Right atrial isolation for atrial fibrillation associated with atrial septal defect

Two patients with atrial fibrillation associated with an atrial septal defect underwent simultaneous surgical correction of the atrial septal defect and right atrial isolation. The right atrium was surgically isolated while the continuity with the sinoatrial node was preserved in the remainder of the heart. After the operation, the patients maintained normal sinus rhythm for 99 and 65 months. Thus, right atrial isolation offers an alternative to the current surgical treatment for atrial fibrillation associated with an atrial septal defect.     

Mechanics of breathing in patients with atrial septal defect

Mechanics of breathing and pulmonary diffusing properties were investigated in 24 adult patients with atrial septal defect. The patients were divided into 3 groups according to mean pulmonary artery pressure: less than 19 mm Hg (group I), 20 to 24 mm Hg (group II), and greater than 25 mm Hg (group III). The only change observed in group I was a marked increase in diffusing capacity. Patients of group II showed not only an increase in diffusing capacity, but also an overt decrease in maximal expiratory flow at all lung volumes and at any given driving pressure. For these two groups, a highly significant inverse correlation was found between changes in diffusing and elastic lung properties (r = -0.71; P less than 0.001). In patients of group III, the expiratory flow remained clearly decreased; furthermore, lung compliance and lung volumes were sharply reduced, airway resistance was elevated, and diffusing capacity was normal. Finally, from group I to group III, the lung elastic recoil became progressively diminished at small lung volumes. These results suggest that an increased pulmonary blood volume induces an increase in diffusing capacity and a slight decrease in lung compliance. Simultaneous existance of high intravascular pressure strengthens the effects of increased pulmonary blood volume on lung mechanics and results in significant abnormalities in the lung mechanical behavior. It is postulated that these effects are due to a competition for space between vessels and airways within the bronchovascular sheaths, with a subsequent compression of small airways.     

Transcatheter closure of atrial septal defect

Isolated secundum atrial septal defect is one of the most common congenital heart defects. Surgical closure is the treatment of choice but is associated with a chest scar, some morbidity and a relatively long recovery and the use of cardiopulmonary bypass. Transcatheter closure of secundum atrial septal defect is therefore an attractive approach. 3 children, aged 5-10 years, underwent successful transcatheter closure of moderate to large central atrial septal defects with the Cardioseal device. The procedures were performed under x-ray and transesophageal echocardiographic guidance. Our initial experience, and that of others, indicates that transcatheter occlusion of secundum atrial septal defects is safe and effective and can be an appropriate alternative in approximately 60% of patients.     

A case of congenital tricuspid regurgitation associated with atrial septal defect and peripheral pulmonary stenosis

This report describes a 5-year-old girl with congenital tricuspid regurgitation associated with an atrial septal defect and peripheral pulmonary stenosis. The girl was diagnosed with the heart murmur at birth and recently developed the cardiomegaly. Cardiac echocardiography and catheterization showed severe tricuspid regurgitation, an atrial septal defect of the secundum type and peripheral pulmonary stenosis. In the operative findings, the tricuspid annulus was dilated to 33 mm in diameter, and leaflets were attached normally to the antomic annulus. There was a large cleft of the anterior leaflet of the tricuspid valve. Suture of the cleft and annuloplasty of the tricuspid valve, suture closure of the atrial septal defect and patch dilatation of peripheral pulmonary stenosis were successfully performed. Including this case, 19 other cases with congenital tricuspid regurgitation undergoing surgery were reported to date.     

Echocardiography determination of shunt volume in children with atrial septal defect

The accuracy of echocardiographic estimation of left-to-right shunts was studied prospectively in children with secundum ASD. Fifty-one consecutive patients were examined from March 1987 to August 1991. Mean age was 64/12 years with a minimum age of 12/12 and a maximum of 131/12 years. Twenty-five children were included in the first part of the study. The ratios of right and left atrial and ventricular areas and pulmonary and aortic diameters were correlated with the left-to-right shunts determined by oximetry (mean shunt 48.7%; min. 10.1%, max. 73.2%). The pulmonary/aortic diameter ratio provided the closest correlation (r = 0.95; p < 0.01). During the second part of the study the left-to-right shunt was estimated using the regression equations developed from part one. Thus, in 26 subsequent patients these values were compared with oximetric shunt values. Again, the pulmonary/aortic diameter ratio provided the closest correlation (r = 0.97). The pair comparison yielded a difference of 0.7 +/- 3.8%. Based on these results since 1991, surgery for ASD II has been performed without preoperative cardiac catheterization in 33 patients, provided echocardiographic shunt estimation was > or = 48%.     

