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Posts Tagged ‘ostium secundum’

ASD is the most common acyanotic heart disease. Clinically distinguishing  ostium primum (OP-ASD ) from ostium secundum (OS- ASD) is not an easy  task . A Wide fixed split pf S2  , a short systolic  murmur and PA pulsations  in left second space, a loud P2 and a hyperdyanmic RV occur in both .  The following features might give a clue for OP -ASD .

  • While  OS-ASD is  often an  isolated anomaly , isolated  OP- ASD is very rare.It usually occur as a part of partial or complete AV canal .
  • Early onset of symptoms
  • Early onset of pulmonary arterial hypertension( PAH )
  • Extra murmur of  1.VSD 2.MR (Cleft mitral valve ) may be present
  • Biventricular enlargement (MR/VSD)
  • ECG -Left axis deviation -Structural defect in left bundle ?

Confirmation is by Echocardiography and angiogram is rarely required today . Documentation of  classical goose neck deformity of LV outflow confirms the diagnosis.

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Atrial septal defect is one among the commonest congenital heart disease .After years of controversy, there is consensus  now , all significant ASDs  need to be closed ,  at whatever age it is detected.

This rule does not apply to small ASDs without chamber  right atrial and right ventricular dilatation. These defects and PFOs need not be closed .

Over the years , the  controversy  has shifted  from   Should we close ?  to  How to close ?

There are two options available : Device closure , Surgical closure

asd closure device www.drsvenkatesan.com

asd closure www.drsvenkatesan.com

The following table compares the both treatment  modalities

( Personal perspective )

asd device closure 4

Final message

Device closure is a complex, costly, often  difficult  and  error prone   cardiac procedure .It needs long term follow up and may  carry a life long risk of major cardiac complication.It is useful only in selected subset of ASD patients. Surgical closure prevails over device closure in most situations.

Is this article  has biased view against this  emerging pediatric  interventional procedure of ASD closure ?

It may appear so . But that is the reality as on 2009 !.May we hope technology evolves further and take our surgeons head on .

2012 update on ASD device closure .

The   hard-ware  as well as the  expertise has   improved a lot and it is on right track to become a real challenge to surgery.

The only issue again is the availability of  rims to mount the device . Another  realistic and sensitive issue  which  have I come across is  , many interventionist cardiologist do feel awkward  when they experience  unexpected rim shortage on table.  They should realise it is not their  fault.

Always be ready to abandon the procedure and refer to the surgeon , according to your  true conscience 

After all , improperly delivered device is  a life long pain for the patient .He has come to you with a  great belief  isn’t !

2014 update

Device closure for most ASDs in both children and adult is  now possible with high degree of success. We have crossed about 50 patient experience. And  I am truly amazed  , how within a short period the device closure is about to conquer the crown from the surgeons ! (Exciting new data are coming from   my colleague Dr Gnanavelu from  the new Super specialty hospital of Government of Tamil Nadu Chennai. )

 

Reference

Aortic erosion following ASD closure

http://content.onlinejacc.org/cgi/content/full/45/8/1213

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