Comparison of Medium-term Results of Transcatheter Correction Versus Surgical Treatment for Secundum Type Atrial Septal Defect Combined With Pulmonary Valve Stenosis

Abstract

SummaryThis study was undertaken to compare the clinical results of traditional surgery and a percutaneous procedure for secundum type atrial septal defect (ASD) combined with pulmonary valve stenosis (PS). A total of 78 consecutive patients were identified between March 2004 and July 2012 in our institution. Thirty-five patients (44.9%) underwent percutaneous correction and the remaining 43 patients (55.1%) were treated surgically. All patients had simultaneous complete correction in both groups and no serious complications occurred. The surgical group was significantly younger (13.9 ± 13.0 versus 31.0 ± 17.5 years, P < 0.001) and had a longer mean hospital stay (12.6 ± 4.7 versus 5.3 ± 1.5 days, P < 0.001). There were no significant differences in defect size (18.0 ± 7.9 versus 16.9 ± 8.4 mm, P = 0.553) and transvalvular gradient detected by transthoracic echocardiography (TTE) (74.7 ± 28.3 versus 87.6 ± 37.8 mmHg, P = 0.089) between the two groups. Significant tricuspid regurgitation (TR) decreased from 66% to 14% in the transcatheter group and from 40% to 9% in the surgical group. Mild pulmonary regurgitation was detected in 8 patients in the transcatheter cohort and in 6 patients in the surgical cohort after the procedure. At last follow-up, 83% and 93% of the patients in the transcatheter and surgical groups, respectively, were free of any symptoms, and a significant improvement from preprocedure was observed in the transcatheter group but not in the surgical group (P = 0.005 and P = 0.062). In conclusion, transcatheter correction is a valuable alternative to surgery and allows more patients to be effectively treated in China. (Int Heart J 2014; 55: 326-330) Key words: Congenital heart disease, Pulmonary stenosis, Interventional therapy, Surgical P ulmonary valve stenosis (PS) combined with atrial septal defect (ASD) is a relatively common form of congenital heart disease. Traditional treatment for PS and ASD is open surgery, which is widely performed with low mortality and excellent early and late results, although it still carries risks, such as residual shunt, postpericardiotomy syndrome, low cardiac output syndrome (LCOS), and wound infection after cardiopulmonary bypass (CPB). In addition, formation of scar tissue after surgery is also a common concern for many patients, especially young females. Since the first successful clinical application and report in 1982, 1) percutaneous balloon pulmonary valvuloplasty (PBPV) has replaced surgery as the initial treatment of choice in patients of all ages with pure PS.2-4) Percutaneous ASD closure has become an established therapy that is performed in increasing numbers of adults and children for its good clinical and follow-up results.5-8) Currently, it is already well known and accepted that ASD closure and balloon valvuloplasty of a nondysplastic pulmonary valve can both be accomplished with high rates of success using the transcatheter approach.9-11) However, there is inadequate literature on the comparison of clinical results between surgical treatment ...

A Meta-Analysis of the Relationship Between Maternal Folic Acid Supplementation and the Risk of Congenital Heart Defects

“…2-4) Recently, the survival of newborns with CHDs has increased due to massive breakthroughs in cardiovascular diagnostics and cardiothoracic surgery, 5,6) however, this trend consequently generates a completely novel and steady increasing population with grown-up congenital heart disease (GUCH). Patients with GUCH often need long-term expert medical care with high healthcare-related costs.…”

The Correlation between Infants’ Congenital Heart Defects and Maternal Folic Acid Supplementation

“…It is reported that the prevalence of CHDs accounts for 6% of all neonatal death factors, and also accounts for 46% of all congenital lethal factors [3] . Recently, the survival of newborns with CHDs has increased due to massive breakthrough in cardiovascular diagnostics and cardiothoracic surgery [4] . Arious studies have shown the etiology of congenital heart disease (CHD) and its pattern of inheritance to be of multifactorial origin [5] .A review of the literatures showed that consanguinity [6] , and a variety of maternal ailments e.g., infections, maternal smoking, and gestational diabetes mellitus play a major role in the development of CHD.…”

Predictors of Atrial Septal Defect Occluder Dislodgement

“…9) The development of transcatheter closure techniques and devices has provided a treatment alternative to ASD closure surgery even in pulmonary valve stenosis and targeted treated pulmonary hypertension patients. 10,11) Additionally, transcatheter closure techniques are a preferred choice from a cosmetic perspective, as they greatly diminish the morbidity associated with open-heart surgery, reduce hospital stay, and allow patients to return to their normal daily activities sooner. Complications of percutaneous transcatheter ASD closure: Although the complication rate following percutaneous transcatheter ASD closure is low, 12) the most frequent serious complications as reported in a recent analysis of the Food and Drug Administration Manufacturer and User Facility Device Experience (MAUDE) database are device dislodgement and cardiac perforation, erosion, or rupture (PERs).…”