Percutaneous device closure for secundum atrial septal defects (ASDs) has been performed commonly and safely with high success rates. However, it is still challenging to close ASDs that are surrounded with deficient or hypermobile rims and could be compromised with an unexpected migration of device. We report a case of percutaneous Amplazter Septal Occluder (ASO; St. Jude Medical Inc., St. Paul, Minnesota, USA) device closure for an ASD with a thin and floppy interatrial septum, which immediately migrated into the right atrium and was not pulled back into the delivery sheath. To our knowledge, this is the first report on a successful percutaneous retrieval and redeployment of the device in such a situation, preventing any vascular injury or unplanned emergency open heart surgery.
Echocardiography, Three-Dimensional ; Echocardiography, Transesophageal ; Female ; Fluoroscopy ; Heart Atria/ultrasonography ; Heart Septal Defects, Atrial/*therapy ; Humans ; Middle Aged ; *Septal Occluder Device

OBJECTIVE: To discuss the preoperative, intraoperative, and postoperative application of echocardiography in mini-invasive surgical device closure of secundum atrial septal defects, including those special and difficulty-occluded defects. METHODS: We performed mini-invasive surgical device closure of secundum atrial septal defects on 287 patients. Before the surgery, transthoracic echocardiography was applied for screening; during the surgery we reassessed the sizes of the defects and their remaining margins, designated the suitable occluders, and guided the placement of the occluders by multiplane transesophageal echocardiography. The patients were postoperatively followed up at regular intervals by multiplane transesophageal echocardiography (MTEE) which was employed to assess the therapeutic efficacy. RESULTS: Out of the 287 atrial septal defects, 276 (96.17%) were successfully closed. There were 37 porous defects and 23 cases with short posterior-inferior margin of defects. Follow-ups at intervals showed the occluders stayed firmly and echoed clearly. No notable residual shunt or valve regurgitation was observed. CONCLUSION Echocardiography plays a vital and reliable role in mini-invasive surgical device closure of secundum atrial septal defects, especially those special and difficulty-occluded defects.
Adolescent ; Child ; Child, Preschool ; Echocardiography, Transesophageal ; methods ; Female ; Heart Septal Defects, Atrial ; surgery ; Humans ; Infant ; Male ; Minimally Invasive Surgical Procedures ; methods ; Septal Occluder Device ; Ultrasonography, Interventional

BACKGROUNDThe percutaneous transcatheter closure of secundum atrial septal defect (ASD) is increasingly a widespread alternative to surgical closure. The aim of this study was to assess long-term results of percutaneous closure of secundum-type atrial septal defect (ASDII).

METHODSBetween January 2001 and December 2005, 61 patients underwent a successful percutaneous closure of ASDII; including 25 male and 36 female. All were included in the patient study and were followed up to monitor by electrocardiogram and echocardiography, at intervals of 3 days, 3 months, 6 months, 1 year, 2 years, and 5 years after operation.

RESULTSThree days after percutaneous transcatheter septal closure (PTSC), the right atrium diameter, right ventricular end-diastolic left-right diameter and right ventricular end-diastolic volume (RVEDV) decreased significantly (P < 0.05). Right ventricular end-diastolic anteroposterior diameter (RVEDD), right ventricular end-systolic volume (RVESV) and right ventricular ejection fraction (RVEF) also decreased (P < 0.01). During the period from 3 to 6 months, the size of the right atrium and right ventricle returned to normal range. Three days after PTSC, the left ventricular end-diastolic diameter (LVEDD), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left ventricular-systolic volume (LVSV) and left ventricular ejection fraction (LVEF) were significantly increased (P < 0.05). At 1 year, the size of the left atrium, left ventricle and left cardiac function returned to normal range (P < 0.01). There were no deaths or significant complications during the study. At five year follow-up, all defects were completely closed and remained closed thereafter.

CONCLUSIONTranscatheter closure of ASDII effectively eliminated the abnormal shunt and, subsequently improved the dimensions of each chamber and cardiac function.