Acquired atrial septal defect as a complication of endocarditis--a case report

BACKGROUND: An original technique for the treatment of inguinal hernia is described: this operative technique consists of a Marlex (mono-filament knitted polypropylene) mesh sutured in the preperitoneal space under the fascia trasversalis. METHODS: A total of 202 hernioplasties have been treated: 100 of these have been controlled after six months to detect complications and recurrencies. RESULTS: One recurrency (1%) was found. No previous selection of patients was done. The mesh-repair is simple, rapid, and causes less discomfort than conventional sutured herniorraphy. This technique is compared with the other tension-free mesh hernioplasties. CONCLUSIONS: This operative technique is a prophylaxis for the femoral hernia described as later complication of other techniques.     

Microangiopathic hemolytic anemia and thrombocytopenia in a child with atrial septal defect and pulmonary hypertension

We found that exposure to room temperature (RT/21 degrees C) causes apoptosis in HL-60 cells. Here we characterized RT-induced apoptosis in HL-60. After exposure to RT, apoptosis starts within 6 h and more than 80% of the cells underwent apoptosis within 20 h. All cells, however, were committed to apoptosis after 16 h and no viable cells could be recovered. The caspase-1 inhibitor (YVAD-CHO) effectively blocked apoptosis, whereas the caspase-3 inhibitor (DEVD-CHO) did not. About 20% of newly obtained early passage HL-60 cells (passage 10) also underwent apoptosis by RT treatment. These data suggest that some population in HL-60 which responds to RT with apoptosis became dominant during passaging.     

Right ventricular aneurysm associated with postinfarction ventricular septal defect

Isolated right ventricular aneurysms are rare. Postinfarction right ventricular aneurysm associated with a ventricular septal defect is a very unusual complication. We present such a case that was successfully treated surgically.     

Balloon pulmonary valvuloplasty for pulmonary valve stenosis with atrial septal defect

We performed successful balloon pulmonary valvuloplasty (BPV) in 6 patients with pulmonary valve stenosis and atrial septal defect (ASD) accompanied by atrial left-to-right shunt without an increase of shunting immediately after BPV. It suggests that such patients should be treated by BPV initially and the need for ASD repair can be assessed during long-term follow-up.     

Diastolic murmurs in atrial septal defect (author's transl)

No correlation was found between the presence of a diastolic murmur in about 50% of patients with artrial septal defect and the calculated shunt volume. A significant correlation was found in respect to the age of the patient, the majority of the murmurs being found in young patients and especially in young patients with tachycardia. Similar murmurs were found in healthy persons and, hence, a functional stenosis of the AV-valve ring could be the reason for this diastolic murmur, which may occur more frequently in patients with atrial septal defect on account of an alteration in the blood stream patterns.     

Comparison of three different atrial septal defect occlusion devices

Three different devices were used to close secundum-type atrial septal defects in 28 patients. The "Amplatzer" is associated with an easier and shorter procedure than are the "Sideris Buttoned Device" and the Microvena "Angel Wings" devices.     

Surgical management of aortic regurgitation associated with ventricular septal defect

The intracarotid amobarbital procedure was carried out in 8 male and 7 female candidates to temporal lobectomy, and a female candidate to frontal lesionectomy, aged 18-50 (mean 32.5) years. Language and memory were tested after injection in each hemisphere. Both were measured by the Montreal procedure. In 9 patients language and memory were evaluated with the Seattle procedure too. In 12 patients the left hemisphere was dominant for language; three had bilateral dominance. In 1 patient the Seattle procedure demonstrated the dominant hemisphere by relatively slowness of speech during the drug effect in the left hemisphere. Memory was defined to be in the left hemisphere in 12 patients, in the right in 2, bilateral in 1 and in another lateralization was not possible. In 1 patient memory dominance was determined by the Montreal protocol alone because of lack of cooperation. These early results indicate that the methods may be complementary for determination of language and memory dominance in epilepsy surgery candidates.