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PubMed1983

[Atrial septal defect of the ostium secundum associated with incomplete left bundle branch block].

The ECG in Ostium Secundum Atrial Septal Defect (O.S. ASD) shows typically a pattern of incomplete right bundle branch block with right axis deviation and a 12 year old boy suspected of having O.S. ASD on the basis of x-ray and echocardiographic findings showed an ECG pattern of incomplete left bundle branch block. Physical examination and a phonocardiogram revealed a single second heart sound. An ECG recorded at age five showed a typical pattern consistent with O.S. ASD. The angiographic examination confirmed the suggested diagnosis. This is, to our knowledge, the first case of O.S. ASD with incomplete left bundle branch block. The conduction disorder may have abolished the fixed splitting of the second heart sound.

Bundle-Branch Block↗
PubMed1983

[Quantification of atrial septal defects of the secundum type by subcostal 2-dimensional echocardiography].

Visualization of the interatrial septum (IAS) was most consistently achieved by subcostal 2-dimensional echocardiography (s2-DE) as compared with the apical and parasternal view. This approach also enabled a quantitative assessment of isolated atrial septal defects of secundum type (ASD II). The study group consisted of 33 children aged 5-14, mean 8 years, with ASD II (2 patent foramina ovale) and normal pulmonary vascular resistance. A good correlation was demonstrated between the end-diastolic diameter of the defect measured by s2-DE and left-to-right shunt determined by the Fick principle (r = 0.89). With respect to the endsystolic diameter of the defect, the correlation was less favourable (r = 0.76). This may be explained by the greater variability of the maximal defect in size in end-systole determined frame-by-frame. In conclusion, the size of an ASD II can be evaluated with accuracy by s2-DE. School children with isolated ASD II and diameters larger than 15 mm, corresponding to a 40% left-to-right shunt, will need surgical closure. However, surgery is not indicated in defects less than 11 mm and shunts smaller than 30%. In questionable cases we would be in favour of surgical closure.

Adolescent↗
PubMed1982

[Comparison of 2-d-echocardiographic and hemodynamic findings in patients with atrial and ventricular septal defects (author's transl)].

57 patients (age 2 to 79 years) with atrial septal defect and 28 patients (age 1 month to 60 years) with ventricular septal defect were examined to find out whether the 2-d-echo allows to predict the shunt flow and the hemodynamic parameters of the pulmonary system. In 96% of the patients with asd, the defect could be demonstrated in the subcostal view. In 68% of the patients with vsd, the defect was shown in the long axis or the subcostal view. There was a low correlation between the size of the defect and the quotient of pulmonary to systemic flow (for asd: r = 0.73; for vsd: r = 0.62). Also, the quotient of pulmonary to systemic flow related rather poorly to the quotient of pulmonary artery diameter to aortic diameter as determined in th short axis (for asdii: r = 0.75; for vsd: r = 0.73). Nor relation could be found between echocardiographic parameters and pulmonary artery pressure with one exception: if contrast-echocardiography revealed a right-to-left shunt in patients with vsd, the pulmonary pressure exceeded the systemic pressure by 50%. The results show that in patients with asd or vsd the hemodynamic situation cannot be exactly judged from echocardiographic findings alone. The consideration of several echocardiographic parameters, however, seems to allow a distinction between hemodynamically relevant and irrelevant defects, which might be helpful for clinical purposes. For patients with asd, a shunt volume of minor importance (Qp:Qs less than 1.5:1) is found if the defect does not exceed 35% of the atrial septum length and if the quotient of pulmonary to aortic diameter is less than 1. In patients with vsd, the demonstration of the defect itself and a quotient of pulmonary to aortic diameter larger than 1 means that a shunt volume with Qp:Qs greater than 1.5:1 can be expected. Unsatisfactory results concerning the pulmonary pressure are obtained even when applying the contrast-echocardiography.

Adolescent↗
PubMed1982

[Ostium secundum type of interatrial septal defect associated with cleft mitral valve].

