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PubMed2002

Acute stress disorder symptoms in children and their parents after pediatric traffic injury.

OBJECTIVE: The American Academy of Pediatrics highlights the important role of pediatricians in recognizing adverse child responses to tragic events, such as traffic crashes. One challenge in effectively identifying children and their parents with troubling psychological responses to trauma is that little is known about the normal range of acute psychological responses in children and their parents in the immediate aftermath of traumatic events, making identification of adverse child responses difficult. Within the first month after a traumatic event, individuals may display reexperiencing, avoidance, and hyperarousal symptoms as well as dissociation (eg, feelings of unreality or emotional numbing). The presence of these responses, collectively known as acute stress disorder (ASD), alerts providers to those who may be at risk for ongoing difficulties. For beginning to develop an evidence base to guide pediatric care providers in addressing acute traumatic responses, the aim of the current investigation was to describe systematically the range and type of symptoms of ASD in children and their parents after pediatric traffic injury. METHODS: A prospective cohort study was conducted of traffic-injured children, who were 5 to 17 years of age and admitted to the hospital for treatment of injuries from traffic crashes, and their parents. All children who met eligibility criteria between July 1999 and May 2000 were invited to participate in the study. After consent/assent was obtained, children and their custodial parents (or guardians) were interviewed within 1 month after injury via a structured assessment to determine the circumstances of the crash and the presence of ASD symptoms. Relevant demographic and clinical information (eg, age, race, gender, date of injury) was abstracted from the medical records of subjects. A survey instrument to assess the presence of ASD symptoms was completed by both the child and his or her guardian. All children completed the Child Acute Stress Questionnaire, and all parents completed the Stanford Acute Stress Reaction Questionnaire. Responses were scored for the presence of dissociation, reexperiencing, avoidance, and/or hyperarousal symptoms as well as broad distress (symptoms present in every category). RESULTS: Symptoms of ASD were commonly observed in the children and parents. Eighty-eight percent of children and 83% of parents reported having at least 1 clinically significant symptom; this affected 90% of the families. Broad distress was observed for a large minority: 28% of children and 23% of parents. No statistically significant association was found between child broad distress and either child age (r = -0.12) or child injury severity score (r = -0.05). chi(2) analyses revealed no significant association between broad distress and child gender, child race, or mechanism of injury. No statistically significant association was found between parent broad distress and child age (r = -0.06) or child injury severity score (r = 0.09). chi(2) analyses revealed no significant association between parent broad distress and child gender or parent presence at the crash scene. Associations were found between parent broad distress and race in that fewer white parents reported broad distress. In addition, mechanism of injury was associated with parent broad distress: more parents reported broad distress when their children were involved in pedestrian-motor vehicle crashes, and fewer parents reported broad distress when their children were injured in a bicycle fall. CONCLUSIONS: Pediatric care providers can expect to see some ASD symptoms in most children and parents in the immediate aftermath of traffic-related injury. Brief education is appropriate to explain that these symptoms are normal reactions that are likely to resolve. If symptoms persist for >1 month or are particularly distressing in their intensity, then referral for psychological care may be necessary for treatment of posttraumatic stress disorder. Given the high prevalence of pediatric traffic crashes and the underdiagnosis of posttraumatic stress disorder, probing for recent crash exposure might be appropriate during routine child health maintenance. The following are recommendations for pediatricians: 1) routinely call the family several days and 1 to 2 weeks after a traffic injury and ask about behavioral symptoms and family function; 2) make use of the ongoing physician-patient relationship to explore symptom presence and intensity and any functional impairment in the injured child; a brief office visit with the child and parents could serve this purpose; 3) be sure to explore the effect that the child's injury has had on the family; remember that the parent's experience posttraumatic stress symptoms after pediatric traffic-related injuries and these symptoms may limit the parent's ability to support the child; 4) provide supportive care and give families the opportunity to discuss the crash and their current feelings; do not force families to talk about the crash; 5) although any child in a traffic crash or his or her parent is at risk for posttraumatic symptomatology, regardless of injury severity, particular attention should be paid to the parents of child pedestrians who are struck by motor vehicles. These parents experience posttraumatic symptoms more commonly than parents of children in other traffic crashes.

Accidents, Traffic↗
PubMed2026

Genomic landscape of autism spectrum disorder in Brazil.

