title: Incidence and predictors of atrial septal defect after percutaneous transvenous mitral commissurotomy - a transesophageal echocardiographic study of 209 cases.
abstract: BACKGROUND
  The incidence of atrial septal defect (ASD) after percutaneous transvenous mitral commissurotomy (PTMC) ranges from 15.2% to 92% in small studies.
  
  
  OBJECTIVE
  To estimate the incidence of atrial septal defect (ASD) following PTMC and to determine the factors contributing to its development.
  
  
  METHODS
  We studied 209 patients with mitral stenosis (MS) undergoing PTMC. Transesophageal echocardiography (TEE) with color Doppler examination was performed to detect ASD.
  
  
  RESULTS
  TEE demonstrated ASD in 139 (66.5%) of 209 patients. The mean diameter of the interatrial septal defect detected by TEE was 4.47 ± 1.7 mm. The most common site of septal puncture was the inferior vena caval side of the interatrial septum followed by fossa ovalis. Color flow imaging across the defect showed left to right shunting in all the patients (100%). We examined the relationship of age, Wilkins score, left atrial volumes, the mitral valve orifice area, mitral valve gradient, and the degree of mitral and tricuspid regurgitation between the group that developed ASD and the group without ASD and found that none of these factors predicted the development of ASD. A residual ASD was seen in 11 patients (8.7%) at 6-month follow-up.
  
  
  CONCLUSIONS
  Incidence of residual atrial septal defect immediately following PTMC by TEE color flow Doppler imaging is 66.5%. Surrogate markers of elevated left atrial pressures do not determine the development of atrial septal defect after PTMC. The majority of the defects close spontaneously and a residual defect is observed in 8.7% patients at 6 months.
authors.affiliation: Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bengaluru, Karnataka, India. cnm_vidhatri@satyam.net.in
authors.forename: Chollenahally Nanjappa
authors.initials: CN
authors.lastname: Manjunath
authors.forename: Arunkumar
authors.initials: A
authors.lastname: Panneerselvam
authors.forename: Kikkeri Hemanna Setty
authors.initials: KH
authors.lastname: Srinivasa
authors.forename: Bhat
authors.initials: B
authors.lastname: Prabhavathi
authors.forename: Kapil
authors.initials: K
authors.lastname: Rangan
authors.forename: Chandrasekaran
authors.initials: C
authors.lastname: Dhanalakshmi
authors.forename: Khandenahally Shankarappa
authors.initials: KS
authors.lastname: Ravindranath
mesh_terms: D000293:Adolescent; D000328:Adult; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000379:methods; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D015150:Echocardiography, Doppler / Q000379:methods*; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D055815:Young Adult