Hemodynamic assessment of atrial septal defects

Torres, Alejandro

doi:10.21037/jtd.2018.02.17

Cited by 27 publications

(21 citation statements)

References 36 publications

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“…In our series, genes regulating apoptosis were expressed at mRNA level in the RA myocardium and apoptotic bodies were detected at TUNEL staining. This is concordant with a previous study demonstrating increased apoptosis in the RA of patients with ASD, most of them being adults (39). However, in our patients, concentrations of Bcl-xL-mRNA were higher than those of Bak and FasL and negatively correlated with those of TGF-β-mRNA, suggesting that antiapoptotic signals might predominate over pro-apoptotic ones in preschool children with ASD and prevent fibrosis.…”

Section: Discussionsupporting

confidence: 93%

Right Atrial Myocardial Remodeling in Children With Atrial Septal Defect Involves Inflammation, Growth, Fibrosis, and Apoptosis

Rouatbi¹,

Farhat²,

Heying

et al. 2020

Front. Pediatr.

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Introduction: Myocardial remodeling due to large atrial septum defect (ASD) is macroscopically characterized by dilation of the right-sided cardiac cavities secondary to volume overload, the cellular mechanisms of which are not yet understood. We postulated that inflammation, fibrosis, and cell death are actors of right atrial remodeling secondary to ASD. Patients and Methods: In 12 children with large ASD (median age: 63 months), expression of genes coding for proteins involved in the response to cell stress and-protection, inflammation, growth and angiogenesis, fibrosis, and apoptosis was assessed by RT-PCR in right atrial myocardial biopsies taken during cardiac surgery. The presence of cytokines in myocardial cells was confirmed by immunohistochemistry and effective apoptosis by TUNEL assay. Results: In all patients investigated, a cellular response to early mechanical stress with the initiation of early protective mechanisms, of inflammation (and its control),-growth, and-angiogenesis, of fibrosis and apoptosis was present. The apoptotic index assessed by TUNEL assay averaged 0.3%. Conclusions: In children with large ASD, macroscopic right atrial remodeling relates to cellular mechanisms involving the expression of numerous genes that either still act to protect cells and tissues but that also harm as they initiate and/or sustain inflammation, fibrosis, and cell death by apoptosis. This may contribute to long term morbidity in patients with ASD.

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Section: Discussionsupporting

confidence: 93%

Right Atrial Myocardial Remodeling in Children With Atrial Septal Defect Involves Inflammation, Growth, Fibrosis, and Apoptosis

Rouatbi¹,

Farhat²,

Heying

et al. 2020

Front. Pediatr.

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“…Closure of ASD has been suggested when there is clinical evidence of volume overload with pulmonary to systemic blood flow (Qp:Qs) >1.5 and right heart enlargement. ASD-related symptoms, such as failure to thrive and impaired exercise tolerance, pulmonary hypertension and failure to wean from respiratory support may lead to early ASD closure (1,15,19,20). In our study, persistent pulmonary hypertension after birth was linked to an increased risk of early closure, especially when the ASD size: weight ratio was low.…”

Section: Discussionmentioning

confidence: 53%

“…An atrial septal defect (ASD) allows the shunting of blood from the systemic and pulmonary circulation and causes right heart volume overload (15). Spontaneous closure has been described for small or moderate sized ASD (16)(17)(18).…”

Section: Discussionmentioning

confidence: 99%

“…Spontaneous closure has been described for small or moderate sized ASD (16)(17)(18). In children with an asymptomatic ASD, guidelines recommend elective ASD closure at 3to 5 years old (15). Closure of ASD has been suggested when there is clinical evidence of volume overload with pulmonary to systemic blood flow (Qp:Qs) >1.5 and right heart enlargement.…”

Section: Discussionmentioning

confidence: 99%

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Predictors of the Need for an Atrial Septal Defect Closure at Very Young Age

Tanghöj

Liuba

Sjöberg

et al. 2020

Front. Cardiovasc. Med.