Eight patients (7 females and one male) ranging in age from 6 to 30 years (mean 11.2 years), with secundum-type atrial septal defect (o.s. ASD) and cleft mitral valve (CVM) were surgically corrected at the Cardiac Surgery Department of Massa Hospital (Massa-Italy) from 1974 to 1981. All patients were studied with non invasive diagnostic techniques and with cardiac catheterization and angiography. All had mitral regurgitation of variable degree. On the ECG, there were P and QRS wave abnormalities but no superior quadrant QRS axis deviation suggestive of endocardial cushion defect. At operation the cleft(s) was found in variable positions: on the anterior leaflet in 4 cases and on the posterior leaflet in four. In two cases there was a double cleft. Correction was accomplished in 5 cases with direct repair of CVM, associated with various types of anuloplasty and in 2 cases anuloplasty only was done, without suturing the cleft. The septal defect was closed by direct suture in one case and with a Dacron patch in the remaining seven. There was one early death in the first 24 hour post-operatively. The seven surviving patients have been followed for a period of time ranging between 2 and 93 months (mean 29 months). No survivor has been re-evaluated by cardiac catheterization and cineangiography. No patient shows clinical or non-invasive evidence of residual mitral regurgitation behind grade I (slight). We conclude that: 1) the CVM associated with o.s. ASD cannot be securely diagnosed preoperatively with the common diagnostic techniques, even when producing severe mitral regurgitation, except perhaps by B-mode echocardiography; 2) the CVM (part of the spectrum of endocardial cushion defect malformations) in no cases was associated with the typical ECG or angiocardiographic abnormalities; 3) the CVM associated with o.s. ASD should always be repaired because, compared to the CVM that occurs with endocardial cushion defects, its site and regurgitation characteristics are variable, and simple ASD closure may not be sufficient.

Adolescent↗
PubMedDate not supplied

[Measurement of tricuspid transvalvular flow by M-mode echocardiography and its application in the calculation of the A-V shunt in interatrial communication].

Previous studies have demonstrated that it is possible to measure the cardiac output by M-mode echocardiography (M-echo), using the echogram of the mitral (MV) or aortic valves. In this communication we pretend to demonstrate the possibility of calculating the right cardiac output by the echocardiographic image of the tricuspid valve (TV). We studied patients with atrial septal defects (ASD) because the anatomic and physiologic conditions allowed us to obtain a complete record of the TV. The study was done in a prospective form with 12 patients with isolated ASD, without pulmonary hypertension, cases with ostiumprimum were excluded. The measure of stroke volume of the MV and TV was made using Rasmussen's formula and mechanic planimetric measure of the diastolic opening area of both valves. For the TV area calculation it was considered that the area of the posterior valve was similar to the septal valve and the area of the last one was multiplicated by 2, in this form we obtained the value of the whole TV. For confirmation of the reliability of this method, we studied 8 healthy subjects for the comparison of the mitral and tricuspid flows. The velocity of the transvalvular flow was obtained by measuring the D-E slope. The correlation between MV and TV flows was good in healthy subjects (r = 0.957). Similar results were obtained with the areas of MV and TV in the same group (r = 0.971). In patients with ASD, the comparison between Rasmussen's method and the planimetric method showed that the value of TV increased higher than the MV values. The difference is most important between the areas. The correlation of the cardiac output calculated by the Fick method and M-echo was not significative. The defective output determined by catheterization and M-echo showed a significative correlation (r = 0.793). It is possible the quantitation of the right ventricle output by M-echo, this technic is useful because it shows the hemodynamic conditions of patients with ASD, and it is possible the measure the TV flow, and probably it will be useful in patients with other congenital heart disease with left right shunts.

Adult↗
PubMed1981

[Diagnosis of atrial left-to-right shunts by cross-sectional contrast echocardiography (author's transl)].

We have used cross-sectional contrast echocardiography with peripheral venous injection in 3 groups of patients: A) 23 patients with atrial septal defect (ASD); B) 19 patients with various forms of heart disease, but no evidence of ASD; C) 11 patients with proven interatrial communication, but no significant left-to-right shunt. The contrast studies were performed with a mechanical sector scanner and were evaluated retrospectively but "blindly", i.e. without knowing the patient's name and diagnosis and without knowing that part of the echocardiogram, which had been recorded before injecting contrast. The sound track of the video recorder was turned off. Left-to-right atrial shunting could be demonstrated in 20/23 (87%) patients with ASD, and in all 14 patients in whom both the parasternal and the apical examination technique had been used. The left-to-right shunt was seen as a stream of contrast-free blood flowing from the left atrium into the right atrium and washing away the contrast echoes at the site of the defect. This "negative contrast" or "wash-out" effect was accompanied by turbulences in the right atrium. All 22 patients with this sign had interatrial communications, but interestingly there were 2 patients in whom no definite left-to-right shunt could be demonstrated by oxymetry. Thus the "wash-out" phenomenon seems to be specific for a defect, but not necessarily a significant left-to-right shunt. Right-to-left atrial shunts were diagnosed in 65% of the ASD group. A left-to-right or right-to-left shunt was never diagnosed in any of the control patients. Seemingly turbulent blood flow, the intermittent appearance of contrast-free blood (presumably from the coronary sinus or the inferior vena cava) in the right atrium and a "wash-out" effect at the site of the entry of the inferior vena cava are potential sources of error. However, our blind analysis has shown that these pitfalls can be avoided.

