Ali N Zaidi

Nationwide Children's Hospital, Columbus, Ohio, United States

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Publications (22)49.14 Total impact

  • Ali N. Zaidi, W. Aaron Kay, Curt J. Daniels
    01/2014: pages 2651-2668; , ISBN: 978-1-4471-4618-6
  • Lauren Lastinger, Ali N Zaidi
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    ABSTRACT: The univentricular heart includes a spectrum of complex cardiac defects that are managed by staged palliative surgical procedures, ultimately resulting in a Fontan procedure. Since 1971, when it was first developed, the procedure has undergone several variations. These patients require lifelong management, including a thorough knowledge of their anatomic substrate, hemodynamic status, management of rhythm and ventricular function, together with multi-organ evaluation. As these patients enter middle age, there is increasing awareness of long-term complications and mortality. This review highlights the concept behind the staged surgical palliations, the unique single ventricle physiology and the long-term complications in this complex cohort of patients.
    Circulation Journal 10/2013; · 3.58 Impact Factor
  • American Journal of Respiratory and Critical Care Medicine 05/2013; 187(10):1141-3. · 11.04 Impact Factor
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    ABSTRACT: Background Adult congenital heart disease (ACHD) clinicians are hampered by the paucity of data to inform clinical decision-making. The objective of this study was to identify priorities for clinical research in ACHD. Methods A list of 45 research questions was developed by the Alliance for Adult Research in Congenital Cardiology (AARCC), compiled into a survey, and administered to ACHD providers. Patient input was sought via the Adult Congenital Heart Association at community meetings and online forums. The 25 top questions were sent to ACHD providers worldwide via an online survey. Each question was ranked based on perceived priority and weighted based on time spent in ACHD care. The top 10 topics identified are presented and discussed. Results The final online survey yielded 139 responses. Top priority questions related to tetralogy of Fallot (timing of pulmonary valve replacement and criteria for primary prevention ICDs), patients with systemic right ventricles (determining the optimal echocardiographic techniques for measuring right ventricular function, and indications for tricuspid valve replacement and primary prevention ICDs), and single ventricle/Fontan patients (role of pulmonary vasodilators, optimal anticoagulation, medical therapy for preservation of ventricular function, treatment for protein losing enteropathy). In addition, establishing criteria to refer ACHD patients for cardiac transplantation was deemed a priority. Conclusions The ACHD field is in need of prospective research to address fundamental clinical questions. It is hoped that this methodical consultation process will inform researchers and funding organizations about clinical research topics deemed to be of high priority.
    International journal of cardiology 01/2013; · 6.18 Impact Factor
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    ABSTRACT: AIMS: There is a fivefold increase in the frequency of intracranial aneurysm (IA) in adults with coarctation of the aorta (CoA). Current guidelines for management of adults with CoA recommend computed tomography angiography (CTA) or magnetic resonance imaging of the intracranial vessels. However, this recommendation has not been universally accepted. The purpose of our study was to prospectively perform CTA of the intracranial vessels in adults with CoA to evaluate the prevalence and identify high-risk features of this complication. METHODS AND RESULTS: From January 2008 to February 2011, adults ≥18 years of age with CoA were prospectively enrolled in a screening program with CTA of the intracranial vessels. Analyses of prognostic variables were performed with both Fisher's exact and two sample t-test. Forty-three patients (58% female, 33.55 ± 10.21 years) with CoA completed CTA of the intracranial vessels. Five patients (11%) were found to have IA. Patients with IA were older than those without (45.6 ± 8.17 vs. 30.89 ± 7.89, P = 0.0003). There were no statistically significant differences detected between measurements of fasting lipid profiles, C-reactive protein, brain natriuretic peptide, and homocysteine levels among CoA patients with and without IA (P = not significant). CONCLUSION: Prospective screening of adults with CoA confirmed the increased prevalence of IA but also identified increased age as the sole risk factor. These data suggested that screening is justified particularly in the fourth and fifth decades of life. Further studies are required that focus on the development, natural history, and treatment of IA.
