151
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Alobaidan M, Moamenah T, Abdullah H. Initial experience with intracardiac echocardiography guidance in transcatheter closure of interatrial communication (atrial septal defect, patent foramen ovale, fenestrated Fontan) in Saudi Arabia. Ann Saudi Med 2006; 26:216-9. [PMID: 16861863 PMCID: PMC6074436 DOI: 10.5144/0256-4947.2006.216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/01/2005] [Indexed: 12/02/2022] Open
Affiliation(s)
- Mashail Alobaidan
- Paediatric Cardiology Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.
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152
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Santoro G, Bigazzi MC, Lacono C, Gaio G, Caputo S, Pisacane C, Caianiello G, Russo MG, Calabrò R. Transcatheter closure of complex atrial septal defects: feasibility and mid-term results. J Cardiovasc Med (Hagerstown) 2006; 7:176-81. [PMID: 16645382 DOI: 10.2459/01.jcm.0000203852.82643.f2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Transcatheter closure of atrial septal defects (ASDs) is currently a reliable alternative to surgery, even though challenging in the case of complex septal anatomy. The aim of this study was to evaluate the feasibility and mid-term results of percutaneous closure of complex ASDs in a tertiary referral centre compared with simple ASD closure. METHODS Between April 2000 and November 2004, 209 patients were submitted to transcatheter ASD closure; 83 patients (39.7%) presented with a complex defect (large ASDs with a deficient rim or a multifenestrated/aneurysmal septum) and were treated using different devices tailored to the atrial septal anatomy. RESULTS The transcatheter procedure was successful in 72 patients (86.8%), using a single device in 69 patients and two devices in the remaining three patients. Overall, 71 Amplatzer septal occluders, two multifenestrated Amplatzer septal occluders and two Cardioseal/Starflex devices were used. Procedural and fluoroscopy times were 141 +/- 45 min and 28 +/- 22 min, respectively (P < 0.0001 vs. simple ASD closure for both comparisons). Procedure-related complications were recorded in nine patients (12.5%) (P < 0.01 vs. simple ASD closure). One patient required surgical repair of a femoral arteriovenous fistula and another developed mitral valve dysfunction. Immediate ASD occlusion was recorded in 59.7% of patients, reaching 95.9% at the last follow-up control (P = NS vs. simple ASD closure for both comparisons). CONCLUSIONS Percutaneous closure of complex ASDs may be considered technically feasible, relatively safe and highly effective, although the procedure is still significantly more demanding than transcatheter closure of simple ASDs.
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Affiliation(s)
- Giuseppe Santoro
- Division of Cardiology, Monaldi Hospital, Second University of Naples, Naples, Italy.
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153
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Bjørnstad PG. Is interventional closure the current treatment of choice for selected patients with deficient atrial septation? Cardiol Young 2006; 16:3-10. [PMID: 16454871 DOI: 10.1017/s1047951105002027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/06/2005] [Indexed: 11/06/2022]
Affiliation(s)
- Per G Bjørnstad
- Paediatric Cardiology, Rikshospitalet - The National Hospital, University of Oslo, Oslo, Norway.
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154
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Vida VL, Barnoya J, O'Connell M, Leon-Wyss J, Larrazabal LA, Castañeda AR. Surgical Versus Percutaneous Occlusion of Ostium Secundum Atrial Septal Defects. J Am Coll Cardiol 2006; 47:326-31. [PMID: 16412855 DOI: 10.1016/j.jacc.2005.06.086] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2005] [Revised: 05/27/2005] [Accepted: 06/06/2005] [Indexed: 11/15/2022]
Abstract
OBJECTIVES We compared the effectiveness and cost of percutaneous occlusion using an Amplatzer septal occluder (ASO) (AGA Medical Corp., Golden Valley, Minnesota) device compared with surgical closure of an ostium secundum atrial septal defect (ASD II) in Guatemala. BACKGROUND The percutaneous occlusion of ASD II in first-world nations seems to offer better clinical results and lower cost compared with surgical closure. METHODS We reviewed the clinical course of 111 patients referred to our institution for closure of isolated ASD II. Successful closure was assessed immediately after the procedures and at 12 months. Actual hospital costs were calculated for every patient who underwent either of the two procedures. RESULTS Eighty-three patients with ASD II (75%) were selected for percutaneous occlusion with the ASO device, and the remaining 28 patients (25%) underwent surgical closure. In the device group, in 72 patients (86.7%) devices were successfully deployed. At immediate and 12-month follow-up, the complete closure rate was 87.5% (63 of 72 patients) and 97.2% (70 of 71 patients), respectively. In the surgical group, all patients had successful closure immediately after the procedure and at 12 months. Surgical closure offered a 27% cost savings in comparison with percutaneous occlusion (U.S. 3,329.50 dollars +/- 411.30 dollars and U.S. 4,521.03 dollars +/- 429.71 dollars; p < 0.001, respectively). Cost of the device (U.S. 2,930.00 dollars) proved to be the main cause for this difference. CONCLUSIONS We confirmed the clinical advantages of percutaneous occlusion over surgical closure of ASD II. However, percutaneous occlusion costs were higher compared with surgical closure. In Guatemala, where health care resources are limited, ASD II closure with the ASO device did not prove to be cost-effective.
