atrial septal defect – ABC CARDIOL

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Review Article

My Approach to Agitated Saline Contrast Echocardiography in Pediatric Patients

Karen Saori Shiraishi Sawamura et al. Márcio Miranda Brito

Abstract

Agitated saline contrast is a simple, safe, widely available echocardiography technique. It is particularly useful for evaluating right-to-left shunts and pulmonary vascular abnormalities in the pediatric population. This article presents a practical approach to using this technique in pediatric echocardiography. It reviews the underlying physiological principles, the technical aspects of preparation and image acquisition, and the main clinical applications.

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Artigo Original

Effectiveness of the Amplatzer ™ device for transcatheter closure of an ostium secundum atrial septal defect

Cristiano Oliveira Cardoso et al. Raul Ivo Rossi Filho Paulo Renato Machado Lisia M. Galant François … Estela S. K. Horowitz Rogério Sarmento-Leite

OBJECTIVE: To evaluate the effectiveness of the Amplatzer™ septal occluder in the treatment of ostium secundum atrial septal defects (OS ASDs). METHODS: Retrospective cohort study conducted between November 1998 and September 2005 involving 101 OS ASD transcatheter occlusion procedures in our institution. All procedures were conducted in the hemodynamic laboratory under general anesthesia with transoesophageal echocardiographic monitoring (TEE). Clinical and echocardiography assessments of the patients were conducted at 30 days, six months and on an annual basis. The results are presented as averages, standard deviations and percentages. Event-free survival was estimated using the Kaplan-Meier curve. RESULTS: From the 101 patients, 60 (59.4%) were females. Mean age, weight, height, body mass index and body surface area were, respectively: 24.3 ± 18.31 years, 51.88 ± 23.76kg, 140.59 ± 39.3cm, 23.18 ± 18.9kg/m² and 1.24 ± 0.21m². The prevalence of interatrial septum aneurysms was 4.95%, and 98 cases had an isolated defect. ASD diameters were 21.47 ± 6.96mm using an angiography and 21.22 ± 7.93 mm using a TEE. The average size of the implanted devices was 23.92 ± 7.25mm, ranging from 9mm to 40mm. The procedure time was 90.47 ± 26.67 minutes and the average hospital stay was 2.51 ± 0.62 days. Clinical and echocardiography follow-up was conducted at 12.81 ± 8.41 months and all devices were securely anchored without any residual shunts. The procedure success rate was 93% (94/101). In five cases adequate deployment of the device was not possible and 2 patients presented residual ASD. No major complications occurred. CONCLUSION: The Amplatzer™ septal occluder is an effective OS ASD transcatheter treatment device.

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Case Report

Extrinsic compression of left main coronary artery from aneurysmal dilation of pulmonary trunk in a adolescent: involution after surgery occlusion of sinus venosus atrial septal defect and pulmonary trunk plasty for reduction

Fernando T. V. Amaral et al. Lafaiete Alves Jr. João A. Granzotti Paulo H. Manso … Moysés O. Lima Filho Mauro C. Jurca Alfredo J. Rodrigues Walter V. A. Vicente

We report the case of an adolescent referred with initial diagnosis of pulmonary hypertension. Non-invasive investigation disclosed a sinus venous atrial septal defect with pulmonary hypertension. The hemodynamic study confirmed diagnosis, and also showed extrinsic compression of left main coronary artery by pulmonary trunk. Surgical closure of the defect in addition to pulmonary trunk plasty were undertaken. Two years after the surgery the patient is well, with clinical signs of mild pulmonary hypertension, and showing no evidence – also on echocardiogram – of left coronary artery trunk obstruction.

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Artigo Original

Clinical efficacy and safety of the percutaneous treatment of secundum atrial septal defect with the Amplatzer occluder

Sérgio Luiz Navarro Braga et al. Amanda Guerra de Moraes Rego Sousa Carlos Augusto Cardoso Pedra César Augusto Esteves … Simone Rolim Fernandes Fontes Pedra Valmir Fernandes Fontes

OBJECTIVE: To assess the clinical efficacy and safety of the Amplatzer occluder for percutaneous closure of secundum atrial septal defect. METHODS: Forty-nine patients underwent the procedure guided by transesophageal echocardiography (TEE) while under general anesthesia, afterwards being clinically followed up for 12 months. RESULTS: The defect presented as a single orifice in 91.8% of the cases. The means of the longitudinal and transverse diameters were 14.3±5.0 mm and 14.4±4.9 mm, respectively. The means of the stretched diameters and prostheses were 19.3±5.1 mm and 20.3±4.9 mm, respectively. Technical success occurred in 97.9% of the cases. Immediate residual flow was observed in 54.1% of the patients, being minimum or small in 45.8% and moderate in 8.3%. After 24 hours, residual flow was observed in 25% of the patients (P = 0.0002). At the end of 13.1±1.3 months, the incidence of the overall residual flow decreased to 14.6%, only 4.1% being moderate. A significant reduction in the right ventricular diastolic diameter was observed in the different phases of clinical follow-up (P < 0.001). CONCLUSION: Implantation of the Amplatzer prosthesis proved to be effective and safe, constituting an option for the treatment of the secundum atrial septal defect in selected cases.

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Original Article

Initial experience in Brazil with the Helex septal occluder for percutaneous occlusion of atrial septal defects

Carlos A.C. Pedra et al. Simone F. Pedra César A. Esteves Francisco Chamiê … Sérgio Ramos Sérgio C. Pontes Jr João Carlos Tress Sérgio L. N. Braga Larry A. Latson Valmir F. Fontes

OBJECTIVE: To evaluate the initial clinical experience with the Helex septal occluder for percutaneous closure of atrial septal defects. METHODS: Ten patients underwent the procedure, 7 patients with ostium secundum atrial septal defects (ASD) with hemodynamic repercussions and 3 patients with pervious foramen ovale (PFO) and a history of stroke. Mean age was 33.8 years and mean weight was 55.4 kg. Mean diameter by transesophageal echocardiography and mean stretched ASD diameter were 11.33 ± 3.3mm, and 15.2 ± 3.8mm, respectively. The Qp/Qs ratio was 1.9 ± 0.3 in patients with ASD. RESULTS: Eleven occluders were placed because a patient with 2 holes needed 2 devices. It was necessary to retrieve and replace 4 devices in 3 patients. We observed immediate residual shunt (< 2mm) in 4 patients with ASD, and in those with patent foramen ovale total occlusion of the defect occurred. No complications were noted, and all patients were discharged on the following day. After 1 month, 2 patients with ASD experienced trivial residual shunts (1mm). In 1 patient, we observed mild prolapse in the proximal disk in the right atrium, without consequences. CONCLUSION: The Helex septal occluder was safe and effective for occluding small to moderate atrial septal defects. Because the implantation technique is demanding, it requires specific training of the operator. Even so, small technical failures may occur in the beginning of the learning curve, but they do not involve patient safety.

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My Approach to Agitated Saline Contrast Echocardiography in Pediatric Patients

Abstract

Effectiveness of the Amplatzer ™ device for transcatheter closure of an ostium secundum atrial septal defect

Extrinsic compression of left main coronary artery from aneurysmal dilation of pulmonary trunk in a adolescent: involution after surgery occlusion of sinus venosus atrial septal defect and pulmonary trunk plasty for reduction

Clinical efficacy and safety of the percutaneous treatment of secundum atrial septal defect with the Amplatzer occluder

Initial experience in Brazil with the Helex septal occluder for percutaneous occlusion of atrial septal defects

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