Genomic studies of autism spectrum disorder (ASD) have largely excluded admixed populations. To address this gap, we characterized the genomic landscape of ASD in Brazil by combining a systematic literature review with whole-exome sequencing analysis of 441 Brazilian individuals and their families. Our analysis revealed a conclusive molecular diagnosis in 13.1% of probands. The diagnostic yield was higher among individuals with clinical features, particularly comorbid signs of intellectual disability, hypotonia, and seizures, providing a basis for prioritizing genetic testing. The sample presented a diverse ancestry, with major European, African, and Native American contributions. Notably, more than half of the identified rare risk variants were located on non-European haplotypes. Both de novo and inherited variants contributed to ASD risk, and we reinforce NPAS3 as a candidate ASD risk gene. This study provides the first comprehensive genomic overview of ASD in a large Brazilian cohort, reinforcing the critical need to include diversely admixed populations in genomic research to expand the understanding of ASD architecture and improve diagnostic strategies in resource-limited settings.

Journal Article↗
PubMed1977

Pulmonary arterial pressure-flow characteristics in atrial septal defect: comparative study with ventricular septal defect and patent ductus arteriosus.

Pulmonary arterial pressure-flow relation was studied in 142 patients with artrial septal defect (ASD) and was compared with that of 139 patients with ventricular septal defect (VSD) and was compared with that of ductus arteriosus (PDA). The incidence of pulmonary arterial mean pressure (PAm) over 25 mmHg was 21 percent in ASD, 36 percent in VSD and 43 percent in PDA, and that over 40 mmHg was 3 percent, 23 percent and 19 percent, respectively. Large left to right shunt over 50 percent was found more frequently in ASD (58 percent) than in VSD (22 percent) and PDA (30 percent). When patients were separated into 2 groups at a PAm of 40 mmHg, lower pressure group showed a positive correlation between PAm and left-to-right shunt in each disease, although the correlation was poor in ASD (r equals 0.23) as compared with VSD (r equals 0.49) and PDA (r equals 0.47). The slope of the regression line was less steep in ASD (0.08) than in VSD (0.17) and PDA (0.14). It is considered that pulmonary hypertension in ASD develops on the basis of pulmonary vascular changes caused by prolonged hyperkinetic circulation.

Adolescent↗
PubMed2003

Acute Stress Disorder in physical assault victims visiting a Danish emergency ward.

UNLABELLED: The purpose of this article is to assess the prevalence of Acute Stress Disorder (ASD) following violent assault in victims who come to the emergency ward, and compare the effects with degrees of injury. Two hundred and fourteen victims of violence completed a questionnaire 1 to 2 weeks after the assault. Measures included the Harvard Trauma Questionnaire, the Trauma Symptom Checklist and the Crisis Support Scale. RESULTS: Twenty-four percent met the full ASD diagnosis and 21% a subclinical ASD diagnosis. Childhood sexual and physical abuse and shock due to a traumatic event that happened to someone close increased the likelihood of ASD four to ten times. Feeling of security and ability to express feelings reduced the likelihood of ASD by one-quarter, while feeling let down by others and hopelessness increased the likelihood of ASD respectively 1.4 and 2.6 times.

Acute Disease↗
PubMed1999

[Percutaneous closure of ostium secundum atrial septal defects using the Amplatz device. Preliminary study on 29 patients].

The aim of the study was to assess the results of percutaneous closure of ostium secundum atrial septal defects (ASD) by the Amplatz device and to compare them with those obtained by other methods. Over a one year period, closure of ASD was performed in 28 patients aged 7 to 66 years (mean of 32 years) with exclusive left-to-right shunts. The selection of patients was made by transthoracic echocardiography. Cardiac catheterisation was performed to measure the stretched diameter of the defect. After patient or parental consent, the procedure was performed under general anaesthesia. The implantation was performed under transoesophageal echocardiographic control. The diameter of the Amplatz device corresponded to the stretched diameter of the ASD. The patients were discharged from hospital 48 hours later under platelet anti-aggregant therapy for 6 months. Clinical, electrocardiographic, radiological and echocardiographic examinations were performed at 1 month, 3 months and 1 year after implantation. The stretched diameter was 12-27 mm (mean 22 mm). The device was withdrawn in one case because of a double ASD and, in another patient, failure was due to embolisation of the obturator to the pulmonary artery before its implantation. The closure was complete in 21 of the 26 cases immediately after the procedure; at one month, two residual shunts were observed but they had disappeared at 3 months and at 1 year. Out of 46 ASD closed by the Sidéris button prosthesis, occlusion was total in 29 cases and partial in 17 cases. The authors conclude that the Amplatz device is an effective prosthesis for closure of ostium secundum ASD. With strict selection procedures, the results are excellent.

