Right atrial myxoma associated with atrial septal defect: a case report and review of the literature.

We describe a case of right atrial myxoma with mild cyanosis due to a right-to-left shunt at the atrial level. The patient was a 31-year-old woman with a 10-month history of easy fatigability and shortness of breath. Echocardiography showed a right atrial tumor producing a partial dynamic tricuspid obstruction. Digital subtraction angiography via the superior vena cava disclosed a mass lesion which occupied the right atrium with early visualization of the ascending aorta. Successful excision of the tumor and repair of the atrial septal defect totally relieved her presenting symptoms. In a rare association of a right atrial myxoma with atrial septal defect, preoperative evaluation and operative management are discussed.     

Surgical treatment of infant atrial septal defect: report of two cases

The operation for the isolated secundum type of atrial septal defect (ASD) is usually conducted electively in the older age. Small number of cases, however, inevitably require surgical treatment for the reason of intractable heart failure. We have experienced such two infants with the isolated secundum type of ASD, whose conservative treatment was ineffective.     

Right parasternal minithoracotomy for repair of atrial septal defect

Various surgical approaches for repair of atrial septal defect (ASD) have recently been introduced for superior cosmetic and less invasive results. A technique for repair of isolated ASD through a small right parasternal minithoracotomy is described. In spite of the smaller incision, there is no need to use femoral cannulation or video-assisted endoscopy. This approach is simple, less invasive, and cosmetic. We believe that right parasternal minithoracotomy is a suitable alternative to a median sternotomy for ASD closure, especially in young male patients.     

Robotic atrial septal defect repair and endoscopic treatment of atrial fibrillation

Computer (robotic) enhancement has emerged as a facilitator of minimally invasive cardiac surgery and has been used to perform portions of intracardiac procedures via thoracotomy incisions. This report describes the use of the da Vinci surgical system in two totally endoscopic ("closed chest") cardiac operations: atrial septal defect closure and pulmonary vein isolation of atrial fibrillation. ASD closure: Fifteen patients underwent repair of a secundum-type atrial septal defect or patent foramen ovale by a totally endoscopic approach, utilizing the da Vinci robotic system. Cardiopulmonary bypass (CPB) was achieved peripherally. Cardioplegia was administered via the distal port of the arterial cannula after endoballoon inflation. Via three port incisions in the right chest, the entire operation including pericardiotomy; bicaval occlusion; atriotomy; atrial septopexy; and atrial closure was performed by a surgeon seated at a computer console. A fourth 15 mm port was utilized for suction and suture passage by a patient-side assistant. In one case, a recurrent shunt was identified and repaired on POD 5. Median ICU length of stay (LOS) was 20 hours, and median hospital LOS was 4 days. Atrial fibrillation surgery: This report also describes the pathway that we have pursued in the development of a totally endoscopic operation for atrial fibrillation. Beginning with animal models, we tested various ablative energy sources; methods of ablation; and minimally invasive approaches. This work has led to the development of a variety of minimally invasive surgical approaches including a totally endoscopic, robotically assisted beating heart procedure for the treatment of atrial fibrillation.     

Constrictive pericarditis with atrial septal defect.

We report on a case of constrictive pericarditis (CP) with atrial septal defect (ASD) in a 50-year-old man. The combination of CP with ASD is rare and occasionally difficult to diagnose. Transthoracic echocardiography demonstrated ASD, but the finding of a thickened pericardium was poor. Diagnosis was confirmed by cardiac catheterization. Pericardiectomy and direct closure of ASD was performed during cardioplegic arrest under the support of cardiopulmonary bypass. The postoperative course was uneventful with marked improvement in symptoms.     

Chylopericardium following atrial septal defect repair: case report

Chylopericardium after intrapericardial cardiac operations is extremely rare. We present an unusual case of postoperative chylopericardium with cardiac tamponade following atrial septal defect repair, and we comment on the clinical course and treatment.     

Incidence of atrial flutter/fibrillation in adults with atrial septal defect before and after surgery.

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.     

电视胸腔镜辅助下房间隔缺损修补术36例报告

目的　总结 36例电视胸腔镜下房间隔缺损修补的体外循环方法 ;　方法　 36例房间隔缺损患者 ,采用股动脉和股静脉 ,上腔静脉插管建立体外循环 ,经第七肋置入胸腔镜 ,另选第四肋打两个用作手术操作孔 ,在电视胸腔镜下行房间隔缺损修补 ;　结果　第 1例因体外循环停机后血氧饱和度在80 %～ 88% ,而延长第四肋间切口重新作心内探查 ,其他手术顺利 ,术后无并发症 ;　结论　电视胸腔镜体外循环下行房间隔缺损修补术安全可靠。     

Noonan syndrome associated with atrial septal defect, ventricular septal defect and pulmonary stenosis--a case report

A 10 year old girl with diagnosis of Noonan syndrome was admitted to our hospital because of easy fatiguability and cardiac murmur. She had a peculiar face with hypertelorism, saddle nose, webbed neck and kyphosis. Chromosomal analysis demonstrated normal 46 XX pattern. Associated cardiac anomalies in this case were atrial septal defect, ventricular septal defect and pulmonary stenosis caused by pulmonary valvular dysplasia. The cardiac anomalies were corrected successfully and postoperative clinical course was uneventful.     

