocardiography in outpatients / 中国胸心血管外科临床杂志

@#Objective    To assess the feasibility and safety of percutaneous transcatheter closure of atrial septal defect (ASD) guided by transthoracic echocardiography (TTE) in outpatients. Methods    From December 2016 to June 2018, 50 simple ASD patients underwent TTE-guided transcatheter closure in the outpatient operating room of our hospital (a TTE group) including 22 males and 28 females at the age of 16-48 (27.40±6.95) years. Fifty patients with simple ASD treated with the guidance of conventional fluoroscopy during the same period were treated as a control group, including 22 males and 28 females at the age of 15-48 (28.58±6.96) years. Both groups were re-examined by TTE during follow-up at 1 month, 3 months, 6 months and 1 year. Results    The mean age, body weight, the size of ASD and occluder and success rate had no statistical difference between the two groups (P>0.05). Compared with the control group, the TTE group had significantly lower mean operation time (P<0.01) and less cost (P<0.01) since patients need not to be hospitalized. No related complications were found in the TTE group during follow-up. Conclusion    Percutaneous transcatheter closure of ASD guided by TTE appears safe and effective for outpatients, and can significantly reduce the cost.