Adolescent↗
PubMed2000

A prospective study of psychophysiological arousal, acute stress disorder, and posttraumatic stress disorder.

This study investigated the role of acute arousal in the development of posttraumatic stress disorder (PTSD). Hospitalized motor-vehicle-accident survivors (n = 146) were assessed for acute stress disorder (ASD) within 1 month of the trauma and were reassessed (n = 113) for PTSD 6 months posttrauma. Heart rate (HR) and blood pressure (BP) were assessed on the day of hospital discharge. Participants with subclinical ASD had higher HR than those with ASD and no ASD. Participants who developed PTSD had higher HR in the acute posttrauma phase than those without PTSD. Diagnosis of ASD and resting HR accounted for 36% of the variance of the number of PTSD symptoms. A formula composed of a diagnosis of ASD or a resting HR of > 90 beats per minute possessed strong sensitivity (88%) and specificity (85%) in predicting PTSD. These findings are discussed in terms of acute arousal and longer term adaptation to trauma.

Accidents, Traffic↗
PubMed2000

Totally endoscopic atrial septal defect closure using robotic techniques: report of two cases.

BACKGROUND: The development of minimally invasive cardiac surgery has shown good clinical results with shorter recovery time and better cosmetic results. We report 2 cases of totally endoscopic atrial septal defect (ASD) closure using a robotic system. Open-heart closure of an ASD without opening the chest has never been previously reported. METHODS: Following percutaneous cannulation for cardiopulmonary bypass, aortic occlusion and delivery of cardioplegia, 2 patients with an ASD were successfully operated on using a robotic surgical device. After exclusion of the right lung, two robotic arms and an endoscopic camera were inserted through ports in the right hemithorax. A fourth port was inserted for an accessory endoscopic instrument. The ASD closure was carried out with interrupted stitches in one case and with a continuous suture in the other. RESULTS: Cardiopulmonary bypass and cardioplegic arrest times were respectively 130 and 75 min in the first and 87 and 60 min in the second case. Extubation was carried out 3 and 5 hours postoperatively. Both patients resumed a totally normal lifestyle 1 week after the operation. CONCLUSIONS: Totally endoscopic open-heart ASD closure can be carried out safely using robotic techniques with rapid postoperative recovery and excellent cosmetic results. This modality of treatment can be considered an alternative to the transcatheter closure of ASD.

Female↗
PubMedDate not supplied

Transcatheter closure of secundum atrial septal defects, a ventricular septal defect, and a patent arterial duct.

We report our clinical experience with the newly developed Amplatzer device in transcatheter closure of nine atrial septal defects (ASDs), one ventricular septal defect (VSD), and one patent arterial duct (PDA). Eleven patients with ASD (age range 2.5-18 years) selected according to the location and size of the defect by transesophageal echocardiography (TEE), a five-year-old patient with muscular VSD and a one-year-old patient with PDA were considered for transcatheter closure with Amplatzer devices. All procedures were performed under general anesthesia with fluoroscopic and TEE guidance, following a routine hemodynamic evaluation in the catheter laboratory. The optimal device size was selected after the balloon sizing of the ASDs. The sizes of the VSD and PDA were measured on TEE and angiography. The patients were discharged at 24 hours, after an evaluation with x-ray, electrocardiogram (ECG), and echocardiography; they were on 3-5 mg/kg/day aspirin and infective endocarditis prophylaxis for six months after the procedure. They were reassessed at six to eight weeks and Holter monitoring was done in addition. Devices were used for nine ASD patients, and for the VSD and the PDA patients. Mean ASD size was 14.3 +/- 5.3 mm at TEE and 18.3 +/- 4.3 mm at balloon sizing (p=0.02). The mean size of the device was 18.7 +/- 4.2 mm. The procedure time and the fluoroscopy time were 46.1 +/- 12.3 and 12.9 +/- 1.6 minutes, respectively. Immediately after the procedure, four patients (44%) had trivial shunts (TS). TS remained in only two during discharge, and no shunt was observed at second evaluation. The devices were similarly applied to VSD (12-7 mm) and PDA (8-6 mm) patients. Both cases had TS immediately, which disappeared at 24 hours. None of the patients had major complications. Junctional rhythm developed in one patient, and another patient had frequent supraventricular extrasystoles. Amplatzer is an effective and safe device for transcatheter closure of ASD, VSD, or PDA, especially in pediatric patients.

