Atrial Septal Defect

Atrial Septal Defects (ASDs) are relatively common both in children and adults. Recent reports of increase in the prevalence of ASD may be related use of color Doppler echocardiography. The etiology of the ASD is largely unknown. While the majority of the book addresses closure of ASDs, one chapter in particular focuses on creating atrial defects in the fetus with hypoplastic left heart syndrome. This book, I hope, will give the needed knowledge to the physician caring for infants, children, adults and elderly with ASD which may help them provide best possible care for their patients

Pediatric Cardiac Devices: Recent Progress and Remaining Problems

Pediatric cardiology is a field that largely relies on translation of innovation in its adult counterpart in order to improve patient outcomes and introduce new technology to the field. Few FDA-approved pediatric cardiac devices are available for clinical use, thus leading to widespread off-label use within the field. Nonetheless, adaption of devices and technology from the adult field has proven to improve patient outcomes and overall wellness. However, the diversity of congenital heart disease, in terms of basic anatomy and treatment response, continues to complicate results. The combination of diversity of anatomy and small population size make it difficult for identifying control populations on which to test new devices, thus limiting the amount of safety and efficacy data that can be gathered. With little guidance and long-term data due to off-label use and poor reporting infrastructure, physicians are often left to devise solutions on a case-by-case basis. While surgery continues to be a mainstay of pediatric cardiology, transcatheter approaches to treating congenital heart disease have continued to gain momentum. With increasing data and multiplying device options, physicians have various options for approaching congenital heart disease. More recently, the creation of large databases such as Pediatric Interagency Registry for Mechanical Circulatory Support (PediMACS) has made evaluating the safety and efficacy of pediatric cardiac devices more realistic. In this review, various approaches to surgical and device treatment of congenital heart diseases and conditions will be explored in order to shed light on the current status of pediatric cardiac devices

Comparison of the Response of the Right Ventricle with Endovascular Occlusion and Surgical Closure in Adults with Atrial Septal Defect One Year After Intervention

Background Use of the Amplatzer septal occluder (ASO) for the closure of secundum atrial septal defect (ASD) has recently become the procedure of choice, while earlier the only treatment for ASD was surgical closure. This study compares the right ventricular indices of the ASO group with the surgical closure group one year after intervention in adults. Methods From January 2008 to February 2010, 38 patients with isolated atrial septal defect of the secundum type one year after surgical (n = 20, age = 27 ± 4 years, 13 females, 7 males) or Amplatzer septal occluder closure (n = 18, age = 25 ± 4 years, 12 females, 6 males) were studied. At the same time, thirty-one age-matched normal subjects (age = 26 ± 6 years, 23 females, 9 males) were included as the control group. Strain and strain rate of the right ventricle were measured. Results The mean values of strain of the midportion were −26% ± 11.7%, −8.9% ± 4.2%, and 24.5% ± 7.4% ( P < 0.001). Strain rates of the midportion were −2.19 ± 0.6 s −1 , −1.2 ± 0.4 s −1 , −1.9 ± 0.6 s −1 ( P < 0.001) in ASO, surgery, and control groups, respectively. Conclusion This study showed that the right ventricle might show better performance in the ASO than the surgery group in adults with ASD in midterm follow-up

Surgical Versus Percutaneous Occlusion of Ostium Secundum Atrial Septal Defects Results and Cost-Effective Considerations in a Low-Income Country

ObjectivesWe compared the effectiveness and cost of percutaneous occlusion using an Amplatzer septal occluder (ASO) (AGA Medical Corp., Golden Valley, Minnesota) device compared with surgical closure of an ostium secundum atrial septal defect (ASD II) in Guatemala.BackgroundThe percutaneous occlusion of ASD II in first-world nations seems to offer better clinical results and lower cost compared with surgical closure.MethodsWe reviewed the clinical course of 111 patients referred to our institution for closure of isolated ASD II. Successful closure was assessed immediately after the procedures and at 12 months. Actual hospital costs were calculated for every patient who underwent either of the two procedures.ResultsEighty-three patients with ASD II (75%) were selected for percutaneous occlusion with the ASO device, and the remaining 28 patients (25%) underwent surgical closure. In the device group, in 72 patients (86.7%) devices were successfully deployed. At immediate and 12-month follow-up, the complete closure rate was 87.5% (63 of 72 patients) and 97.2% (70 of 71 patients), respectively. In the surgical group, all patients had successful closure immediately after the procedure and at 12 months. Surgical closure offered a 27% cost savings in comparison with percutaneous occlusion (U.S. $3,329.50 ±$411.30 and U.S. $4,521.03 ±$429.71; p < 0.001, respectively). Cost of the device (U.S. $2,930.00) proved to be the main cause for this difference.ConclusionsWe confirmed the clinical advantages of percutaneous occlusion over surgical closure of ASD II. However, percutaneous occlusion costs were higher compared with surgical closure. In Guatemala, where health care resources are limited, ASD II closure with the ASO device did not prove to be cost-effective

