Atrial Septal Defect in Adults: Thirty-eight-year Follow-up of a Surgically and a Conservatively Managed Group

This report describes the long-term (up to 38 years) outcome, in terms of mortality and cardiovascular morbidity, in a non-randomized clinical observation study of a surgically and a conservatively managed group of adult patients with shunt lesions at atrial level. Haemodynamic status was assessed at baseline and at repeat examination. Twelve patients underwent surgical repair of the lesion between these two heart catheterizations, resulting in a marked reduction in heart size and right ventricular systolic pressure. These changes were associated with improvement in functional class and a trend towards less risk of cerebrovascular incidents, but not atrial fibrillation, during follow-up. Among 12 patients not operated on between catheterizations, symptomatic deterioration was common, often necessitating later surgical repair. The results support the assumption that early surgery should be recommended for adults with a haemodynamically significant lesion, to reduce the risk of mortality and prevent symptomatic deterioration.     

Prediction of atrial fibrillation in patients with severe mitral stenosis—role of atrial contribution to ventricular filling

Objective—Atrial contribution to ventricular filling was studied to assess its role in predicting the future development of atrial fibrillation (AF) in patients with severe mitral stenosis (MS) and sinus rhythm.

Design—Two hundred and eight patients with severe MS and sinus rhythm were followed up for 1 year. Baseline data were compared between group I (who developed AF at follow‐up) and group II (who maintained sinus rhythm). Left atrial size, severity of MS, velocity time integral (VTI) of mitral valve flow and VTI due to atrial systole (A‐VTI) were noted. Percentage contribution of A‐VTI to the total VTI (A‐%) was calculated. Sensitivity and specificity of A‐% to predict the onset of AF was obtained.

Results—Left atrial size, severity of MS and total VTI were similar in the two groups. Group I patients were older (31.1?±?9.1 and 18.4?±?6.5 years, respectively, p?<?0.03) with smaller A‐VTI (5.3?±?2.2 and 6.7?± 3.4?cm, respectively, p?<?0.01) and A‐% (8.9?±?1.8 and 11.2?±?2.7, respectively, p?<?0.003). A‐% of <9% (mean value of A‐VTI in group I) had high sensitivity (84%, positive predictive value 76%) and specificity (80%, negative predictive value 87%) to predict the development of AF.

Conclusion—Atrial contribution to ventricular filling is reduced in patients prone to develop AF (due to inefficient left atrial contraction, much before its dilatation). It can be used for early identification of patients likely to develop AF with high sensitivity and specificity. It is simple, easily available, cost‐effective and will guide earlier intervention and more frequent follow‐up. There is a preclinical loss in atrial pump function much before the eventual onset of AF.     

A case of abdominal bleeding after mitral valvuloplasty assisted by da Vinci robotic surgery

A 66-year-old female patient was admitted with abdominal bleeding as an unexpected complication of robotic surgery. Assessments included the patient's medical history, physical examination, laboratory data, and abdominal ultrasound scan results. In our case, laparotomy revealed an injury to the diaphragm and liver of the patient caused by the previous robotic surgery. In conclusion, although abdominal bleeding is a rare condition, it should be taken into consideration as a complication of robotic cardiac surgery.