Clinical characteristics of adult uncorrected secundum atrial septal defect: a pilot study

Abstract

Atrial septal defect (ASD) is the most frequent congenital heart disease in adulthood. Pulmonary hypertension (PH) complicating ASD compels patients seeking medical assistance because of its disabling symptom. Most adult ASD develop PH which render significant morbidity and mortality. The aim of the study is to characterize the clinical profiles of adult patients with ASD. The study design was cross sectional. The subjects were enrolled consecutively from outpatient clinics and inpatient wards. The demography, medical and imaging data were collected and recorded in case report form. Descriptive statistics was applied to characterize the subjects. Seventy-six subjects were enrolled. The majority were women (77.6 %) in the productive and child-bearing ages (63.2%). The most common symptoms were dyspneu on effort, fatigue, and palpitation. Most subjects had functional capacity of WHO class functional II (70.2 %). The mean oxygen saturation was 96.4 %. Based on the echocardiography examination, 77.6% of subjects had suffered from PH. The mean longest diameter of defects were 2.7 cm. The direction of blood flow was mostly left to right (77.6 %). Left and right ventricle function were within normal limit. Right heart catheterization showed mean left atrial pressure 11.5 mmHg, which confirmed the precapillary or arterial PH. Mean pulmonary artery pressure was 42.0 mmHg. The pulmonary artery resistance index mostly less than 4 Wood Unit/ m 2 (63.7 %), indicating the feasibility to close the defect. Whereas 24.6 % of subjects were contraindicated for closing. Pulmonary artery hypertension (PAH) was diagnosed in 77.6 % subjects, meanwhile 13.2 % had borderline PAH. In conclusion, most adult ASD patients had developed PAH, mostly young women in productive ages, mainly visited hospital due to symptom of PH, the direction of flow predominantly left to right side and mostly had reduced functional capacity. ABSTRAKDefek septum atrium (DSA) merupakan penyakit jantung bawaan yang paling sering dijumpai pada usia dewasa karena tanda dan gejalanya yang samar. Hipertensi paru (HP) merupakan komplikasi DSA yang mendorong pasien ke rumah sakit karena munculnya gejala yang berat. Hampir semua pasien DSA dewasa mengalami HP yang menyebabkan angka kesakitan dan kematian bermakna. Tujuan penelitian ini adalah untuk mengkaji karakteristik klinis pasien dengan DSA dan HP. Desain penelitian adalah potong lintang. J Med Sci, Volume 48, No. 2, 2016 April: 89-97 90Subjek diseleksi secara berurutan dari klinik rawat jalan dan rawat inap. Data demografi, medis dan pencitraan dikumpulkan dan dicatat dalam suatu blangko laporan kasus. Penelitian deskriptif dilakukan untuk menilai karakteristik subjek. Sebanyak tujuh puluh enam subjek dilibatkan dalam penelitian. Sebagian besar subjek adalah wanita (77,6%) usia muda, produktif dan subur (63,2%). Gejala paling sering adalah sesak saat aktivitas, mudah lelah, dan berdebar. Sebagian besar pasien masuk dalam kelas fungsional WHO II (70,2%). Rerata saturasi oksigen 96,4%. Berdasar hasil ekok...

Severe pulmonary hypertension and reduced right ventricle systolic function associated with maternal mortality in pregnant uncorrected congenital heart diseases

“…5 They presented to the hospital due to signs and symptoms of PH and/or right heart failure. 5 In this study, 64.8% of patients were first diagnosed as CHD during this pregnancy. As many as five of six nonsurvivors were first diagnosed during current pregnancy, therefore no antenatal care for CHD condition was done to the patients.…”

The Accuracy of Combined Electrocardiogram Criteria to Diagnose Right Atrial Enlargement in Adults With Uncorrected Secundum Atrial Septal Defect

“…Our registry indicates that ASD patients, who remain asymptomatic for decades and have obscured physical finding, seek medical treatment after they develop pulmonary hypertension or right heart failure. 7 Therefore, the ECG with more sensitive and accurate criteria for detecting RA enlargement can assist the screening and early finding which will lead to further examination, such as transthoracic echocardiography, to confirm the diagnosis of ASD.…”

“…The COHARD-PH registry is a hospital-based single-center registry of adult patients with CHDs in Dr Sardjito Hospital, Jogjakarta, Indonesia which has been conducted since 2012 and continues to date. 7 For this study, the inclusion criteria were as follows: (1) uncorrected secundum ASD; (2) complete clinical data, 12-lead ECG recording, and transthoracic echocardiogram taken within 1 month of this study; and (3) having sinus rhythm during ECG recording. The exclusion criteria in this study were as follows: (1) having other congenital abnormalities, (2) having left ventricular ejection fraction < 50%, (3) having significant valve abnormalities (ie, mitral stenosis, aortic stenosis, pulmonary stenosis, and aortic regurgitation), (4) having other respiratory system or lung disease, (5) having a history of acute myocardial infarction, and (6) having atrioventricular and bundle branch blocks.…”

Profile of Endothelin-1, Nitric Oxide, and Prostacyclin Levels in Pulmonary Arterial Hypertension Related to Uncorrected Atrial Septal Defect: Results from a Single Center Study in Indonesia

“…We conducted a cross-sectional study using the COngenital HeARt Disease in adult and Pulmonary Hypertension Registry of Universitas Gadjah Mada, Dr. Sardjito Hospital, Yogyakarta, Indonesia (COHARD-PH Registry). e pilot study of this registry had been published elsewhere [8].…”