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The GORE CARDIOFORM ASD Occluder (GCA, W. L. Gore & Associates) was approved in 2019 for ostium secundum atrial septal defect (ASD) closure. This study sought to report the combined pivotal and continued access cohorts of the ASSURED (Safety and Efficacy Study of Transcatheter Closure of Ostium Secundum ASDs) trial results through 36 months. This prospective, multicenter, single-arm trial evaluated procedural and clinical outcomes of ASD closure with the GCA. The primary endpoints were 6-month closure success following device implantation and composite clinical success (deployment/retention of device, safety, and closure). Technical and procedure success, safety, clinically significant new arrhythmia (CSNA) secondary endpoints, and wire frame fracture (WFF, with fluoroscopy) at 6 and 36 months were evaluated. Of 569 patients (median age of 10.4 years and median weight of 35.0 kg) who underwent attempted secundum ASD closure, 526 were technical successes. The mean stop-flow ASD diameter was 17.6 ± 5.3 mm. All 478 patients with 6-month imaging achieved closure success. Composite clinical success at 6 and 36 months was achieved in 87.6% (468/534) and 84.0% (351/418) of patients, respectively. Technical failure occurred in 8.1% (43/548), 30-day device- or procedure-related serious adverse event in 3.9% (21/534), and 6-month device events in 2.8% (15/534) of patients. At 30 days, 21 of 569 patients (3.7%) had CSNA. At 6 months, 138 of 436 (31.7%) patients had WFFs and 105 of 185 (56.8%) at 36 months (without sequelae). In this large congenital ASD device trial, the GCA had acceptable results. WFFs, although common, did not result in any clinical sequelae. The unique features, size range, and safety profile expand the options for secundum ASD closure. (Safety and Efficacy Study of Transcatheter Closure of Ostium Secundum ASDs [ASSURED]; NCT02985684) [Display omitted] [ABSTRACT FROM AUTHOR]

Purpose: For the repair of atrial/ventricular septal defects (ASD/VSD), transthoracic echocardiography (TTE) is easy to perform, cost‐effective, and does not require general anesthesia and intubation. Still, TTE is not universally accepted. To compare efficacy and safety of TTE versus transesophageal echocardiography (TEE) to guide percutaneous ASD/VSD closure. Methods: PubMed, Embase, and the Cochrane library were searched for articles published from their inception to December 2023. The primary outcome was the procedural success rate. The secondary outcomes were residual shunt, late complications, procedure time, and fluoroscopy time. All meta‐analyses were performed using a random‐effects model. Results: Eight studies and 1295 patients were included. There were no significant differences between TTE and TEE regarding the procedural success rate (OR = 1.93, 95% CI: 0.90–4.13, p = 0.092; I2 = 52.2%, Pheterogeneity = 0.063) and residual shunt rate (OR = 0.81, 95% CI: 0.38–1.76, p = 0.600; I2 = 0%, Pheterogeneity = 0.518). Compared with TEE, TTE reduced the frequency of late complications (OR = 0.25, 95% CI: 0.14–0.43, p < 0.001; I2 = 13.8%, Pheterogeneity = 0.326), reduced the procedure time (WMD = −8.92, 95% CI: −12.08, −5.75, p < 0.001; I2 = 87.4%, Pheterogeneity < 0.001), and reduced the fluoroscopy time (WMD = −5.08, 95% CI: −9.59, −0.56, p = 0.028; I2 = 95.6%, Pheterogeneity < 0.001). The sensitivity analyses showed that the results of the meta‐analyses were robust. Conclusion: Compared with TEE, TTE showed no differences regarding the rates of success and residual shunt, but there were lower rates of late complications and shorter procedure and fluoroscopy times. [ABSTRACT FROM AUTHOR]

• Atria make both active and passive contributions throughout the cardiac cycle. • Atrial cardiomyopathy is gaining recognition in various cardiac conditions and is associated with worse prognosis. • Alterations in atrial mechanics are associated with incident heart failure and atrial fibrillation. • Atrial interventions may have adverse subclinical effects on atrial mechanics, which could ultimately result in overt clinical symptoms. • Standardized assessment of atrial mechanics following atrial interventions might allow early detection and prevention of irreversible atrial remodeling. Our comprehension of atrial mechanics, atrial cardiomyopathy and their clinical implications across various cardiovascular conditions has advanced significantly. Atrial interventions can have differing effects on atrial mechanics. With the rapid increase in the use of atrial interventions, it is crucial for investigators and clinicians to acknowledge the potential adverse effects of these interventions on atrial mechanics that might not be clinically significant at the time of interventions. Recognizing the preclinical stage of atrial maladaptation might enable early interventions before the development of irreversible atrial remodeling and clinical manifestation. We review normal atrial function and mechanics, and atrial cardiomyopathy in select cardiovascular conditions. We also summarize and discuss the current evidence of the impact of various atrial interventions on atrial function and mechanics. [Display omitted] [ABSTRACT FROM AUTHOR]

Atrial septal defects (ASDs) are among the most prevalent congenital cardiac malformations. Closure of the defect and repair of associated cardiac malformations are typically indicated if an ASD is hemodynamically significant or symptomatic. This narrative review aims to summarize key aspects of surgical ASD closures. A non-systematic literature review was conducted to cover surgically relevant aspects of (developmental) anatomy, morphology, and treatment. ASDs result from diverse developmental alterations, leading to subtype-specific associated cardiac malformations, meaning surgical therapy varies accordingly. Presently, surgical repair yields excellent outcomes for all ASD subtypes, with minimally invasive approaches, especially in adults, increasingly employed for ASD closure. Surgical ASD repair is safe with excellent results. However, familiarity with ASD subtypes and typically associated lesions is crucial for optimal patient management. [ABSTRACT FROM AUTHOR]

Introduction: Delivery systems are crucially important for the implantation of medical devices in patients with congenital heart disease. However, very little data is available comparing the advantages and disadvantages of the various delivery systems. Areas covered: This article describes the delivery systems and methods used for delivery of atrial septal occluder devices, ventricular septal occluder devices, devices to occlude patent arterial ducts, and transcatheter pulmonary valves. Delivery systems are compared relating to prepping and loading, positioning of the delivery sheath/catheter, deployment, ability to recapture and reposition, as well as device release. Expert opinion: For most ASD/VSD/PDA occluder devices, the basic delivery mechanism has changed very little over the preceding 20 years. Future modifications may focus on meaningful modifications to the cable systems that reduce stiffness and improve angulation at the connection to the device. Over the next 5–10 years, it is expected to see significant changes to delivery systems used for transcatheter pulmonary valve implantation, that result in improvements in the ability to recapture and reposition self-expandable transcatheter valves during the deployment process, combined with kink resistant sheaths that facilitate easy tracking across often complex right ventricular outflow tracts. [ABSTRACT FROM AUTHOR]

Background: An atrial septal defect (ASD) is considered oval-shaped when its shortest diameter is less than 75% of the longest diameter. Research on percutaneous closure of oval-shaped ASDs is limited, with no known reports of non-fluoroscopic closure for this population. Objective: To assess the effectiveness of non-fluoroscopic percutaneous closure for oval-shaped ASDs. Methods: This single-center retrospective study evaluates patients undergoing non-fluoroscopic percutaneous closure of oval-shaped ASDs, defined by the shortest to longest diameter ratio < 0.75, a circular index of 1.33, or ultrasound visualization of an oval shape. Device size was chosen to be 0–4 mm larger than the defect’s longest diameter, based on transthoracic and transesophageal ultrasound measurements. Results: We identified 78 patients (33.3% children, 20.5% males) with a mean age of 27.4 ± 16.3 years and a mean weight of 46.8 ± 19.8 kg. The mean longest diameter and mean shortest diameter of ASDs were 23.3 ± 6.8 mm and 15.8 ± 5 mm, respectively. The mean ratio of the shortest to longest diameter was 0.7 ± 0.1. Percutaneous closure was not attempted in 7/78 (9%) patients. Three out of 71 (4.2%) procedures were fluoroscopy-guided upfront due to technical difficulties, and 5/71 (7%) were converted to fluoroscopy-guided closure. Overall procedural success rate was 98.6% (70/71) including 63/71 (88.7%) performed with zero fluoroscopy. Mean device size was 26.5 ± 7.1 mm. Mean procedural time was 45.3 ± 22.6 min. Eleven intraprocedural complications occurred including 6 arrhythmias, 3 pericardial effusions, and 2 device dislodgements. Conclusion: Transcatheter closure of oval-shaped ASD is safe and feasible. Echocardiography is adequate for adequate operative guidance. [ABSTRACT FROM AUTHOR]

