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      Thrombus Formation in the Right Atrium after Surgical Closure of Atrial Septal Defect

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          Abstract

          Atrial septal defect is the most common congenital lesion in adults following bicuspid aortic valve. There are two closure strategies as follows: one surgical and the other percutaneous. Various complications such as atrial arrhythmias and development of thrombus have been reported after surgical closure. Herein, we present a case of right atrial thrombi formed at different localizations in the right atrium in a patient who was asymptomatic and diagnosed late.

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          Most cited references9

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          Early and late complications associated with transcatheter occlusion of secundum atrial septal defect.

          The goal of this study was to report the early and late complications experienced in atrial septal defect (ASD) transcatheter closure. Atrial septal defect transcatheter occlusion techniques have become an alternative to surgical procedures. A number of different devices are available for transcatheter ASD closure. The type and rate of complications are different for different devices. Between December 1996 and January 2001, 417 patients (mean age: 26.6 +/- 19 years) underwent transcatheter occlusion of secundum type ASD. Complications were categorized into major and minor. Two different devices were used: the CardioSEAL/STARFlex in 159 patients and the Amplatzer septal occluder in 258 patients. Thirty-four patients experienced 36 complications during the hospitalization (8.6%, 95% confidence interval: 6.1% to 11.1%). Ten patients underwent elective surgical repair because of device malposition (three patients) or device embolization (seven patients). Twenty-four patients experienced 25 minor complications: unsatisfactory device position or embolization. Devices were retrieved using a gooseneck snare and/or a basket; 11 patients experienced arrhythmic problems. Other complications were: pericardial effusion, thrombus formation on the left atrial disc, right iliac vein dissection, groin hematoma, hemorrhage in the retropharynx and sizing balloon rupture. Two patients had late complications: peripheral embolization in the left leg one year after implantation of an Amplatzer device and sudden death 1.5 year later. Our series of patients with ASD by transcatheter occlusion shows that the procedure is safe and effective in the vast majority of cases. To further reduce the complications rate, the criteria of device selection according to ASD morphology and some technical tips during implantation are discussed.
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            Free-floating thrombi in the right heart: diagnosis, management, and prognostic indexes in 38 consecutive patients.

            Floating right heart thrombi (FRHTS) are a rare phenomenon, encountered almost exclusively in patients with suspected or proven pulmonary embolism and diagnosed by transthoracic echocardiography. Their management remains controversial. We report on a series of 38 consecutive patients encountered over the past 12 years. Thirty-two patients were in NYHA class IV, 20 in cardiogenic shock. Echocardiography usually demonstrated signs of cor pulmonale: right ventricular overload (91.7% of the population), paradoxical interventricular septal motion (75%), and pulmonary hypertension (86. 1%). The thrombus was typically wormlike (36 of 38 patients). It extended from the left atrium through a patent foramen ovale in 4 patients. Pulmonary embolism was confirmed in all but 1. Mortality was high (17 of 38 patients) irrespective of the therapeutic option chosen: surgery (8 of 17), thrombolytics (2 of 9), heparin (5 of 8), or interventional percutaneous techniques (2 of 4). The in-hospital mortality rate was significantly linked with the occurrence of cardiac arrest. Conversely, the outcome after discharge was usually good, because 18 of 21 patients were still alive 47.2 months later (range, 1 to 70 months). Severe pulmonary embolism was the rule in our series of FRHTS (mortality rate, 44.7%). The choice of therapy had no effect on mortality. Emergency surgery is usually advocated. However, thrombolysis is a faster, readily available treatment and seems promising either as the only treatment or as a bridge to surgery. In patients with contraindications to surgery or lytic therapy, interventional techniques may be proposed.
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              Isthmus-dependent right atrial flutter as the leading cause of atrial tachycardias after surgical atrial septal defect repair

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                Author and article information

                Journal
                J Cardiovasc Echogr
                J Cardiovasc Echogr
                JCE
                Journal of Cardiovascular Echography
                Medknow Publications & Media Pvt Ltd (India )
                2211-4122
                2347-193X
                Oct-Dec 2018
                : 28
                : 4
                : 242-244
                Affiliations
                [1]Department of Cardiology, Umraniye Training and Research Hospital, Istanbul, Turkey
                [1 ]Department of Cardiology, Kartal Kosuyolu Heart and Research Hospital, Istanbul, Turkey
                Author notes
                Address for correspondence: Dr. Muzaffer Kahyaoğlu, Department of Cardiology, Umraniye Training and Research Hospital, Umraniye, 34764, Istanbul, Turkey. E-mail: mkahyaoglu09@ 123456hotmail.com
                Article
                JCE-28-242
                10.4103/jcecho.jcecho_34_18
                6341848
                f99f93bc-ab10-4c33-8196-6f2ffdf6e0d1
                Copyright: © 2018 Journal of Cardiovascular Echography

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                Categories
                Case Report

                atrial septal defect,right atrium,thrombus
                atrial septal defect, right atrium, thrombus

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