    Congenital Heart Disease 12/2012; · 1.01 Impact Factor
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    ABSTRACT: BACKGROUND: In studies of adult patients, increased QRS duration and mechanical dyssynchrony have been associated with decreased ventricular function. The aim of this study was to test the hypothesis that similar findings would be present in a population of patients with hypoplastic left heart syndrome (HLHS) after the Fontan procedure. METHODS: A retrospective cross-sectional study was conducted. All patients with HLHS after the Fontan procedure were eligible. QRS duration was measured using 12-lead electrocardiography. Echocardiographic measurements of mechanical dyssynchrony included Doppler tissue imaging (DTI) QRS to onset of s' wave difference between the left ventricle and the right ventricle, time to peak strain, time to peak systolic strain rate (SRs), the standard deviation of time to peak strain rate (modified Yu strain), and the standard deviation of time to peak SRs (modified Yu SRs). Right ventricular (RV) functional measurements included DTI s' wave, DTI RV myocardial performance index, global strain, global SRs, and RV fractional area change. Pearson's correlations were performed between the variables. RESULTS: Thirty-one echocardiographic studies were performed on 26 patients. The median age was 5.3 years (range, 2.5-15.4 years). QRS duration was correlated significantly with global SRs (r = 0.42). Time to peak SRs was correlated significantly with DTI s' wave (r = -0.48) and global SRs (r = 0.37). Modified Yu SRs was correlated significantly with global strain (r = 0.35) and RV fractional area change (r = -0.35). CONCLUSIONS: Both QRS duration and mechanical dyssynchrony were correlated with RV function, albeit weakly. The clinical significance of these findings is intriguing, but only larger studies will determine if these measurements are reliable in guiding treatment options for this complex patient population.
    Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography 12/2012; · 2.98 Impact Factor
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    ABSTRACT: Coarctation of the aorta (CoA) occurs in 0.04% of the population and accounts for approximately 10% of lesions in adults with congenital heart disease (ACHD). It can occur as an isolated lesion or as a part of a complex defect and is associated with multiple complications, both with and without treatment. Since the first surgical repair in 1944, significant refinement in surgical techniques has expanded the available treatment options. While transcatheter therapy for both native and especially recurrent CoA has become the standard of care for young patients, the use of bare metal stent has been associated with significant complications in adults. Perhaps one of the most important advances in the management of CoA, has been the development of covered stent technology. Covered stents offer the advantage of excluding any stretch-induced wall trauma from the endoluminal aspect of the aorta, particularly in the catastrophic event of aortic rupture which has been reported. Here we describe the indications for and the limitations in the use of covered stents in the treatment of CoA. These may be used as the therapy of choice in patients with native CoA, complications after prior CoA repair, patients with severe and complex CoA lesions, or patients with advanced age.
    Progress in Pediatric Cardiology 12/2012; 34(2):97–103.
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    ABSTRACT: BACKGROUND: With advances in cardiac care, patients with congenital heart disease, including single ventricle (SV) physiology, now survive into adulthood. These patients often suffer from congestive heart failure (CHF) with overexpression of serum biomarkers. Strain and strain rate (SR) may better describe the myocardial mechanics of a failing SV. Our objective was to determine the correlation between strain/SR and biomarkers in adult patients with SV and CHF. METHODS: Adult patients (age ≥8 years) with a SV were enrolled. Strain/SR in a 16-segment model of a SV was measured using 2D speckle echocardiography. Serum levels of interleukin 6, interleukin 8, matrix metalloproteinase 9, procollagen I C-terminal peptide (PCIP), cross-linked carboxy-terminal telopeptide of type I collagen (ICTP), pro-B-type natriuretic peptide, nitrotryrosine, tissue growth factor beta (TGF-β), tumor necrosis factor alpha, vascular endothelial growth factor, and creatinine (Cr) were measured. Patients underwent a complete 6 Minute Walk Test (MWT). Pearson correlation coefficient was used. P <.05 was considered significant. RESULTS: Ten patients with SV (LV = 7, RV = 3) were enrolled. Mean age was 35.5 years (25-42 years). Mean single ventricular ejection fraction (SVEF) was 47%. ICTP correlated with the basal, mid, and apical anterolateral SR, as well as apical anterior and inferior SR. PCIP correlated with mid anterolateral, basal anteroseptal, and mid inferolateral SR. TGF-β correlated with apical inferior SR. Cr correlated with mid inferior-septal and apical lateral SR. 6 MWT negatively correlated with the apical anterior septum SR. CONCLUSIONS: ICTP, Cr, and PCIP correlated best with segmental SR values. Our results provide a preliminary platform for future studies to follow the results of treatment modalities using strain/SR and biomarkers for CHF in this population.
