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      Availability of Percutaneous Closure for an Adult Population with Interatrial Shunts

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          Objectives: To report the availability of percutaneous closure for an adult population with interatrial septal defects. Methods: Observational study with 66 consecutive patients referred to a tertiary center for evaluation of the possibility of percutaneous closure. The patients were selected initially after review of transesophageal echocardiography (TEE) and finally after heart catheterization. Results: Out of 66 patients, 50 were selected after the review of TEE and 38 of them were selected after catheterization; all of the 38 were effectively closed. Conclusion: Percutaneous closure is possible and can be carried out safely in a majority of the adult population with interatrial shunts.

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          A comparison of surgical and medical therapy for atrial septal defect in adults.

          The surgical closure of an atrial septal defect is frequently recommended for patients over 40 years of age. However, the prognosis for such patients with unrepaired defects is largely unknown, and the outcome for patients operated on after the fourth decade of life has not yet been compared with that for medically treated patients in a controlled follow-up study. In a retrospective study, we examined the clinical course of 179 consecutive patients with isolated atrial septal defects diagnosed after the age of 40. The 84 patients (47 percent) who underwent surgical repair were compared with the 95 patients (53 percent) who were treated medically. The mean (+/-SD) follow-up period was 8.9 +/- 5.2 years (range, 1 to 26). Multivariate analysis revealed that surgical closure of the defect significantly reduced mortality from all causes (relative risk, 0.31; 95 percent confidence interval, 0.11 to 0.85). The adjusted 10-year survival rate of surgically treated patients was 95 percent, as compared with 84 percent for the medically treated patients. In addition, surgical treatment prevented functional deterioration, as measured by the New York Heart Association class (relative risk, 0.21; 95 percent confidence interval, 0.08 to 0.55). However, the incidence of new atrial arrhythmias or of cerebrovascular insults in the two groups was not significantly different. The surgical repair of an atrial septal defect in patients over 40 years of age, as compared with medical therapy, increases long-term survival and limits the deterioration of function due to heart failure. However, surgically treated patients should be followed closely for the onset of atrial arrhythmias so as to reduce the risk of thromboembolic complications.
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            Diagnosis of patent foramen ovale by transesophageal echocardiography and association with cerebral and peripheral embolic events.

            This study compares the value of transthoracic (TTE) and transesophageal (TEE) color Doppler and contrast echocardiography for detecting a patent foramen ovale (PFO). A total of 238 patients were studied: 74 patients with a history of otherwise unexplained ischemic stroke, transient cerebral ischemic attacks or peripheral embolic events (group A), 48 with a history of similar episodes explained by other cardiac abnormalities (group B), and 116 with no embolic events (group C). A PFO was detected by contrast TEE in 50 of 238 patients (21%) compared with 45 patients (19%) by color Doppler TTE. In a subgroup of 198 patients, TEE results could be compared with TTE findings. No patient had a PFO identified by color Doppler TTE. Contrast TTE detected a PFO in 15 patients (8%) compared with contrast TEE which demonstrated a PFO in 44 of 198 patients (22%) (p less than 0.001). Prevalence of PFO by TEE was 22, 21 and 22% in groups A, B and C, respectively. A PFO was present in 50% of patients aged less than 40 years and otherwise unexplained ischemic stroke; this percentage was higher (p less than 0.05) than corresponding values found in all other groups. Thus, contrast and color Doppler TEE are significantly superior to TTE for detecting PFO. The prevalence of PFO is significantly increased in young adults with otherwise unexplained ischemic stroke.

              Author and article information

              S. Karger AG
              April 2003
              25 April 2003
              : 99
              : 2
              : 85-89
              aDepartment of Clinical Physiology, bThe Queen Silvia Children’s Hospital, and cGrown-Up Congenital Heart Disease Unit, Östra University Hospital, Göteborg, Sweden
              69730 Cardiology 2003;99:85–89
              © 2003 S. Karger AG, Basel

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              Page count
              Figures: 2, Tables: 3, References: 21, Pages: 5
              Congenital Heart Disease


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