#ASD MACBOOK PRO EARLY 2009 SERIES#

The real value of the technique for these indications has yet to be proven. Other more miscellaneous indications for closure of ASD or PFO are the platypneaвЂ“orthodexia syndrome, characterized by dyspnea and desaturation in an upright position due to right-to-left shunting through a PFO, decompression illness in divers and migraine. PFO closure is thought to prevent recurrences in young patients with a PFO in the absence of another cause of the stroke being found (cryptogenic stroke). Patients presenting with a stroke and a PFO are considered to present a high risk of paradoxical embolism. The commonly accepted indications for closure are hemodynamically significant ASD with left-to-right shunt and right ventricular volume overload. The association of a PFO and an aneurismal interatrial septum has been shown to increase the risk for recurrences in patients with cryptogenic stroke. In approximately 2% of patients, a PFO is associated with an aneurysm of the interatrial septum, characterized by septal tissue in the area of the foramen ovale that is very redundant and very thin and membrane-like. In most people, this PFO will not produce any symptoms, but in some, paradoxical emboli will pass the foramen and be responsible for stroke. The size of this PFO can differ considerably. In 25% of cases however, fusion is not complete and the foramen ovale remains patent. In the majority of people (75%) those two layers fuse permanently, sealing the foramen. After birth, left atrial pressure rises and right atrial pressure drops, resulting in a functional closure of the foramen ovale by apposing the septum primum against the septum secundum. During fetal life, the septum primum serves as a one-way вЂvalveвЂ™, allowing right-to-left shunting of placental blood towards the left atrium. During fetal life, the two overlaying structures of the atrial septum, the fibrous septum primum and the muscular septum secundum, leave a central opening, the foramen ovale. Large ASDs can eventually lead to pulmonary hypertension and even Eisenmenger syndrome if left untreated.ДЄ PFO occurs in up to 25% of adults and is a remnant of the fetal circulation. If undetected during childhood, most patients will present with symptoms beyond the age of 40 years with progressive exercise intolerance and rhythm disturbances as their most frequent symptoms.

Infants with a weight below 10 kg presented with 70% associated lesions.

#ASD MACBOOK PRO EARLY 2009 SERIES#

In another series of small children that were treated with percutaneous closure of ASD, the majority of the smallest children had associated cardiac (21%) or noncardiac lesions (33%). The postoperative course can be complicated, but the ultimate outcomes were good, with persistent normalization of pulmonary artery pressures. In a series of pediatric patients treated either surgically or by catheter intervention for isolated ASDs, 2.2% were infants with pulmonary hypertension. Some children are symptomatic at a young age and need closure of their ASD. Importantly, leftto- right atrial shunting can be symptomatic at a young age if the ASD is large, but in most cases diagnosis is made on the occasion of a cardiac evaluation for an asymptomatic cardiac murmur. The ASD 2 is responsible for a variable left-to-right shunt, depending on its size. Sinus venosus ASD and primum ASD are not suitable for percutaneous closure. In certain cases, the posterior, posteroinferior or coronary sinus rims are missing, limiting the chances of successful percutaneous closure. Not infrequently, the anterior rim between the defect and the aorta is missing. Typically the defect is located in the middle of the atrial septum with rims surrounding the defect. The secundum ASD (ASD 2) is a congenital defect in the fossa ovalis of the atrial septum. Two types of atrial defects are amenable to percutaneous closure. Percutaneous closure of patent foramen ovale (PFO) in stroke patients was introduced in the 1990s and is now widely practiced. Since the first attempts, several new devices have been introduced with a continuous increase in indications (size, rims and complexity) and better results. Percutaneous closure of ASD has been reported since the 1970s, became widely used in the 1990s in many centers, and replaced surgical ASD closure for anatomically suitable ASD.

Surgical closure of atrial septal defect (ASD) has been the treatment of choice for decades, with excellent results, negligible mortality and limited morbidity. Department of Pediatric Cardiology, Ghent University Hospital UZ Gent, De Pintelaan 185, 9000 Gent, Belgium Corresponding Author: Daniel De WolfДЄtrial septal defect, closure, complications, device, patent foramen ovale