A.R. Taksande

A.U. Mahajan

H. Shah

H.J. Pawar

H.T. Kokane

P.J. Nathani

Indian Heart Journal

Pawar, H.J.

Kokane, H.T.

Taksande, A.R.

Shah, H.

Mahajan, A.U.

Nathani, P.J.

Elsevier - Publisher Connector 

Right ventricular form and functional assessment after percutaneous atrial septal defect device closure 

were showing significant MAPCAs. There was statistical signifi-
cant association between hypoplastic LPA &RPA and presence of
MAPCAs (p-value <0.0001). 21 (75%) patients out of 56 with pres-
ence of MAPCAs, had O2 saturation of >80%, while only 6 (22.2%)
had O2 saturation <70%. 21 (77.8) Oxygen saturation had statisti-
cal significant association with MAPCAs present (pvalue¼0.0062).
Out of 56 patients with MAPCAs present, 34 (60.7%) were greater
than 5 years of age. Greater than 5 years age group of patients had
statistical significant association with the presence of MAPCAs (p
value¼0.038). Patients with hypoplastic pulmonary artery
branches hadmore number of MAPCAs with direct origin. (p value
<0.001). The diameter of MAPCAs  3 mm was present in 19
(70.3%) and 26 (65%) patients with hypoplastic LPA and hypo-
plastic RPA respectively.
Conclusions: MAPCAS were present in significant no. of patients
of TOF/PA/severe PS and were significantly associated with hy-
poplastic pulmonary arteries, higher O2 saturation, and higher
age. Also size of MAPCAS was inversely related to the size of
pulmonary arteries.
Right ventricular form and functional assessment
after percutaneous atrial septal defect device
closure
H.J. Pawar, H.T. Kokane, A.R. Taksande, H. Shah, A.U. Mahajan,
P.J. Nathani
Lokmanya Tilak Medical College and Hospital, Sion, Mumbai, India
Objectives: We sought to assess the right heart’s response to
percutaneous device closure of moderate sized atrial septal de-
fects (ASDs) in adults over a one-year follow-up period. We also
study the right ventricular function (RV) assessed by myocardial
performance index (MPI).
Background: Percutaneous ASD device closure is a safe and
effective means of reducing or eliminating interatrial shunting.
The response of the adult’s right heart to device closure is
incompletely understood.
Methods: 25 adult patients underwent secundum ASD device
closure from December 2012 to July2013 at tertiary care center in
Mumbai. Of which 23 had Amplatzer device occluder and 2 life-
tech device). The patients were assessed with echocardiography,
chest radiography and electrocardiography before the procedure
and at 1, 6 and 12 months.Data are presented as the mean value
±SD fornormally distributed data obtained before the procedure
and at 1, 6 and 12 months after the procedure. Echocardiographic,
ECG and chest radiographic variables at each follow-up period
were compared with the pre-procedural values.
Results: The mean ASD size was 21± 5.80 mm, and the device size
ranged from 14mm to 36 mm. At one month, heart size (49% vs.
45%),four-chamber right ventricular (RV) size (45 vs. 40 mm),
paradoxical septal motion (80% vs.8%), QRS duration (110 vs. 104
ms), PR interval (178 vs. 157ms) and echocardiographically deter-
mined significant improvement in RV MPI (0.36 to 0.28, p  0.004),
pulmonary artery systolic pressure decreased significantly and
was maintained at12-month follow-up. At six months, right atrial
length decreased from 48 to 41 mm. At one year, 20% of patients
had persistent RV enlargement.
Conclusions: Right heart morphology undergoes rapid improve-
ment within one month of defect closure, with associated
mechanoelectrical benefit. Device closure of ASDs leads to
improvement of RV function too. A small number of patients had
persistent RV enlargement or pulmonary hypertension, or both, at
one year. Our data support the application of transcatheter
methods in achieving excellent hemodynamic and anatomic
outcomes.
The role of preoperative cardiac catheterisation in
predicting outcomes of surgery for CHD e The
PRECIOUS-CHD study
P.K. Dash, B. Barooah, Prayaag Kini, R. Varyani
Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield,
Bangalore, India
Background: Patients with congenital heart disease with PAH are
frequently subjected to preoperative cardiac catheterization for
determining operability based on various hemodynamic param-
eters as also the PVR,PVRI and shunt fractions.This study was
conducted to determine whether, during a cath study for deter-
mination of operability in shunt lesions,an improvement in pul-
monary saturation alone, a fall in pulmonary artery mean or
diastolic pressure or a combination of the two was better in
prognosticating postoperative outcomes especially post operative
PAH.
Methods: 50 (M¼22, F¼28) patients who had shunt lesions and
PAHwere serially recruited between Jan 1 2012 to Jan 1 2013 for the
study. Of these, 32 patients had been given at least a three month
course of sildenafil and then underwent cath. All 50 patients un-
derwent a preoperative cath study which consisted of measure-
ment of pulmonary artery systolic and end-diastolic pressures,
pulmonary and systemic saturation, pulmonary wedge pressures,
as well as systemic saturation, and measurement of the same
parameters after administration of 100% oxygen for 10 minutes.
Suitable sized wedge catheters were employed for this purpose.
PVR, PVRI, SVR, SVRI and shunt fraction Qp:Qs were calculated by
the usual formulae.The patients were then followed up immedi-
ately postoperatively during hospital stay and at third- month
follow-up visit ( non invasively).
Results: Average age of the patients was 12.8+/-1.28 years. Of the
50 patients who underwent cath, (ASD¼14 VSD ¼23, PDA¼7, APW
¼3, TAPVC¼2, Lutembacher¼1), post operative need for longer ICU
stay and ventilation, and need for milrinone was seen in 13 pa-
tients. Multiple regression analysis and Pearsons rank linear cor-
relation coeefficients were calculated for each of the
hemodynamic parameters in correlation with the use of milri-
none for post op PAH and for residual PAH at third month fol-
lowup. This had good relation with degree in fall in PA end
diastolic pressure (r¼0.67 for fall in PA diastolic pressure ) .Fair
corelation was seen for improvement in pulmonary artery satu-
rations during oxygen administration in pre op cath( r¼ 0.61)and
fall in PA systolic pressure with oxygen¼0.61)and with PA mean
pressure drop with oxygen administration(r¼0.60 ).However the
strongest correlation was seen with combination of both fall in
PAEDP and improvement in pulmonary artery saturations(0.74
when combination of fall in PA diastolic pressure and improve-
ment in PA sats), indicating best outcomes when both these pa-
rameters were satisfied.
Conclusion: The PRECIOUS-CHD inferred that a combination of
both fall in PAEDP and improvement in pulmonary artery saturation
with oxygen administration during preoperative cath may be a
better predictor of post operative outcomes after surgery for
congenital heart disease than a fall in the PA mean or a fall in PVR
i n d i a n h e a r t j o u rn a l 6 6 ( 2 0 1 4 ) s 1es 1 4 3S50


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Right ventricular form and functional assessment after percutaneous atrial septal defect device closure

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Right ventricular form and functional assessment after percutaneous atrial septal defect device closure

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