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Concept: Ventricular septal defect

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Several complications have been reported regarding the percutaneous closure of secondary atrial septal defects such as erosion, thromboembolic events, arrhythmias, and endocarditis. In this report, we describe the case of a 75-year-old woman who underwent percutaneous closure of a secondary atrial septal defect with a 12 mm Amplatzer septal occluder. Six months after the uneventful implantation of the device, we manifested an asymptomatic late embolization of the device in the abdominal aorta. The device was surgically retrieved.

Concepts: Surgery, Report, Abdominal aorta, Crystallographic defect, Ventricular septal defect, Atrial septal defect, Levo-Transposition of the great arteries, Cardiac shunt

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Ventricular septal defects (VSD) are the most common subtype of congenital heart defects (CHD) and are estimated to account for 20 to 30% of all cases of CHD. The etiology of isolated VSD remains poorly understood. Eight core aminoacyl-tRNA synthetases (ARSs) (EPRS, MARS, QARS, RARS, IARS, LARS, KARS, and DARS) combine with three nonenzymatic components to form a complex known as the multisynthetase complex (MSC). Four single nucleotide polymorphisms (SNPs) in EPRS have been reported to be associated with risks of CHD in Chinese populations.

Concepts: DNA, China, Han Chinese, People's Republic of China, Overseas Chinese, Ventricular septal defect, Qing Dynasty, World population

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Background: Atrial fibrosis or fatty deposition is known to increase the propensity for the development of atrial fibrillation (AF). Apart from the pulmonic veins, the interatrial septum (IAS) might play a role in the maintenance of AF. In contrast to left atrial anatomy and adjacent veins, the IAS cannot be visualized in detail with computed tomography. Thus, preprocedural transesophageal echocardiography (TEE) may provide important morphologic information beyond exclusion from atrial thrombi. Methods: The study comprised 108 consecutive patients (mean age 60 ± 11 years; 98 men). AF was paroxysmal in 91 (84%) and persistent in 17 (16%) patients. We investigated the morphological characteristics of the IAS by TEE in patients who underwent radiofrequency ablation of AF. Results: The IAS was structurally abnormal in 46 (43%) patients, showing the following echocardiograhic findings: atrial septal hypermobility or aneurysm (n = 27) associated with a patent foramen ovale (PFO) (n = 11) or with a small atrial septal defect (ASD) (n = 2), a septal flap associated with a PFO or an ASD (n = 8), and an abnormally thickened IAS (n = 12). A thrombus in the left atrial appendage was discovered in only 2 (2%) patients. Conclusions: A structurally abnormal IAS was diagnosed in nearly half of the patients undergoing ablation therapy for AF. The information obtained by TEE is mandatory to exclude left atrial thrombi prior the ablation procedure. Moreover, detailed knowledge of morphologic characteristics of the IAS facilitates an optimized and safe performance of the transseptal puncture using long sheaths with large diameters.

Concepts: Cardiology, Atrial fibrillation, Ventricular septal defect, Atrial septal defect, Foramen ovale, Eisenmenger's syndrome, Interatrial septum, Left atrium

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Abstract Objective. In general the analytical epidemiological studies evaluated cases with congenital heart defects together. However, different congenital heart defect entities have different etiology, and in the vast majority of patients the underlying causes are unclear. Thus the objective of the study was to evaluate the possible etiological factors in the origin of single ventricular septal defect (VSD) after surgical intervention or lethal outcome, i.e. as homogeneous as possible. Method. In the population-based large dataset of the Hungarian Case-Control Surveillance of Congenital Abnormalities acute and chronic maternal diseases with related drug treatments and pregnancy supplements in early pregnancy were evaluated in the mothers of 1,661 cases with isolated/single VSD and their 2,534 matched and 38,151 all controls without defect, and 19,833 malformed controls with other isolated non-cardiac defect. Results. There was a higher risk of VSD in the children of mothers with high fever related influenza during the critical period of VSD and this risk was limited by antifever therapy. In addition paroxysmal supraventricular tachycardia and epilepsy treated with anticonvulsant drugs associated with higher risk of VSD. Finally the high doses of folic acid alone in early pregnancy Conclusions. H high fever related maternal diseases may have a role in the origin of VSD which is preventable with antifever drug therapy, and the high doses of folic acid in early pregnancy were able to reduce the risk of VSD.

Concepts: Epidemiology, Down syndrome, Congenital heart defect, Congenital heart disease, Ventricular septal defect