Diagnosis, Differential↗
PubMed1981

[A simple method for enhancing interatrial right-to-left shunt in the diagnosis of small atrial septal defect using contrast echocardiography (author's transl)].

Commonly used contrast echocardiography is often inadequate to detect a small right-to-left (R--L) shunt in minimum atrial septal defect (ASD). We found that the diagnostic accuracy in ASD could be significantly improved by simply employing a Valsalva maneuver immediately followed by a Müller maneuver to enhance the R--L shunt. This procedure enabled contrast echo to be more clearly detected in both the left atrium and left ventricle, compared with conventional contrast echocardiography. The new technique was successful in diagnosing ASD in 5 patients with Qp/Qs ratio less than 2 determined by right heart cardiac catheterization. In conclusion, the diagnosis of a small ASD is greatly improved by simply employing this new procedure of a Valsalva-Müller maneuver during contrast echocardiography.

Adult↗
PubMed1995

[A case of recurrent constrictive pericarditis complicated with atrial septal defect].

A case of recurrent constrictive pericarditis complicated with atrial septal defect (ASD) was operated successfully at our institute. ASD was missed at the time of the first operation. The combination of ASD and constrictive pericarditis is rare and this case is the fifth reported one in Japan. Difficulty in diagnosis of ASD and operative procedure for recurrent constrictive pericarditis are described and discussed.

Heart Septal Defects, Atrial↗
PubMed1993

Cross-linking of lipopolysaccharide (LPS) to CD14 on THP-1 cells mediated by LPS-binding protein.

Recent work has established that bacterial endotoxin (LPS) binds to the plasma protein LPS-binding protein (LBP) forming high affinity complexes (LPS-LBP), that LBP is an opsonin for LPS-bearing particles, and that LPS-LBP complexes are potent agonists for monocytic cells (MO). mAb to the MO plasma membrane protein, CD14, inhibit LBP-dependent binding of LPS to MO, and LPS-LBP-dependent stimulation of cytokine release from MO. These data suggest that CD14 functions as a membrane receptor for LPS but do not demonstrate a direct association of LPS with CD14. Calcitriol was used to induce a high level of CD14 expression in the human monocyte-like cell line THP-1, resulting in enhanced responses of these cells to LPS-LBP complexes manifested by enhanced binding of LPS and a decrease in the amount of LPS needed to induce IL-8 release. An Re595 LPS derivative containing a radioiodinated, photoreactive, phenyl azide (125I-ASD-LPS) was used in cross-linking experiments to identify membrane proteins in calcitriol-treated THP-1 cells that interact with LPS. 125I-ASD-LPS was added to calcitriol-induced THP-1 cells in the presence or absence of LBP, the mixture photolyzed, and the resultant radioiodinated proteins analyzed by SDS-PAGE and autoradiography. We observed strong cross-linking of 125I-ASD-LPS to a 55-kDa membrane protein when LBP was present, but failed to observe radiolabeling of any other proteins with apparent molecular masses distinct from CD14. The cross-linked product was identified as CD14 by immunoprecipitation with anti-human CD14 mAb. Studies with human CD14 expressing transfectants of the murine B cell line 70Z/3 also revealed LBP-dependent cross-linking of 125I-ASD-LPS to CD14. These data document binding of LPS to a specific membrane protein that serves as an LPS receptor.

Acute-Phase Proteins↗
PubMed1994

Total preservation of chordae tendinae in mitral valve replacement (MVR).

