Relationship between atrial septal defects and asthma-like dyspnoea: the impact of transcatheter closure

Background: An atrial septal defect (ASD) is a persistent interatrial communication. It is distinct from a patent foramen ovale wherein there is a flap with intermittent communication. The aim of this work was to assess prevalence of mitral valve regurge or prolapse and left atrial volume in patients with secundum type ASD. Methods: This prospective study was carried out at the cardiovascular department, Tanta University Hospitals on 140 patients either adult or children who were diagnosed as atrial septal defect by 2-D echocardiography. They were subjected to detailed history, detailed clinical examination, chest x-ray and echocardiography (2-D echo & Doppler). Results: 95% of patients were trivial or mild mitral regurgitation, 3.6% were moderate and 1.4% were severe. Cause of mitral valve regurgitation was 2.86% prolapse, 1.43% rheumatic and 0.71 dysplastic. Left atrial enlargement was found in 2.1% of patients. Mean LA diameter was 34.68 ± 3.9 mm, mean LA volume was 45.75 ± 3.44 ml and mean LA volume index was 24.14 ± 2.97 ml/m2. 1.43% of patients have history of rheumatic fever. 51.4% of patients presented with fatigue, 45.7% presented with palpitation, 41.4% of the patients presented with exertional dyspnea and 22.8% presented with tachypnea. Conclusions: The prevalence of mitral regurgitation is low in secundum ASD. Mitral regurgitation associated with secundum atrial septal defect could exist as a coexistent lesion, its recognition is important and most of them could be repaired with satisfactory results. Also, the left atrial volume was not affected except in sever mitral regurgitation.

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“…Our results are supported by another study in which of all 80 patients with ASD, 62 reported exertional dyspnea (78 %) [12].…”

Section: Discussionsupporting

confidence: 89%

Prevalence of Mitral Valve Regurge with or without Prolapse and Left Atrial Volume among Patients with Secundum Type Atrial Septal Defect

Elgebaly

Shaban

Elsheikh

et al. 2022

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“…Older subjects with ASD should be screened for respiratory elements in suspected cases and treated appropriately. This has the double benefit of symptomatic improvement and reduction in the PAH and associated challenges in device closure also found in the present study [22,23].…”

Section: Discussionsupporting

confidence: 76%

Challenges in Device Closure of Secundum Atrial Septal Defect in Older Patients in Their Fifth Decade and Beyond

Singhi¹,

Mahapatra²,

Dey³

et al. 2022

Cureus

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Transcatheter atrial septal defect (ASD) device closure in the older population presents a greater challenge due to the long-standing effect of atrial left-to-right shunt. This study analyzes the challenges encountered in transcatheter ASD device closure in older patients in their fifth decade and beyond. MethodsAdults aged 40 years and above with significant secundum ASD who underwent transcatheter ASD device closure between June 2015 and April 2021 were analyzed. Challenges were classified as major and minor challenges based on their impact on the alteration of the treatment protocol. Patients were categorized into three subgroups according to age. Group 1 consisted of patients aged 40-49 years (n = 13), Group 2 consisted of patients aged 50-59 years (n = 16), and Group 3 consisted of patients aged 60 years and above (n = 8). ResultsA total of 37 patients were analyzed. The challenges encountered were arrhythmia, pulmonary hypertension, left ventricular diastolic dysfunction, bleeding, stroke, coronary artery disease (CAD), hypertension, and airway disease. Thirteen percent of challenges were seen in pre-procedure time, whereas 79% of challenges during the procedure and 8% of challenges during post-procedure were seen. Thirty-five patients (94.6%) underwent transcatheter ASD device closure. Two patients (5.4%) did not undergo transcatheter ASD device closure due to severe diastolic dysfunction and associated CAD, respectively. Eleven major challenges were encountered in 10 patients in which one patient had a dual challenge of bleeding and arrhythmia. Thirteen patients (35.1%) had smooth procedures without any challenges encountered. Twentyseven minor challenges were encountered in 20 patients with some patients having an overlap of multiple major and minor challenges. The patients were doing well at the mean follow-up of 28 months. ConclusionsTranscatheter ASD device closure in older patients who are 40 years and above is safe and effective. Such high-risk patients are prone to various challenges that can be effectively managed if optimally monitored on the basis of a proper understanding of the altered physiology and anticipation of the deviated course at various stages of the procedure.