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Background. Device closure of atrial septal defect (ASD) and patent foramen ovale (PFO) are both associated with short- and long-term complications. Our knowledge of the complication rates of ASD and PFO closure is limited. Our objective was to review the peri-procedural and long-term complications of ASD and PFO closure. Methods. Medline, EMBASE, and Scopus databases were searched between 1973 and 2012. A total of 28142 patients from 203 case series were included. Of these 203 articles, 111 were reporting ASD closure, 61 were reporting PFO closure, and 31 were reporting both. Pooled incidence rates of cardiac complications were calculated separately for peri-procedural and at follow-up. Results. Peri-procedural major complications were reported from 0% to 9.4%, with a pooled estimate rate of 1.4% (95% CI: 1.3% to 1.6%). It was 1.6% (95% CI, 1.4-1.8) in ASD group, 1.1% (95% CI, 0.9-1.3) in PFO group, and 1.3% (95% CI, 0.9-1.9) in ASD/PFO group. The most common major complication was the device embolization requiring surgery. Peri-procedural minor complications were reported with a pooled estimate rate of 1.4% (95% CI, 1.2-1.7). It was 1.6% (95% CI, 1.2-2.1) in ASD group, 1.3% (95% CI, 1.0-1.7) in PFO group, and 1.5% (95% CI, 1.1-1.2.1) in ASD/PFO group. The most frequent major complications at follow-up were cerebrovascular events (1.3% (95% CI: 1.1% to 1.6%)) and device thrombosis (1.2% (95% CI: 1.0% to 1.4%)). Both were more frequent in PFO group. Conclusion. Device closure of ASD and PFO are associated with non-negligible serious complications, both in early and long-term. © 2013 Wiley Periodicals, Inc.

Concepts: Ventricular septal defect, Atrial septal defect, Foramen ovale, Ostium primum

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This study concerns the morphological differentiation between double outlet right ventricle (DORV) and aortic dextroposition (AD) defects, namely tetralogy of Fallot and Eisenmenger anomaly. Indeed, despite the similar condition in terms of sequential ventriculo-arterial connections, DORV and AD are two distinct morphological entities. It is proposed that the borderline between these two groups of malformations is represented by the specific insertion of the infundibular septum into the left anterior cranial division of the septomarginal trabeculation (or septal band) occurring in ADs and lacking in DORV. Furthermore, the spiraliform versus straight parallel arrangement of the great arteries in the two groups of anomalies is emphasized as an additional and distinctive morphological feature. Emphasis is also given to the association of straight parallel great arteries conotruncal malformations, DORV and transposition of the great arteries, with the asplenia type of heterotaxy laterality defects. Within this context, the absence of subaortic ventricular septal defect and concomitantly of spiraliform great arteries in the asplenia group of heterotaxy anomalies, as detected by this study, further substantiates our belief of not mixing collectively the ADs with the DORV in clinico-pathological diagnosis. Anat Rec, 00:000-000, 2013. © 2013 Wiley Periodicals, Inc.

Concepts: Heart, Left ventricle, Congenital heart disease, Tetralogy of Fallot, Ventricular septal defect, Atrial septal defect, Transposition of the great vessels, Double outlet right ventricle

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Iatrogenic erosion of the septum primum after foramen ovale closure is an anecdotal event. We report the case of a 39-year-old woman admitted to our institution for multifocal cryptogenic cerebral ischemia and a patent foramen ovale (PFO) associated with an aneurysm of the septum primum. The patient underwent percutaneous closure of the PFO with an Amplatzer PFO Occluder device. At the 6-months follow up, the device was in the right position, but a jagged defect of the septum primum and evidence of significant left-to-right shunting was detected. The atrial septal defect was then repaired by a surgical approach. Although this event is not life-threatening, it should be considered as a therapeutic pitfall, resulting in a risk of paradoxical embolism recurrences and long-term hemodynamic impairment. © 2013 Wiley Periodicals, Inc.

Concepts: Ventricular septal defect, Atrial septal defect, Foramen ovale, Ostium primum, Cardiac shunt

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The aim of this retrospective study was to compare the short-term outcomes of surgical versus transcatheter closure of secundum atrial septal defect (ASD) in adults.

Concepts: Surgery, Ventricular septal defect, Atrial septal defect

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We report here the indications and the results of a surgical option associating a Damus procedure with a ‘Réparation à l'Etage Ventriculaire’ (REV)/Rastelli procedure, for anatomical repair of patients presenting with complex transposition of great arteries (TGA), restrictive/remote ventricular septal defect (VSD) and pulmonary stenosis (PS). Five consecutive patients (median age: 11 months (range: 20 days to 15 years)) presenting with complex TGA-VSD-PS and anatomical lesions resulting in a contraindication to a Nikaidoh procedure were included. Two of them presented with a postoperative restrictive left ventricle-to-aorta baffle and secondarily underwent a modified Damus procedure a few days after the REV or Rastelli procedure. In the other 3 patients, the Damus procedure was primarily performed at the time of the REV or Rastelli procedure. No death occurred. At the last follow-up (mean: 31 ± 37 months), all patients displayed an excellent functional status and an unobstructed left ventricular outflow tract in echocardiography. Associating a Damus procedure with a REV/Rastelli procedure can be considered as an effective and low-risk surgical option to extend the indications for anatomical repair in patients with complex TGA-VSD-PS and anatomical findings precluding other surgical options.

Concepts: Heart, Surgery, Physician, Hypertrophic cardiomyopathy, Congenital heart disease, Ventricular septal defect, Transposition of the great vessels, The Rev

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Clinical outcomes for transcatheter and operative closures of atrial septal defects (ASDs) are similar. Economic cost for each method has not been well described.

Concepts: Ventricular septal defect, Atrial septal defect, Foramen ovale, Ostium primum, Ostium secundum