Adolescent↗
PubMed2002

[Good results after closure of a arterial septal defect during heart catheterisation instead of surgery].

OBJECTIVE: Evaluation of the first results in the Netherlands of percutaneous and transvenous closure of an ASD II in children with an Amplatzer Septal Occluder (ASO). DESIGN: Prospective. METHOD: Data were collected from children with an ASD II prior to, during and up to 24 months after the insertion of an ASO during heart catheterisation in Leiden University Hospital, the Netherlands. RESULTS: Between 1 January 1998 and 29 February 2000, 28 patients (12 girls, 16 boys; mean age: 74 months (range: 15-198 months)) underwent heart catheterisation to close an ASD II with an ASO. In 26 patients an ASO could be placed without significant complications. The size of the device varied from 9-34 mm (median 16 mm). In one patient ASD closure was not attempted because of multiple ASDs. In another patient the procedure was stopped after air embolism into the coronary arteries had occurred during preparation of ASO implantation. In 23/26 patients with an implanted ASO, no residual shunt was present after 24 hours. One child, in whom the defect was found to be closed after 24 hours and after three weeks, returned abroad and was lost to follow-up. After one year all defects (n = 22) were completely closed. CONCLUSION: Percutaneous transvenous closure of an ASD II with an ASO was possible, was not associated with any significant complications and had a high success rate, even in relatively young children with large defects.

Adolescent↗
PubMed2001

The influence of tubule density and area of solid dentin on bond strength of two adhesive systems to dentin.

PURPOSE: To determine the correlation between the tubule density (TD) and the area occupied by solid dentin (ASD) with the bond strength of one conventional and one self-etching adhesive system to dentin. MATERIALS AND METHODS: The crown of extracted human third molars was transversally sectioned with a diamond saw to expose either superficial, middle, or deep dentin. The three groups of dentin surfaces were randomly divided and bonded with either Clearfil Liner Bond 2V (LB) or Prime & Bond 2.1 (PB) adhesive systems according to manufacturer's directions. Resin composite buildup crowns (10.0 mm high) were incrementally constructed on the bonded surfaces and the teeth stored in water at 37 degrees C. After 24 h of storage, the teeth were vertically, serially sectioned in both x and y directions to obtain several bonded sticks of approximately 0.7 mm2 cross-sectional area. Each stick was tested in tension in a EMIC DL-500 tester at 0.5 mm/min until failure. After testing, the dentin side of the fractured specimen was gently abraded with a 1000-grit SiC paper, etched with 37% phosphoric acid for 15 s and allowed to air dry. SEM micrographs at 1000x and 4000x magnification were taken to permit calculation of the TD (number of tubules/mm2) and ASD (% of total area) at the site of fracture. Correlation between TD and ASD with the bond strength data was performed by linear regression. All statistical analysis was done with alpha = 0.05. RESULTS: Overall bond strength (MPa) for LB was 26.0 +/- 10.2, and 42.6 +/- 15.2 for PB. There was a significant direct relationship between bond strength and ASD for both materials (r2 = 0.20, p < 0.05 and r2 = 0.66, p < 0.01, respectively for LB and PB). PB bond strength dropped significantly as the TD increased (r2 = 0.63, p < 0.05), while LB was not sensitive to TD (r2 = 0.05, p > 0.05). Mean bond strength of PB was significantly higher than LB for both superficial and middle dentin (p < 0.05), while there was no significant difference for deep dentin (p > 0.05). CONCLUSION: Regional variations in TD and ASD may modify bond strength of both conventional and self-etching adhesive systems. Bonding sites with larger ASD seem to yield higher bond strengths regardless of the type of adhesive system used.

Acetone↗
PubMed2002

Transcatheter closure of secundum atrial septal defect using an Amplatzer septal occluder.

OBJECTIVE: To evaluate the safety and efficacy of the Amplatzer septal occluder for transcatheter closure in patients with secundum atrial septal defect (ASD II). METHODS: Patients with clinically confirmed ASD II were recommended for transcatheter closure of ASD II. RESULTS: 30 ASD II patients (20 females) underwent transcatheter closure at a median age of 18.4 years (5-55 years). Both the stretched diameters of ASDs and the sizes of the devices were from 18 to 34 mm (25 +/- 7 mm). The successful placement rate was 100%. The rest shunt documented by color Doppler, was immediately after implantation in 40% of patients, in 9.9% after 24 hours, and in 3.3% trace at 3 months. No serious complications were observed. There was improvement in symptoms and in cardiac size. Septal motion abnormalities normalized in all patients after 3 months follow-up. CONCLUSION: The Amplatzer septal occluder is a safe and effective device for transcatheter closure of ASD II. Long-term follow-up is still required before widespread clinical use can be recommended.