    Congenital Heart Disease 10/2012; · 1.01 Impact Factor
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    ABSTRACT: Background: Currently >85% of children in the US with congenital heart disease (CHD) survive to adulthood. Patients with repaired Tetralogy of Fallot (TOF) and critical pulmonary stenosis (PS) frequently present with late sequelae including pulmonary insufficiency, right ventricular (RV) enlargement and systolic dysfunction. These patients may have left ventricular (LV) systolic dysfunction for no apparent cause. Prior studies have demonstrated improvement in RV size and function after pulmonary valve replacement (PVR); however changes in LV function post-PVR have rarely been described. We sought to determine the mid term results on LV function after PVR using cardiac magnetic resonance imaging (CMR). Methods: Retrospective review of pts (≥16 years) from 1/1/06 to 7/1/11 was performed. Demographics, clinical variables, cardiopulmonary bypass (CPB) time and post-op medication use were reviewed. Pre and post-PVR CMR scans were analyzed for LV and RV volumes and ejection fraction (EF). Paired t-test was used to compare pre and post-PVR volumes and EF. Pearson linear correlation and multivariate analysis evaluated the effect of variables on LVEF. Results: There were 40 pts who met inclusion criteria (TOF=29, PS=11). Mean age was 29±9 yrs (range:16-53). Each pt had a CMR before (173 days±103) and after PVR (446 days±264). For the entire cohort, the mean LVEF increased from 54±8% to 57±6% (p = 0.023). Pre-PVR, 9 pts had depressed LVEF (44±5%, range 36-49%). In this group, the LVEF significantly increased post-PVR by 10±7% (p=.004). By multivariate analysis to assess CMR predictors for improved LVEF post-PVR, the only variable to emerge was low EF pre-PVR (regression coefficient:-.7,R2=.59, p<0.0001). Demographics, clinical variables, medications, prior pregnancies and CPB time had no effect on LVEF post-PVR. Conclusion: This is the largest CMR study to describe the mid-term results of LV function after PVR in adults with CHD. Patients with depressed LVEF pre-PVR had significant improvement in LV function post-PVR. Larger studies are needed to further evaluate predictors and pathophysiologic mechanisms associated with improved LVEF.
    American College of Cardiology Scientific Sessions, 2012; 03/2012
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    ABSTRACT: Bartonella spp. are a known cause of culture-negative endocarditis. We report a 42-year-old male with underlying surgically corrected congenital heart disease who was diagnosed with Bartonella henselae endocarditis involving the right-ventricle-to-pulmonary-artery conduit.
    Journal of Cardiac Surgery 03/2012; 27(4):449-52. · 1.35 Impact Factor
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    ABSTRACT: Double outlet right ventricle is a heterogeneous congenital defect that encompasses a variety of anatomic aberrations and physiologic consequences. We describe the unusual cardiovascular magnetic resonance anatomic findings and sequelae of a 44-year-old man who underwent biventricular repair of double outlet right ventricle, subpulmonary type, which included tunneling of the ventricular septal defect to the pulmonary artery, right ventricular-to-pulmonary artery conduit and Damus-Kaye-Stansel procedure.