Case Reports

Abstracts of the 12th Indonesian Society of Interventional Cardiology Annual Meeting (ISICAM) 2020 27-29 November 202

Pediatric Cardiac Interventions

The field of pediatric cardiac interventions has witnessed a dramatic increase in the number and type of procedures performed. We review the most common procedures performed in the catheter laboratory. Lesions are divided according to their physiological characteristics into left-to-right shunting lesions (atrial septal defect, patent ductus arteriosus, ventricular septal defect), right-to-left shunting lesions (pulmonary stenosis, pulmonary atresia/intact ventricular septum), right heart obstructive lesions (peripheral arterial pulmonic stenosis, right ventricular outflow tract obstruction), and left heart obstructive lesions (aortic valve stenosis, coarctation of the aorta). In addition, a miscellaneous group of lesions is discussed

Percutaneous treatment of patients with heart diseases: selection, guidance and follow-up. A review

Aortic stenosis and mitral regurgitation, patent foramen ovale, interatrial septal defect, atrial fibrillation and perivalvular leak, are now amenable to percutaneous treatment. These percutaneous procedures require the use of Transthoracic (TTE), Transesophageal (TEE) and/or Intracardiac echocardiography (ICE). This paper provides an overview of the different percutaneous interventions, trying to provide a systematic and comprehensive approach for selection, guidance and follow-up of patients undergoing these procedures, illustrating the key role of 2D echocardiography

Transcatheter vs. surgical closure of atrial septal defects in adults

Funding Information: This study was supported in part by Latvian National Research Programme “Biomedicine for Public Health” (BIOMEDICINE) and by grant from corporation „Sistçmu Inovâcijas". Publisher Copyright: © 2018 De Gruyter Open Ltd. All rights reserved.Percutaneous transcatheter device closure of secundum atrial septal defects (ASD) has now largely replaced surgical closure in most centres. The aim of this study was to compare results of transcatheter and surgical ASD closure in adults in Latvia during the years 2002-2014 and to analyse long-term outcomes of transcatheter closure. We analysed data from 334 patients with secundum ASD who underwent ASD closure in Pauls Stradiņč Clinical University Hospital. Patients were included into device or surgical closure groups. In the device group, three follow-ups were made 1, 6, and 12 months after the procedure. No follow-up data were available for surgical arm patients beyond their hospitalisation period. The mean age of patients was 45.3 ± 19.9 years for the device group and 40.0 ± 16.9 years for the surgical group (p = 0.023). The mean secundum ASD size in the device and surgical groups was 14.2 ± 5.6 mm and 28.7 ± 10.0 mm, respectively (p < 0.001). No differences were observed regarding procedure success rates: 99.2% in the device group and 100% in the surgical group (p = 0.451). Periprocedural complications generally were more common in the surgical closure group. The study results show a successful introduction of the percutaneous ASD closure method in Latvia with good early and late outcomes and without significant differences in procedure success rate compared to surgical closure.publishersversionPeer reviewe

New Applications of Cardiopulmonary Exercise Testing and Training in Paediatric Heart Disease

Congenital heart defects (CHD) have an incidence of 4-8/1000 live births and encompass a broad spectrum of disorders. Due to advances in cardiac surgery and cardiology care, most children born with CHD are now surviving into adulthood and there are currently more adults affected than children. Exercise capacity is reduced across the spectrum of patients with CHD, both in natural history and after surgical and interventional treatment. The aim of this project was to better understand exercise limitations and safety/usefulness of training in young patients with heart disease across a broad spectrum of disorders and in particular we focused on left-to-right shunts, systemic right ventricular physiology, univentricular physiology with Fontan palliation and dilated cardiomyopathy. Future perspective include exploring new ways of engaging teenagers with univentricular palliation in systemic and respiratory muscle training. Furthermore, the collaboration with biomedical engineers will allow us to gain in depth understanding of univentricular physiology. Similarities exisit in the physiological changes observed during exercise and pregnancy and the final goal is to implement the model with these variables to achieve better clinical outcome in this growing population of young adults with complex lesions and limited exercise and child-bearing potential. Exercise testing and training are becoming more and more relevant to guide therapy and management but also to assess the ability in daily activities that play an important role in many aspects of life that have not been addressed specifically until now. The increasing data available enable physicians to give adequate counseling regarding vocational or professional choices, suitable leisure activities and family planning according to the levels of activity considered safe and sustainable in the specific physiology. Further studies will warrant deeper understanding of issues that are specific to univentricular physiology and will help us to target interventions to improve quantity and quality of life