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Felix Berger - One of the best experts on this subject based on the ideXlab platform.
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Atrial Septal Defect waiting for symptoms remains an unsolved medical anachronism
European Heart Journal, 2011Co-Authors: Felix Berger, Peter EwertAbstract:This editorial refers to ‘Benefit of Atrial Septal Defect closure in adults: impact of age’[†][1], by M. Humenberger et al ., on page 553 During the past decade a ‘more modern’ natural history of Atrial Septal Defect (ASD) in adults has been written, but still the ASD remains by far the most underdiagnosed congenital heart disease in the adult age group. The moment of diagnosis within the adult population is mostly tantamount to the initiation of treatment. Due to the superiority of closure of the Defect over medical treatment alone,1 the consequence is closure either by intervention in selected patients or by surgery for all unselected or at least for the remaining patients not treatable by intervention. Meanwhile supported by direct comparison of the two methods, interventional treatment in selected patients has been accepted as the standard treatment and the treatment of choice due to its lesser invasiveness and lower complication rate.2,3 The study by Humenberger et al. 4 shows nicely in a relatively large cohort of adult patients with an age range of 20–80 years that the Defects were able to be closed successfully by intervention regardless of age, with excellent results and no significant complications. New York Heart Association functional class improved in almost all patients and rapid right ventricular remodelling occurred with a statistically significant improvement in right ventricular measurements and a decrease in pulmonary artery (PA) pressure levels in those with formerly elevated pressures and resistances. The authors again affirm the findings of numerous publications during the past decade and also uniformly … [1]: #fn-2
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aortic sinus left Atrial fistula after interventional closure of Atrial Septal Defect
Catheterization and Cardiovascular Interventions, 2005Co-Authors: Walter Knirsch, Ali Dodgekhatami, Christian Balmer, Matthias Peuster, Alexander Kadner, Markus Weiss, Rene Pretre, Felix BergerAbstract:A 3-year-old boy underwent interventional closure of an Atrial Septal Defect using an Amplatzer Septal occluder. After 4 weeks, an aortic sinus-to-left Atrial fistula was detected by echocardiography in an asymptomatic child. The device was surgically explanted with fistula and Atrial Septal Defect closure. Follow-up was uneventful.
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incidence of Atrial flutter fibrillation in adults with Atrial Septal Defect before and after surgery
The Annals of Thoracic Surgery, 1999Co-Authors: Felix Berger, Michael Vogel, Andrea Kramer, Vladimir Aleximeskishvili, Yugo Weng, Peter E Lange, Roland HetzerAbstract:Abstract Background . There is controversy about the benefit of surgical repair for Atrial Septal Defect in adults, especially its effect on the incidence of supraventricular dysrhythmias, Atrial flutter and fibrillation. We studied their incidence before and after operation. Methods . We examined surface and 24-hour Holter electrocardiograms before, early (between 3 and 7 days), and late (more than 6 months) after operation, performed at age 42.2 years (range, 18.5 to 74.9 years), in 211 adults with Atrial Septal Defect. Patients were arbitrarily divided into three groups: age 18 to 40 years (n = 101), age 40 to 60 years (n = 83), and age more than 60 years (n = 27). All consecutive patients operated on between January 1988 and December 1996 and having a pulmonary to systemic flow ratio of 1.5:1 or greater were included in this study. Results . The age of patients without arrhythmias before or after Atrial Septal Defect closure (39 ± 13 years) was significantly lower than that of patients with flutter (54 ± 12 years) or fibrillation (59 ± 8 years). The incidence of Atrial flutter was influenced by surgical repair as Atrial flutter converted to sinus rhythm late after operation in 10 of 18 patients. However, there was no change in the incidence of Atrial fibrillation before (n = 28) and after (n = 21) operation. Conclusions . Our data show that surgical correction of Atrial Septal Defect leads to regression of the incidence of Atrial flutter but not fibrillation. Thus, surgical repair of Atrial Septal Defect to abolish supraventricular tachyarrhythmias in adults is warranted, but in patients with fibrillation, it may have to be combined with a Maze operation in the future.
Robert L. Geggel - One of the best experts on this subject based on the ideXlab platform.
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clinical detection of hemodynamically significant isolated secundum Atrial Septal Defect
The Journal of Pediatrics, 2017Co-Authors: Robert L. GeggelAbstract:The diagnosis of secundum Atrial Septal Defect often is delayed. For 310 patients with hemodynamically significant secundum Atrial Septal Defect undergoing closure over a 5-year period at a single medical center, this study reviews the symptoms prompting referral, limitations of physical examination and electrocardiography, and basis for initially missing the diagnosis.
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Possible new autosomal recessive syndrome of lymphedema, hydroceles, Atrial Septal Defect, and characteristic facial changes.
American Journal of Medical Genetics, 1996Co-Authors: Mira B. Irons, Robert L. Geggel, Gerald R. Marx, Diana W Bianchi, Ina BhanAbstract:We describe two brothers with congenital lymphedema of lower limbs, Atrial Septal Defect (ASD), and similar facial appearance. A sister had severe hydrops fetalis, ASD, omphalocele, and other anomalies. This combination of congenital lymphedema and ASD differs from other reported cases of congenital lymphedema and most likely constitutes a previously unrecognized autosomal recessive syndrome.