    Congenital Heart Disease 07/2011; 6(6):641-5. · 1.01 Impact Factor
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    ABSTRACT: Atrial function is increasingly being recognized as a significant factor in overall cardiac function in adults. Limited studies evaluating atrial properties exist in the pediatric congenital heart disease population. The goal of this study was to evaluate atrial properties in patients with single ventricle physiology after Fontan completion and compare these values with normal control patients. Echocardiograms were performed in patients with single ventricular physiology and in control patients. Tissue Doppler and blood flow measurements were obtained. Atrial fraction and atrial electromechanical values were calculated. Differences were assessed with one-way analysis of variance. Post hoc comparisons were performed with Tukey adjustment. P < .05 was considered significant. No significant difference was present in age or heart rate between single ventricle and control patients. The single right ventricle tricuspid valve A wave (52.6 ± 14.5 vs. 36.7 ± 10.4 cm/s) and atrial fraction (39.2 ± 6.2 vs. 32.7 ± 7.7%) were significantly higher, and the E/A ratio (1.4 + 0.3 vs. 1.8 + 0.4), tricuspid valve E/A velocity-time integral (1.6 + 0.4 vs. 2.2 + 0.7 cm), and late diastolic annular value (5.3 + 1.5 vs. 8.7 + 1.4 cm/s) were significantly lower compared with the controls. The single left ventricle late diastolic annular velocity (4.2 + 1.0 vs. 6.7 + 1.3 cm/s) was significantly lower and atrial fraction was significantly higher compared with the controls (37.7 ± 12.5 vs. 29.8 ± 4.3%). There were no significant differences in atrial electromechanical measurements between groups, but the single right ventricle patients tended to have increased atrial dyssynchrony compared with controls. Patients with single ventricle physiology after Fontan completion have differences in atrial properties when compared with normal controls. These differences may have important implications in their long-term outcomes. Further studies are necessary to determine the clinical significance of these findings.
    Congenital Heart Disease 05/2011; 6(3):247-52. · 1.01 Impact Factor
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    ABSTRACT: As the prevalence of obesity continues to increase, it now includes the growing number of patients with congenital heart disease (CHD). This particular obese patient population may pose additional intraoperative as well as postoperative challenges that may contribute to poor outcomes. Our aims were to determine the influence of obesity on morbidity and mortality in adults with CHD undergoing surgical repair at a free standing children's hospital. A retrospective analysis of adult (≥18 years) CHD surgery cases from 2002 to 2008 was performed. Congenital heart lesions were defined as mild, moderate, or complex. Patients were categorized by body mass index (BMI): underweight (BMI < 20 kg/m(2)), normal (BMI 20-24.9 kg/m(2)), overweight (BMI 25-29.9 kg/m(2)), and obese (BMI ≥ 30 kg/m(2)). Demographics, incidence of mortality, or specific morbidities were statistically compared using Fisher's exact test and analyses of variance (anovas). In this population (n = 165), overweight (29%) and obese (22%) patients were prevalent. Hypertension (HTN) and pre-HTN were more prevalent in obese and overweight patients. Postoperative renal dysfunction was observed in obese patients with complex CHD (P = .04). Mortality was not different among groups. Obesity is becoming increasingly common among adults with CHD. Despite marginal evidence of postoperative renal complications in obese patients with CHD of severe complexity, the overall presence of obesity did not influence mortality or short term postoperative morbidities.
    Congenital Heart Disease 05/2011; 6(3):241-6. · 1.01 Impact Factor
  • Ali N Zaidi, Richard J Gumina
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    ABSTRACT: Myocardial bridging is characterized by intra-myocardial course of a segment of an epicardial coronary artery, leading to systolic compression. In most cases, it is considered a benign condition but rarely has been associated with serious cardiac events like myocardial infarction and sudden death. We describe a 25-year-old man with known d-transposition of the great arteries (d-TGA) status post-Mustard procedure who presented with palpitations and chest pain. Cardiac catheterization revealed complete systolic compression of a myocardial bridging segment of the left anterior descending artery and also complete compression of the first septal perforator during episodes of ectopic atrial tachycardia. No percutaneous or surgical interventions were performed. Symptoms improved after cautious use of beta-blockers. This appears to be the first report of symptomatic myocardial bridging in an adult patient with d-TGA.