Chordal papillary integrity is crucial for a good left ventricular performance following mitral valve surgery. From June 1991-July 1993 (2 years), 200 mitral surgeries were performed by the authors out of which MVR were done by preserving all chordae tendineae in 36 patients (18%), ages 11-64 years (mean 36 +/- 13.2 SD), female to male ratio 3:1, New York Heart Association (NYHA) functional class III-IV. Preoperative workup revealed pure mitral stenosis (MS) in 12 patients (33%), mitral regurgitation (MR) in 16 (44%), MS + MR in 7 (19%), MS + aortic regurgitation (AR) in 4 (11%), MR + secundum atrial septal defect (ASD) in 2 (6%), MR + primum ASD in 1, MR + coronary artery disease (CAD) in 1 (3%) and moderate to severe pulmonary hypertension in all. Twenty-two patients (61%) had MVR only, 4 (11%) had MVR + aortic valve replacement (AVR), 10 (29%) had MVR + tricuspid annuloplasty (TVA), MVR + secundum ASD closure in 2 (6%), MVR+primum ASD closure in 1 (3%) and MVR + coronary artery bypass grafting (CABG) in 1 (3%). Bioprosthesis used were: St. Vincents 17 (47%) and Carpentier Edwards 2 (6%). Mechanical valves used were: St. Jude's 1 (3%), Bjork-Shiley 2 (6%), St. Vincents 5 (14%), CarboMedics 9 (25%). Success of the procedure were accomplished in all (100%) and was judged by extubation period of 6-18 hours, decreased pulmonary artery pressure, good prosthetic function and adequate ventricular performance by subsequent echocardiographic assessments. There were no early (< 30 days) mortality. All patients showed NYHA functional class I-II except in one with Marfan syndrome.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

[Surgical management for atrial septal defect secundum in aged patients].

Between 1989 and 1992, atrial septal defect secundum (ASD) were closed in 8 patients aged 51 to 77 years with the use of cardiopulmonary bypass. The notable characteristics in our cases were; 1) All but one had slight or moderate left to right shunt ratios. Although pulmonary hypertension was present, the obstructive pulmonary vascular change had not progressed so far. 2) Atrial fibrillation was present in 6 patients (75%) and some other cardiac lesions (atrioventricular insufficiency, ischemic heart disease, intracardiac anomaly) coexisted with ASD in a high frequency. And surgical procedures other than ASD closure were required in 5 patients. 3) We must take care to prevent cardiac complications (i.e., arrhythmia) as well as extracardiac malfunctions in postoperative care, because aged patients had some organic dysfunctions of respiratory, renal and hepatic systems. 4) Post-operative courses were satisfactory and there was no operative mortality. All patients obtained improvements in their quality of life. Consequently, we concluded that surgical closure is recommended even for aged patients with ASD, except for Eisenmenger's syndrome.

Aged↗
PubMed1993

[Evaluation of pulmonary arterial trunk on frontal chest radiograph in patients with atrial septal defects].

Atrial septal defect (ASD) is one of the most common congenital cardiac anomalies encountered in adulthood. The evaluation of the pulmonary hypertension in ASD is clinically important for operative indication and prognosis. The pulmonary vasculature in chest radiographs in patients with ASD is characterized as dilatation of the central pulmonary arteries and increase of the peripheral pulmonary vessels in patients without pulmonary arterial hypertension (PH) and constriction of the peripheral pulmonary arteries in those with pulmonary hypertension. While the dilatation of the main pulmonary artery occurs in the patients both with and without pulmonary hypertension, its precise radiographic evaluation with regard to the morphological and hemodynamic change of the right ventricle and pulmonary arteries has not been reported. This study was to determine if the contour of the main pulmonary artery segment of the cardiac silhouette in the conventional frontal chest radiograph could be used 1) as indicators of PH or raised right ventricular pressure and 2) as a reliable base for evaluation of the size of the right ventricule (RV) in ASD. The intersection of the line (line A) drawn tangentially to the lateral lower margin of the main pulmonary artery segment to the horizontal line at the left hemidiaphragm is closely related to the apex of RV as measured by right ventricular angiography in supine position. The ratios of the distance of the intersection from the midline of the frontal chest radiograph to the internal diameter of the left hemithorax in normal subjects were 0.50 +/- 0.08 (mean +/- standard deviation) for male and 0.54 +/- 0.09 for female. The ratio increased with increasing left-to-right shunt [0.59(Qp/QS < 2), and 0.71 (Qp/QS > 2)] and shows a tendency of decrease with raised right ventricular systolic pressure (0.52-0.64 in normal subjects and patients with mild raised right ventricular systolic pressure and 0.43 in patients with severe raised right ventricular systolic pressure). The measurement of the angle of the line A from the vertical line tends to show increasing decrease with raised pulmonary arterial and right ventricular systolic pressure (20.1 degrees +/- 4.9 in mild PH and 10.3 degrees +/- 4.1 in moderate to severe PH). The decrease of the angle of the line A to the vertical line was well correlated with conventional radiographic criteria of the right and left central pulmonary arteries of PH.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMedDate not supplied

Effect of atrial septal defect created during balloon mitral valvuloplasty on calculation of cardiac output and mitral valve area.

