Heart Septal Defects, Atrial/diagnostic imaging* ; Humans ; Liver ; Vena Cava, Inferior ; Vena Cava, Superior

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

No abstract available.
Aged ; *Cardiac Catheterization/instrumentation ; Computed Tomography Angiography ; Coronary Angiography/methods ; Echocardiography, Doppler, Color ; Echocardiography, Transesophageal ; Female ; Heart Septal Defects, Atrial/diagnostic imaging/*therapy ; Humans ; Septal Occluder Device ; Treatment Outcome

A 12-year-old spayed female Pomeranian (weighing 2.4 kg) was referred with primary complaints of acute dyspnea, cough, and lethargy. Diagnostic imaging studies found degenerative mitral valve cusps, chordae tendinae rupture, severe mitral regurgitation (5.45 m/s of peak velocity), and marked left atrial and ventricular dilation. The dog was diagnosed as having degenerative mitral valve disease (DMVD) with ISACHC stage IIIa heart failure. Her clinical condition was stabilized after administration of cardiac medication (e.g. diuretics and pimobendan). Ten months later, the dog was referred back to the clinic due to a sudden worsening of clinical signs. Echocardiographic study found pulmonary hypertension in addition to DMVD. After medication was adjusted, clinical signs were stabilized in 2 weeks. The patient was returned after 4 months for cardiac recheck and there was no obvious worsening of clinical signs. Incidental finding of a left-to-right atrial septal defect from rupture of the atrial septum secondary to marked left atrial dilation by DMVD was noted by echocardiography. To diminish left atrial volume overload, the frequencies of both furosemide and pimobendan were increased (i.e. from q 12 hr to q 8 hr) in addition to adding spironolactone (1 mg/kg q 12 hr). Based on diagnostic findings, this case was re-diagnosed as acquired atrial septal defect secondary to rupture of the atrial septum with advanced stage DMVD. The dog was then stabilized and is currently being regularly monitored.
Animals ; Atrial Septum* ; Child ; Cough ; Diagnostic Imaging ; Diuretics ; Dogs* ; Dyspnea ; Echocardiography ; Female ; Furosemide ; Heart Failure ; Heart Septal Defects, Atrial ; Humans ; Hypertension, Pulmonary ; Incidental Findings ; Lethargy ; Mitral Valve Insufficiency ; Mitral Valve* ; Rupture* ; Spironolactone

OBJECTIVETo observe the effect of oversized occluder on endothelialization post percutaneous closure of experimental atrial septal defect (ASD) in dogs.

METHODSASD was established with the help of transthoracic echocardiography in 18 dogs. ASD size was (6.0 ± 0.2) mm. Dogs were randomly divided into normal size group (implanted with 8 mm occlude, n = 9) and oversized group (implanted with 12 mm occluder, n = 9). Dogs were randomly killed at 3, 6 and 14 months after percutaneous closure. The endothelialization process on device surface was observed by scanning electron microscope.

RESULTSFour animals died around 1 month post procedure. Microscopic sections from normal group showed nearly complete endothelialization at 3 months after device implantation and complete endothelialization at 6 and 14 months after device implantation. While microscopic sections showed lack of endothelialization at 3 months post implantation, nearly endothelialization at 6 months, and complete endothelialization at 14 months after device implantation in oversized group.

CONCLUSIONIncomplete endothelialization of occluder surface is observed at 6 months after implantation of an oversized ASD occluder device in this model.

Animals ; Dogs ; Echocardiography ; Heart Septal Defects, Atrial ; diagnostic imaging ; therapy ; Percutaneous Coronary Intervention ; Septal Occluder Device

Adult ; Coronary Vessel Anomalies ; diagnostic imaging ; Diagnosis, Differential ; Echocardiography ; methods ; Female ; Heart Septal Defects, Atrial ; diagnostic imaging ; Humans ; Pulmonary Artery ; abnormalities

OBJECTIVETo investigate partial anomalous pulmonary venous connection (PAPVC) with echocardiography.

METHODSThe right ventricular volume overload was detected by routine echocardiography in 37 child patients, who underwent further echocardiography to find the abnormal locations of pulmonary vein opening at superior, inferior vena cava and right atrium. The ultrasound results were compared with surgical findings.

RESULTSIn 30 patients the ultrasound diagnosis was consistent with surgery results, 7 were misdiagnosed by ultrasound with a detective rate of 81.1 %. All 37 PAPVC patients presented varying degrees of right heart enlargement; PAPVC combined with atrial septal defect (ASD) was found in 34 cases.

CONCLUSIONThe possibility of PAPVC should be considered when unexplained right heart volume overload was detected by echocardiography. Superior, inferior vena cava and right atrium should be inspected when the pulmonary veins were not seen in echocardiography.

Child ; Child, Preschool ; Echocardiography ; Female ; Heart Atria ; abnormalities ; diagnostic imaging ; Heart Septal Defects, Atrial ; diagnostic imaging ; Humans ; Infant ; Male ; Pulmonary Veins ; abnormalities ; diagnostic imaging

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

Echocardiography, Transesophageal ; Electrodes, Implanted ; Heart Septal Defects, Atrial ; diagnostic imaging ; Humans ; Intraoperative Complications ; diagnostic imaging ; Male ; Middle Aged ; Pacemaker, Artificial