Explore the vast range of titles available.

Atrial septal defects are the third most common type of congenital heart disease. Included in this group of malformations are several types of atrial communications that allow shunting of blood between the systemic and the pulmonary circulations. Most children with isolated atrial septal defects are free of symptoms, but the rates of exercise intolerance, atrial tachyarrhythmias, right ventricular dysfunction, and pulmonary hypertension increase with advancing age and life expectancy is reduced in adults with untreated defects. The risk of development of pulmonary vascular disease, a potentially lethal complication, is higher in female patients and in older adults with untreated defects. Surgical closure is safe and effective and when done before age 25 years is associated with normal life expectancy. Transcatheter closure offers a less invasive alternative for patients with a secundum defect who fulfil anatomical and size criteria. In this Seminar we review the causes, anatomy, pathophysiology, treatment, and outcomes of atrial septal defects in children and adult patients in whom this defect is the primary cardiac anomaly.

Background Complete endothelialization is often not achieved within 6 months after implantation of an atrial septal defect (ASD) occluder, which may lead to microthrombus or thrombosis. This study aimed to assess the endothelialization and morphology of a novel puncturable ASD occluder (ReAces) compared with traditional occluders 1 year post-implantation using computed tomography angiography (CTA). Methods Fifteen patients from each group in a randomized controlled trial comparing ReAces with traditional occluders were included at the 1-year follow-up at Zhongshan Hospital, Fudan University. Baseline characteristics and procedural data were recorded. CTA was performed to assess the device morphology and degree of endothelialization. Independent samples t-test and Fisher's exact test were primarily used to compare the above data. Results Each patient received a single device and had no residual shunts. There were no differences in defect size (15.3 ± 4.0 mm vs. 15.3 ± 4.7 mm, p  = 1.00) or occluder size (21.2 ± 4.4 mm vs. 21.5 ± 5.3 mm, p  = 0.882) between the two groups. At the 1-year follow-up CTA, the central region thickness (4.2 mm ± 0.9 mm vs. 7.8 mm ± 2.4 mm, p  < 0.0001), left atrial device-occupied volume (1863.3 mm 2  ± 404.4 mm 2 vs. 4764.4 mm 2  ± 2321.2 mm 2 , p  < 0.001), and device compression rates (10.1 ± 4.8% vs. 17.5 ± 5.6%, p  = 0.001) were significantly lower in the experimental group. All occluders in the experimental group achieved complete endothelialization, whereas in the control group, 7 patients did not (100% vs. 53.3%, p  = 0.006). Conclusions Compared with traditional occluders, ReAces presented a significantly greater complete endothelialization rate, lower central region thickness, lower left atrial device-occupied volume, and lower device compression rates at 1 year post-implantation by CTA. Trial registration Trial registry: ClinicalTrials.gov. Unique identifying number: NCT05371366. Date of registration: 04/05/2022. Graphical Abstract

The changes in tricuspid regurgitation (TR) following transcatheter atrial septal defect (ASD) closure, in relation to preprocedural cardiac rhythms, remain unknown. This study aimed to assess sequential changes in TR after ASD closure based on cardiac rhythms. Patients were categorized as sinus rhythm (SR group, n = 89), SR after catheter ablation for atrial fibrillation (ABL group, n = 14), and permanent atrial fibrillation (AF group, n = 12). Echocardiography was performed at baseline, 1 day, 1 month, and 12 months after the procedure. There were significant differences in age (54.5 ± 17.5 years vs 63.9 ± 12.6 years vs 74.3 ± 8.4 years; p < 0.01) and prevalence of moderate ≥ TR at baseline (44.9% vs 78.6% vs 91.7%; p < 0.01) in the SR, ABL, and AF groups, respectively. The SR group showed significant improvement in TR as early as 1-day postclosure, which persisted at 12 months, whereas the ABL and AF groups exhibited no significant improvements in TR at any point postprocedure. Independent predictors of residual moderate ≥ TR at 12 months included being in the ABL or AF groups and having a higher right atrial volume index (RAVI) at baseline. In conclusion, persistent TR may remain after ASD closure, even for patients who achieve SR postablation and those with permanent AF. This persistence may reflect baseline atrial remodeling, as indicated by larger RAVI, beyond volume unloading after ASD closure. These findings highlight the importance of timely therapeutic interventions and careful monitoring for residual TR following ASD closure, especially in patients with a history of AF. [Display omitted]