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An asymptomatic Atrial Septal Defect (ASD) is often closed at the age of 3-5 years using a transcatheter or surgical technique. Symptomatic ASD or ASD associated with pulmonary hypertension (PHT) may require earlier closure, particularly in combination with other non-cardiac risk factors for PHT, but the indications for early closure and the potential risk for complications are largely unknown. The aim of this study was to assess risk factors for needing ASD closure during the first and second years of life. This case-control study included all children treated with surgical or percutaneous ASD closure between 2000 and 2014 at two out of three pediatric heart centers in Sweden. "Cases" were children with ASD closure at ≤1 or ≤2 years of age. Clinical data were retrieved from medical journals and national registries. Overall, 413 children were included. Of these, 131 (32%) were ≤2 years, and 50 (12%) were ≤1 year. Risk factors associated with a ≤2 years ASD closure were preterm birth, OR = 2.4 (95% CI: 1.5-3.9); additional chromosomal abnormalities, OR = 3.4 (95% CI: 1.8-6.5); pulmonary hypertension, OR = 5.8 (95% CI: 2.6-12.6); and additional congenital heart defects, OR = 2.6 (95% CI: 1.7-4.1). These risk associations remained after adjustments for confounding factors, such as need for neonatal respiratory support, neonatal pulmonary diseases, neonatal sepsis, additional congenital heart defects (CHD) and chromosomal abnormalities. ASD size:body weight ratio of 2.0, as well as a ratio of 0.8 (upper and lower limit of the ASD size:body weight ratios), was associated with increased risk of an early ASD closure. Risk factors such as very premature birth, very low birth weight, congenital, and chromosomal abnormalities, neonatal pulmonary disease and need for ventilation support, as well as pulmonary hypertension, were associated with very early (<1 year of age) ASD closure. Several independent neonatal risk factors were associated with an increased risk of early ASD closure at 2 and at 1 year of age. An ASD size:body weight ratio is a poor predictor for indications for ASD closure.

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“…22 The haemodynamic repercussion criteria for CHD were defined based on the echocardiographic findings; for ventricular and interatrial defects, these included ventricular dysfunction, pulmonary hypertension, right heart chamber volume overload and dilation, the size of the heart defects, the interdependence of the defects, interventricular septal displacement, and left ventricular geometric changes and systolic dysfunction. 23 In the particular case of patent ductus arteriosus, the relationship between the left atrium and the aorta, the size of the defect, pulmonary over-circulation, and left ventricular systolic and diastolic dysfunction were taken into account. 24 All echocardiograms were performed by paediatric cardiologists at the researchers' institution.…”

Section: Pulmonary Hypertension and Congenital Heart Disease Detectedmentioning

confidence: 99%

Impact of pulmonary hypertension and congenital heart disease with hemodynamic repercussion on the severity of acute respiratory infections in children under 5 years of age at a pediatric referral center in Colombia, South America

Lozano-Espinosa¹,

Huertas-Quiñones

Rodríguez‐Martínez

2020

Cardiol Young

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Background: Acute respiratory infection is one of the main causes of morbidity in children. Some studies have suggested that pulmonary hypertension and congenital heart disease with haemodynamic repercussion increase the severity of respiratory infections, but there are few publications in developing countries. Methods: This was a prospective cohort study evaluating the impact of pulmonary hypertension and congenital heart disease (CHD) with haemodynamic repercussion as predictors of severity in children under 5 years of age hospitalised for acute respiratory infection. Results: Altogether, 217 children hospitalised for a respiratory infection who underwent an echocardiogram were evaluated; 62 children were diagnosed with CHD with haemodynamic repercussion or pulmonary hypertension. Independent predictors of admission to intensive care included: pulmonary hypertension (RR 2.14; 95% CI 1.06–4.35, p = 0.034), respiratory syncytial virus (RR 2.52; 95% CI 1.29–4.92, p = 0.006), and bacterial pneumonia (RR 3.09; 95% CI 1.65–5.81, p = 0.000). A significant difference was found in average length of hospital stay in children with the cardiovascular conditions studied (p = 0.000). Conclusions: Pulmonary hypertension and CHD with haemodynamic repercussion as well as respiratory syncytial virus and bacterial pneumonia were predictors of severity in children with respiratory infections in this study. Early recognition of cardiovascular risks in paediatric populations is necessary to lessen the impact on respiratory infections.

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Hemodynamic assessment of atrial septal defects

Cited by 27 publications

References 36 publications

Right Atrial Myocardial Remodeling in Children With Atrial Septal Defect Involves Inflammation, Growth, Fibrosis, and Apoptosis

Right Atrial Myocardial Remodeling in Children With Atrial Septal Defect Involves Inflammation, Growth, Fibrosis, and Apoptosis

Predictors of the Need for an Atrial Septal Defect Closure at Very Young Age

Impact of pulmonary hypertension and congenital heart disease with hemodynamic repercussion on the severity of acute respiratory infections in children under 5 years of age at a pediatric referral center in Colombia, South America

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