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Affiliation(s)
- Vladimiro L Vida
- Department of Pediatric Cardiovascular Surgery, Unidad de Cirugía Cardiovascular de Cardiovascular (UNICAR), Guatemala City, Guatemala.
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155
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Choi JY. Recent advances in transcatheter treatment of congenital heart disease. KOREAN JOURNAL OF PEDIATRICS 2006. [DOI: 10.3345/kjp.2006.49.9.917] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Jae Young Choi
- Division of Pediatric Cardiology, Department of Pediatrics, Severance Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea
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156
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Chessa M, Carrozza M, Butera G, Negura D, Piazza L, Giamberti A, Feslova V, Bossone E, Vigna C, Carminati M. The impact of interventional cardiology for the management of adults with congenital heart defects. Catheter Cardiovasc Interv 2006; 67:258-64. [PMID: 16416475 DOI: 10.1002/ccd.20612] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The objective of this study is to assess the impact of interventional cardiology procedures for the management of ACHD. The interventional approach to the management of CHD in the adult population is becoming increasingly recognized as the preferred treatment option for a wide number of congenital cardiac conditions. The files of all consecutive patients over 18 years of age who were hospitalized in our department from January 2000 to December 2004 were reviewed. Over the study period, 1,115 ACHD (583 women; mean age 41 +/- 13.8, years, range 18-72 years) were hospitalized in our department; 752 patients underwent cardiac catheterization and 82.4% of them had an interventional procedure carried out. ASD (329/620) and PFO (159/620) closure account for 78% of all the procedures carried out, with a 2.7% of major complications incidence (all of them closing ASDs). Other procedures such as stenting aortic coarctation (40/620), ventricular septal defect closure (33/620), patent ductus arteriosus embolization (30/620), pulmonary valvuloplasty (12/620), stenting pulmonary artery branches (8/620), etc (5/620) were carried out. The most important complication was one death, which occurred in the case of a 22-year-old woman after stent implantation for a recurrent aortic coarctation. A trivial residual shunt was detected in only 5% of the patients who had a 6-month follow-up after VSD closure; no residual shunt was found after PDA embolization during the 12-month follow-up. In conclusion, we believe that the interventional approach is a safe and successful treatment option for a wide number of congenital cardiac conditions. The increasing use of catheter interventions for these patients will be responsible for an increase of complex cases in surgery.
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Affiliation(s)
- Massimo Chessa
- Pediatric Cardiology and Adult with Congenital Heart Disease Department, Policlinico San Donato, Milan-Italy.