    Congenital Heart Disease 03/2011; 6(2):157-61. · 1.01 Impact Factor
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    ABSTRACT: Patients with single left ventricle (LV) physiology maybe at increased risk for myocardial dysfunction and mechanical dyssynchrony. Newer echocardiographic modalities may be able to better quantitate LV function in this unique population. Our objective was to use 2D-speckle analysis of strain and strain rate to quantify systolic function and dyssynchrony in single LV post-Fontan patients and compare them to control LV patients. Patients with single LV status post-Fontan procedure and patients with normal biventricular anatomy were studied. Two-dimensional speckle echocardiography was used to measure strain, strain rate, time to peak, and longitudinal displacement in a six-segment model of the LV. Independent t-tests were used to compare group means. Twelve patients with single LV physiology and thirteen control patients were studied. There was no significant difference in ages for the single LV patients vs. control patients (7.1 + 2.8 years vs. 5.7 + 1.8 years). Single LV strain values were significantly lower in four of the six segments compared with control LV (mid interventricular septal [IVS]: -19.3 + 6.4% vs. -23.8 + 3.5%, apical IVS: -20.8 + 5.4% vs. -27.4 + 4.7%, basal LV: -20.6 + 6.6% vs. -25.8 + 3.4%, and apical LV: -21.0 + 6.2% vs. -26.1 + 4.3%). Longitudinal displacement was lower for all three segments of the IVS for the single LV vs. control LV. Modified Yu index for strain and strain rate time to peak was longer in the single LV patients vs. controls (51.2 + 18.2 ms vs. 27.9 + 8.0 ms and 90.2 + 24.2 ms vs. 52.5 + 23.7 ms, respectively). Significant differences in strain analysis between single LV patients vs. control patients with normal biventricular physiology exist at a relatively young age. Future studies are needed to determine the significance of these differences.
    Congenital Heart Disease 11/2010; 5(6):579-86. · 1.01 Impact Factor
  • Ali N Zaidi
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    ABSTRACT: Brugada syndrome is an arrhythmogenic disease characterized by a pattern of ST segment elevation in the right precordial leads on an electrocardiogram with an increased risk of sudden cardiac death. It is primarily reported in adults with limited data about the prevalence, prognosis, and long-term management in children. We describe a 10-year-old boy with a family history of sudden cardiac death, who had near syncope associated with a febrile illness. A screening electrocardiogram revealed ST segment elevation in the right precordial leads consistent with Type-1 Brugada syndrome. An electrocardiogram after recovery from his illness showed Type-2 "saddle-back" ST segment changes. An echocardiogram and a cardiac magnetic resonance imaging revealed a normal heart without myocardial fibrofatty infiltration, scar, or ischemia. A tilt-table test was negative. Implantable cardioverter-defibrillator placement remains the only effective treatment for patients with symptomatic Brugada syndrome; however, risk stratification of asymptomatic patients continues to remain a challenge. Although some investigators have reported the use of electrophysiological studies for distinguishing between high and low risk patients with Brugada syndrome, there are no precise predictors of risk for sudden cardiac death in pediatric patients. After careful discussion, this patient was considered intermediate to high risk for sudden cardiac death and had successful implantation of a transvenous defibrillator. Although Brugada syndrome is a rare diagnosis in the pediatric population, such patients should be referred for further evaluation and management.
    Congenital Heart Disease 11/2010; 5(6):594-8. · 1.01 Impact Factor
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    ABSTRACT: Tissue Doppler imaging measurements could be used to quantitate ventricular function in patients with systemic single ventricles. The objective of the present study was to measure the tissue doppler imaging-derived indexes of function and dyssynchrony in patients with single ventricular physiology and compare these values with those from control patients. Echocardiograms were performed in patients with single left or right ventricular physiology and control patients. Measurements were made of the free walls at the level of the atrioventricular annulus. Differences were assessed with one-way analysis of variance. Post hoc comparisons were performed with a Tukey adjustment. No significant difference was present in age among the control (5.75 +/- 1.73 years, n = 16), single left ventricle (7.07 +/- 2.81 years, n = 12), or single right ventricle (6.25 +/- 2.2 years, n = 14) groups. The single right ventricular free wall peak systolic annular, peak early diastolic annular, and peak late diastolic annular velocities were significantly lower and the myocardial performance index and interval to mechanical activation greater compared to the controls. The single left ventricular free wall peak systolic annular, peak early diastolic annular, and peak late diastolic annular velocities were also significantly lower and the myocardial performance index and interval to mechanical activation greater compared to controls. In conclusion, significant decreases in systolic and diastolic function, as well as differences in dyssynchrony, using tissue Doppler imaging exist in patients with single ventricular physiology compared to control patients.