Adolescent ; Adult ; Child ; Child, Preschool ; Female ; Follow-Up Studies ; Heart Septal Defects, Atrial ; diagnostic imaging ; surgery ; Humans ; Male ; Middle Aged ; Ultrasonography ; Young Adult

OBJECTIVE: To introduce peratrial device closure of secundum atrial septal defects (ASD) under the guidance of transesophageal echocardiography (TEE) without cardiopulmonary bypass (CPB) in children, and to summarize the clinical experiences. METHODS: A total of 115 children with secundum ASD (the occlusion group) underwent peratrial device closure of atrial septal defects through a small sternotomy under TEE guidance without cardiopulmonary bypass. Children were followed up closely for 1-13 months. Another 59 children (the bypass group) had closed atrial septal defects under cardiopulmonary bypass during the same period. The differences in the operation duration, convalescence and complication between the 2 groups were compared. RESULTS: Except 1 patient was operated under the CPB, the rest 114 patients in the occlusion group were successfully closed by the occluders. The duration of the operation, mechanical ventilation, intensive care and hospitalization, and the rate of blood-transfusion in the occlusion group were significantly lower than those in the bypass group (P<0.01), with no difference in complications in the 2 groups (P>0.05). CONCLUSION Minimally invasive peratrial device closure of ASD without CPB is a relatively simple, safe and effective operation under the guidance of TEE for children. The short and mid-term clinical outcomes are promising. Long-term follow-up is indispensable.
Child ; Child, Preschool ; Echocardiography, Transesophageal ; methods ; Female ; Follow-Up Studies ; Heart Septal Defects, Atrial ; diagnostic imaging ; surgery ; Humans ; Infant ; Male ; Minimally Invasive Surgical Procedures ; methods ; Septal Occluder Device ; Ultrasonography, Interventional

OBJECTIVE: To explore the value of transthoracic echocardiography (TTE) in transcatheter closure of atrial septal aneurysm (ASA) combined with secoundum-type atrial septal defect (ASD). METHODS: Fourteen patients (3 males and 11 females) who had ASA combined with secoundum-type ASD were diagnosed by TTE or transesophageal echocardiography. The ASA projected to the right atrium in all patients. The width of basilar part was 13 approximately 24 (18.5+/-3.9) mm, and the vertical extent was 7 approximately 11(9.7+/-1.8) mm. Ten patients combined with single hole ASD and 4 patients with multiple hole ASD. Blood shifting from the left atrium to the right atrium was displayed in color Doppler in all patients. All patients were treated by transcatheter closure under the guiding of X fluoroscopy and TTE, and examined with TTE during the follow-up. RESULTS: Transcatheter closure was successfully performed by 14 occluders in all patients. No residual shunt was detected immediately by TTE after the procedure in all patients. During the 6 approximately 12 month follow-up, no residual shunt or occluder shifting was found, the dimensions of the heart became normal in 11 patients (79%) and were significantly decreased in 4. CONCLUSION Transcatheter closure is feasible in patients with ASA combined with secoundum-type ASD, and extra attention must be paid to the specialty. TTE is very important in case selection before transcatheter closure, and it may be used to monitor and guide the procedure during transcatheter closure.
Adult ; Atrial Septum ; Balloon Occlusion ; methods ; Cardiac Catheterization ; Echocardiography ; Female ; Heart Aneurysm ; complications ; therapy ; Heart Septal Defects, Atrial ; complications ; therapy ; Humans ; Male ; Middle Aged ; Ultrasonography, Interventional ; Young Adult

To evaluate the morphology of atrial septum by the live three-dimensional echocardiography (L3DE) and its value of clinical application, L3DE was performed in 62 subjects to observe the morphological characteristics and dynamic change of the overall anatomic structure of atrial septum. The study examined 49 patients with atrial septal defect (ASD), including 3 patients with atrial septal aneurysm, and 10 healthy subjects. ASD in the 35 patients was surgically confirmed. The maximal diameters of ASD were measured and the percentages of area change were calculated. The parameters derived from L3DE were compared with intraoperative measurements. The results showed that L3DE could directly and clearly display the morphological features of overall anatomic structure of normal atrial septum, repaired and artificially-occluded atrial septum, atrial septal aneurysm. The defect area in ASD patients changed significantly during cardiac cycle, which reached a maximum at end-systole and a minimum at end-diastole, with a mean change percentage of 46.6%, ranging from 14.8% to 73.4%. The sizes obtained from L3DE bore an excellent correlation with intraoperative findings (r=0.90). It is concluded that L3DE can clearly display the overall morphological features and dynamic change of atrial septum and measure the size of ASD area accurately, which is important in the decision to choose therapeutic protocols.
Atrial Septum/*ultrasonography ; Echocardiography, Three-Dimensional/*methods ; Heart Septal Defects, Atrial/*pathology ; Heart Septal Defects, Atrial/*ultrasonography ; Young Adult