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157
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Pascotto M, Santoro G, Cerrato F, Caputo S, Bigazzi MC, Iacono C, Carrozza M, Russo MG, Caianiello G, Calabrò R. Time-course of cardiac remodeling following transcatheter closure of atrial septal defect. Int J Cardiol 2005; 112:348-52. [PMID: 16303193 DOI: 10.1016/j.ijcard.2005.10.008] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2005] [Revised: 09/27/2005] [Accepted: 10/02/2005] [Indexed: 11/29/2022]
Abstract
BACKGROUND Right chamber dilatation and right-to-left volumetric unbalance are well-known cardiac consequences of atrial septal defect (ASD) shunt, accounting for most of its long-term complications. Thus, cardiac volumetric unloading is a major aim of ASD closure. Different from surgery, transcatheter option might be considered as an "unbiased" tool to evaluate the cardiac geometric remodeling following ASD closure. METHODS Extent and time-course of cardiac geometric changes were assessed by echocardiography 24 h, 1 and 6 months after percutaneous closure of large ASD (mean diameter 17+/-6 mm, QP/QS 2.2+/-0.9) in 42 asymptomatic patients (age 22+/-18 years). RESULTS Transcatheter closure was accomplished using the Amplatzer Septal Occluder device (mean 23+/-7 mm, median 24 mm), achieving a complete occlusion in all patients at the 6-month follow-up control. After ASD closure, right atrial (RA) volume reduced from 45+/-24 to 28+/-12 ml (-37.8%, p<0.001), while left atrial (LA) volume did not significantly change. Inlet and infundibulum right ventricular (RV) end-diastolic diameters reduced by 23+/-2% and 23+/-3%, respectively (p<0.001 for both measurements), although with a different time-course of changes. Finally, transverse left ventricular (LV) end-diastolic diameter increased from 39+/-7 to 44+/-5 mm (+11.4%, p<0.01). These geometric changes resulted in an RV/LV diameter ratio decrease by 34+/-3% (p<0.001). Nearly 90% of cardiac remodeling ensued within 1 month from shunt disappearance (50% within 24 h). CONCLUSIONS Percutaneous ASD closure results in early and striking cardiac geometric changes that almost completely revert the right-to-left volumetric unbalance. Most of this geometric remodeling ensues within a few weeks from ASD closure.
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Affiliation(s)
- Marco Pascotto
- Division of Cardiology, A.O. Monaldi, 2nd University of Naples, Naples, Italy
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158
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Schoen SP, Kittner T, Bohl S, Braun MU, Simonis G, Schmeisser A, Strasser RH. Transcatheter closure of atrial septal defects improves right ventricular volume, mass, function, pulmonary pressure, and functional class: a magnetic resonance imaging study. Heart 2005; 92:821-6. [PMID: 16284222 PMCID: PMC1860672 DOI: 10.1136/hrt.2005.070060] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To characterise prospectively by magnetic resonance imaging (MRI) changes in right ventricular (RV) volume, function, and mass after transcatheter closure of atrial septal defects (ASDs) and to evaluate the course of pulmonary pressure and functional class criteria. METHODS In 20 patients with secundum-type ASD and dilated RV diameter, MRI was performed to quantify RV end diastolic (RVEDV) and end systolic volumes (RVESV), RV mass, tricuspid annular diameter, and RV ejection fraction before and 6 and 12 months after transcatheter closure of the ASD. RV systolic pressure was measured during follow up by transthoracic echocardiography. RESULTS Functional class improved in the majority of patients after ASD closure. RVESV (from 81 (18) ml/m2 to 53 (15) ml/m2, p < 0.001), RVEDV (from 127 (17) ml/m2 to 99 (18) ml/m2, p < 0.001), and RV mass (from 79 (10) g to 63 (8) g, p < 0.01) decreased significantly during follow up, although tricuspid annular diameter did not. RV ejection fraction improved (by 9% compared with baseline, p < 0.05) and RV systolic pressure decreased significantly (from 33 (8) mm Hg to 24 (6) mm Hg, p < 0.001) after closure. CONCLUSION MRI studies showed significant improvement of RV volumes, mass, and function after transcatheter closure of ASDs. Restoration of the RV leads to decreased pulmonary pressure resulting in a better functional class in the majority of patients.
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Affiliation(s)
- S P Schoen
- Department of Cardiology, University of Dresden, Dresden, Germany.
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159
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Abstract
Transcatheter device closure of atrial septal defects has proved to be remarkably successful, and is usually preferred by both patients and parents. But how does it compare with the gold standard of surgical closure?
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160
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Blom NA, Ottenkamp J, Jongeneel TH, DeRuiter MC, Gittenberger-de Groot AC. Morphogenetic differences of secundum atrial septal defects. Pediatr Cardiol 2005; 26:338-43. [PMID: 16374682 DOI: 10.1007/s00246-004-0711-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
It is generally considered that the development of secundum atrial septal defect (ASDII) or oval fossa defect is the result of excessive resorption of the embryological atrial septum primum, but this does not seem to explain all defects. We investigated 58 postmortem hearts with an ASDII and 22 normal hearts from patients ranging in age from 1 day to 49 years. The different structures of the oval fossa were examined. In 86% of the specimens, the defects were the result of a malformation of the valvula foraminis ovalis or embryological atrial septum primum, and in 14% an absent superior limbus (septum secundum) was the cause of the interatrial communication. The "septum primum" ASDs were divided into four subgroups based on the degree of deficiency of the septum primum and position of the ostium secundum within the septum primum. We conclude that the morphogenesis of ASDII is variable and both septum primum and septum secundum defects occur, which may be relevant in view of genetic studies that may lead to further differentiation of patients with and without genetically determined ASDIIs.
