Transcatheter Atrial Septal Defect Closure Before Versus After Adulthood.

Objectives: To evaluate the long-term outcome of patients who underwent percutaneous transcatheter closure of secundum atrial septal defects during teenage life versus adulthood. Methods: The study included 100 patients with secundum type ASD who were treated by transcatheter closure of their defects 2-5 years before enrollment. The study population was subdivided into 2 equal groups: group 1 who underwent transcatheter closure during teenage life (13-19 years) and group 2 who underwent transcatheter closure after the age of 30 years. The two groups were compared according to resting 12 lead ECG, 24-h Holter ECG and transthoracic echocardiographic findings (Right ventricular size and functions, right atrial size, etc.). Results: The study population showed female predominance. The average follow up period was similar in both groups. Adult patients had more frequent right bundle branch block morphology in their resting 12 lead ECG than teenagers (69% versus 45% respectively, p < 0.01). The incidence of arrhythmias encountered in Holter ECG was also significantly higher in the adult group. Premature atrial contractions (PAC) were present in 10 patients (20%) in adult group while 3 patients (6%) had PACs in teenagers' group with p < 0.01. The mean PAC burden was also higher in the adult group (9% versus 1.3%, p < 0.001). Paroxysmal AF lasting more than 30 seconds was found in 6 patients (12%) in the adult group while 1 patient in teenagers developed AF, p < 0.01. Regarding transthoracic echocardiography, adult patients showed significantly larger RV diameter, indexed RA area, indexed LA volume and more LV diastolic dysfunction. RV systolic functions were better in the teenage group as measured by 2D echocardiography. Adult patients with higher age, bigger defect size and device size had more abnormal ECG and echocardiographic findings. Conclusion: Early trans-catheter closure of secundum ASD during teenage life yields better right ventricular systolic function, better right ventricular size and less incidence of atrial arrhythmia.

Immediate and short-term effect of balloon mitral valvuloplasty on global and regional biventricular function: a two-dimensional strain echocardiographic study.

AIM: To assess the effect of balloon mitral valvuloplasty (BMV) on global and regional ventricular functions using 2D strain. METHODS AND RESULTS: Thirty-two patients with mitral stenosis (MS) and 30 healthy subjects underwent full echocardiographic examinations, including left ventricle (LV) and right ventricle (RV) regional and global longitudinal strain (GLS) measurements. In MS patients, measurements were repeated within 24 h and 3 months after BMV. Patients with MS had lower LV and RV GLS compared with control group (-16.5 ± 2.7% vs. -21.0 ± 1.5) and (-18.3 ± 4.7 vs. -19.8 ± 1.3), respectively. Significant decrease was noted in the basal and septal segments compared with the apical LV segments and RV free wall. BMV resulted in significant improvement in LV and RV GLS within 24 h post-BMV compared with baseline values (P = 0.0001 and 0.0002, respectively), an improvement which was maintained after 3 months. There was significant positive correlation between both LV and RV GLS at baseline and mitral valve mean pressure gradient and RV systolic pressure and significant inverse correlation between LV GLS and MVA. CONCLUSION: MS patients have subclinical LV and RV systolic dysfunction by GLS despite normal ejection fraction and fractional area change. BMV results in marked improvement in LV and RV GLS immediately post-BMV with trend towards normalization at follow-up after 3 months. A mixed aetiology theory involving a myocardial as well as a haemodynamic factor is believed to be the cause for this subclinical biventricular dysfunction and its improvement at short-term follow-up post-BMV.

Double-balloon valvuloplasty of calcified bioprosthetic pulmonary valve twenty-three years after implantation.

Balloon valvuloplasty to dilate stenotic bioprosthetic valves is rarely used, but has been applied successfully to dilate bioprosthetic mitral, aortic, tricuspid and, to a lesser extent, pulmonary valves. The case is reported of a 45-year-old male patient with right-sided heart failure who underwent a successful dilatation of a stenotic, calcific bioprosthetic pulmonary valve using double-balloon valvuloplasty.