Background: The coronary sinus type of atrial septal defect is rare. Standard treatment typically involves intracardiac repair using conventional sternotomy or thoracotomy incisions; however, robotic technology can offer a feasible alternative due to its ability to provide a high-quality surgical view of this anomaly. Case presentation: A 72-year-old man presented with asymptomatic atrial septal defect. Echocardiography revealed a direct communication between the left atrium and CS with left-to-right shunt flow and a Qp/Qs ratio of 2.1:1. The coronary sinus type of atrial septal defect was indicated for the totally endoscopic robotic repair considering few comorbidities. We present a successful robotic repair of coronary sinus atrial septal defect with concomitant tricuspid annuloplasty via the right atrium, properly identifying the boundary between the mitral annulus and coronary sinus through a high-quality surgical view. Conclusion: Robotic repair can serve as a viable and therapeutically effective alternative for cases of coronary sinus atrial septal defect with concomitant tricuspid annuloplasty. [ABSTRACT FROM AUTHOR]

Background: Congenital cardiac malformations are a significant subset of developmental abnormalities, affecting approximately 6-8 per 1,000 live births and 2% of stillbirths. These malformations account for nearly one-quarter of all developmental anomalies, yet the etiology remains unknown in over 90% of cases. Hereditary factors and environmental conditions, such as high altitude and seasonal variations, have been implicated. The prevalence and types of congenital cardiac malformations in North India are not well-documented, prompting this study to investigate these aspects in adult and fetal cadavers at Bhagalpur. Materials and Methods: The study was conducted in the Department of Anatomy at Jawaharlal Nehru Medical College, Bhagalpur, using 25 adult and 45 fetal cadaver hearts, preserved in 10% formaldehyde solution. The hearts were dissected using a standardized method, examining and classifying malformations according to abnormalities in position, developmental progress, and visceral arches. Morphological features were assessed with tools including a dissection kit, magnifying lens, torch, probe, and measuring tape. Results: Out of 70 cases studied, 14 (20%) displayed congenital cardiac malformations, with a higher incidence in adults (24%) than in fetuses (17.78%). A total of 25 anomalies were identified among the 14 cases, with 10 types of anomalies observed. The most common malformation was atrial septal defect, followed by anomalous positions of the great arteries and cor biloculare. Coexistent external anomalies were found in 3 of the 14 cases (21.43%), affecting the face and multiple systems. Conclusion: The incidence of congenital cardiac malformations in Bhagalpur is consistent with findings from other regions of India and internationally. Atrial septal defect is the most prevalent malformation in this population, aligning with patterns observed in other Indian studies but differing from international reports. [ABSTRACT FROM AUTHOR]

To date, no significant association has been reported between atrial septal defects (ASD) and cardiac myxomas. This study reports a 56-year-old woman with cardiac myxoma following transcatheter closure of ASD. She presented with a 3-month history of recurrent dizziness, vertigo, palpitations, and generalized weakness after undergoing ASD occlusion a year earlier. Echocardiography and cardiac computed tomography scans identified a large, mobile mass (7.2 cm × 2.8 cm) in the left atrium, protruding through the mitral valve. The patient underwent median sternotomy and pericardiotomy, and the histopathological examination confirmed the diagnosis of atrial myxoma. The current case illustrates the challenges in determining whether an atrial mass is a benign myxoma or a dangerous thrombus. While there is no definitive link between the implantation of an ASD closure device and the formation of a myxoma, the emergence of this tumor is a potential occurrence. [ABSTRACT FROM AUTHOR]

Aim: The Amplatzer Piccolo Occluder (APO) is approved for patent ductus arteriosus (PDA) occlusion in infants weighing >700 g but could offer versatility to treat other lesions. Methods: Retrospective review of children in whom APO was utilized for defects other than PDA between January 2022 and June 2023. Results: The APO was used in nine patients; three for ventricular septal defects, four with coronary fistulas, one for a ventricular pseudoaneurysm and one where APO deployed within a fenestration of a previously placed Amplatzer Septal Occluder. All nine patients had successful occlusions without complications. Conclusion: The APO is a versatile device that can be used to treat various small diameter lesions in children besides the PDA for which it is currently approved for. Article highlights The Amplatzer Piccolo Occluder (APO) is currently used for closure of patent ductus arteriosus in infants and children. Its utility to treat other small lesions in children has not been previously described. In this series, the APO was used to treat small lesions such as coronary artery fistulas, residual ventricular septal defects, etc. All lesions were successfully treated using the APO, and there were no procedural complications. The APO can be used to successfully occlude small defects of many varieties in infants and children. The advantage of delivering a disc device through a relatively small catheter may prove valuable while treating certain vascular lesions in infants and small children. The 4-French delivery system allows this device to be used in small patients that cannot tolerate the large delivery systems of other devices. The symmetric design of the APO also allows for both antegrade and retrograde deployment. [ABSTRACT FROM AUTHOR]

Abstract Background An atrial septal defect (ASD) is considered oval-shaped when its shortest diameter is less than 75% of the longest diameter. Research on percutaneous closure of oval-shaped ASDs is limited, with no known reports of non-fluoroscopic closure for this population. Objective To assess the effectiveness of non-fluoroscopic percutaneous closure for oval-shaped ASDs. Methods This single-center retrospective study evaluates patients undergoing non-fluoroscopic percutaneous closure of oval-shaped ASDs, defined by the shortest to longest diameter ratio

Abdul Ghafar Sherzad,1 Ahmad Shakib Zalmai,2 Imran Zafarzai,2 Mahmoud Khan Zazai,3 Qingchun Zeng4 1Department of Biochemistry, Faculty of Medicine, Nangarhar University, Nangarhar, Afghanistan; 2Department of Forensic Medicine, Faculty of Medicine, Nangarhar University, Nangarhar, Afghanistan; 3Department of Family Medicine, Beteam International Cure Hospital, Kabul, Afghanistan; 4Department of Cardiology, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, People’s Republic of ChinaCorrespondence: Abdul Ghafar Sherzad, Department of Biochemistry, Faculty of Medicine, Nangarhar University, Nangarhar, Afghanistan, Tel +93783545284, Email ghafarsherzad15@gmail.comBackground: Congenital heart disease (CHD), characterized by anatomical and functional abnormalities of the heart, can impair an individual’s quality of life and, if not treated with appropriate interventions, it can result in early death. Morbidity and mortality from CHD are greatly reduced by early diagnosis and timely therapy. Therefore, this study aimed to determine the frequency of various forms of CHD among affected children in Eastern Afghanistan considering age, gender, and region of distribution (countryside and city).Patients and Methods: A retrospective hospital-based study was conducted on 1323 patients with a confirmed diagnosis of CHD who were referred for echocardiography to public and private hospitals in Jalalabad City, Afghanistan, from July 2018 to June 2022. Patients from day one of life till 18 years were included. The study participants were chosen using a non-probability convenience sampling technique, and the data were analyzed using the statistical package for social sciences (SPSS) version 27.0.Results: In this study, males comprised 60.4% of the participants, while females made up 39.6%. More than three-quarters (86.4%) of the diagnoses were in children below 1 year of age. 86.5% of them were patients with acyanotic, and 13.5% had cyanotic CHD. The most common acyanotic heart disease was patent ductus arteriosus (PDA; 252.6%), followed by ventricular septal defect (VSD; 18.4%) and atrial septal defect (ASD; 8.5%). The most frequent cyanotic heart disease was Tetralogy of Fallot (TOF). 79.9% of the total cases were patients with simple CDH lesions, and 20.1% had complex CHD lesions. In addition, participants from rural areas had a higher (78.9%) frequency of CHD compared to those from urban areas (21.1%).Conclusion: The study concluded that over 85% of CHD-diagnosed cases were under 1 year of age, with PDA, VSD, ASD, and TOF being the most commonly diagnosed acyanotic and cyanotic lesions. Participants from rural residence had a higher frequency of CHD compared to those from urban residence. Additionally, our study found that more males were affected by CHD compared to females. In order to avoid serious complications, reduce mortality, and improve quality of life, early identification and correction of disease is crucial.Keywords: cyanotic heart disease, acyanotic heart disease, atrial septal defect, ventricular septal defect, patent ductus arteriosus, tetralogy of Fallot

