Atrial Septal Defect (ASD)
K. Gupta, P. Carmichael, A. Zumla in 100 Short Cases for the MRCP, 2020
Atrial septal defects are almost always congenital in origin. The two main types are the ostium primum and ostium secundum. The former results from a failure of fusion of the septum primum with the endocardial cushion, and is commonly associated with other atrioventricular valvular defects. Ostium secundum is the most common form of congenital heart disease in adults. Most patients remain asymptomatic for many years; with small defects (less than 2 cms) patients may live into their seventh or eighth decades. With larger lesions symptoms often appear with the development of pulmonary hypertension and understandably include progressive dyspnoea and fatigue. Surgery is the treatment of choice and is indicated for all patients with significant shunts (pulmonary:systemic flow ratio of greater than 1.5). Surgical closure of an ASD at a young age (3-4 years) is usually associated with good results.
Research Methods
Deborah Fish Ragin in Health Psychology, 2017
The lettuce was shipped to the Taco Bell restaurants in Delaware, New Jersey, New York, and Pennsylvania, and was consumed by the customers who became ill (Centers for Disease Control, 2006c). After further investigation, the CDC determined that the contamination resulted from poor hygiene or poor food preparation procedures at the processing plant that supplied lettuce to the Taco Bell restaurants in the four states. You will notice, however, that the fifth state, South Carolina, was not included in the delivery. If the contaminated lettuce, the proximal factor, was not delivered to South Carolina, why was a related case of E. coli discovered there? In one word: travel. A resident of South Carolina dined at a Taco Bell restaurant in one of the four affected states before returning home. The “medical detective” work of the epidemiologists helped to tie the incident of E. coli in South Carolina to the proximal environmental cause in the other 70 cases by probing into the recent travels of the South Carolina resident. Distal To explain distal causes of an illness, researchers may need to examine factors or events that predate the illness by months or perhaps years. For example, heart disease in adults is an illness that could have several distal causes. One cause could be a congenital problem, or a problem present at birth, such as an atrial septal defect . Sometimes called a hole in the wall of the heart, atrial septal defect often is undetected at birth. And, if left undetected, the defect may develop into hypertension (high blood pressure) in adolescence or adulthood. Thus, a child born with an atrial septal defect may be predisposed to developing heart-related problems such as hypertension (see Chapter 9, Cardiovascular Disease) as an adolescent or adult. For this reason, atrial septal defect could be considered a distal factor that could cause heart disease in later years.
Lutembacher syndrome
Neeraj Parakh, Ravi S. Math, Vivek Chaturvedi in Mitral Stenosis, 2018
It is more common in females, as both secundum atrial septal defects and rheumatic MS are more common in females. Although age at presentation can vary, maximum prevalence is during the second and third decades. The incidence of mitral stenosis in patients with an ostium secundum atrial septal defect has been estimated to be around 4%.3–5 Atrial septal defects are seen in 0.6% of patients with mitral stenosis.3–5 Repeated transseptal punctures for balloon mitral valvotomy generally produce a small defect, which is usually hemodynamically insignificant.6The syndrome is likely to be seen with even lesser frequency in the future, not only due to a decrease in the incidence of rheumatic heart disease, but also due to better school health screening programs, with most children undergoing closure of atrial septal defects in early childhood. Interestingly, despite our center having large volumes of patients who have been treated with PTMC and surgical or device closure of ASD, we have seen very few cases of mitral stenosis developing later in life, after closure of ASD. We have had only three patients needing PTMC after previous surgical closure of ASD. Septal puncture can be challenging in this subset. There have been few studies on the actual pathology of the mitral valve and it has been thought to be of exclusive rheumatic etiology. Vaideeswar et al. have recently published the pathologic findings seen in 44 patients with a diagnosis of Lutembacher syndrome in autopsies carried out over a period of 16 years.7 54.4% of their patients had a nonrheumatic etiology for mitral valve disease, based on the lack of features to suggest postinflammatory change or chronic rheumatic involvement. A history of rheumatic fever was obtained in only two of these patients, suggesting that not all acquired mitral valve disease is rheumatic in nature. A clinical diagnosis of atrial septal defect was made in only 18 of these 44 patients. Some of these turned out to be sinus venosus defects, since they may not have been clinically differentiable. They observed involvement of the posteromedial commissure in patients with rheumatic and non-rheumatic etiology. This has been postulated to be a consequence of friction at this region, arising from altered left-ventricular geometry due to right-ventricular volume overload.