Thomas R Lloyd - One of the best experts on this subject based on the ideXlab platform.
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international experience with secundum Atrial Septal Defect occlusion by the buttoned device
American Heart Journal, 1994Co-Authors: Eleftherios B Sideris, Gerd Hausdort, Ann Worms, Francois Bourlon, M Khalilullah, Eustaquio Onorato, Thomas R Lloyd, Robert H. Beekman, Jorge HaddadAbstract:Abstract Several devices are available for transcatheter occlusion of Atrial Septal Defect. This report describes the international experience with the buttoned device. During a 4.5-year period ending in February 1993, 180 transcatheter Atrial Septal Defect occlusions were performed with the buttoned device. Patient age varied between 0.6 and 76 years and stretched Atrial Defect diameter between 5 and 25 mm. The Defects were closed with 25 to 50 mm devices delivered through 8F (148 patients) or 9F (32 patients) sheaths. Twelve patients were adults whose Defects were closed to prevent recurrence of cerebrovascular accidents caused by presumed paradoxic embolism. In the remaining patients the Atrial Defect was closed to treat the left-to-right shunt. The Atrial Septal Defects were effectively occluded as demonstrated by (1) decrease in pulmonary-to-systemic flow ratio from 2.1 ± 0.6 (mean ± SD) to 1.05 ± 0.1 (p
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international experience with secundum Atrial Septal Defect occlusion by the buttoned device
American Heart Journal, 1994Co-Authors: Syamasundar P Rao, Eleftherios B Sideris, Gerd Hausdort, Ann Worms, Francois Bourlon, Thomas R Lloyd, Robert H. Beekman, C Rey, Eustaquio OnoratoAbstract:Several devices are available for transcatheter occlusion of Atrial Septal Defect. This report describes the international experience with the buttoned device. During a 4.5-year period ending in February 1993, 180 transcatheter Atrial Septal Defect occlusions were performed with the buttoned device. Patient age varied between 0.6 and 76 years and stretched Atrial Defect diameter between 5 and 25 mm. The Defects were closed with 25 to 50 mm devices delivered through 8F (148 patients) or 9F (32 patients) sheaths. Twelve patients were adults whose Defects were closed to prevent recurrence of cerebrovascular accidents caused by presumed paradoxic embolism. In the remaining patients the Atrial Defect was closed to treat the left-to-right shunt. The Atrial Septal Defects were effectively occluded as demonstrated by (1) decrease in pulmonary-to-systemic flow ratio from 2.1 +/- 0.6 (mean +/- SD) to 1.05 +/- 0.1 (p < 0.01) by oximetry; (2) normalized S2 and disappearance of the diastolic murmur by auscultation; and (3) improvement in right ventricular volume overloading by echocardiogram. However, trivial to small shunts could be detected by color Doppler studies in 76 (45%) of 168 patients in whom such data are available. Complications included unbuttoning in 13 and whole-device embolization in 1. All patients remained stable, and retrieval of the device and surgical closure of the Atrial Septal Defect were accomplished in 10 patients. Transcatheter retrieval was used in the remaining 4 patients. The incidence of unbuttoning, a major complication of the procedure, appeared to decrease with the increasing experience of the investigators and with device modification (third-generation). The follow-up duration varied between 1 month and 4 years. Six patients required surgery during the follow-up period. In the remaining patients (n = 160), clinical examination did not reveal signs of Atrial shunts. Color Doppler studies revealed either complete disappearance of the previously demonstrated shunts or further diminution of their size. The results indicate that transcatheter occlusion of the Atrial Septal Defects with buttoned devices is feasible, relatively safe, and effective, and it appears to be a viable alternative to surgery for some patients with secundum Atrial Septal Defect. Complications are infrequent and should improve with experience.
Matthew E. Schwinger - One of the best experts on this subject based on the ideXlab platform.
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Transesophageal echocardiography is superior to transthoracic echocardiography in the diagnosis of sinus venosus Atrial Septal Defect
Journal of the American College of Cardiology, 1991Co-Authors: Itzhak Kronzon, Naresh Trehan, Paul A. Tunick, Robin S. Freedberg, Barry P. Rosenzweig, Matthew E. SchwingerAbstract:The purpose of this study was to compare transthoracic and transesophageal echocardiography in the diagnosis of various types of Atrial Septal Defects. Forty-one adult patients with the clinical diagnosis of Atrial Septal Defect were studied by transthoracic and transesophageal echocardiography (30 women, 11 men; 18 to 81 years of age). Transthoracic echocardiography demonstrated the Atrial Septal Defect in 33 patients (secundum type in 28, primum type in 3 and sinus venosus type in 2). Transesophageal echocardiography demonstrated the Defect in all 41 patients. Thus, in 8 (20%) of 41 patients the Atrial Septal Defect was demonstrated by transesophageal and not by transthoracic echocardiography. Six of the eight had a sinus venosus type Atrial Septal Defect; the other two patients had a secundum Atrial Septal Defect (one of these two had a technically poor transthoracic echocardiogram and the other had a small Atrial Septal Defect). Transthoracic echocardiography, therefore, failed to demonstrate the sinus venosus Defect in six (75%) of eight patients. An anomalous venous connection associated with the sinus venosus Defect was visualized by transesophageal echocardiography in seven of the eight patients but was not seen on transthoracic echocardiography in any patient. Sinus venosus type Atrial Septal Defects are frequently not visualized in adults by conventional transthoracic echocardiography. Transesophageal echocardiography is recommended when an Atrial Septal Defect is clinically suspected but cannot be visualized by transthoracic echocardiography.