Adolescent↗
PubMed2001

Adrenal C19 steroids and serum lipoprotein levels in healthy men.

BACKGROUND AND AIM: It has become apparent that dehydroepiandrosterone (DHEA) plays a protective role in atherosclerosis, but its influence on serum lipids has not yet been clarified. The aim of this study was to evaluate the association of endogenous adrenal C19 steroid hormones [(DHEA) and androstenedione (ASD)] and serum lipoprotein levels. METHODS AND RESULTS: The serum concentrations of dehydroepiandrosterone sulphate (DHEA-S), ASD, total and free testosterone, estradiol, total cholesterol, LDL-cholesterol (LDL-C), HDL-cholesterol (HDL-C), triglycerides, apolipoprotein AI (ApoAI) and apolipoprotein B100 (ApoB100) were measured in a sample of 88 healthy men. Statistical analysis using Spearman's correlation coefficient showed a positive correlation between DHEA-S levels and ApoAI (p = 0.034), a negative correlation between ASD and triglycerides (p = 0.005), a positive correlation between ASD and LDL-C (p = 0.005), and a negative correlation between estradiol and HDL-C (p = 0.042). Multiple regression analysis revealed that DHEA-S is an independent factor for ApoAI, ASD an independent factor for triglycerides and LDL-C, and age an independent factor for ApoB100; estradiol was found to be a suggestive factor for HDL. CONCLUSIONS: The results suggest that the plasma levels of DHEA-S and ASD (adrenal C19 steroid hormones) correlate with the plasma lipid profiles of healthy men. It remains to be seen whether this profile is favourable.

Adult↗
PubMed2002

[Bone marrow accumulation in gallium scintigraphy in patients with adult Still's disease].

We investigated the features and the usefulness of gallium scintigraphy in the diagnosis and the assessment of Adult Still's disease (ASD) by retrospective case review. Gallium scintigraphy have been done for 11 cases of ASD (3 males and 8 females) and 4 females were positive. Among these, 67 Ga-citrate was accumulated to the bone marrow in all 4 cases and to the major joints in 2 cases. Positive cases were rather serious and administered more immunosuppressants than negative cases. In order to characterize gallium scintigraphy findings of ASD, i.e. bone marrow accumulation, we analyzed 130 cases of collagen vascular diseases. Although 101 cases (77.7%) were positive, only 7 cases (5.4%) showed the accumulation of 67Ga-citrate to the bone marrow. These include 3 cases with ASD, and 1 case with systemic lupus erythematosus, polyarteritis nodosa, Wegener's granulomatosis and Sjögren's syndrome. We also accumulated 18 patients who exhibited bone marrow accumulation of 67Ga-citrate, and found that 7 patients had collagen vascular and their related diseases. In conclusion, bone marrow accumulation in gallium scintigraphy is a specific feature of collagen vascular diseases, especially ASD, and it is suggested that cases with positive gallium scintigraphy in ASD can be serious and resistant to treatment.

Adult↗
PubMedDate not supplied

[Residual postoperative murmurs in children with congenital heart defects].

Fifty-four children without postoperative complications were admitted to the Department of Pediatrics, University Hospital Rebro, following a complete surgical correction of ventricular septal defect (VSD), atrial septal defect - secundum type (ASD II) and patent ductus arteriosus (PDA) in the period from June, 1989, to February, 1991. Twenty-two patients were treated surgically for VSD, 17 for ASD II and 15 for PDA. There were 23 male and 31 female children. In the early postoperative period, 57% of all the examinees had a murmur with the innocent or functional characteristics. The murmur was significantly more frequent among children with VSD than among children of other groups (ASD II, PDA). Sex, age and hematocrit did not influence this difference. There were 8 anemic children (3 with operated VSD, 4 with ASD II, and 1 with PDA). From this, it may be concluded that anemia also did not cause this difference. However, anemic children represented 50% of the examinees with a murmur among the operated for ASD II and 33% among those treated surgically for PDA. When these anemic children were eliminated, the others operated on for ASD II and PDA probably had the innocent murmurs, since the proportion of examinees with a murmur fits into the incidence of innocent murmurs in the population. The children operated for VSD have had a greater proportion of examinees with a murmur, and most likely, some of these murmurs do not belong to a group of innocent or functional murmurs. Their cause is unknown, as yet (probably, small organic lesion).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

[Identification and early diagnosis of the autistic spectrum disorders].