Retinal vascular occlusions are rare in young people, and any occlusion warrants an extensive clinical evaluation to establish the etiology. Cardiac malformations are a source of embolism. We present a case of atrial septal defect (ASD) in a patient with type II Mayer-Rokitansky-Küster-Hauser syndrome, leading to unilateral branch retinal arterial occlusion (BRAO) in a young woman. A 21-year-old woman presented with sudden, painless, blurring of vision, and a superior visual field defect in her right eye. A fundus examination confirmed the BRAO diagnosis. Ocular and systemic evaluation revealed primary amenorrhea, ASD, ectopic kidneys, and pelvic cyst. Any vascular occlusion in a young patient must be thoroughly evaluated, including a detailed systemic history.

Re-expansion pulmonary edema (RPE) is a rare complication of minimally invasive cardiac surgery (MICS). We present a case of RPE following atrial septal defect (ASD) closure using a thoracotomy approach and cardiopulmonary bypass (CPB). REP contributes to significant morbidity and extends the length of stays in the intensive care unit. Understanding the pathophysiology and risk factors of RPE allows us to prevent or minimize the incidence.

Holt-Oram syndrome is a rare congenital autosomal dominant disorder caused by a mutation in the TBX5 gene. It is characterised by upper limb abnormalities and congenital heart lesions, such as Atrial Septal Defect (ASD), typically affecting children. In this case, a six-year-old boy presented with facial puffiness and decreased urine output following an upper respiratory infection. Upon examination, he was found to have Holt-Oram syndrome, a rare genetic disorder characterised by abnormalities in the bones of the upper limbs and congenital heart defects. He developed acute Post Streptococcal Glomerulonephritis (PSGN) following a streptococcal infection, resulting in persistent hypertension. Each condition independently poses significant health challenges, and their simultaneous occurrence complicates the clinical picture considerably. Following detailed investigations and management, the child required continued treatment with two antihypertensive medications upon discharge. The need for dual therapy in a paediatric patient highlights the severity of his condition and the challenges in managing it effectively. Close follow-up is essential to monitor disease progression and ensure optimal outcomes. This case features both a genetic disorder (Holt-Oram syndrome due to a TBX5 gene mutation) and an immune-mediated renal disease (PSGN), representing a rare intersection of genetic and postinfectious pathologies. The co-existence of these two conditions is unusual and complicates the clinical picture, necessitating a tailored approach to management. This case underscores the need for a multidisciplinary approach involving cardiology, nephrology, and genetics. Coordinated care is crucial for monitoring disease progression, managing complications, and ensuring comprehensive treatment.

Congenital anomalies are diverse in nature and can affect multiple organ systems, posing significant diagnostic and management challenges. Among these, nubbins, characterised by the absence or underdevelopment of distal terminal phalanges, present a rare clinical finding. The present case report discusses a neonate born via normal vaginal delivery who demonstrated immediate cries upon birth. The patient’s clinical presentation led to a series of diagnostic investigations. The absence of distal terminal phalanges in both hands was concerning; however, radiographs of the forearms showed normal structural findings. The detection of mild Developmental Dysplasia of the Hip (DDH) on hip Ultrasonography (USG) necessitated regular monitoring with USG and radiographs of both hips to ensure proper hip joint development. The USG of the spine revealed no anomalies, which was reassuring. The most significant finding came from the Echocardiogram (ECHO), which identified a small ostium secundum Atrial Septal Defect (ASD) with mild tricuspid regurgitation and pulmonary hypertension. The present case underscores the importance of ongoing research and collaboration in advancing our understanding and management of rare congenital anomalies.

N-terminal pro b-type natriuretic peptide levels reflect cardiac overload in congenital heart disease. The aim of the present study was to investigate N-terminal pro b-type natriuretic peptide during the stages of surgical correction of atrial septal defect in an older age group living in a lowland and highland area. A retrospective analysis of operated patients from 2013 to 2021 was performed. The main group consisted of 30 patients with atrial septal defect living in the high mountainous area. The control group included 30 patients living in the plain area. A comparative analysis of the immediate results of N-terminal pro b-type natriuretic peptide at the stages of disease-modifying antirheumatic drug plasty was performed, which was the basis for performing this study. N-terminal pro b-type natriuretic peptide values in healthy people vary from 0 to 125 pg/mL (control group). At the preoperative stage N-terminal pro b-type natriuretic peptide values in patients living in the plain averaged 532.33±257.31 pg/mL, which was significantly 6.48 times (p<0.001) higher than in the control group. In highlanders with interatrial septal defect N-terminal pro b-type natriuretic peptide levels significantly exceeded the values of the control group amounted to 2743.67±163.87 pg/mL (p<0.001). Positive correlation between N-terminal pro b-type natriuretic peptide, tricuspid annular plane systolic excursion and systolic dysfunction of the left atrium was determined. N-terminal pro b-type natriuretic peptide indices in highlanders are significantly higher than in lowlanders both before and at all stages of surgical correction. Preoperative N-terminal pro b-type natriuretic peptide level more than 2743.6±163.87 pg/mL in patients with ventricular septal defect living in high mountainous areas, New York Heart Association class III - IV, left ventricular ejection fraction less than 50% leads to secondary surgical outcome development in early postoperative period. N-terminal pro b-type natriuretic peptide is an independent reliable marker of heart failure. [ABSTRACT FROM AUTHOR]

Atrial septal defect (ASD) kompleks yang tidak didiagnosis dan dikoreksi hingga usia dewasa dapat menyebabkan hipertensi pulmonal. Manajemen perioperatif operasi penutupan defek pasien ASD dewasa dengan hipertensi pulmonal memberikan tantangan tersendiri karena dikaitkan dengan tingginya komplikasi perioperatif serta peningkatan morbiditas dan mortalitas. Kami melaporkan seorang wanita berusia 23 tahun dengan ASD dan hipertensi pulmonal yang menjalani operasi tutup defek. Pemeriksaan ekokardiografi praoperasi menunjukkan ASD sekundum right-to-left shunt dengan diameter 25–30 mm dan kateterisasi jantung kanan yang menunjukkan rerata tekanan arteri pulmonal 58 mmHg dan pulmonary vascular resistance 8,1 WU. Induksi anestesi dilakukan dengan balanced opioid, dosis kecil agen induksi, dan pelumpuh otot. Hemodinamik selama operasi stabil, dan periode penyapihan cardiopulmonary bypass berjalan lancar dengan topangan dobutamin dan norepinefrin. Pascaoperasi, pasien dirawat di Intensive Care Unit dengan keadaan umum baik, hemodinamik stabil, nyeri pascaoperasi terkontrol dan tanpa kejadian komplikasi. Penilaian praoperatif yang tepat, manajemen intraoperatif yang berhasil menjaga stabilitas hemodinamik, dan manajemen pascaoperatif yang dapat mencegah dan mengatasi komplikasi pascaoperasi dapat menghasilkan luaran yang baik pada pasien ini.