Eleftherios B Sideris - One of the best experts on this subject based on the ideXlab platform.
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transcatheter patch closure of an Atrial Septal Defect of sinus venosus type using the immediate release patch
Catheterization and Cardiovascular Interventions, 2015Co-Authors: Jennifer Franke, Eleftherios B Sideris, Stefan C Bertog, Ilona Hofmann, Nina Wunderlich, Marius Hornung, Horst SievertAbstract:Following promising preclinical studies, we report our first clinical experience with transcatheter closure of an Atrial Septal Defect of sinus venosus type in a 65-year-old patient using the Immediate Release Patch. © 2015 Wiley Periodicals, Inc.
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international experience with secundum Atrial Septal Defect occlusion by the buttoned device
American Heart Journal, 1994Co-Authors: Eleftherios B Sideris, Gerd Hausdort, Ann Worms, Francois Bourlon, M Khalilullah, Eustaquio Onorato, Thomas R Lloyd, Robert H. Beekman, Jorge HaddadAbstract:Abstract Several devices are available for transcatheter occlusion of Atrial Septal Defect. This report describes the international experience with the buttoned device. During a 4.5-year period ending in February 1993, 180 transcatheter Atrial Septal Defect occlusions were performed with the buttoned device. Patient age varied between 0.6 and 76 years and stretched Atrial Defect diameter between 5 and 25 mm. The Defects were closed with 25 to 50 mm devices delivered through 8F (148 patients) or 9F (32 patients) sheaths. Twelve patients were adults whose Defects were closed to prevent recurrence of cerebrovascular accidents caused by presumed paradoxic embolism. In the remaining patients the Atrial Defect was closed to treat the left-to-right shunt. The Atrial Septal Defects were effectively occluded as demonstrated by (1) decrease in pulmonary-to-systemic flow ratio from 2.1 ± 0.6 (mean ± SD) to 1.05 ± 0.1 (p
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international experience with secundum Atrial Septal Defect occlusion by the buttoned device
American Heart Journal, 1994Co-Authors: Syamasundar P Rao, Eleftherios B Sideris, Gerd Hausdort, Ann Worms, Francois Bourlon, Thomas R Lloyd, Robert H. Beekman, C Rey, Eustaquio OnoratoAbstract:Several devices are available for transcatheter occlusion of Atrial Septal Defect. This report describes the international experience with the buttoned device. During a 4.5-year period ending in February 1993, 180 transcatheter Atrial Septal Defect occlusions were performed with the buttoned device. Patient age varied between 0.6 and 76 years and stretched Atrial Defect diameter between 5 and 25 mm. The Defects were closed with 25 to 50 mm devices delivered through 8F (148 patients) or 9F (32 patients) sheaths. Twelve patients were adults whose Defects were closed to prevent recurrence of cerebrovascular accidents caused by presumed paradoxic embolism. In the remaining patients the Atrial Defect was closed to treat the left-to-right shunt. The Atrial Septal Defects were effectively occluded as demonstrated by (1) decrease in pulmonary-to-systemic flow ratio from 2.1 +/- 0.6 (mean +/- SD) to 1.05 +/- 0.1 (p < 0.01) by oximetry; (2) normalized S2 and disappearance of the diastolic murmur by auscultation; and (3) improvement in right ventricular volume overloading by echocardiogram. However, trivial to small shunts could be detected by color Doppler studies in 76 (45%) of 168 patients in whom such data are available. Complications included unbuttoning in 13 and whole-device embolization in 1. All patients remained stable, and retrieval of the device and surgical closure of the Atrial Septal Defect were accomplished in 10 patients. Transcatheter retrieval was used in the remaining 4 patients. The incidence of unbuttoning, a major complication of the procedure, appeared to decrease with the increasing experience of the investigators and with device modification (third-generation). The follow-up duration varied between 1 month and 4 years. Six patients required surgery during the follow-up period. In the remaining patients (n = 160), clinical examination did not reveal signs of Atrial shunts. Color Doppler studies revealed either complete disappearance of the previously demonstrated shunts or further diminution of their size. The results indicate that transcatheter occlusion of the Atrial Septal Defects with buttoned devices is feasible, relatively safe, and effective, and it appears to be a viable alternative to surgery for some patients with secundum Atrial Septal Defect. Complications are infrequent and should improve with experience.
