We report a case of a 61-year-old woman with a large atrial septal defect (ASD) that was detected incidentally on chest radiography and computed tomography when she presented with sepsis. Echocardiography confirmed a large secundum ASD with left-to-right shunt flow, right heart dilatation and severe pulmonary hypertension. The patient had a poor clinical outcome despite intensive care and eventually passed away. Haemodynamically significant ASDs have a known association with increased morbidity and mortality, and their early detection and closure cannot be understated. This article aimed to highlight the imaging features of ASD, with special emphasis on the routine chest radiograph. The pathophysiology and clinical manifestations of ASD are also briefly discussed.
Cardiomegaly ; complications ; diagnostic imaging ; Critical Care ; Female ; Heart Septal Defects, Atrial ; complications ; diagnostic imaging ; Hemodynamics ; Humans ; Hypertension, Pulmonary ; complications ; diagnostic imaging ; Middle Aged ; Patient Admission ; Pulmonary Artery ; diagnostic imaging ; Radiography, Abdominal ; Radiography, Thoracic ; Sepsis ; complications ; diagnostic imaging ; Tomography, X-Ray Computed ; Young Adult

PURPOSE: We evaluated the hemodynamic statuses of patients after partial closure of atrial septal defects with fenestration due to pulmonary hypertension. MATERIALS AND METHODS: Seventeen adult patients underwent partial atrial septal defect closure and follow-up cardiac catheterization. We analyzed hemodynamic data and clinical parameters before and after closure. RESULTS: The median age at closure was 29 years old. The baseline Qp/Qs was 1.9+/-0.6. The median interval from the operation to the cardiac catheterization was 27 months. The CT ratio decreased from 0.55+/-0.07 to 0.48+/-0.06 (p<0.05). The mean pulmonary arterial pressure decreased from 50.0+/-11.5 mm Hg to 32.5+/-14.4 mm Hg (p<0.05), and the pulmonary resistance index decreased from 9.2+/-3.6 Wood units*m2 to 6.3+/-3.8 Wood units*m2 (p<0.05). Eleven patients (64.7%) continued to exhibit high pulmonary resistance (over 3.0 Wood units*m2) after closure. These patients had significantly higher pulmonary resistance indices and mean pulmonary arterial pressures based on oxygen testing before the partial closures (p<0.05). However, no significant predictors of post-closure pulmonary hypertension were identified. CONCLUSION: Despite improvement in symptoms and hemodynamics after partial closure of an atrial septal defect, pulmonary hypertension should be monitored carefully.
Adult ; Aged ; Cardiac Catheterization/*adverse effects ; Female ; Follow-Up Studies ; Heart Defects, Congenital/epidemiology/*physiopathology/*surgery ; Heart Septal Defects, Atrial/surgery ; Hemodynamics/*physiology ; Humans ; Hypertension, Pulmonary/diagnosis/epidemiology/*physiopathology ; Male ; Middle Aged ; Oxygen ; Postoperative Complications/diagnosis/epidemiology/*physiopathology ; Retrospective Studies ; Treatment Outcome ; Young Adult

A 20-year-old female had undergone definitive surgical repair for pulmonary atresia with intact ventricular septum soon after birth. She was referred to our institution with the chief complaint of clubbing fingers. A thorough examination revealed platypnea-orthodeoxia syndrome due to an interatrial right-to-left shunt through a secundum atrial septal defect. Percutaneous closure with an Amplatzer Septal Occluder resulted in resolution of the syndrome.
Dyspnea/*diagnosis/*etiology/surgery ; Female ; Heart Defects, Congenital/complications/*surgery ; Heart Septal Defects, Atrial/*complications/*diagnosis/surgery ; Humans ; Hypoxia ; Pulmonary Atresia/complications/*surgery ; *Septal Occluder Device ; Syndrome ; Treatment Outcome

Embolization of the occlusion device after percutaneous closure of atrial septal defect (ASD) is a potential disastrous complication. The usual site of embolization is the right side of the heart including pulmonary artery, but the device embolization to the extracardiac aorta is extremely rare. Here, we report a successful percutaneous retrieval case of the embolized Amplatzer Septal Occluder (ASO) to the descending thoracic aorta after the successful deployment of two ASO devices in a patient with double ASD. Competition between the two devices to obtain a stable position may be an explanation for the migration of ASO.
Adult ; Device Removal/*methods ; Embolism/*etiology/*surgery ; Heart Septal Defects, Atrial/*complications/surgery ; Humans ; Male ; Septal Occluder Device/*adverse effects ; Treatment Outcome