    The American journal of cardiology 07/2010; 106(1):99-103. · 3.58 Impact Factor
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    ABSTRACT: Patients with single-right ventricle (RV) physiology are at increased risk for myocardial dysfunction and mechanical dyssynchrony. Newer echocardiographic modalities may be better able to quantitate right ventricular function in this unique population. The aim of this study was to use two-dimensional speckle analysis of strain and strain rate to quantify systolic function and dyssynchrony in single-RV post-Fontan patients and compare them with values for controls. Patients with single RV who underwent Fontan palliation and patients with normal biventricular anatomy were studied. Two-dimensional speckle echocardiography was used to measure strain, strain rate, time to peak, and longitudinal displacement in a 6-segment model of the RV. Independent t tests were used to compare group means. P values < .05 were considered significant. Thirteen patients were studied in each group. There was no significant difference in age between single-RV patients and controls (6.60 +/- 2.07 vs 5.75 +/- 1.83 years, respectively). Single-RV strain values were significantly lower in all 6 segments compared with values in controls (basal interventricular septum [IVS], -14.28 +/- 7.78% vs -22.00 +/- 2.36%; mid IVS, -17.70 +/- 4.54% vs -22.99 +/- 2.71%; apical IVS, -19.46 +/- 4.97% vs -25.42 +/- 4.06%; basal RV, -22.40 +/- 5.7% vs -41.42 +/- 5.42%; mid RV, -21.20 +/- 3.21% vs -39.67 +/- 6.04%; apical RV, -20.70 +/- 4.90% vs -33.68 +/- 3.90%). Systolic strain rate and longitudinal displacement were also lower in the free wall and apical IVS in single-RV patients compared with controls. The modified Yu index for strain time to peak was longer in the single-RV patients (43.16 +/- 13.63 vs 21.72 +/- 7.25 ms). Significant differences in strain analysis between single-RV patients and patients with biventricular physiology exist at a relatively young age. Future studies are needed to determine the clinical significance of these differences.
    Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography 06/2010; 23(6):673-9. · 2.98 Impact Factor
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    ABSTRACT: Percutaneous device closure in patients with an atrial septal defect (ASD) or patent foramen ovale (PFO) has gained popularity because of the short learning curve, cosmetic advantage and relative safety compared with surgery. Device complications may include device embolism, erosion, pericardial tamponade or thrombus formation, and most complications occur early. Herein we describe the previously unreported finding of a late thrombus on a Helex device after PFO closure in a patient with cystic fibrosis and double-lung transplantation.
    The Journal of heart and lung transplantation: the official publication of the International Society for Heart Transplantation 04/2010; 29(7):814-6. · 3.54 Impact Factor
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    ABSTRACT: Complications of transcatheter closure of atrial septal defects (ASDs) include pericardial effusion, tamponade, and even death. Transthoracic echocardiography in the adult is often limited by poor acoustic windows that lead to incomplete device assessment. Advances in multislice computed tomography (MSCT) provide an alternative modality to assess the anatomy of the Amplatzer Septal Occluder (ASO) device. The purpose of this study was to determine the feasibility of MSCT in providing anatomic information in patients with persistent or recurrent symptoms after transcatheter closure of ASDs with ASO devices. A retrospective analysis of adult patients who underwent ASO device implantation with subsequent MSCT imaging as a result of symptoms from June 2006 to May 2007 was performed. Data analysis included age, gender, size of ASO device, relationship of the device to surrounding structures, symptoms, and the length of time between device implantation and onset of symptoms. Eleven patients were identified with a mean age of 41 years. Patients presented with symptoms 1 week to 2.4 years after implantation. ASO size ranged from 8 to 36 mm. MSCT provided detailed information in all 11 cases regarding anatomic location of the device with respect to surrounding structures. Nonobstructive coronary plaque disease was identified in one patient. Two patients had pericardial effusions. Cardiac symptoms after ASO implant deserve thorough investigation. MSCT is feasible in the assessment of such patients and offers a unique assessment of the device to surrounding anatomic structures and should be considered as a useful adjunct to echocardiography in symptomatic patients.
    Journal of Interventional Cardiology 01/2009; 22(1):92-7. · 1.50 Impact Factor