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“…The association between ASD and asthma‐like dyspnea, such as wheezing and chest tightness, is commonly acknowledged in the pediatric community, yet unequally established in adult cardiology. The prevalence of asthma‐like symptoms and pulmonary inhalant use in an adult ASD study cohort has recently been suggested in a questionnaire‐based study of 80 adult ASD patients in which one‐third of patients reported wheezing and chest tightness and 20% used bronchodilators . Also, in a multicenter population‐based study (unpublished data), use of pulmonary inhalants was found to be twice as high in adult ASD patients compared to the general population, both before and long after shunt repair.…”

Section: Introductionmentioning

confidence: 93%

“…The prevalence of asthma-like symptoms and pulmonary inhalant use in an adult ASD study cohort has recently been suggested in a questionnaire-based study of 80 adult ASD patients in which one-third of patients reported wheezing and chest tightness and 20% used bronchodilators. 3 Also, in a multicenter population-based study (unpublished data), use of pulmonary inhalants was found to be twice as high in adult ASD patients compared to the general population, both before and long after shunt repair. As of now, however, the possible underlying mechanism of asthma-like dyspnea with consequent long-term pulmonary inhalant use in adult ASD patients still remains unclear.…”

Section: Introductionmentioning

confidence: 95%

Atrial septal defect in adults is associated with airway hyperresponsiveness

Nassif

Steenwijk

Hogenhout

et al. 2018

Congenital Heart Disease

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Objective The association between secundum atrial septal defects (ASD) and asthma‐like dyspnea with consequent long‐term pulmonary inhalant use, is poorly understood in adult ASD patients. Airway hyperresponsiveness is suggested to be the underlying mechanism of cardiac asthma from mitral valve disease and ischemic cardiomyopathy. We hypothesized that airway hyperresponsiveness may also be found in adult ASD patients. Our aim was to study airway responsiveness in adult ASD patients before percutaneous closure and at short‐and long‐term postprocedural follow‐up. Methods This prospective study included 31 ASD patients (65% female, mean age 49 ± 15y) who underwent spirometry and bronchoprovocation testing pre‐and six‐month postprocedurally, with additional bronchoprovocation at 2‐year follow‐up. Airway hyperresponsiveness was defined as ≥20% fall of forced expiratory volume in 1‐second (FEV1) following <8.0 mg/mL of inhaled methacholine. Results Airway hyperresponsiveness was found in 19/30 patients (63%[95%CI 45%‐81%]; post hoc statistical power = 89%). Asthma‐like symptoms wheezing, chest tightness, and cough were more frequently reported in airway hyperresponsive patients. Airway responsiveness was not influenced by successful percutaneous ASD closure, corresponding to persistence of asthma‐like symptoms postclosure. Regardless of airway responsiveness, postprocedural right‐sided reverse remodeling significantly improved dyspnea and pulmonary function. Conclusions This study is the first to report a high prevalence of airway hyperresponsiveness in a cohort of unrepaired adult ASD patients, and confirms the association between asthma‐like symptoms and ASD in adults. Attention to symptoms and pulmonary function should be given during clinical follow‐up of adult ASD patients, both before and long after repair.

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Relationship between atrial septal defects and asthma-like dyspnoea: the impact of transcatheter closure

Cited by 5 publications

References 30 publications

Prevalence of Mitral Valve Regurge with or without Prolapse and Left Atrial Volume among Patients with Secundum Type Atrial Septal Defect

Prevalence of Mitral Valve Regurge with or without Prolapse and Left Atrial Volume among Patients with Secundum Type Atrial Septal Defect

Challenges in Device Closure of Secundum Atrial Septal Defect in Older Patients in Their Fifth Decade and Beyond

Atrial septal defect in adults is associated with airway hyperresponsiveness

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