Abstract Background Cleft in the mitral valve leaflet is a primary cause of congenital mitral regurgitation, stemming from developmental anomalies in the mitral valve and frequently associated with other congenital heart defects. Concurrent presence of cleft in mitral valve leaflet with atrial septal defect and ventricular septal defect is relatively rare. Echocardiography, especially transesophageal echocardiography, is essential in diagnosing cleft mitral valve leaflet and related congenital heart defects, providing critical, detailed imagery for accurate assessment. This study presents a young female patient whose anterior mitral cleft, along with atrial septal defect and ventricular septal defect, was revealed through three-dimensional transesophageal echocardiography. Case presentation A 25-year-old Iranian female, experiencing progressive dyspnea and diminished physical capacity over 3 months, was referred to our hospital. Initial examination and transthoracic echocardiography indicated severe mitral regurgitation. Further evaluation with transesophageal echocardiography corroborated these findings and identified a cleft in the anterior mitral valve leaflet, coupled with mild left ventricular enlargement and significant left atrial enlargement. The complexity of the patient’s condition was heightened by the diagnosis of cleft mitral valve leaflet in conjunction with atrial septal defect and ventricular septal defect, showing the complex nature of congenital defects. Conclusion This case emphasizes the critical role of transthoracic echocardiography in diagnosing cleft of mitral valve leaflet and associated cardiac anomalies, showcasing its superiority over transthoracic echocardiography for detailed visualization of cardiac structures. The identification of multiple congenital defects highlights the necessity for a comprehensive diagnostic approach to manage and treat patients with complex congenital heart diseases effectively. Future research should aim to refine diagnostic methodologies to enhance patient outcomes for cleft of mitral valve leaflets and related congenital conditions.

Background: Atrial septal defect (ASD) is one of the most common congenital heart diseases. The diagnosis of ASD via transthoracic echocardiography is subjective and time-consuming. Methods: The objective of this study was to evaluate the feasibility and accuracy of automatic detection of ASD in children based on color Doppler echocardiographic static images using end-to-end convolutional neural networks. The proposed depthwise separable convolution model identifies ASDs with static color Doppler images in a standard view. Among the standard views, we selected two echocardiographic views, i.e., the subcostal sagittal view of the atrium septum and the low parasternal four-chamber view. The developed ASD detection system was validated using a training set consisting of 396 echocardiographic images corresponding to 198 cases. Additionally, an independent test dataset of 112 images corresponding to 56 cases was used, including 101 cases with ASDs and 153 cases with normal hearts. Results: The average area under the receiver operating characteristic curve, recall, precision, specificity, F1-score, and accuracy of the proposed ASD detection model were 91.99, 80.00, 82.22, 87.50, 79.57, and 83.04, respectively. Conclusions: The proposed model can accurately and automatically identify ASD, providing a strong foundation for the intelligent diagnosis of congenital heart diseases.

Abstract Background Atrial septal defects (ASD) are the most common type of adult congenital heart disease (ACHD) associated with a high risk developing of pulmonary arterial hypertension (PAH). ASD closure is not recommended in patients with PAH and Pulmonary Vascular Resistance (PVR) ≥ 5 Wood Unit (WU). Noninvasive methods have been proposed to measure PVR; however, their accuracy remains low. Right Ventricle (RV) - Pulmonary Artery (PA) coupling is defined as the ability of the RV to adapt to high-resistance conditions. Tricuspid Annular Plane Systolic Excursion (TAPSE)/estimated pulmonary artery systolic pressure (ePASP) calculation using echocardiography is a noninvasive technique that has been proposed as a surrogate equation to evaluate RV-PA coupling. Currently, no research has demonstrated a relationship between RV-PA coupling and PVR in patients with ASD. Methods The study participants were consecutive eligible patients with ASD who underwent right heart catheterization (RHC) and echocardiography at Hasan Sadikin General Hospital, Bandung. Both the procedures were performed on the same day. RV-PA Coupling, defined as TAPSE/ePASP > 0.31, was assessed using echocardiography. The PVR was calculated during RHC using the indirect Fick method. Results There were 58 patients with ASD underwent RHC and echocardiography. Among them, 18 had RV/PA Coupling and 40 had RV/PA Uncoupling. The PVR values were significantly different between the two groups (p = 0.000). Correlation test between TAPSE/ePASP with PVR showed moderate negative correlation (r= -0.502, p = 0.001). TAPSE/ePASP ≤ 0.34 is the cutoff point to predict PVR > 5 WU with sensitivity of 91.7% and specificity 63.6%. Conclusion This study showed a moderate negative correlation between TAPSE/ePASP and PVR. TAPSE/ePASP ≤ 0.34 could predict PVR > 5 WU with good sensitivity.

Background: Cleft in the mitral valve leaflet is a primary cause of congenital mitral regurgitation, stemming from developmental anomalies in the mitral valve and frequently associated with other congenital heart defects. Concurrent presence of cleft in mitral valve leaflet with atrial septal defect and ventricular septal defect is relatively rare. Echocardiography, especially transesophageal echocardiography, is essential in diagnosing cleft mitral valve leaflet and related congenital heart defects, providing critical, detailed imagery for accurate assessment. This study presents a young female patient whose anterior mitral cleft, along with atrial septal defect and ventricular septal defect, was revealed through three-dimensional transesophageal echocardiography. Case presentation: A 25-year-old Iranian female, experiencing progressive dyspnea and diminished physical capacity over 3 months, was referred to our hospital. Initial examination and transthoracic echocardiography indicated severe mitral regurgitation. Further evaluation with transesophageal echocardiography corroborated these findings and identified a cleft in the anterior mitral valve leaflet, coupled with mild left ventricular enlargement and significant left atrial enlargement. The complexity of the patient's condition was heightened by the diagnosis of cleft mitral valve leaflet in conjunction with atrial septal defect and ventricular septal defect, showing the complex nature of congenital defects. Conclusion: This case emphasizes the critical role of transthoracic echocardiography in diagnosing cleft of mitral valve leaflet and associated cardiac anomalies, showcasing its superiority over transthoracic echocardiography for detailed visualization of cardiac structures. The identification of multiple congenital defects highlights the necessity for a comprehensive diagnostic approach to manage and treat patients with complex congenital heart diseases effectively. Future research should aim to refine diagnostic methodologies to enhance patient outcomes for cleft of mitral valve leaflets and related congenital conditions. [ABSTRACT FROM AUTHOR]

Congenital heart diseases (CHD) are one of the most common birth defects and the main leading cause of death in children. Many patients with CHD are reaching adulthood due to the success of improved contemporary surgical procedures. Understanding the etiology of CHD remains important for patient clinical management. Both genetic and environmental factors are involved in the development and progression of CHD. Variations in many different genes and chromosomal anomalies can be associated with CHD, by expression of different mechanisms. Sporadic cases are the most frequently encountered in these patients. Atrial septal defect is a common congenital heart disease that refers to direct communication between atrial chambers, found isolated or associated with other syndromes. Imaging techniques, especially transthoracic and transesophageal echocardiography (TOE) represent the key for diagnosis and management of ASD. The disease has a major incidence in adulthood, due to late symptomatology, but assessment and treatment are important to avoid time-related complications. Ebstein's anomaly is a rare congenital disease, with a dominant genetic participation, characterized by an abnormal displacement of the tricuspid valve and right ventricular myopathy, often requiring surgical intervention. Alongside echocardiography, cardiac magnetic resonance (CMR) imaging is the gold standard tool for the assessment of ventricular volumes. Early diagnosis and adequate treatment are mandatory to avoid possible complications of CHD, and thus, ECG, as well as imaging techniques, are important diagnostic tools. However, patients with CHD need a special healthcare team for the entire monitorization in various life stages. [ABSTRACT FROM AUTHOR]

