A case of left atrial myxoma associated with atrial septal defect

Cardiac myxoma is the most frequent primary tumor of the heart. However, it is rarely associated with congenital cardiac anomalies such as atrial septal defect in the literature. We present a 72-year-old woman referred to the emergency department with loss of consciousness and finally diagnosed as a pedinculated mobile left atrial myxoma and concomitant occurrence of an ostium secundum type atrial septal defect. The mass was successfully excised, and atrial septal defect was safely repaired by primary suture. The patient is currently well after surgery. Atrial myxoma should be considered in the differential diagnosis when patients present with neurological consequences of systemic embolization.     

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.     

A case of pericardial cyst associated with atrial septal defect

A 51-year-old woman with an abnormal shadow in the right upper mediastinum and systolic heart murmur was diagnosed as mediastinal cyst and atrial septal defect (ASD). Before the operation, the cyst was suspected as bronchogenic cyst or cystic thymoma based on the findings by CT and NMR. Both cystectomy and closure of ASD was successfully performed and the cyst was diagnosed as pericardial cyst by pathological examination. A brief of literature on the pericardial cyst is given.     

Atrial septal defect associated with von Willebrand's disease--a case report]

Von Willebrand's disease is common hemorrhagic disorder that deserves particular attention in the patient undergoing open-heart surgery, because of perioperative unexpected bleeding. The present case is atrial septal defect associated with Willebrand's disease, affecting a 19-year-old female who has the past history of bleeding tendency with frequent subcutaneous bleeding. It is mandatory to maintain adequate levels of both factor VIII coagulation and ristocetin cofactor activities during the perioperative period. An infusion study of heat-treated evaluate the response and half-life of both factor VIII coagulation and ristocetin cofactor activities; and to calculate the effective dose and duration of the drug action as well as to formulate a protocol for patient's management in the perioperative periods in order for the surgical intervention to be performed uneventfully. Our case demonstrated that it is possible to perform an open heart surgery in patients with von Willebrand's disease without major bleeding as far as the levels of both factor VIII coagulation and ristocetin cofactor activities are maintained above 50% in the postoperative critical period.     

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.     

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 of tricuspid pouch associated with ventricular septal defect and functional left ventricular-right atrial communication]

We reported a 60-year-old woman with tricuspid pouch associated with ventricular septal defect and subsequent left ventricular-right atrial communication. Preoperative angiographic findings suggested the presence of membranous septal aneurysm, ventricular and atrial septal defects, and tricuspid insufficiency. However, at operation, besides perimembranous inlet type ventricular septal defect, a pouch, 1.5 cm in diameter was found in the adjacent part to the septal leaflet within the anterior one of the tricuspid valve. The ventricular septal defect was closed with a patch. From these findings, it is speculated that the tricuspid pouch was formed by the effect of jet stream through the ventricular septal defect.     

A case of cor triatriatum with atrial septal defect in an adult]

A surgical treatment of a 54 year-old female with cor triatriatum was reported. Two dimensional echocardiography had demonstrated an abnormal septum in the left atrium. The abnormal septum had a 2 x 1 cm fenestration and existed between the left and right pulmonary veins. Preoperatively, we had misjudged the septum as ASD and misdiagnosed this case as PAPVC. During surgery we found that there was the accessory atrial chamber posterior to the true ASD. The accessory chamber received right pulmonary veins and connected to the left atrium. The left pulmonary veins connected to the left atrium normally behind the abnormal septum. We diagnosed this case as Lucas-Shmidt IIIA1 type cor triatriatum with ASD. The abnormal septum was resected, and the ASD was closed with a bovine pericardium. The postoperative course was uneventful and she was discharged 19 days after the operation.     

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 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.     

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.     

A surgical case of atrial septal defect with myotonic dystrophy

A case report is presented of a 16-year-old woman with myotonic dystrophy, who required open-heart surgery for an atrial septal defect. We successfully repaired an atrial septal defect using normothermic cardiopulmonary bypass and electrically maintained ventricular fibrillation. Anesthesia using fentanyl, vecronium and isoflurane was uneventful and there were no postoperative complications. Anesthetic agents must be selected with care, and ventilation requires meticulous attention.     

A case report: successful direct closure of atrial septal defect in isolated right ventricular hypoplasia]

We experienced a surgery for an isolated right ventricular hypoplasia with atrial septal defect (ASD). The patient, 3 1/2-year-old girl, underwent direct closure of ASD. Preoperatively right ventricular end diastolic volume was 18 ml or 22 ml including trabecular portion by angiocardiographic examination. It was almost a half of normal. We performed intraoperative ASD occlusion test using a Foley 12 F balloon catheter before surgical closure of ASD. Postoperatively, mild right pleural effusion was found, but it disappeared soon with a use of diuretics. ASD occlusion test was safe and useful for estimating surgical closure of ASD. Postoperative cardiac catheterization revealed slight increase of right atrial pressure. It is necessary to follow up her condition carefully.     

Surgical treatment for mitral regurgitation associated with secundum atrial septal defect]

We reviewed 25 patients who underwent a mitral valvuloplasty, from 1984 to 1996, for mitral regurgitation (MR) associated with atrial septal defect (ASD). Mean grade of MR was 2.3 +/- 0.7. The locations of mitral valve lesion were as follows; Postero-medial side of the anterior leaflet (AML) (11 patients: 44%), posteromedial side to center of the AML (7 patients: 28%), whole of the AML (5 patients: 20%), center of the AML (1 patient: 4%), posteromedial side of the posterior leaflet (PML) (1 patient: 4%). In summary, the mitral valve lesion was located in the AML in 96% patients and were seen in the postero-medial side of 96% patients. Mitral valve repair was performed as follows; chordae shortening only (3 patients: 12%), chordae shortening + Kay's annuloplasty (9 patients: 36%), Kay's anuloplasty (10 patients: 40%), using artificial chordae only (1 patient: 4%), using artificial chordae + Kay's annuloplasty (1 patient: 4%), using artificial chordae + ring annuloplasty (1 patient: 4%). In 24 patients, the grade of MR was less than 2/4 in the early postoperative period. In one patient, the grade of 3/4 MR was still remained. Reoperation were required in 2 patients, because of gradual increase of MR, 9 years and 10 years after the initial operation, respectively. In another patient, the grade 3/4 MR recurrently occurred at 6 months after the operation. He has been well maintained medically. In all 4 patients who had more than the grade 3/4 MR postoperatively, the annuloplasty was performed with Kay's method and the cause of MR was poor coaptation around the center of the AML. The mitral valve lesion associated with ASD seemed to be the dislocation of the AML which cause the discrepancy of the coaptation zone between both leaflets, without any prominent prolapse and chordae elongation. We put a particular emphasis on that the mitral valve repair should be performed with the recognition of the etiology of the mitral valve lesion. Especially, if the lesion extends around the center of the AML, sufficient coaptation area of both leaflets at the center of the AML should be obtained by anuloplasty.