Suprarenal aortic aneurysm closure with an atrial septal defect Amplatzer device
Published in Acta Cardiologica, 2014
Sepideh Sokhanvar, Arsis Ahmadiyeh, Zahra Golmohamadi
Conventional repair of pararenal aortic aneurysms has been a technically challenging operation, with a significant morbidity rate of 28-35%. Endovascular stent grafting requires satisfactory landing zones for stent graft anchoring. Therefore, pararenal abdominal aortic aneurysms are usually contraindicated for this procedure because of difficulties associated with proximal graft fixation. In this case, we attempted to use a new strategy with an implanted atrial septal defect (ASD) Amplatzer device across the neck of the aneurysm. However, one month after this procedure the patient was referred to the hospital due to significant compression of the right inferior vena cava (IVC). Conclusion In patients with an atrial septal defect and abdominal pain due to an aneurysm, implantation of an Amplatzer device across the aneurysm neck, may be beneficial.
Increased pulmonary artery pressures during exercise are related to persistent tricuspid regurgitation after atrial septal defect closure
Published in Acta Cardiologica, 2013
Pieter De Meester, Alexander Van De Bruaene, Paul Herijgers, Jens-Uwe Voigt, Luc Vanhees, Werner Budts
Objective Although closure of an atrial septal defect type secundum often normalizes right heart dimensions and pressures, mild tricuspid insufficiency might persist. This study aimed at (1) identifi cation of determinants explaining the persistence of tricuspid insuffi ciency after atrial septal defect closure, and (2) evaluation of functional capacity of patients with persistent mild tricuspid insuffi ciency. Methods and results Twenty-five consecutive patients (age 42 ± 17 y) were included from the outpatient clinic of congenital heart disease at the University Hospitals of Leuven. All underwent transthoracic echocardiography, semi-supine bicycle stress echocardiography and cardio-pulmonary exercise testing. Six patients (24%) had mild tricuspid insuffi ciency (2/4) compared to 19 patients (76%) with no or minimal tricuspid insuffi ciency (≤ 1/4) as assessed by semi-quantitative colour Doppler echocardiography. Mann-Whitney U and Fisher’s exact tests were performed where applicable. Patients with persistent mild tricuspid insuffi ciency were signifi cantly older than those with no or minimal tricuspid insuffi ciency (P = 0.042). At rest, no diff erences in right heart confi guration, mean pulmonary artery pressure or right ventricular function were found. At peak exercise, mean pulmonary artery pressure was signifi cantly higher in patients with mild persistent tricuspid insuffi ciency (P = 0.026). Peak oxygen uptake was signifi cantly lower in patients with mild persistent tricuspid insuffi ciency (P = 0.019). Conclusions Mild tricuspid insuffi ciency after atrial septal defect repair occurs more frequently in older patients and in patients with higher mean pulmonary artery pressure at peak exercise. In patients with mild tricuspid insuffi ciency, functional capacity was more reduced. Mild tricuspid insuffi ciency could be a marker of subclinical persistent pressure load on the right ventricle.
Primary Stroke in a Woman With Sickle Cell Anemia Responsive to Hydroxyurea Therapy
Published in Hemoglobin, 2014
Samir K. Ballas, Ubaldo Martinez, Michael Savage
The most common cause of stroke in children with sickle cell anemia is infarction due to ischemia. In adults, however, stroke is most commonly hemorrhagic in nature. Other causes of stroke in patients with sickle cell disease are very rare. In this short communication, we describe a woman with sickle cell anemia responsive to hydroxyurea (HU) therapy who had primary stroke due to paradoxical embolization caused by a large atrial septal defect. Successful management of the stroke included surgical closure of the defect with trans-esophageal echocardiographic guidance. To the best of our knowledge, this is the first patient with sickle cell anemia and stroke due to congenital heart disease who did not require open heart surgery for successful management.
Related Knowledge Centers
- Mitral Valve Stenosis
- Foramen Ovale
- Ostium Secundum Atrial Septal Defect
- Atrial Septum
- Heart Septal Defects
- Heart Septum
- Ventricular Septum