The Holt-Oram syndrome or cardiomelic syndrome is characterized by the association of upper limb and heart malformations. Most frequently, abnormalities of the thumb and secundum atrial septal defects are associated with the disease. The mode of inheritance is autosomal dominant. The etiology of this disease is unknown but is most likely of multifactorial origin. Here we report a case Holt-Oram syndrome with affected mother which was diagnosed at 18th gestational weeks by prenatal ultrasonograpy. Fetal ultrasonography revealed abnormalities of upper limbs, and heart. The upper limbs were shorter than normal, syndactyly of both hands were seen and both wrists were markedly angulated. Ventricular septal defect was suspicious. After genetic counselling her pregnancy was terminated at 22nd gestational week.
Hand ; Heart ; Heart Septal Defects, Atrial ; Heart Septal Defects, Ventricular ; Humans ; Mothers* ; Pregnancy ; Syndactyly ; Thumb ; Ultrasonography* ; Ultrasonography, Prenatal ; Upper Extremity ; Wills ; Wrist

Meckel-Gruber syndrome is a rare autosomal recessive disorder characterized by the triad of posterior meningoencephalocele, cystic change of kidney and polydactyly. It is associated with varying degree of multiple congenital anomalies. So the karyotype is normal, but the phenotype is highly variable. This syndrome is lethal and the patient seldom survive more than a few days to weeks. Prenatal diagnosis may be possible by elevated alpha fetoprotein level in amniotic fluid and sonographic examination. Regarding the 25% recurrence risk, obstetrician and pediatrician should do genetic counseling and serial antenatal examination. Here we describe a female neonate who showed multiple congenital anomalies including cystic change of left kidney, polydactyly of left hand, short neck, micrognathia, low set ears, subaortic stenosis, patent ductus arteriosus and atrial septal defects which could best be designate as Meckel-Gruber syndrome. She died at 22 days of life. We report a case of Meckel-Gruber syndrome with brief review of some related literatures.
alpha-Fetoproteins ; Amniotic Fluid ; Constriction, Pathologic ; Ductus Arteriosus, Patent ; Ear ; Female ; Genetic Counseling ; Hand ; Heart Septal Defects, Atrial ; Humans ; Infant, Newborn ; Karyotype ; Kidney ; Neck ; Phenotype ; Polydactyly ; Prenatal Diagnosis ; Recurrence ; Ultrasonography

Sporadic reports of hypernatremic dehydration in breastfed newborn infants have appeared in medical literature for at least 3 decades. We report the first case of hypernatremic dehydration resulting from inadequate breast-feeding in Korea. A 14-day old baby, born to a mentally retarded mother, was transferred to our hospital with a body weight loss of 460 g since birth(17%) and a serum sodium(Na) level of 179 mEq/L, after initial hydration at another hospital. On admission, a cardiac murmur was heard and an enlarged liver was palpated. Cardiac ultrasonogram revealed ventricular septal defect and ostium secundum atrial septal defect. During hydration, a seizure-like attack developed. Serum Na decreased to 135 mEq/L on the 5th day of admission. Brain ultrasonography and brain magnetic resonance image revealed no remarkable abnormalities. Electroencephalography was normal. She suffered from prerenal azotemia, hyperglycemia and disseminated intravascular coagulation at admission but was treated successfully. Heart failure was also controlled with dobutamine, diuretics and digoxin.
Azotemia ; Body Weight ; Brain ; Breast Feeding ; Dehydration* ; Digoxin ; Disseminated Intravascular Coagulation ; Diuretics ; Dobutamine ; Electroencephalography ; Heart Failure ; Heart Murmurs ; Heart Septal Defects, Atrial ; Heart Septal Defects, Ventricular ; Hepatomegaly ; Humans ; Hyperglycemia ; Hypernatremia ; Infant, Newborn* ; Korea ; Mentally Disabled Persons ; Mothers ; Ultrasonography

Patau syndrome is trisomy 13, one of the abnormalities of chromosomal structure and, is relatively common with Down syndrome and Edward syndrome. Also it is associated with intrauterine growth retardation, holoprosencephaly, cyclopia, cleft lip, cleft palate, ventricular septal defect, atrial septal defect, extremity abnormalities, and renal malformations. Because early death is typical with 50% of infants with trisomy 13 dying within 1 month and only 18% surviving more than 1 year, prevention through genetic counseling may be important for subsequent pregnancy. We present one case of trisomy 13 with abnormal ultrasound finding of holoprosencephaly, cyclopia, micrognathia, ventricular septal defect, atrial septal defect, and intrauterine growth retardation. And confirmed chromosomally with pregnancy termination.
Cleft Lip ; Cleft Palate ; Down Syndrome ; Extremities ; Female ; Fetal Growth Retardation ; Genetic Counseling ; Heart Septal Defects, Atrial ; Heart Septal Defects, Ventricular ; Holoprosencephaly ; Humans ; Infant ; Pregnancy ; Pregnancy Trimester, Second* ; Trisomy ; Ultrasonography