الفهرس 
Congenital heart defectsOnly 14 pages are availabe for public view
 |  | from | 120 |  |  |
| | | from | 120 | | |
Abstract
Atrial septal defect (ASD) is one of the most common types of congenital heart defects, occurring in about 25% of children. An atrial septal defect occurs when there is a failure to close the communication between the right and left atria.
It encompasses defects involving both the true septal membrane and other defects that allow for communication between both atria.
There are five types of atrial septal defects ranging from most frequent to least: patent foramen ovale, ostium secundum defect, ostium primum defect, sinus venosus defect, and coronary sinus defect. Small atrial septal defects usually spontaneously close in childhood. Large defects that do not close spontaneously may require percutaneous or surgical intervention to prevent further complications such as stroke, dysrhythmias, and pulmonary hypertension.
In conclusion, atrial septal defects are common congenital heart defects and can range from clinically asymptomatic lesions to lesions that cause pulmonary hypertension, systemic cyanosis and vascular complications such as strokes. Most small defects will spontaneously close in the first year of life; however, large defects associated with significant systemic to pulmonary shunts and systemic oxygen desaturation require percutaneous of surgical intervention .
The echocardiographic evaluation of ASD includes the detection of the size and shape of the septal defects, the rims of tissue surrounding the defect, the degree and direction of shunting, and the changes in size and function of the cardiac chambers and pulmonary circulation pre versus post ASD closure. The evaluation of RV function by echocardiography remains difficult due to its complex geometry.
Although clinical investigations of the RV have been focused on the use of two- dimensional echocardiography, recent developments in echocardiographic techniques as the three dimensional echocardiography (3DE), tissue doppler imaging (TDI), strain and strain rate imaging, which are sensitive and noninvasive have enhanced for accurate assessment of RV function .
The aim of this study to assess the right ventricular function in children with ASD before closure as compared to patients after closure and to compare RV functions in cases post-surgical versus post transcatheter device closure.
This study conducted on 30 patients with evaluation of right ventricular function in patients with atrial septal defects before intervention and early within one week after surgical or transcatheter device closure .All Patients were subjected to Complete blood count; Renal functions and Liver functions; full history taking. Complete diagnostic transthoracic examination was done by 2D Doppler echocardiogram (Echo), and Tissue Doppler Imaging.
There was significant difference between two groups according to intensive care unit (ICU) stay P <0.001. When Comparison between the two studied groups according to laboratory investigations ; There is no significant difference between the two groups according to Complete blood count; Renal functions and Liver functions P >0.05 . There is significant difference between two groups according to ventilation P <0.001, with no significant difference according to arrhythmia and heart block. There was significant difference between two groups before and after intervention according to measurement of S′, E′ and A’, However there was no difference in E′/A′.
Finally we concluded that, in contrast to surgery, transcatheter closure of atrial septal defect preserves atrial and right ventricular function. Tissue Doppler derived strain rate can be applied to provide quantitative analysis of regional atrial and ventricular performance.
The long-term ventricular function of children after surgical and transcatheter closure of secundum atrial septal defects was assessed by Doppler tissue imaging and compared with that of age-matched controls. Long-term right ventricular function was impaired in patients after surgical repair, as reflected by decreased systolic and diastolic tricuspid annular velocities. In contrast, right ventricular function was preserved after transcatheter device closure.
Many cardiologists recommend surgery to repair a medium to large atrial septal defect that’s diagnosed during childhood or adulthood to prevent future complications. For adults and children, atrial septal defect repair surgery involves closing the hole in the heart .Transcatheter approach had a high success rate, lower rates of adverse events, and shorter hospital stays compared to surgery, without any mortality.