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Affiliation(s)
- N A Blom
- Department of Pediatric Cardiology, Leiden University Medical Center, P.O. Box 9602, The Netherlands
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161
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Abstract
Atrial septal defects have traditionally been repaired by surgical closure. Recently, transcatheter device closure has increasingly been used with excellent results. Although there is limited comparative research evaluating long-term outcomes of the transcatheter technique, preliminary data reveal significantly fewer complications and shorter hospital stays than those reported for surgical repair. This article reviews relevant literature comparing efficacy, cost, and complications of the transcatheter device procedures with the surgical closure of ASDs.
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Affiliation(s)
- Lindy Moake
- Department of Inpatient Cardiology, Children's Medical Center of Dallas, TX 75235, USA.
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162
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Masura J, Gavora P, Podnar T. Long-term outcome of transcatheter secundum-type atrial septal defect closure using Amplatzer septal occluders. J Am Coll Cardiol 2005; 45:505-7. [PMID: 15708695 DOI: 10.1016/j.jacc.2004.10.066] [Citation(s) in RCA: 202] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2004] [Revised: 09/13/2004] [Accepted: 10/25/2004] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The aim of this study was to assess long-term results of percutaneous closure of secundum-type atrial septal defect (ASD II) using Amplatzer septal occluders (ASO). BACKGROUND Only immediate-, short-, and intermediate-term results of ASO implantation are known so far. METHODS Between September 1995 and January 2000, 151 patients underwent a successful percutaneous closure of ASD II in our institution. All were included in the present study and were followed up until September 2004. RESULTS This group of patients was followed up from 56 to 108 months (median 78 months). The mean stretched defect diameter was 15.9 +/- 4.8 mm. There were no deaths or significant complications during the study. At three years of follow-up, all defects were completely closed and remained closed thereafter. CONCLUSIONS Since the first human implantations in September 1995, the Amplatzer septal occluder proved as a safe and effective device for percutaneous closure of ASD II.
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Affiliation(s)
- Jozef Masura
- Children's Cardiac Center, University Children's Hospital, Bratislava, Slovakia
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163
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Kotthoff S, Lê TP, Debus V. Late coil displacement after interventional closure of a perimembranous ventricular septal defect: A case report. Catheter Cardiovasc Interv 2005; 66:273-6. [PMID: 16086430 DOI: 10.1002/ccd.20452] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Muscular and perimembranous ventricular septal defects can be closed with nitinol plugs or spiral coils. Displacement and embolization of the device are well known complications that usually occur during or early after the procedure. We present the case of a 12-year-old boy with asymptomatic coil displacement detected at a routine examination 5 months after closure of a perimembranous ventricular septal defect.
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Affiliation(s)
- Stefan Kotthoff
- Department of Pediatric Cardiology, University Children's Hospital Muenster, Muenster, Germany.
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164
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Holzer R, Cao QL, Hijazi ZM. Closure of a moderately large atrial septal defect with a self-fabricated fenestrated Amplatzer septal occluder in an 85-year-old patient with reduced diastolic elasticity of the left ventricle. Catheter Cardiovasc Interv 2005; 64:513-8; discussion 519-21. [PMID: 15789387 DOI: 10.1002/ccd.20315] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Percutaneous closure of an atrial septal defect (ASD) in the elderly with reduced diastolic elasticity of the left ventricle poses a significant management challenge. We report on the case of an 85-year-old patient who was admitted for percutaneous device closure of a moderately large secundum atrial septal defect. Hemodynamic evaluation documented an increase in left atrial pressure from a mean of 12 mm Hg to a mean of 32 mm Hg after balloon test occlusion of the ASD. Two months later, after adequate pretreatment with diuretics and afterload-reducing substances, he underwent successful closure of the ASD using a self-fabricated fenestrated Amplatzer septal occluder, which resulted in a postimplantation left atrial pressure of a mean of 18 mm Hg. Recovery was unremarkable and the fenestration has remained patent for 3 months since implantation of the device. This unique case highlights the feasibility of using a self-fabricated fenestrated Amplatzer septal occluder to close interatrial communications in elderly patients with diastolic dysfunction of the left ventricle.
