[Therapeutic properties of ASD preparation; experimental and clinical investigations].
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This report describes successful radiofrequency ablation of typical atrioventricular (AV) node reentrant tachycardiafollowed by transcatheter closure of a large secundum atrial septal defect in a patient of the Jehovah's Witness faith. Both procedures were performed successfully during the same catheterization, without complication or need for blood transfusion.
The majority of patients with atrial septal defect require a single device for closure but a small proportion have more than one defect in the atrial septum. We report a patient who had two moderate-sized atrial septal defects in whom transcatheter closure of both the defects using two Amplatzer septal occluders was performed successfully.
A 32-year-old man with 17 mm secundum atrial septal defect showed hemodynamic deterioration during temporary balloon occlusion of the defect. The closure was not done. Further investigation led to the diagnosis of primary cardiac amyloidosis.
By means of ++angiographic and microanatomical methods of revascularization of the metadiaphyseal autotransplant dosely transferred into the defect of a long tubular bone and without a distraction factor has been studied in the experiment on 23 dogs. Restoration of the arterial vascularization in the transplant under conditions of distraction demonstrates that it is expedient to combine osteoplasty with distractive osteosynthesis in order to decrease time for substitution of the defect and reconstruction of a new bone.
5 surgical cases of atrial septal defect of the secundum type, aged 43, 45, 54, 58 and 67 respectively, are reported. Two of them were initially in functional class III, one in class II and two in class I. CTR were increased in all cases. Three of them had severe heart failure, especially in a 67 years-old patient severe respiratory obstructive disfunction was observed (FEV1.0:0.561). All of the cases had large pulmonary to systemic flow ratio (QP/QS greater than 3.0) and one had pressure-gradient of 20 mmHg between RV and PA. After the surgery CTR decreased, pulmonary arterial pressure also fell to normal value, and all cases symptomatically improved. It is concluded that surgery is life saving and appears to offer sustained clinical benefit to the older age group with advanced symptomatic disability, even if pulmonary hypertension or congestive heart failure are associated.
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