Atrial septal defects

Krumsdorf U, Ostermayer S, Billinger K, et al. Incidence and clinical course of thrombus formation on atrial septal defect and patient foramen ovale closure devices in 1,000 consecutive patients. J Am Coll Cardiol 2004 43(2) 302-309. Review. 

Blunt chest injury Mechanical artificial heart Atrial septal defect Ventricular septal defect Patent foramen ovale Pulmonary arteriovenous fistula Particularly with right to left shunt Catheterization, angioplasty Primary oxalosis, hydatid cyst... 

Autopsy examples have established that paradoxical embolism can occur from venous thrombi through the right to the left side of the heart. Emboli may pass through a patent foramen ovale, which is found in approximately one-quarter of healthy people, an atrial septal defect or a ventriculoseptal defect (Gautier et al. 1991 Jeanrenaud and Kappenberger 1991 Cabanes et al. 1993). There is an increased incidence of patent foramen ovale in... 

Left atrial thrombus Left atrial appendage thrombus Spontaneous echo contrast Intracardiac tumors Atrial septal defect ... 

ECHO remains the procedure of choice in the diagnosis and evaluation of a number of conditions such as valvular dysfunction (aortic and mitral stenosis and regurgitation and endocarditis), wall motion abnormalities associated with ischemia, and congenital abnormalities, such as ventricular or atrial septal defects. Images obtained from ECHO are used to estimate chamber wall thickness and left ventricle ejection fraction, assess ventricular function, and detect abnormalities of the pericardium such as effusions or thickening. 

A transthoracic echocardiogram (TTE) will determine whether valve abnormalities or wall motion abnormalities are sources of emboli to the brain. A "bubble test" can be done to look for an intraatrial shunt indicating an atrial septal defect or a patent foramen ovale. 

Low- or no-risk conditions Secundum atrial septal defect, ischemic heart disease, previous coronary artery bypass graft surgery, and mitral valve prolapse with thin leaflets in the absence of regurgitations Temperature >38°C (100.4°F)... 

Negligible-risk category (no greater risk than the general population) Isolated secundum atrial septal defect... 

Surgical repair of atrial septal defect, ventricular septal defect, or patent ductus arteriosus (without residua beyond 6 mo)... 

Tetralogy of fallot Transposition of the great vessels Tricuspid atresia Truncus arteriosis ventricular septal defect (VSD) atrial septal defect (ASD) PDA... 

The lack of response in the other patients suggests that pulmonary vasoconstriction is not the cause of the desaturation and that perhaps other factors, such as cerebral blood flow requirements, have a significant effect on pulmonary blood flow (superior vena cava flow) in these patients. We have delivered nitric oxide to two patients following the total cavopulmonary anastomosis (Fontan), with an elevated transpulmonary gradient in the presence of left atrial hypertension due to a restrictive atrial septal defect in one patient and pulmonary venous obstruction by the Fontan baffle in another. Inhaled nitric oxide produced a reliable decrease in transpulmonary gradient in both, with an increase in saturation in one (with a fenestrated... 

Malm, T. Bowald, S. Karacagil, S. Bylock, A. and Busch, C. A new biodegradable patch for closure of atrial septal defect. An experimental study. Scand J Thorac Car-diovascSurg. 1992 26(1),9- A ). 

FIGURE 14.9 Medical uses of Dacron. A Dacron patch is used to close an atrial septal defect in a heart patient. 

Abstract An atrial septal defect (ASD) is the third most common form of congenital heart disease and is often only diagnosed in adulthood. The chapter describes different forms of ASD with their symptoms and diagnoses and methods that have historically been used to repair them. Transcatheter ASD repair technology is explained and the construction and functioning of a variety of devices is described, with particular reference to the advantages and disadvantages of a variety of textile components. The chapter concludes with an overview of recent developments. 

Key words congenital heart disease, atrial septal defect, transcatheter repair, sternotomy, thoracotomy, occluding device, endoscopic repair. 

Congenital heart disease (CHD) occurs in approximately 25 000 births per year in the United States. An atrial septal defect (ASD) is a spedfic form of CHD and is the third most common type of defect. Many people suffer from this disorder and in many cases it is only detected when the patient reaches middle age. Effective and efficient methods of repair are therefore needed to minimize the risks associated with traditional methods of ASD repair. In recent years, transcatheter closure methods for secundum type ASD have been developed. Currently the Amplatzer Septal Occluder, the Gore Helex Septal Occluder and the NMT Medical CardioSEAL-STARFiex Septal Occlusion systems have received FDA approval for ASD repair, the first of these only in 2001. This indicates that the use of these devices is still in its infancy. It can therefore be assumed that much more can be done to develop improved and more effective closure devices. It is the purpose of this chapter to describe ASDs and to outline the available technology with regard to transcatheter ASD repair devices. Hie discussion will centre around their construction and functioning, with special reference to their textile component. 

Durham, L. A. and Mendelsohn, A. M. (2003). Congenital heart information network Atrial septal defects Surgical and transcatheter management Retrieved 2 February 2009, from http //tchin.org/resource room/c art 14.htm. 

Ebeid, M. R. (2002). Percutaneous catheter closure of secundum atrial septal defects A review. Journal of Invasive Cardiology, 14(1), 25-31. 

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