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Affiliation(s)
- Ralf Holzer
- Section of Cardiology, Department of Pediatrics, University of Chicago Children's Hospital, IL 60637, USA
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165
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Papadopoulou DI, Yakoumakis EN, Makri TK, Sandilos PH, Thanopoulos BD, Georgiou EK. Assessment of patient radiation doses during transcatheter closure of ventricular and atrial septal defects with Amplatzer devices. Catheter Cardiovasc Interv 2005; 65:434-41. [PMID: 15889406 DOI: 10.1002/ccd.20353] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The purpose of this study was to estimate the radiation dose to which children are exposed during cardiac catheterizations for the treatment of ventricular and atrial septal defects. Radiation doses were estimated for 46 children aged 1-18 years. These children were treated for secundum atrial septal defects (ASD group) for perimembranous ventricular septal defects (VSD group) or underwent a routine diagnostic catheterization (diagnostic group). Thermoluminescent dosimeters (TLDs) were attached in locations, representing the lateral entrance dose, the posterior entrance dose, the thyroid dose, and the gonad dose, respectively. A dose area product (DAP) meter was also attached externally on the posterior-anterior (PA) tube to give a direct value in cGy cm(2) for each procedure. The patient's entrance dose from the PA field ranged from 1.5 to 185.0 mGy for all patients, while the lateral entrance dose varied from 0.9 to 204 mGy. Radiation exposure to the thyroid and the gonads was found to vary from 0.4 to 8.3 and 0.1 to 2.1 mGy, respectively. The DAP meter recorded DAP values for the posterior tube, between 46 and 3,700 cGy cm(2). The mean effective dose was found to be 7.7, 16.2, and 33.3 mSv for the diagnostic, the ASD, and the VSD group, respectively. Very strong correlation was found between the DAP values and the entrance radiation dose measured with TLDs. The mean entrance dose received from therapeutic cardiac catheterizations using the Amplatzer devices was found approximately twice the dose received from a diagnostic one. Even for the most complex procedures, the maximum entrance dose was at least 10 times lower than the threshold, associated with skin erythema.
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166
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Abstract
As a result of recent technological advances, more types of congenital heart disease are amenable to treatment in the cardiac catheter laboratory than ever before.1 Improved imaging techniques allow for better selection of patients, and the development of a wide range of devices specifically for use in children means that many patients can avoid surgery altogether, while those with complex congenital heart disease may require fewer or less complex surgical procedures.2 This allows for a quicker recovery and a shorter hospital stay, and gives many patients an improved quality of life in the short to medium term. However, the long term outcome for many of the newer forms of intervention is still unknown.
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Affiliation(s)
- R E Andrews
- Department of Congenital Heart Disease, Guy's and St Thomas' NHS Trust, Guy's Hospital, St Thomas' Street, London SE1 9RT, UK.
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167
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Prokselj K, Kozelj M, Zadnik V, Podnar T. Echocardiographic characteristics of secundum-type atrial septal defects in adult patients: Implications for percutaneous closure using Amplatzer septal occluders. J Am Soc Echocardiogr 2004; 17:1167-72. [PMID: 15502791 DOI: 10.1016/j.echo.2004.06.033] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The aim of the study was to analyze echocardiographic characteristics of isolated secundum-type atrial septal defects (ASD II) in adult patients and their implications for percutanous closure using Amplatzer septal occluders. The study population consisted of 64 consecutive adult patients with isolated ASD II (mean age 43.6 +/- 15.9 years). Patients were evaluated using both transthoracic and transesophageal echocardiography. Defects in 29 of 64 patients (45.3%) fulfilled the echocardiographic criteria for percutaneous closure. The mean defect diameter in the study was 22.2 +/- 9.5 mm. In all, 13 morphologic variations of ASD II were detected. A statistically significant correlation between defect size and the number of deficient defect rims was found. Less than 50% of ASD II in adult patients fulfilled the echocardiographic criteria for percutaneous closure using Amplatzer septal occluders. Because others have demonstrated growth of ASD II over time, we presume that in some patients, defect growth is associated with attenuation or even disappearance of defect rims causing changing defect morphology with increasing defect size.
