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.

Feasibility of measuring superior mesenteric artery blood flow during cardiac surgery under hypothermic cardiopulmonary bypass using transesophageal echocardiography: An observational study.

Background: Abdominal complications being rare but results in high mortality, commonly due to splanchnic organ hypoperfusion during the perioperative period of cardiac surgery. There are no feasible methods to monitor intraoperative superior mesenteric artery blood flow (SMABF). Hence, the aim of this study was to evaluate the feasibility and to measure SMABF using transesophageal echocardiography (TEE) during cardiac surgery under hypothermic cardiopulmonary bypass (CPB). Methodology: Thirty‑five patients undergoing elective cardiac surgery under CPB were enrolled. Heart rate, mean arterial pressure (MAP), cardiac output (CO), SMABF, superior mesenteric artery (SMA) diameter, superior mesentric artery blood flow over cardiac output (SMA/CO) ratio and arterial blood lactates were recorded at three time intervals. T0: before sternotomy, T1: 30 min after initiation of CPB and T2: after sternal closure. Results: SMA was demonstrated in 32 patients. SMABF, SMA diameter, SMA/CO, MAP and CO-decreased significantly (P < 0.0001) between T0 and T1, increased significantly (P ≤ 0.001) between T1 and T2 and no significant change (P > 0.05) between T0 and T2. Lactates increased progressively from T0 to T2. Conclusion: Study shows that there is decrease in SMABF during CPB and returns to baseline after CPB. Hence, it is feasible to measure SMABF using TEE in patients undergoing cardiac surgery under hypothermic CPB. TEE can be a promising tool in detecting and preventing splanchnic hypoperfusion during perioperative period.