We studied the effect of atrial septal defect (ASD), produced during transseptal puncture, on estimation of cardiac output (CO) and mitral valve area (MVA), after successful balloon mitral valvuloplasty (BMV) using the Inoue balloon in 20 patients. Oximetry run, pressure gradients, thermodilution CO and MVA were measured initially while temporarily occluding the ASD by partially inflating the Inoue balloon catheter. Measurements were repeated after withdrawing the balloon catheter into the right atrium. Post-BMV cardiac output and MVA were similar in both the situations (4.52 +/- 1.37 L/min vs 4.50 +/- 1.19 L/min; 1.89 +/- 0.4 cm2 vs 1.93 +/- 0.38 cm2 respectively, p = ns). Only 2 patients showed a step up at atrial level on oximetry (9% and 16% respectively) but did not have significantly different CO or MVA, both with ASD occluded or otherwise. We conclude that the magnitude of ASD created during BMV by Inoue balloon technique is small and does not significantly affect the estimation of CO or MVA if the septal puncture is done in the fossa ovalis area.

Adolescent↗
PubMed1996

-Diagnostic shunt oximetry of atrial septal defect in adulthood-.

UNLABELLED: There are several circumstances in which data obtained at catheterization should alert the cardiologist to look for a shunt that had not been suspected previously. Aim of the study was to explore the most sensitive parameter which is easily practicable and which gives strong evidence for an atrial septal defect (ASD). Moreover, a simplified method for quantifying left-to-right shunts was analyzed. In 84 patients (58 with an atrial septal defect and 26 patients without shunt) a complete oxygen saturation status was determined. The oxymetrically determined relation between pulmonary bloodflow QP and systemic bloodflow QS was 1.31 to 5.60 in patients with ASD and 0.75 to 1.19 in patients without shunt. The analysis of sensitivity and specificity was determined to define the marginal value which gives suspicion of an ASD. The best values for sensitivity and specificity was found for PA O2-SVC O2 = 7.4% (sens. = 98.3%, spec.= 96.2%), PA O2 -IVC O2 = 2.0% (sens./spec.= 100%), PA O2 - MV O2 = 5.0% (sens./spec.= 100%) and PA O2 = 78.4% (sens./spec. = 97.5%). The correlation between the modified ratio QP/QS and various differences in O2-saturation with the shunt size was examined. A high correlation was found for the modified QP/QS with SVC O2 instead of MV O2 (r = 0.98), PA O2-SVC O2 (r = 0.77) and PA O2 - MV O2 (r = 0.74) with QP/QS, respectively. CONCLUSION: The results demonstrate that an O2-saturation >78% in the pulmonary artery is highly suspicious for the diagnosis of an ASD. With the modified ratio QP/QS = (ART O2-SVC O2)/(PV O2-PA O2) a high sensitive and specific modus of quantifying shunts can be reached. Determination of oxygen saturation from the V. cava interior is therefore not useful.

Adolescent↗
PubMedDate not supplied

Transcatheter closure of atrial septal defect using buttoned device--Indian experience.

Transcatheter closure of secundum atrial septal defect (ASD) < 21 mm in diameter with adequate septal margins, assessed by transthoracic echocardiography (TTE) was attempted using Sideris buttoned device under fluoroscopic and TTE guidance in 27 patients (age range 5-35 years). The stretched diameter of ASD estimated by balloon sizing at cardiac catheterization was, on an average, 3 mm larger than assessed on TTE. A 25 to 50 mm second-generation Sideris device could be successfully implanted in 24 patients, with disappearance of left-to-right shunt, assessed by colour flow mapping on TTE in 17 patients. Residual shunt of 0.12-0.54 L/min/m2 was seen on day one in 7 patients which increased on follow-up in 3 patients over a period of 12 months. The maximum shunt in one patient was 1.1 L/min/m2. On follow-up (14.5 +/- 3.8 months), the device was in a stable position in all patients evaluated by fluoroscopy and TTE, and intracardiac ultrasound study in two patients. The procedure was unsuccessful in 3 patients, due to unbuttoning of the device in one and recurrent slippage of the device through the ASD in two patients. Mitral regurgitation was detected in 5 patients on follow-up (mild in 4 and moderate in 1). There was no mortality and none of the patients required any surgical intervention. It is concluded that transcatheter closure of some selected cases of secundum ASD can be safely and effectively done using Sideris buttoned device through a small sheath; however, a centering device is likely to close larger defects with less interference with mitral valve function.