Background/Objectives: To close the atrial septal defect (ASD) with the transcatheter method, correctly defining the defect and selecting the appropriate closure device size are the most critical steps for the procedure's success. Although ASD can be successfully closed under the guidance of three-dimensional (3D) transesophageal echocardiography (TEE) and two-dimensional (2D) TEE, measurement comparisons between different types of defects are still needed. Methods: Our study was designed retrospectively. Sixty-one patients who underwent transcatheter ASD closure with 2D TEE and 3D TEE between 2020 and 2024 were included. The patients were divided into three groups according to the defect shape: circular, oval, and complex; and the measurement results, perioperative process, and clinical outcomes were compared in each group. Results: The average age of the patients was 35.05 ± 13.87 years, and 41 (67.2%) were women. The average follow-up period of the patients was 15.3 ± 9.18 months. No statistical significance was observed in the comparison of measurements obtained with 3D TEE and 2D TEE in the circular and oval defect groups. The differences between the minimum defect diameters of complex defects measured by 2D TEE and 3D TEE (p: 0.037), IVC rims (p < 0.001), aortic rims (p: 0.012), and the differences between implanted device dimensions and the maximum defect diameters measured by both methods were compared; statistical significance was observed (p: 0.025). Conclusions: In circular and non-complex oval defects, it has been observed that the size of the closure device selected with 2D TEE or 3D TEE is optimal, and the procedure is practical and feasible. While the closure of complex ASDs with 3D TEE provides reliable and optimal results, using only 2D TEE in complex ASDs may lead to selecting a smaller-sized device. [ABSTRACT FROM AUTHOR]

Aim Saline contrast-enhanced electrical impedance tomography (EIT) has been used to identify the respiratory failure etiologies through assessment of regional lung perfusion at the bedside. In this study, we introduce a novel approach to detect right-to-left intracardiac shunt based on the center of heart (CoH) parameter determined from the early phase of impedance–time curve after saline bolus injection. Methods and result The timepoints when the saline bolus enter the heart (T0) and the lung regions (T1) are identified at first. A moving time window from T0 to T1 is then generated with steps of 0.5 s and the slope of the impedance–time curve in each pixel within the window calculated. CoH is calculated as the geometric center of pixel slope values in the right-to-left image direction. To illustrate how this method works in practice, we calculated the CoH values at T0 to T1 in 10 control hypoxic patients with no right-to-left shunt. In addition, we examined two critically ill patients with right-to-left intracardiac shunt. One was postcardiac surgery patient who had a residual atrial septal defect by color doppler of transesophageal echocardiograph. The other patient had a congenital heart disease of ventricular septal defect by color doppler of trans-thoracic echocardiography. A large difference in CoH between T0 to T1 was observed in the two patients with intracardiac shunt than in the control patients (11.06 ± 3.17% vs. 1.99 ± 1.43%, P  = 0.030). Conclusion Saline bolus EIT for lung perfusion might be used as ventriculography to identify the right-to-left intracardiac shunt at the bedside. [ABSTRACT FROM AUTHOR]

Data on concomitant cardiac surgery (CCS) performed during pediatric lung transplantation (LTx) is limited. Therefore, we conducted a multi-institutional analysis to identify the incidence and outcomes of CCS in pediatric (< 18 years) LTx recipients by merging data (2004–2023) from the United Network for Organ Sharing (UNOS) and Pediatric Health Information System (PHIS) databases. Of the total of 596 pediatric LTx recipients, 87 (15%) underwent CCS. The majority of these cardiac surgeries were atrial septal defect (ASD) closure (90%) followed by aortic arch/descending aortic repair (3%), atrial repair (3%), ventricular septal defect closure (2%), patent ductus arteriosus ligation (2%), and tricuspid valve repair (2%). The median age at LTx was 3 years (IQR: 0–12). Pulmonary hypertension (PHT) was the predominant indication for LTx (54%). Survival to discharge was 94% and 5-years survival was 64%. Our findings indicate CCS in children undergoing LTx has acceptable outcomes. [ABSTRACT FROM AUTHOR]

An 82-year-old man with a secundum atrial septal defect (ASD) underwent transcatheter closure. The patient had a wide area of aortic and superior rim deficiency, with left ventricular diastolic dysfunction and moderate mitral regurgitation. These findings suggested the risk of both cardiac erosion and increased left atrial pressure after closure. To avoid cardiac erosion, a GORE® CARDIOFORM ASD (GCA) occluder (W.L. Gore & Associates, Flagstaff, AZ, USA) was considered an appropriate device in this patient. However, the possibility of excessively high left atrial pressure due to complete defect closure was a concern. Thus, we created a 4.5-mm fenestration using a surgical punch in the fabric membrane of a 44-mm GCA. The device was deployed in an appropriate position, and no significant elevation of pulmonary capillary wedge pressure was observed. One month after the closure, marked improvement in clinical symptoms and continuous flow through the fenestration were observed. This novel fenestration technique may contribute to expansion of the indications for transcatheter ASD closure in patients who require a GCA owing to an anatomically high risk of erosion accompanied by left ventricular diastolic dysfunction. In elderly patients with left ventricular diastolic dysfunction, transcatheter atrial septal defect (ASD) closure is difficult because rapid resolution of an ASD shunt can cause an increase in left atrial pressure. Previous reports described the creation of a fenestration in the closure device. The use of a GORE® CARDIOFORM ASD (GCA) occluder can reduce the erosion risk; however, creating a stable fenestration is difficult. We developed a novel technique to create a stable fenestration in a GCA. [ABSTRACT FROM AUTHOR]

Minimally invasive approaches for cardiac surgery in children have been lagging in comparison to the adult world. A wide range of the most common congenital heart defects in infants and children can be repaired successfully through a variety of non-sternotomy incisions. This has been shown to be associated with superior cosmetic results, shorter hospital stays, and rapid return to full activity compared to sternotomy. These approaches have been around for decades, but they have not been widely adopted for a variety of reasons. Right axillary thoracotomy is one of these approaches that we believe should be the new standard for the repair of a wide variety of heart defects in children and will be the focus of our current review. [ABSTRACT FROM AUTHOR]

BACKGROUND: Secundum Atrial Septal Defects (ASDs) are the most common type of atrial septal defects. Today, using different types of occluders, transcatheter closure is widely used to treat ASD and has replaced the surgical procedure in anatomically suitable patients. This study was performed to evaluate the short-term clinical outcomes of treatment of adult patients requiring an ASD device closure referred to Shahid Chamran Cardiovascular Center in Isfahan, Iran. METHODS: All patients who underwent ASD treatment using transcatheter closure at Shahid Chamran Cardiovascular Center in 2020 and 2021 were recruited in this retrospective descriptive study. The characteristics of the treated lesion and the cardiovascular complications during treatment were recorded immediately and one month after treatment. RESULTS: A total of 70 patients (47 females and 23 males) with a mean age of 39.81±12.56 years were investigated in this study. The number of difficult anomalies was 46 (65.7%), and the most common type was the deficient aortic rim. In terms of the incidence of vascular complications, hematoma, bleeding, and pseudoaneurysm were observed in 8 patients. The most common cardiac complication was atrial fibrillation, which occurred in 12 patients. No cardiovascular complications were observed during the one-month follow-up. CONCLUSION: The results of this single-institute study showed that ASD treatment by the transcatheter procedure using an ASO device at Shahid Chamran Cardiovascular Center was performed safely and successfully with very few complications. The short-term analysis of the outcomes indicated no major complications, deaths, or device malposition. [ABSTRACT FROM AUTHOR]