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168
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Chun TUH, Gruenstein DH, Cripe LH, Beekman RH. Blade consolidation of multiple atrial septal defects: a novel approach to transcatheter closure. Pediatr Cardiol 2004; 25:671-4. [PMID: 15175838 DOI: 10.1007/s00246-003-0610-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The Amplatzer atrial septal defect occlusion device has gained popularity for the nonoperative closure of secundum-type defects. We describe a case of multiple atrial septal defects that were "consolidated" into a single defect using blade atrial septostomy for successful closure with single Amplatzer device.
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Affiliation(s)
- T U H Chun
- Division of Cardiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, 45229, Cincinnati, OH 45229, USA
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169
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Abstract
Intracardiac shunts, such as atrial septal defects (ASDs), patent foramen ovales (PFOs), and ventricular septal defects (VSDs), are common forms of congenital or acquired heart disease. Traditional treatment has consisted of surgical closure. Transcatheter closure using implantable devices is now an alternative approach to the treatment of these lesions. Transcatheter closure offers advantages over surgical closure: 1) it is less invasive, resulting in shorter recovery times, less hospital time, and no scarring; 2) it avoids the deleterious neurocognitive effects of cardiopulmonary bypass; 3) it avoids the proarrhythmic effects of atrial or ventricular incisions; and 4) it is potentially less costly. Device closure of secundum ASDs is the procedure of choice. Device closure of PFOs can be performed under humanitarian device exemption (HDE) guidelines, although the indications for this procedure and its effectiveness compared with medical management remain controversial. Ongoing studies are addressing these issues. Transcatheter closure of muscular VSDs is an alternative to surgical treatment, especially for apical defects or those anterior to the moderator band. The CardioSEAL device (NMT Medical, Boston, MA) has HDE status for this purpose and the Amplatzer muscular VSD device (AGA Medical Corp., Golden Valley, MN) is being reviewed by the US Food and Drug Administration for market approval. Phase 1 investigations are underway for device closure of perimembranous VSDs using the Amplatzer perimembranous VSD device (AGA Medical Corp.). Until more data are available, surgical closure of perimembranous VSDs is still the procedure of choice. Closure of postinfarct VSDs can also be accomplished using intracardiac devices; however, this remains a high-risk procedure. Early experience compares favorably with surgical closure. Transcatheter device closure of intracardiac defects is a relatively new procedure. Long-term data for these procedures are currently lacking and, therefore, recommendations regarding the use of these devices will continue to evolve with time.
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Affiliation(s)
- David T. Balzer
- Washington University School of Medicine, St. Louis Children's Hospital, 1 Children's Place, Room 5S30, St. Louis, MO 63110, USA.
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170
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Abstract
POSSIBLITIES FOR PROGNOSTIC IMPROVEMENT: The inter-auricular communication (IAC) is the most frequent of congential malformations in adults and is responsible for enhanced morbidity and rduction in life expectancy. The closure of an IAC with volumic overload eradicates such morbidity and mortality. The technical progress in the conception of prosthesises that obstrue the interauricular communications via the percutaneous route make this technique a reliable alternative to surgery that, itself, leads to a certain degree of discomfort and considerable morbidity. DEPENDING ON THE ECHOCARDIOGRAPHICAL DATA: The selection of patients is crucial and relies on trans-thoracic echocardiography. It is indicated in isolated ostium secundum-type inter-auricular communications with a border of at least 4 mm separating it from the adjacent structures of the heart; the size on the echocardiography must not exceed 30 mm. FROM A TECHNICAL POINT OF VIEW: The closure is made under fluoroscopic and echocardiographic control via the trans-oesophageal route. It is rapid, simple, and induces a low rate of morbidity. With Amplatz's prosthesis, the percentage of complete closure is equivalent to that obtained with surgery but with less morbidity with regard to arrhythmia. Today the reliable percutaneous closure of an IAC will probably permit the extension of the indications for the closure of this congenital abnormality in adults.
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Affiliation(s)
- Jean Losay
- Unité de cardiologie pédiatrique, laboratoire d'hémodynamique et d'angiographie, Hôpital Marie Lannelongue, Le Plessis-Robinson.
