4 years old boy with weight of 10.5 Kg and height of 100 cm, he is known case of moderate to large ASD secondum with recurrent chest infections and failure to thrive under treatment with frosimed and close follow up in the clinic. Cardiovascular examination reviled: normal S1+fixed and splitting of S2+ejection systolic murmur at left upper sternal border, per-procedure electrocardiogram showed normal sinus rhythm with heart rate 95-100/min ,incomplete right bundle brunch block. His echocardiography reviled large ASD secondum of 15-16 mm with adequate SVC, IVC and aortic rims and slightly short AV valve rim associated with dilated right atrium and ventricle with sings of increased pulmonary blood flow. During cardiac catheterization under general anesthesia and transesophaygeal echocardiography guidance we confirmed the accurate size of the defect and decided to precede and close this ASD by 18 mm Amplatzer septal occluder (the device/height ratio is : 0.18 )The procedure went smoothly without any complications in the cath lab and the patient was observed in the recovery area then in PICU with stable vital sings, sinus rhythm around 99-101/ min and after 24 h of the closure electrocardiography showed normal sinus rhythm with same degree of PRBBB ( Figure 1). Echocardiography showed big ASD device insite without any residual shunt or interacting with adjacent structures ( Figure Heart Block After ASD Device Closure 2).Patient was discharged home on aspirin 50 mg daily and given appointment after one week for follow up in the clinic. After one week he came to pediatric cardiology for follow up, he was asymptomatic with no complain, his heart rate was 66/min with regular rhythm, other vital signs were stable. Echocardiography at that time showed ASD device in good position without any residual shunt or interfering with A-V valves or other structures. His ECG showed dominant sinus rhythm with HR = 66/min , prolonged PR interval l0.18 -0.2 sec (first degree heart block) and occasional 2:1 heart block ( Figure 3). 24 hour holter monitor also confirm the finding of first degree heart block with occasional second degree as 2:1 but no escape rhythm or long pauses. The parents refused the admission for observation and they preferred to come daily for close follow up so we started him on oral prednisolone 1 mg/kg/day with ECG monitoring every 2 days. After 5 days from this plan the patient remain stable with no complain but his ECG showed normal sinus rhythm with shorter PR interval 0.16 -0.17 sec and no signs of heart block (recovered normal sinus rhythm) (Figure 4). 24 hour holter monitor also confirm the normal sinus rhythm without any arrhythmias so we stopped the prednisolone and kept him under observation every week with new ECG.After one month he was stable,no complains and started to gain some weight on aspirin only.ECG at that time showed normal sinus rhythm with normal PR interval 0.16 sec and no signs of heart block ( Figure 5). Echocardography revealed the device inn place, no residual shunt, no interfering wi...
BackgroundTranscatheter closure of atrial septal defects (ASDs) is well-established. However, this procedure can be challenging, requiring multiple attempts and advanced implantation maneuvers.Materials and methodsFrom July 2019 to July 2022, patients to whom the fast atrial sheath traction (FAST) technique was applied for ASD device closure were prospectively followed up. The device was rapidly unsheathed in the middle of the left atrium (LA) to let it clamp the ASD from both sides simultaneously. This novel technique was directly applied in patients with absent aortic rims and/or ASD size-to-body weight ratio higher than 0.9 or after failed attempts of standard implantation.ResultsSeventeen patients (64.7% males) were involved with a median age of 9.8 years [interquartile range (IQR), 7.6–15.1] and a median weight of 34 kg (IQR, 22–44). The median ASD size on ultrasound was 19 mm (IQR, 16–22). Five (29.4%) patients had absent aortic rims, and three (17.6%) patients had an ASD size-to-body weight ratio higher than 0.9. The median device size was 22 mm (IQR, 17–24). The median difference between device size and ASD two-dimensional static diameter was 3 mm (IQR, 1–3). All interventions were straightforward without any complications using three different occluder devices. One device was removed before release and upsized to the next size. The median fluoroscopy time was 4.1 min (IQR, 3.6–4.6). All patients were discharged the next postoperative day. On a median follow-up of 13 months (IQR, 8–13), no complications were detected. All patients achieved full clinical recovery with complete shunt closure.ConclusionWe present a new implantation technique to efficiently close simple and complex ASDs. The FAST technique can be of benefit in overcoming left disc malalignment to the septum in defects with absent aortic rims and in avoiding complex implantation maneuvers and the risks of injuring the pulmonary veins.
Fetal tachyarrhythmia is one of the main reasons of referral to fetal cardiology clinic [1], because it might be associated with different forms of complex congenital heart disease [2,3] and also cause high antenatal mortality and morbidity due to heart failure [4,5]. There are is different protocols of medical therapy with variable clinical results [6]. We are reporting a successful management of 2 cases of fetal tachycardia with heart failure signs who responded dramatically to oral Satolol.Gynaecology clinic due to fetal tachyarrhythmia with moderate amount of ascites and plural pleural effusion. The mother was investigated to rule out the secondary causes of tachyarrhythmia like hyperthyroidism, anemia, fever, electrolyte imbalance and etc which were all normal.Fetal echocardiography was done at 29 weeks gestational age which showed normal fetal heart anatomy, tachycardia with fetal heart rate 250-290 beats/ min, impaired cardiac function with moderate amount of plural effusion and ascites (Figure 1 & 2). We decided to start her on oral satolol as a trial to control the fetal tachyarrhythmia, so we sent the mother to adult cardiology clinic for routine check up before starting the medicine (Electrocardiogram, Echocardiogram, blood pressure, etc). We started her on low dose initially, 80 mg orally twice daily and she was kept as inpatient under observation.The patient tolerated the medicine very well and fetal heart rate check up was done daily for 3 days which showed no response in the heart rate so we increased the dose to 80 mg three times daily orally and we kept her under observation every 3 days as outpatient (ECG for the mother and fetal heart rate monitoring), again no response in fetal heart rate with same amount of ascites and plural effusion.After that we increased the dose to 160 mg twice daily and after 3 days from this dose the mother remains stable without any change in her ECG (QTc interval) and blood pressure and the fetal heart rate reduced dramatically to 140-150 /min. Patient was kept in same dose of Satolol (160 mg twice daily) and regular weekly follow up in fetal cardiology clinic. Case (1)30 year olds lady with 28 weeks gestational, normal pregnancy without risk factors. She was referred to fetal cardiology clinic from
Baby of S.R. born at term 37 gestational weeks, maternal age 32 years old, maternal screen for (HIV, HBV, Syph, GBS) were negative. Fetal scanning showed intra-cardiac echogenic foci at the level of AV junction. He born with good apgars 8/9/9 at 1/5/10 minutes. On examinationHe looks comfortable in himself, active, well perfused, no distress, precordium looks normal. CVS: S1 normal +S2 splitted, can hear additional sound like? friction. Regular rhythm, 2-3/6ESM/LSUE murmur, no thrill, no gallop Femorals and peripherals pulses are good.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.