Natural history of atrial septal defect in the sixth decade : study of 5 cases.

BACKGROUND: Atrial septal defect (ASD) is one of the most common causes of congenital heart disease manifested in adulthood. AIM: To describe clinical and likelihood picture of adults over 60 years born with an ASD type II. METHODS: We performed a retrospective study of adult'sASD referred toourinstitutionfrom 1985 through 2010. Clinical, electrocardiographic, echocardiographic and hemodynamic data were reviewed. On follow up study, patients were investigated by echocardiography, ECG and assessed for quality of life by a questionnaire RESULTS: Among forty ASD type II manifested in adulthood which were referred to our department of cardiology five cases of ASD manifested in the sixth decades (2 men and 3 women). Complaints were dyspnea and palpitations in 4 cases and chest pain in only one patient. Slight anterior chest deformity was present in the older patient. Systolic murmur was found in the 3rd left intercostals space and the pulmonary second heart sound was accentuated in all patients. Complete right bundle branch block and right ventricular hypertrophy were found in all cases. Three patients presented atrial fibrillation. There was marked cardiomegaly in four patients. The pulmonary arteries were markedly enlarged and the peripheral vascular markings were increased. Echocardiographic data revealed large secundum ASD (mean 20 mm, ranged between 10 and 30mm), severe systolic pulmonary pressure in two cases (>5O mmhg). MeanQP/QS was 2.2 and contrast revealed bidirectional shunt in one patient. All patients were studied by venous cardiac catheterization. They showed a significant increase in the oxygen content of right atrial blood. Three patients underwent surgical atrial septal defect closure under general anesthesia. There were no operative or peri operative deaths. At mean follow up of 50±75 months, there was one late death from heart failure in a patient with advanced preoperative heart failure. The oldest patient is in the medical group and he is 75years old. Most survival patients remain in good clinical condition. Some of them were symptomatic at the last follow up and complained of shortness of breath on effort and palpitations in two cases. Two patients were in chronic atrial fibrillation developed during follow up. However, chest RX showed reduction in cardiothoracic ratio postoperatively. Echocardiographic examination confirmed that there was no residual shunt in across the atrial septum in any patient. Systolic pulmonary pressure felled only in 2 patients in the surgery group. CONCLUSION: To our knowledge, thesepatients havealongue life span, although survivors with ASD described in the world. There is a lack of evidence regarding treatment options for adults with an ASD aged more than 60years. Given the higher risks of surgery in advanced age, the defect should be repaired as early as possible to prevent hemodynamic complications.

[Microalbuminuria and left ventricular geometry in essential arterial hypertension]. / Microalbuminurie et geometrie ventriculaire gauche dans l'hypertension arterielle essentielle.

The association between left ventricular hypertrophy and microalbuminuria is actually admitted. Recent studies shown that patients with microalbuminuria have higher left ventricular mass index, worst systolic function and often concentric geometric kind of left ventricular hypertrophy. The efficiency of an adapted and early therapeutic on a potential relationship between reduction of microalbuminuria and improvement of target organ injury, principally heart and kidney, is still to evaluate. The aim of our study is to review geometric and hemodynamic aspect of left ventricular hypertrophy in hypertensive micro-albuminuria patients.

[Atrial septum aneurysm. Report of 20 cases]. / L'anevrysme du septum interauriculaire. A propos de 20 cas.

Atrial septum aneurysm (ASA) is an uncommon congenital malformation, which is more frequently diagnosed since the introduction of transoesophageal echocardiography. ASA is often involved in the etiology of cerebral and systemic embolic events. The purpose of our study is to determine from our experience the frequency, the diagnostic aspect and therapeutic modalities of ASA. We report in this study 20 cases of ASA collected from the echocardiographic register. The prevalence of this malformation is 0.08%, with a high male predominance. The mean age was 51 years. ASA was detected after brain embolism in 55% of cases. The diagnosis was established in all cases by transesophageal echocardiography, however only 5 cases were diagnosed by Transthoracic echocardiography. The patients showed favorable evolutions after a of follow up of three years.