Adolescent↗
PubMed1996

[Minithoracotomy in cardiac surgery. Initial experience with closure of an atrial septal defect with a minithoracotomy].

The authors describe their own modification of closure of an atrial septal defect (ASD) from right anterolateral minothoracotomy. This minimally invasive approach was selected in girls and women. Right anterolateral thoracotomy was used in 1987 to 1994 in twelve female patients. With regard to the general trend towards aesthetic surgery the authors use at present minimal anterolateral right-sided thoracotomy which with regard to its close relationship with the right atrium makes a safe surgical access to the atrial septum possible. Extracorporeal circulation is implemented by cannulation of the iliac artery in the groin, venous return is ensured by cannulas inserted into the venae cavae in the surgical field (by the auricle of the right atrium into the vena cava superior and the right atrial wall into the vena cava inferior). The operation itself is performed with electric fibrillation of the heart and tightening of the venous tourniquets. Between January 1995 till March 1996 the authors made by the thus modified approach a closure of the ASD type secundum in four female patients age 17, 29, 35 and 40 years. ASD was located always in the fossa ovalis and was repaired by direct suture. The duration of the extracorporeal circulation was on average 30 minutes. The length of the skin incision was 8-10 cm. The operation was free from complications. The cosmetic result is excellent and is consistent with principles of aesthetic surgery. If an arterial cannula is inserted into the groin minithoracotomy can be recommended for closure of ASD with extracorporeal circulation as a safe method.

Adolescent↗
PubMed1996

Construction of a stable and non-resistant bivalent vaccine candidate strain against Shigella flexneri 2a and Shigella sonnei.

The E. coli cs3 gene coding for CFA/II antigen was site-specifically integrated into the asd gene locus of S. flexneri 2a vaccine strain T32, resulting in the inactivation of the asd gene. Meanwhile, the gene cluster for S. sonnei O antigen was cloned into a non-resistant expression vector pXL378 to construct the plasmid pXL390. By transforming the asd-mutant of the T32 strain with pXL390, the bivalent vaccine candidate strain FS01 against S. flexneri 2a and S. sonnei was finally obtained. Experiments showed that the recombinant plasmid pXL390 was very stable in the asd-T32 strain without the use of any antibiotics; the FS01 strain was genetically stable and expressed two kinds of Shigella LPS-O antigens on the surface without any enhancement of its toxicity. Animal tests demonstrated that FS01 strain, when administered subcutaneously in mice, could provide 100% protection against the intraperitoneal challenges of virulent S. flexneri 2a and S. sonnei.

Animals↗
PubMed1998

Results of repair of partial anomalous pulmonary venous connection and sinus venosus atrial septal defect in adults.

BACKGROUND AND AIMS OF THE STUDY: This retrospective study evaluated late results of surgical treatment of partial anomalous pulmonary venous connection (PAPVC) concomitant with sinus venosus-type atrial septal defect (ASD) with the use of pericardial patch technique. METHODS: Between 1981 and 1995, 25 consecutive patients (18 females, seven males) underwent surgical repair of PAVPC with ASD. Mean age at surgery was 37.8 +/- 13.0 (range: 16 to 62 years). All patients underwent the procedure of covering both defect and vein with pericardial patch to direct blood flow from anomalous pulmonary veins through the ASD into the left atrium. Mean follow up was 7.8 +/- 4.0 years (range: 2 to 16 years). No patients were lost to follow up. RESULTS: There were no early deaths. One patient died 11 months after surgery from progressive heart failure. At follow up, 10 (42.7%) patients were clinically asymptomatic. One patient had clinical signs of superior vena cava (SVC) obstruction. Electrocardiography showed no abnormalities in seven (29.2%) patients. Chest radiography revealed normal pulmonary vascularity in 22 (91.7%) patients and no residual shunts were found in the SVC. CONCLUSION: The patch method of repair of PAPVC with sinus venosus ASD in adults with use of autologous pericardium is a safe and effective procedure.

Adult↗