Background: Secundum atrial septal defect (ASD) is one of the most common congenital heart conditions. Transcatheter device closure of secundum ASD has become the preferred treatment for patients with suitable anatomy. While, the impact on ventricular function and volume post-closure has been widely studied, data on atrial performance following percutaneous ASD closure remains limited. Objective: This study aimed to assess atrial function using echocardiographic modalities and atrial rhythm through Holter monitoring early after percutaneous ASD closure. Patients and Methods: The study included 40 patients with secundum ASD, evaluated before and shortly after percutaneous closure. Atrial performance was assessed using two-dimensional echocardiography, tissue Doppler imaging (TDI) velocities, and speckle-tracking echocardiography (STE) to measure reservoir, conduit, and contractile functions. Electrical function was monitored with electrocardiograms (ECG) and Holter monitoring to detect heart rate (HR) rhythms and heart rate variability (HRV) before and after ASD closure. Results: Right atrial diameters, volumes, and TDI velocities significantly decreased post-closure. RA reservoir function dropped from 34.58 ± 11.69 before closure to 28.73 ± 11.52 after closure (p<0.001). Similarly, LA reservoir function decreased from 31.4 ± 7.28 to 27.08 ± 6.93 (p<0.001). Average HR decreased from 98.08 ± 13.51 bpm to 92.05 ± 13.23 bpm (p<0.001). The incidence of supraventricular arrhythmia increased significantly post-closure (0.41 ± 0.46%) compared to pre-closure (0.08 ± 0.19%; p<0.001). Conclusion: Atrial diameters and volumes decreased early after ASD device closure, along with reductions in atrial reservoir, conduit, and contractile functions. Supraventricular arrhythmias increased, but there was an improvement in HR and HRV parameters post-closure. [ABSTRACT FROM AUTHOR]

Objective To explore the relationship between maternal childbearing age and congenital heart disease (CHD) in offspring. Methods Based on the CHD screening data of live births born in midwifery institutions in Liuzhou area of Guangxi Zhuang Autonomous Region from January 1, 2020 to December 31, 2022, they were divided into CHD group (n=1 117) and non-CHD group (n=107 458). The data of the two groups were matched by propensity score matching method. The childbearing age of mothers was divided into five groups: < 20 years old, 20 years old, 24 years old, 25 years old, 29 years old, 30 years old, 34 years old, and ≥ 35 years old. The multivariate logistic regression model was used to analyze the relationship between mothers and their offspring with congenital heart disease in different childbirth age groups. The restricted cubic spline curve was used to further analyze the nonlinear relationship between maternal childbearing age and offspring CHD. Results There were 1 117 cases in CHD group and 3 148 cases in control group without CHD. The corrected Logistic regression model analysis showed that the risk of atrial septal defect (ASD) in offspring of < 20 years old group and ≥ 35 years old group was significantly higher than that of mothers aged 25 to 29 years old (OR=5.38, 95%CI: 2.96-9.79; OR=1.43, 95%CI: 1.01-2.03). The risk of ventricular septal defect (VSD) was significantly increased in the offspring ≥ 35 years old (OR=1.51, 95%CI: 1.04-2.19). Restricted cubic spline and threshold analysis showed that there was a curvilinear relationship between maternal childbearing age and the risk of CHD, ASD, and VSD in offspring. The risk of CHD in offspring increased with childbirth age (OR=1.04, 95%CI: 1.02-1.06) when childbirth age was more than 25.43 years old, and VSD risk increased with childbirth age when childbirth age > 32.04 years old (OR=1.16, 95%CI: 1.09-1.24). When the delivery age was less than 23.75 years old, the risk of ASD in offspring decreased with the increase of delivery age (OR=0.69, 95%CI: 0.58-0.82). Conclusion Maternal childbearing age is an independent risk factor for CHD in offspring. Women of appropriate age should be encouraged to marry and give birth, and screening policies should be more reasonably specified for young and older women, and prenatal screening should be strengthened. [ABSTRACT FROM AUTHOR]

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Clinical data: Female, seven years old, referred to our service complaining about congestive heart failure symptoms due to mitral valve regurgitation and atrial septal defect. Technical description: Echocardiographic findings compatible with Barlow’s disease and atrial septal defect, ostium secundum type. Operation: She was submitted to mitral valvuloplasty with chordal shortening and prosthetic posterior ring (Gregori-Braile®) along with patch atrioseptoplasty. Comments: Mitral valve regurgitation is a rare congenital heart disease and Barlow’s disease is probably rarer. Mitral valve repair is the treatment of choice. [ABSTRACT FROM AUTHOR]

Background Lutembacher's syndrome refers to the rare combination of atrial septal defect and mitral stenosis. This condition is still underdiagnosed despite its distinct clinical, paraclinical, and therapeutic implications. Case summary We report the case of a 60-year-old woman presenting with acute congestive heart failure. Investigations revealed the combination of low-gradient severe rheumatic mitral stenosis and ostium secundum atrial septal defect. Despite the medical team's conservative management of her condition and recommendation for surgical intervention, the patient chose to discharge herself against medical advice. She died 6 months later. Conclusion Lutembacher's syndrome continues to be a rare condition in our practice. Once low-gradient severe mitral stenosis is diagnosed, it is essential to search for an associated atrial septal defect, especially when there is an early onset of significant right ventricular enlargement or dysfunction or when an intriguing inconsistency exists between the mitral area and the transmitral gradient. [ABSTRACT FROM AUTHOR]

Background Right ventricular volume overload is the key finding in a patient with previously undiagnosed atrial septal defect (ASD). Case summary A 68-year-old female was referred to our hospital due to progressive pulmonary artery dilatation observed on her chest X-ray. Echocardiography revealed a secundum ASD with right ventricular dilatation. She had undergone aortic root replacement and aortic valve replacement for annuloaortic ectasia and aortic insufficiency 12 years prior to the diagnosis. She was also diagnosed with Marfan syndrome, which was supported by family histories. Computed tomography did not show a secundum ASD before the surgery. We finally closed the secundum ASD with catheter closure device. Discussion Ascending aneurysm might mask the presence of secundum ASD. Monitoring the change in pulmonary artery dilatation overtime is useful for the diagnosing secundum ASD. [ABSTRACT FROM AUTHOR]

Background Anomalous drainage of inferior vena cava (IVC) into left atrium (LA) is a rare aetiology of cyanosis in adults. This condition may be associated with atrial septal defects, anomalous pulmonary venous drainage, and pulmonary arteriovenous fistulas. This case report presents an instance of anomalous drainage of IVC into LA, associated with ostium secundum atrial septal defect (ASD). It contributes to the existing literature by highlighting the diagnostic challenges associated with this anomaly, particularly during surgical intervention. Case summary A 38-year-old male presented with a six-year history of exertional dyspnoea and episodic palpitation. Transthoracic echocardiography revealed a large secundum (ASD), the IVC draining into LA, a left superior vena cava, and mild mitral regurgitation. These findings were further confirmed by right and left heart catheterization and CT angiogram. The patient was referred to CTVS department for surgical correction. The post-operative course was uneventful. At a 1.4-year follow-up, the patient reported significant improvement in symptoms. Discussion We present a case of anomalous drainage of IVC into LA, associated with ostium secundum ASD. An ASD co-occurs with this condition in ∼70% of the reported cases. This anomaly differs from a low or inferior vena caval secundum ASD, where a prominent Eustachian valve can cause blood shunting from the IVC to LA. If the surgeon is not vigilant, this can be mistaken for the inferior ASD rim, potentially leading to iatrogenic diversion of IVC blood to LA upon ASD closure, resulting in cyanosis. This case underscores the diagnostic and surgical challenges associated with this condition. [ABSTRACT FROM AUTHOR]