Using transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) to investigate the occurrence and related causes of iatrogenic atrial septal defect (iASD) after catheter ablation combined with left atrial appendage closure (LAAC) for atrial fibrillation (AF) and its impact on the right heart system. We retrospectively analyzed 330 patients that underwent combined procedure of catheter ablation for AF and LAAC at General Hospital of Northern Theater Command from January 2018 to March 2022. These patients were divided into iASD group and non-iASD group according to whether there was persistent iASD shown on TEE at 3 months after procedure. There were 96 (29.1%) patients with iASD and 234 patients without in the TEE follow up at 3 months post-operation. Patients with iASD had larger left atrial volumes (76.5 ± 35.2 ml vs. 61.1 ± 21.9 ml, p  = 0.036) as well as higher occurrence of mitral regurgitation (MR) (32.3% vs. 12.8%, p  = 0.018) and tricuspid regurgitation (TR) (27.1% vs. 7.3%, p  = 0.002). Procedural features showed that patients with persistent iASD had longer procedure time (92.1 ± 36.3 vs. 69.1 ± 17.8 min, p  = 0.003) and larger sheath sizes (4.1 ± 1.2 mm vs. 3.3 ± 1.2 mm, p  = 0.022). The preoperative and postoperative right heart parameters of patients in the persistent iASD group were compared, and there were no significant differences on right atrial/ventricular diameter, right heart systolic/diastolic function and pulmonary artery pressure ( P  > 0.05). The occurrence of iASD 3 months after combined atrial fibrillation ablation and LAAC was 29.1%. The size of left atrium, the pressure of left atrium, the manipulation time within left atrium, the size of sheath, and the use of ICE during operation was related to the closure of iASD.

Inferences made regarding the postnatal anatomy of the atrial septum still tend to be based on developmental evidence. Although atrial septation is a well-defined process, it is remarkably complex and remains poorly understood. It is now established, however, that the process involves the conjugation of several myocardial structures and mesenchymal tissues of both intracardiac and extracardiac origin. The resultant postnatal morphology is equally complex, evidenced by the fact that, in the normal heart, only the floor of the oval fossa, along with its anteroinferior muscular buttress, are true anatomical septums. In this regard, septums can be defined as partitions that can be removed without creating communications with the extracavitary space. The true septal components are surrounded by grooves, which themselves largely represent infolding of the atrial walls. These anatomical features can now accurately be revealed using virtual dissection of CT data sets. These images, when carefully reconstructed, demonstrated the anatomy with as much accuracy as when hearts are dissected in the autopsy room. Such virtual dissection, furthermore, shows the components as they are seen within the chest, thus facilitating understanding for those intending to undertake interventional therapeutic procedures. By preparing such images, we show the complexity of the normal atrial septum and its surrounds. We show that it is only defects within the oval fossa, or the much rarer vestibular defects, which can appropriately be illustrated in the context of a normally constructed heart.

ObjectiveTherapeutic strategies for atrial septal defect (ASD) with severe pulmonary arterial hypertension (PAH) are controversial. This study aimed to evaluate the efficacy of PAH-specific medications and subsequent transcatheter closure (ie, treat-and-repair strategy) on clinical outcomes.MethodsWe enrolled 42 patients who were referred to 13 institutions for consideration of ASD closure with concomitant PAH and underwent the treat-and-repair strategy. The endpoint was cardiovascular death or hospitalisation due to heart failure or exacerbated PAH.ResultsAt baseline prior to PAH-specific medications, pulmonary to systemic blood flow ratio (Qp:Qs), pulmonary vascular resistance (PVR), and mean pulmonary artery pressure (PAP) were 1.9±0.8, 6.9±3.2 Wood units and 45±15 mm Hg. Qp:Qs was increased to 2.4±1.2, and PVR and mean PAP were decreased to 4.0±1.5 Wood units and 35±9 mm Hg at the time of transcatheter ASD closure after PAH-specific medications. Transcatheter ASD closure was performed without any complications. During a median follow-up period of 33 months (1–126 months) after transcatheter ASD closure, one older patient died and one patient was hospitalised due to heart failure, but the other patients survived with an improvement in WHO functional class. PAP was further decreased after transcatheter ASD closure.ConclusionsThe treat-and-repair strategy results in low complication and mortality rates with a reduction in PAP in selected patients with ASD complicated with PAH who have a favourable response of medical therapy.