No abstract available.
Asian Continental Ancestry Group/*genetics ; Chromosome Deletion ; Chromosome Disorders/complications/*diagnosis ; Chromosomes, Human, Pair 18 ; Cyanosis/*etiology ; Female ; Heart Septal Defects, Atrial/complications/*diagnosis ; Humans ; Infant ; Karyotyping ; Republic of Korea

BACKGROUNDTranscatheter occlusion has been applied to treat ostium secundum atrial septal defect (OS ASD) since 1997. During the clinical practice, several postoperative complications including arrhythmia have been reported. This study aimed to evaluate the value of the ratio of atrial septal occluder (ASO) versus atrial septal length (ASL) for predicting arrhythmia occurrence after transcatheter closure in children with OS ASD.

METHODSSix hundred and fifty-one children diagnosed with OS ASD underwent occlusion procedures after completing routine examinations. The onsets and types of arrhythmia both during and after the occlusion procedures were monitored. Treatments were given based on the individual types of arrhythmia. The binary logistic regression analysis and receiver-operating characteristic (ROC) curve were used in the analysis of value of the ratio of ASO/ASL for predicting postoperative arrhythmia occurrence.

RESULTSTranscather occlusions were conducted in 651 children, among whom 7 children had different types and degrees of arrhythmia, with an incidence of 1.1%. The types of arrhythmia included sinus bradycardia, atrial premature beats, bundle branch block, and different degrees of atrioventricular block. Normal electrocardiograph findings were resumed in these 7 patients following active therapies such as corticoids, nutrition, and surgeries. The binary logistic regression and ROC analysis suggested that the ratio of ASO/ASL exhibited an intermediate predictive value for predicting arrhythmia occurrence after occlusion procedures. A cut-off value of 0.576 in the ratio provided a sensitivity of 87.5% and a specificity of 76.2% with an area under the ROC curve of 0.791 (95% confidence intervals, 0.655-0.926; P < 0.05) in predicting arrhythmia occurrence after the closure procedures.

CONCLUSIONSThe ratio of ASO/ASL might be a useful index for predicting arrhythmia occurrence after closure procedures in children with OS ASD.

Adolescent ; Arrhythmias, Cardiac ; diagnosis ; Atrial Septum ; surgery ; Cardiac Catheterization ; Child ; Child, Preschool ; Echocardiography, Transesophageal ; Female ; Heart Septal Defects, Atrial ; surgery ; Humans ; Infant ; Male ; Postoperative Complications ; diagnosis ; Septal Occluder Device

Congenital heart defect (CHD) is common in infants with Down syndrome (DS), which is the principle cause of mortality. However, there is no data available for the frequency and types of CHD in infants with DS in Korea. We investigated the frequency of CHD in infants with DS in Korea. After the survey on birth defects was conducted throughout the country, the prevalence of CHD in DS in 2005-2006 was calculated. This study was conducted based on the medical insurance claims database of the National Health Insurance Corporation. The number of total births in Korea was 888,263 in 2005-2006; of them, 25,975 cases of birth defects were identified. The prevalence of DS was 4.4 per 10,000 total births, accounting for 1.5% of all birth defects. Of the 394 infants with DS, 224 (56.9%) had a CHD. Atrial septal defect was the most common defect accounting for 30.5% of DS followed by ventricular septal defect (19.3%), patent duct arteriosus (17.5%), and atrioventricular septal defect (9.4%). Our study will be helpful to demonstrate the current status of DS and to identify the distribution of CHD in infants with DS in Korea.
Adult ; Asian Continental Ancestry Group ; Birth Weight ; Chromosome Aberrations ; Databases, Factual ; Down Syndrome/*complications ; Ductus Arteriosus, Patent/epidemiology ; Female ; Gestational Age ; Heart Defects, Congenital/*epidemiology/etiology ; Heart Septal Defects/epidemiology ; Heart Septal Defects, Atrial/epidemiology ; Heart Septal Defects, Ventricular/epidemiology ; Humans ; Male ; Prevalence ; Republic of Korea/epidemiology

Female ; Heart Septal Defects, Atrial ; complications ; Humans ; Levocardia ; complications ; Situs Inversus ; complications ; Young Adult

Atrial Flutter ; etiology ; Heart Aneurysm ; Heart Septal Defects, Atrial ; complications ; Humans ; Infant, Newborn ; Male

Adolescent ; Female ; Heart Septal Defects, Atrial ; complications ; Humans ; Hypertension, Pulmonary ; complications ; Scimitar Syndrome ; complications ; Tomography, X-Ray Computed