Background: Raghib syndrome is a rare malformation complex consisting of the drainage of the left superior vena cava (LSVC) into the left atrium, ostial atresia of the coronary sinus and an atrial septal defect (ASD). Case Report: This report aims to present the case of a child newly diagnosed with Raghib syndrome, complicated by pulmonary arterial hypertension, and to review previously published cases with the same diagnosis. A six-year-old female patient presented with signs and symptoms of heart failure (Ross III), reduced exercise tolerance and severe delay in stature and ponderal development. The imagistic work-up included echocardiography, followed by computer tomography (CT) and magnetic resonance imaging (MRI), through which a diagnosis of Raghib syndrome was established, complicated by pulmonary hypertension. As in other cases presented in the literature, MRI allowed for an accurate diagnosis, detecting the absent coronary sinus. The decision regarding the surgical closure of the ASD was made, with the patient having a favorable clinical evolution but with the persistence of elevated pulmonary artery pressure, for which Sildenafil therapy was instituted. Conclusions: The malformation complex consisting of an atrial septal defect, ostium atresia of the coronary sinus, uncovered coronary sinus, and persistent left superior vena cava, as identified through multiple imagistic investigations, was suggestive of the rare diagnosis of Raghib syndrome in this case. Among the limited number of cases of Raghib syndrome available in the literature, the present case is distinguished by the severity of the pulmonary artery hypertension at a very young age and in the absence of other concurrent cardiac malformations. [ABSTRACT FROM AUTHOR]

Background: Atrial septal defects (ASD) are the most common type of adult congenital heart disease (ACHD) associated with a high risk developing of pulmonary arterial hypertension (PAH). ASD closure is not recommended in patients with PAH and Pulmonary Vascular Resistance (PVR) ≥ 5 Wood Unit (WU). Noninvasive methods have been proposed to measure PVR; however, their accuracy remains low. Right Ventricle (RV) - Pulmonary Artery (PA) coupling is defined as the ability of the RV to adapt to high-resistance conditions. Tricuspid Annular Plane Systolic Excursion (TAPSE)/estimated pulmonary artery systolic pressure (ePASP) calculation using echocardiography is a noninvasive technique that has been proposed as a surrogate equation to evaluate RV-PA coupling. Currently, no research has demonstrated a relationship between RV-PA coupling and PVR in patients with ASD. Methods: The study participants were consecutive eligible patients with ASD who underwent right heart catheterization (RHC) and echocardiography at Hasan Sadikin General Hospital, Bandung. Both the procedures were performed on the same day. RV-PA Coupling, defined as TAPSE/ePASP > 0.31, was assessed using echocardiography. The PVR was calculated during RHC using the indirect Fick method. Results: There were 58 patients with ASD underwent RHC and echocardiography. Among them, 18 had RV/PA Coupling and 40 had RV/PA Uncoupling. The PVR values were significantly different between the two groups (p = 0.000). Correlation test between TAPSE/ePASP with PVR showed moderate negative correlation (r= -0.502, p = 0.001). TAPSE/ePASP ≤ 0.34 is the cutoff point to predict PVR > 5 WU with sensitivity of 91.7% and specificity 63.6%. Conclusion: This study showed a moderate negative correlation between TAPSE/ePASP and PVR. TAPSE/ePASP ≤ 0.34 could predict PVR > 5 WU with good sensitivity. [ABSTRACT FROM AUTHOR]

Objective: The noninvasive right ventricular pressure‐strain loop (PSL) represents a novel method for the quantitative assessment of right ventricular myocardial function. Given that atrial septal defect (ASD) is a prevalent congenital heart anomaly associated with right ventricular volume overload, this study aimed to quantitatively assess the myocardial function of the right ventricle in ASD patients pre‐ and post‐occlusion by noninvasive right ventricular PSL. Methods: This study included 36 patients diagnosed with secundum ASD group and 30 healthy adults (control group). We compared conventional right ventricular echocardiographic parameters, right ventricular strain, and myocardial work in the ASD group before occlusion, two days post‐occlusion, and three months post‐occlusion, with those in the control group. Results: Prior to and two days following occlusion, the ASD group exhibited higher right ventricular global work index (RVGWI), right ventricular global wasted work (RVGWW), and right ventricular global constructive work (RVGCW) compared to the control group (P <.05). Within the ASD group, post‐occlusion, RVGWI, RVGCW, and RVGWW values were significantly reduced compared to pre‐occlusion values (P <.001). Furthermore, RVGWI and RVGCW showed a significant decrease three months after occlusion compared to two days post‐occlusion (P <.05). Multivariate regression analysis identified ASD diameter and pulmonary artery systolic pressure (PASP) as independent predictors of RVGWI (β =.405, P <.001; β = 2.307, P =.037) and RVGCW(β =.350, P<.001; β = 1.967, P =.023). Conclusions: The noninvasive right ventricular PSL effectively demonstrates the alterations in right ventricular myocardial function in ASD patients, pre‐ and post‐occlusion. The metrics of right ventricular myocardial work (RVMW) offer a novel indicator for evaluating right ventricular myocardial function in these patients. Moreover, ASD diameter and PASP emerge as independent determinants of RVGWI and RVGCW. [ABSTRACT FROM AUTHOR]

Background: Balloon sizing (BS) has been used for device size selection in percutaneous atrial septal defect (ASD) closure. Due to its limitations, alternative imaging techniques like three‐dimensional transesophageal echocardiography (3D‐TEE) are valuable for guiding ASD device size selection during ASD closure procedures. The purpose of this study was to compare ASD sizing using measurements obtained from 3D–TEE to those utilizing the standard balloon sizing method. Methods: We identified 53 patients with single secundum type ASD without PFO who underwent percutaneous closure at the Tehran Heart Center between 2019 and 2022. Balloon sizing was performed in all patients with the stop‐flow technique, and the choice of device size was determined based on the sizing derived from BS. 3D‐TEE imaging was performed before the intervention, and the ASD shape and quality of ASD rims were assessed. Results: Among the 53 patients who underwent single ASD device closure, multiple 3D TEE measurements significantly correlated with balloon sizing results. This included defect area, perimeter, and diameter obtained from 3D‐TEE images multi‐planar reconstruction. ASD perimeter detected by 3D TEE had the best correlation with BS results. When divided by the shape of ASD, there was no significant difference between our 3D‐images data and BS in round or oval‐shaped ASDs. Conclusion: The 3D‐TEE study is reliable for assessing ASD configurational characteristics in percutaneous device closure candidates. 3D‐TEE has the potential to accurately determine the appropriate device size and reduce complications, costs, and procedural duration. Further research is needed to validate these findings and establish the role of 3D‐TEE measurements in guiding the best treatment decisions for ASD closure. [ABSTRACT FROM AUTHOR]

At present, the patent foramen ovale (PFO) does not receive the deserved medical attention. The PFO poses a serious threat to health and even the life of mankind. The first respective case report in the medical literature dates back to the 19th century. It led to death. The fact that a PFO is present in roughly 25% of people underscores its overall potential to cause harm. Yet at the same time, the sheer number discourages the medical community from screening for it and from treating it. About 5% of the population have particularly dangerous forms of PFOs. Such PFOs portray a high enough risk for clinical events, the likes of death, stroke, myocardial infarction, or ocular, visceral, and peripheral embolism, to justify screening for them. Highly significant health incidents being at stake, it appears obvious that PFO closure should be used for primary prevention. This is supported by the fact that closing a PFO is the simplest intervention in cardiology, with presumably the highest clinical yield. Being mainly a preventive measure, PFO closure represents a mechanical vaccination. When closing PFOs for one of the rarer therapeutic indications (migraine, platypnea orthodeoxia, etc.), patients automatically profit from the collateral benefit of getting, at the same time, mechanically vaccinated for life against paradoxical embolism. Vice versa, closing a PFO for the prevention of paradoxical embolism betters or cures migraine or exercise dyspnea not infrequently, thereby improving quality of life as a collateral benefit. [ABSTRACT FROM AUTHOR]