Objective This study aims to characterize the mid and long-term clinical outcomes of 856 atrial septal defect cases that underwent closure using MTCST without the assistance of a robotic system. Methods From June 2009 to September 2023, a total of 856 cases at our center underwent selective repair of a secundum-type atrial septal defect using MTCST without Da Vinci robotic assistance. According to whether the operation was performed during an arrested heart or not, patients were divided into arrested heart group ( n  = 110) and beating heart group ( n  = 746). Cardiopulmonary bypass was established peripherally. Three-port incisions in the right chest were conducted first, followed by a pericardiotomy, superior and inferior vena cava snaring, atriotomy, and the closure of atrial septal defect under a thoracoscope. Patients were followed up from 3 months to 12 years postoperatively. Results The exclusively MTCST for atrial septal defect closure was successfully performed without any in-hospital mortality in both groups. None of the procedures required an alternative technique for the closure. There were significant learning curves for cardiopulmonary bypass time and operation time. No residual shunt was observed in all patients during the follow-up transthoracic echocardiography at 5-day and 3-month timepoints postoperatively. Conclusions This study demonstrates that an exclusively MTCST for atrial septal defect repair is safe, simple, and minimally invasive. Exclusively MTCST is a new desirable alternative beside robotic-assisted atrial septal defect repair.

Left ventricular diastolic dysfunction is associated with poor prognosis in patients with hypertrophic cardiomyopathy and CHD. We report the case of an infant concomitant with hypertrophic cardiomyopathy, an atrial septal defect, and left ventricular diastolic dysfunction, who was successfully managed with fenestrated closure of the atrial septal defect.

To evaluate the feasibility, safety, and short-term outcomes of transcatheter closure of sinus venosus atrial septal defect (SVASD) using covered stents. We conducted an institutional retrospective analysis of 24 consecutive patients aged 15–70 years with superior SVASD and significant left-to-right shunting (QP/QS ≥ 1.5), who underwent percutaneous closure using covered stents between June 2021 and December 2023. Pre-procedural imaging included transesophageal echocardiography and cardiac Computed Tomography angiography (CTA). Procedural details, technical success, and echocardiographic parameters were recorded. Post-procedural outcomes were assessed with transthoracic echocardiography and/or CTA. The Patients’ median age was 38 years (IQR: 28–53), and 50% were female. Median Atrial Septal Defect (ASD) size was 15 mm (IQR: 11–19), and median QP/QS ratio decreased from 1.8 (IQR: 1.7–1.95) to 1.1 (IQR: 1.0–1.25) after closure ( p  < 0.001). Covered stents were used in all cases, and 13 patients (54.1%) required additional non-covered stent support. Technical success was achieved in 96% of patients, with one case of device embolization requiring surgical intervention. Minor complications occurred in 7 patients (29.1%), including hematoma and asymptomatic thrombosis. No mortality was observed. At 3 months, right ventricular dysfunction and enlargement significantly improved ( p  = 0.004 and p  = 0.001, respectively), while right atrial size remained unchanged ( p  = 0.317). Catheter-based repair of SVASD is feasible, safe, and effective with a low rate of complications. This approach may offer a minimally invasive alternative to surgery in anatomically suitable patients.

To evaluate the safety, short-term and mid-term occlusion performance of the Absnow fully biodegradable atrial septal occluder in pediatric patients. The Absnow Occluder, an innovative fully biodegradable closure for ASD, has shown its safety and effectiveness in initial animal studies and preclinical trials. As one of the participating multicenter research institutions, our organization conducted interventional closure procedures on 10 pediatric patients with atrial septal defects employing the Absnow fully biodegradable occluder between November 2018 and May 2019. Subsequently, we conducted a clinical follow-up spanning 4 years. The immediate success rate of the operation was 100% (10/10). The effective closure rates at immediate, 1 day, 1 month, 3 months, 6 months, 1 year, 2 years, 3 years, and 4 years post-operation were, respectively, 100%, 90%, 100%, 100%, 100%, 100%, 80%, 80%, and 70%. The cumulative incidence of complications at 1 year, 2 years, 3 years, and 4 years post-operation were 0%, 20%, 20%, and 30%, respectively. No severe complications, such as device dislodgment, high-degree atrioventricular block, or vascular complications, occurred during the 4-year follow-up. Nevertheless, two patients experienced substantial residual shunting due to occluder degradation or umbrella displacement, and underwent further intervention. This study further confirmed the short-to-mid-term safety and acceptable efficacy of the Absnow fully biodegradable atrial septal occluder based on a 4-year follow-up. The late-occurring residual shunts with device degradation have an important impact on its long-term efficacy.