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171
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Mitchell ARJ, Roberts P, Eichhöfer J, Timperley J, Ormerod OJM. Echocardiographic assessment and percutaneous closure of multiple atrial septal defects. Cardiovasc Ultrasound 2004; 2:9. [PMID: 15268761 PMCID: PMC497050 DOI: 10.1186/1476-7120-2-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2004] [Accepted: 07/21/2004] [Indexed: 11/30/2022] Open
Abstract
Atrial septal defect closure is now routinely performed using a percutaneous approach under echocardiographic guidance. Centrally located, secundum defects are ideal for device closure but there is considerable morphological variation in size and location of the defects. A small proportion of atrial septal defects may have multiple fenestrations and these are often considered unsuitable for device closure. We report three cases of multiple atrial septal defects successfully closed with two Amplatzer septal occluders.
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Affiliation(s)
- Andrew RJ Mitchell
- The Department of Cardiology, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom
| | - Philip Roberts
- The Department of Paediatric Cardiology, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom
| | - Jonas Eichhöfer
- The Department of Cardiology, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom
| | - Jonathan Timperley
- The Department of Cardiology, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom
| | - Oliver JM Ormerod
- The Department of Cardiology, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom
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172
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Kardon RE, Sokoloski MC, Levi DS, Perry JS, Schneider DJ, Allada V, Moore JW. Transthoracic echocardiographic guidance of transcatheter atrial septal defect closure. Am J Cardiol 2004; 94:256-60. [PMID: 15246918 DOI: 10.1016/j.amjcard.2004.03.080] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2003] [Revised: 03/23/2004] [Accepted: 03/23/2004] [Indexed: 11/15/2022]
Abstract
This study examines the safety and efficacy of transthoracic echocardiographic (TTE) guidance of atrial septal defect (ASD) device closure. We evaluated 74 patients for TTE-guided ASD closure. Fifty-six patients had successful device implantation using TTE guidance. Twelve patients were referred for surgical ASD closure on the basis of TTE evaluation. Five patients with multiple ASDs or poor transthoracic acoustic windows had ASD device closure guided by transesophageal echocardiography (TEE).
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Affiliation(s)
- Richard E Kardon
- The Heart Center for Children, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania, USA
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173
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Tuzcu V, Michel-Behnke I, Schranz D. TRANSCATHETER CLOSURE OF ATRIAL SEPTAL DEFECTS: EXPERIENCE OF A PEDIATRIC HEART CENTER. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2004. [DOI: 10.29333/ejgm/82200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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174
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Affiliation(s)
- Thomas P Graham
- Ann and Monroe Carell Family Professor of Pediatric Cardiology, Vanderbilt Children's Hospital, Nashville, Tennessee 37232, USA.
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175
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Sable CA. Ultrasound of congenital heart disease. Semin Roentgenol 2004. [DOI: 10.1053/j.ro.2003.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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176
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Lander SR, Phillips S, Vallabhan RC, Grayburn PA, Anwar A. Percutaneous closure of multiple atrial septal defects with three Amplatzer septal occluder devices. Catheter Cardiovasc Interv 2004; 62:526-9. [PMID: 15274166 DOI: 10.1002/ccd.20099] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We report on the successful closure of three atrial septal defects with three Amplatzer septal occluders in a 55-year-old woman.
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Affiliation(s)
- Stuart R Lander
- Jack and Jane Hamilton Heart and Vascular Hospital, Baylor University Medical Center, Dallas, Texas, USA
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177
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Trehan V, Mehta V, Mukhopadhyay S, Yusuf J, Arora R, Kaul UA. A constricting band: An unusual cause of incomplete expansion of Amplatzer septal occluder device. Catheter Cardiovasc Interv 2004; 61:418-21. [PMID: 14988908 DOI: 10.1002/ccd.10771] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Various problems and complications have been reported during transcatheter closure of ostium secundum atrial septal defect with Amplatzer septal occluder. We report an unusual problem that was responsible for incomplete expansion of the waist of the device, not yet reported in world literature. A polyester band in continuation with the polyester mesh was found constricting the waist of the device, which after being cut led to successful redeployment of the device.
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Affiliation(s)
- Vijay Trehan
- Department of Cardiology, G.B. Pant Hospital, New Delhi, India
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