Key Clinical Message: The key takeaway from this clinical scenario is to choose the most appropriate and reasonable treatment plan when dealing with a patient who has atrial septal defect (ASD) and concurrent atrial and mediastinal masses. In such cases, a heart‐oncology team should make the therapeutic decision. Right atrial masses are not pretty rare and might be a diagnostic challenge. Thrombosis, tumors, and vegetations are primary differential diagnoses. Workup for these masses usually includes multimodality imaging and biopsy in selected cases. We report a case of a 37‐year‐old lady who presented with cough, dyspnea, and head and neck swelling after a cesarean section. Echocardiography revealed a right atrial mass accompanied by a secundum type atrial septal defect (ASD). Pulmonary CT Angiography was performed, in which a lobulated mass in the anterior mediastinum was detected, and a heart‐oncology team made the therapeutic decision. The patient was scheduled for surgical ASD closure and concomitant tissue biopsy. The pathology results were in favor of poorly differentiated germ cell tumors, and chemotherapy was started following the surgery. After two sessions of chemotherapy, the tumor did not respond to the primary regimen. Thus, an updated regimen was initiated. Compliance with the updated regimen was acceptable, and the patient is currently under treatment and follow‐up. [ABSTRACT FROM AUTHOR]

Patent foramen ovale (PFO) and atrial septal defects (ASD) have been described in up to 30 % of subjects in autopsy series but contemporary data are scarce. It is important to confirm the prevalence of ASD/PFO in the general population given the potential associated stroke risk and the increasing availability of intervention via PFO closure. A state-wide prospective out-of-hospital cardiac arrest registry (OHCA) identified all patients aged 1 to 50 years who experienced OHCA in Victoria, Australia from April 2019 to April 2022 and subsequently underwent autopsy with a cardiac cause of death identified. Autopsy was performed including visual description of any ASD and identification of probe patency of foramen ovale. A total of 517 patients underwent autopsy in the setting of sudden cardiac death; 36 patients (6.9 %) had a probe-patent foramen ovale, 2 patients (0.4 %) had secundum ASD, and 2 patients (0.4 %) had both a PFO and ASD (1 of whom had undergone percutaneous repair of both lesions). Twelve patients (2.3 %) had a prior history of cerebrovascular accident either recorded on medical history or detected on neuropathological examination; however none of these patients had a PFO or ASD. The combined rate of PFO and ASD in a cohort of 517 patients undergoing autopsy was 7.9 %. None of these patients had experienced a cerebrovascular accident. This rate of PFOs appears lower than earlier reports and raises the possibility that the relative risk of an associated stroke could be higher than previously estimated. [Display omitted] • Patent foramen ovale (PFO) can be associated with young cryptogenic stroke. • PFO prevalence in young cryptogenic stroke patients can be up to 45 %. • In our sudden cardiac death autopsy cohort, PFO rate was 7.4 %. • This lower PFO rate increases PFO's overrepresentation in cryptogenic stroke. [ABSTRACT FROM AUTHOR]

Thoracic echocardiography (TTE) can provide sufficient cardiac structure information, evaluate hemodynamics and cardiac function, and is an effective method for atrial septal defect (ASD) examination. This paper aims to study a deep learning method based on cardiac ultrasound video to assist in ASD diagnosis. We chose four standard views in pediatric cardiac ultrasound to identify atrial septal defects; the four standard views were as follows: subcostal sagittal view of the atrium septum (subSAS), apical four-chamber view (A4C), the low parasternal four-chamber view (LPS4C), and parasternal short-axis view of large artery (PSAX). We enlist data from 300 children patients as part of a double-blind experiment for five-fold cross-validation to verify the performance of our model. In addition, data from 30 children patients (15 positives and 15 negatives) are collected for clinician testing and compared to our model test results (these 30 samples do not participate in model training). In our model, we present a block random selection, maximal agreement decision, and frame sampling strategy for training and testing respectively, resNet18 and r3D networks are used to extract the frame features and aggregate them to build a rich video-level representation. We validate our model using our private dataset by five cross-validation. For ASD detection, we achieve 89.33 ± 3.13 AUC, 84.95 ± 3.88 accuracy, 85.70 ± 4.91 sensitivity, 81.51 ± 8.15 specificity, and 81.99 ± 5.30 F1 score. The proposed model is a multiple instances learning-based deep learning model for video atrial septal defect detection which effectively improves ASD detection accuracy when compared to the performances of previous networks and clinical doctors. [ABSTRACT FROM AUTHOR]

Background The purpose of this study was to describe the correlates and outcomes in adults with unrepaired partial anomalous pulmonary venous return and intact atrial septum (PAPVR‐IAS). Methods and Results We identified adults with PAPVR‐IAS who received care at the Mayo Clinic, while those with unrepaired PAPVR‐IAS comprised the reference group. Clinical indices (New York Heart Association class, peak oxygen consumption, and NT‐proBNP [N‐terminal pro‐B‐type natriuretic peptide]) and echo‐derived right heart indices (right atrial [RA] volume, RA reservoir strain, right ventricular [RV] free wall strain, RV end‐diastolic area, and RV systolic pressure) were assessed at baseline and 3‐year and 5‐year follow‐up. There were 80 patients and 38 patients with unrepaired versus repaired PAPVR‐IAS, respectively. The clinical predictors of surgical repair were the number of anomalous veins, RA volume, and RV end‐diastolic area. The PAPVR‐IAS risk score, derived from these clinical predictors, was associated with surgical repair (adjusted odds ratio, 1.37 [95% CI, 1.24–1.65] per unit increase in risk score; area under the curve, 0.742). Among patients with unrepaired PAPVR‐IAS with 3‐year (n=73) and 5‐year follow‐up (n=36), there was no temporal change in clinical indices (New York Heart Association class, predicted peak oxygen consumption, and NT‐proBNP) and right heart indices (RA volume index, RA reservoir strain, RV end‐diastolic area index, RV free wall strain, and RV systolic pressure). Conclusions The PAPVR‐IAS risk score can be used to assess the odds of requiring surgical repair. Furthermore, there was no temporal deterioration in clinical and right heart indices during follow‐up in adults with unrepaired PAPVR‐IAS.

[Display omitted] [ABSTRACT FROM AUTHOR]

Holt-Oram syndrome is a rare congenital autosomal dominant disorder caused by a mutation in the TBX5 gene. It is characterised by upper limb abnormalities and congenital heart lesions, such as Atrial Septal Defect (ASD), typically affecting children. In this case, a sixyear-old boy presented with facial puffiness and decreased urine output following an upper respiratory infection. Upon examination, he was found to have Holt-Oram syndrome, a rare genetic disorder characterised by abnormalities in the bones of the upper limbs and congenital heart defects. He developed acute Post Streptococcal Glomerulonephritis (PSGN) following a streptococcal infection, resulting in persistent hypertension. Each condition independently poses significant health challenges, and their simultaneous occurrence complicates the clinical picture considerably. Following detailed investigations and management, the child required continued treatment with two antihypertensive medications upon discharge. The need for dual therapy in a paediatric patient highlights the severity of his condition and the challenges in managing it effectively. Close follow-up is essential to monitor disease progression and ensure optimal outcomes. This case features both a genetic disorder (Holt-Oram syndrome due to a TBX5 gene mutation) and an immune-mediated renal disease (PSGN), representing a rare intersection of genetic and postinfectious pathologies. The co-existence of these two conditions is unusual and complicates the clinical picture, necessitating a tailored approach to management. This case underscores the need for a multidisciplinary approach involving cardiology, nephrology, and genetics. Coordinated care is crucial for monitoring disease progression, managing complications, and ensuring comprehensive treatment. [ABSTRACT FROM AUTHOR]