AIM: To review the empirical evidence and recommendations for early identification and diagnosis of autistic spectrum disorders (ASD). DEVELOPMENT: ASD often remains unrecognized and undiagnosed until late preschool age. A significant delay of almost 3 years was reported between parents' initial concerns about their child and the age of diagnosis. Some research provides further evidence that signs of ASD are evident in the first 2 years of life. The importance of early diagnosis is that it opens the door to early intervention programs which are essentials for the future of these children. Early diagnosis can be facilitated most effectively if early detection is made possible. Progress has recently been made in the earlier identification of children with ASD. Recent researches have identified early behavioural difficulties in social reciprocity, joint attention, theory of mind, gaze engagement, social referencing and hypersensitivity to sound. Professionals need to be aware and sensitive to these behavioural patterns. Their identification would increase the likelihood of a reliable early diagnosis. CONCLUSIONS: At present, it is possible to make earlier diagnosis of ASD. It is important that health and education professionals in childhood know several early manifestations of ASD.

Child↗
PubMed1992

[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.

Child, Preschool↗
PubMed2005

Iatrogenic cardiac arrhythmias following transcatheter or surgical closure of atrial septal defect in children.

BACKGROUND: Invasive procedures involving the atria may promote the development of iatrogenic cardiac arrhythmias. AIM: To analyse the prevalence of cardiac arrhythmias following transcatheter or cardiosurgical closure of the secundum type atrial septal defect (ASD). METHODS: The study group consisted of 91 patients, aged 2-18 years with haemodynamically significant ASD who underwent surgical (n=44) or transcatheter (Amplatzer occluder) (n=47) closure of ASD. Standard ECG and Holter ECG recordings, obtained before and after the procedure, were analysed. The follow-up duration ranged from 2.5 to 5.5 years. Cardiac arrhythmias were divided into benign or significant (requiring pharmacological therapy), early or late, and transient or permanent. RESULTS: Cardiac arrhythmias were detected in 16 (36%) patients who underwent surgery compared with 1 (2.1%) patient who underwent transcatheter ASD closure (p<0.05). In surgically treated patients, arrhythmias were benign in 9 patients, significant in 7 children, early in 15 subjects, late in one patient, transient in 13 children and permanent in 3 subjects. One patient, who underwent transcatheter ASD closure, developed paroxysmal supraventricular tachycardia one day after the procedure, successfully terminated with verapamil. CONCLUSIONS: Transcatheter closure of ASD is associated with a lower risk of procedure-related arrhythmias than surgical treatment. However, longer follow-up in patients treated with transcatheter procedure is needed in order to draw definite conclusions.

Adolescent↗
PubMed2005

Usefulness of transesophageal echocardiography for transcatheter closure of ostium secundum atrial septum defect with the amplatzer septal occluder.

BACKGROUND: Transcatheter closure of ostium secundum atrial septum defect (ASDII) using the new self-centering occluder, Amplatzer Septal Occluder (ASO), has been well developed in recent years. We describe the importance and role of transesophageal echocardiography (TEE) in the selection and closure of such defects. METHODS: Thirty patients referred for transcatheter closure of ASDII by ASO were enrolled in this study. During catheterization, two-dimensional TEE was performed on all patients during and after transcatheter closure. ASD size and morphology were assessed by TEE before catheterization. The ASD stretched diameter was also measured by TEE and fluoroscopy. RESULTS: With the aid of TEE, transcatheter closure of an ASD was successfully, safely and effectively performed on 29 patients. The mean ASD diameter determined by TEE was 17.4 +/- 4.8 mm. The mean stretched diameters measured by TEE and fluoroscopy were 18.7 +/- 5.6 mm and 17.9 +/- 5.5 mm, respectively. The mean device diameter was 19 +/- 5.6 mm. Immediate complete closure was documented by color Doppler TEE in 29 patients. Complications were encountered in one patient, with the device becoming dislodged into the main pulmonary artery. The device was retrieved by surgery and the defect was repaired in the operating room. CONCLUSIONS: Transcatheter closure of ASDs using an Amplatzer device is feasible, safe and effective. Two-dimensional TEE can provide useful information before, during and after transcatheter closure of ASDs.

Adolescent↗