Renal cell carcinoma with right atrial extension with associated atrial septal defect: a case report

We present a case of locally advanced renal cell carcinoma with tumor thrombus in the inferior vena-cava extending into the right atrium with associated atrial septal defect. Tumor removal posed a unique challenge in this patient as there was a risk of paradoxical embolism during the surgery.     

A case report of atrial septal defect with quadricuspid pulmonary valve

We reported the successful case of valvuloplasty on the quadriscuspid pulmonary valve which had pulmonary regurgitation. A 38-year-old woman was admitted with the complaint of palpitation. Atrial septal defect and pulmonary regurgitation were revealed preoperatively by the cardiac catheterization and doppler echocardiography. The malcoaptation of the pulmonary valve and pulmonary dilatation were diagnosed in echocardiography. At operation, the pulmonary valve was found quadricuspid and each cusp was same in size. The patient underwent the valvuloplasty on the abnormal cusps and the remarkable improvement of the coaptation was examined postoperatively. The patient had good clinical course for three years after operation.     

Surgical or interventional treatment for adult patients with atrial septal defect and atrial fibrillation: A systemic review and meta-analysis

The prevalence of atrial fibrillation (AFib) in adult patients with atrial septal defect (ASD) who did not undergo ASD repair in the childhood is higher than that in general population. The primary aim of this study is to collect various related articles published in the literature and to compare the clinical outcomes with different treatment strategies by systemic reviews and meta-analyses. Of the 1299 initially screened articles, 13 studies with 213 patients were included in this study. All the patients were adults and the mean age at presentation was 55.7 years (range 34–79 years) and 47.8% of the patients were male. Regarding the types of the AFib, there were paroxysmal AFib in 62 patients, persistent AFib in 40 patients and long-standing persistent AFib in 111 patients. For adult patients with ASD and AFib, ASD closure is beneficial for most of the patients if significant left-to-right shunt exists but risk stratification cannot be overlooked because worsening of the functional class may be experienced by some patients post-operatively, especially for the patients with advanced age (>75 years). Reduction of prevalence of AFib could be observed after ASD closure alone which is mainly effective for paroxysmal AFib but not for persistent or long-standing persistent AFib. The successful ablation rate of paroxysmal AFib by catheter ablation is similar to that of all kinds of AFib by surgical ablation. Regarding AFib recurrence, bi-atrial surgical ablation is better than right-atrial ablation for the adult patients with ASD and AFib.     

Cardiac rhabdomyomas with atrial septal defect and tricuspid insufficiency: A case report

Primary cardiac tumors are very rare and generally benign. The most common type, cardiac rhabdomyoma, comprises 45% to 75% of primary cardiac tumors. Cardiac rhabdomyoma is a rare benign tumor that commonly presents with tuberous sclerosis. We present a case of an infant with multifocal cardiac rhabdomyomas with an atrial septal defect and tricuspid insufficiency and no sign of tuberous sclerosis. She was successfully treated with an operation, the treatment plan included mass resection, tricuspid annuloplasty, and closure of the patent foramen ovale. The right atrial lesion was resected entirely, while the lobulated lesion in the right ventricle was resected as two pieces. There was no evidence of recurrence 1 year after the surgery.     

Right postero-lateral thoracotomy for atrial septal defect closure; a comparative analysis with median sternotomy

Introduction In a low risk procedure like ASD closure Right Posterolateral thoracotomy approach aims at the cosmetic results as compared to median sternotomy. This paper illustrates our approach for a standardised Right Posterolateral thoracotomy in ostium secundum ASD repair and the analysis of the outcome. Methods Right Posterolateral thoracotomy (RPLT) was offered as a cosmetic alternative for atrial septal defect (ASD) closure in children, and selected adult patients below 30 years with lean body build. A retrospective study comparing these patients with median sternotomy approach during the same period (2000–2003) was performed. Exclusion criteria included preoperative diagnosis of complex ASD, obesity and chest wall deformity. Common variables were considered for analysis. Results There were 96 patients (66 females and 30 males) with an average age of 13yrs (range 3 to 27 years) in RPLT group and 225 patients (95 females and 130 males) with average age of 36 years (range 2 to 46 years) in sternotomy group. Extra corporeal time was 32 minutes (28 to 45) and aortic cross clamp time was 14 minutes (8 to 36) in RPLT while the values were 46 minutes (37 to 90) and 22 minutes (18 to 36) in Median sternotomy approach. Blood loss in postoperative period was 160 ml (20 ml to 400 ml) in thoracotomy group compared to 210 ml (40ml to 600 ml) in sternotomy group. There was no mortality or recurrence after repair of ASD during the follow-up. Significant postoperative morbidity was persisting pain and shoulder movement restriction in 12 patients. The scar was cosmetic in RPLT. Conclusion In selected patients with lean body build Right posterolateral thoracotomy is suitable for ostium secundum atrial septal defect closure. The final appearance has definite cosmetic advantage over sternotomy. Presented at the 50^th Annual Meeting of IACTS, New Delhi, Feb., 2004.