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Torunoğlu Bek Z, Oğuz AD, Soysal Acar AŞ, Terlemez S, Canbeyli FH, Kula S, Tunaoğlu FS. Evaluation of quality of life and parental attitudes in patients who underwent atrial septal defect closure in childhood. Cardiol Young 2024; 34:1071-1076. [PMID: 38073590 DOI: 10.1017/s1047951123004067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2024]
Abstract
OBJECTIVE In this study, we aimed to evaluate quality of life and parental attitudes in children who underwent an atrial septal defect closure procedure with a transcatheter or surgical method in childhood and whether they continued their lives with similar activities to their healthy peers by comparing the two groups. METHODS Patient forms to define sociodemographic and clinical features, the Questionnaire for Measuring Health-Related Quality of Life in Children and Adolescents (KINDL) to measure the quality of life of children, and the Parent-Child Relationship Test (Parental Attitude Research Instrument) to measure parental attitudes were used. RESULTS The groups were similar in terms of age and sex. The mean quality of life scale scores were high in all groups, and there was no statistically significant difference between the scores. Parents of the patients who underwent closure received higher scores from the demographic attitudes and recognition of quality subdimension compared to the parents of the healthy group. CONCLUSIONS The quality of life of children with atrial septal defect closure was found to be similar to their healthy peers. Additionally, the effects of surgical or percutaneous closure of atrial septal defect on quality of life are similar. Children with atrial septal defect closure perceive their health status as well as their healthy peers, and this perception does not cause any difference in the attitudes and behaviours of families.
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Affiliation(s)
| | - A Deniz Oğuz
- Department of Pediatric Cardiology, Gazi University Faculty of Medicine,Ankara, Türkiye
| | | | - Semiha Terlemez
- Department of Pediatric Cardiology, Gazi University Faculty of Medicine,Ankara, Türkiye
| | | | - Serdar Kula
- Department of Pediatric Cardiology, Gazi University Faculty of Medicine,Ankara, Türkiye
| | - Fatma Sedef Tunaoğlu
- Department of Pediatric Cardiology, Gazi University Faculty of Medicine,Ankara, Türkiye
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2
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Xiang K, Ai Q, He L, Fan C. Case report: Amplatzer septal occluder device migration into the descending thoracic aortic isthmus: percutaneous retrieval and redeployment. Front Cardiovasc Med 2023; 10:1269032. [PMID: 37900566 PMCID: PMC10611486 DOI: 10.3389/fcvm.2023.1269032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/02/2023] [Indexed: 10/31/2023] Open
Abstract
Percutaneous closure has emerged as the standard treatment for secundum-type atrial septal defects (ASDs). However, there is a rare but serious complication of occluder device migration and embolization to the heart chambers or distal vasculature during or shortly after implantation. Although this occurrence is extremely rare, it can have disastrous consequences. Fortunately, advancements in equipment and technology have facilitated the transition from surgical procedures to percutaneous techniques for removing embolized occluder devices. In this report, we present a case in which an Amplatzer septal occluder (ASO) device embolized to the descending thoracic aortic isthmus two days after implantation. The device was successfully retrieved using a percutaneous technique, and another ASO device was subsequently redeployed to the ASD. Regrettably, the patient experienced an intraoperative cardiac arrest. Despite prompt rescue efforts and recovery of vital signs, the patient still suffered postoperative sequelae. The main reason for occluder device migration in this case may have been the undersizing of the ASO device due to the operator's lack of caution.
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Affiliation(s)
- Kun Xiang
- Department of Cardiovascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, China
| | - Qi Ai
- Department of Cardiovascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, China
| | - Lin He
- Department of Cardiology, Shaoyang Central Hospital, Shaoyang, China
| | - Chengming Fan
- Department of Cardiovascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, China
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3
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Liao LC, Jan SL, Lin MC, Lee HH, Fu YC. Novel technique to reduce prolapsed device in atrial septal defect closure. Front Cardiovasc Med 2023; 10:1164061. [PMID: 37260942 PMCID: PMC10227603 DOI: 10.3389/fcvm.2023.1164061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 05/02/2023] [Indexed: 06/02/2023] Open
Abstract
Objective Transcatheter closure of atrial septal defect (ASD) has become an alternative treatment to surgical repair. One of the challenges is the prolapse of the left atrial disc during the procedure. Many techniques have been developed to prevent the prolapse but not reduce it. In this study, we present a novel technique, termed push back technique, that help reduce the prolapsed device. Methods We enrolled 24 patients (8 males, 16 females) between May 2008 and January 2023 who underwent the push back technique during transcatheter closure of ASD in Taichung Veterans General Hospital. We recorded the hemodynamic data, success rate and complications including device embolization/migration, valvular regurgitation, pericardial effusion, and residual shunt. Results The median age was 6.3 years (1.2-70.5 years) and the median weight was 19.1 kg (7.8-90 kg). Fifteen (62.5%) patients had mild pulmonary hypertension. The median Qp/Qs was 2.54 (1.5-8.8). The median ASD stretched size was 21.2 mm (7.7-35.3 mm). The median device size was 22 mm (8-40 mm). The median fluoroscopy time was 14 min (5-23 min) and median procedure time was 47 min (25-78 min). The push back technique successfully reduced the prolapsed device in 21 (87.5%) patients. There was no complication in all patients. Conclusion We present a novel push back technique that can successfully reduce the prolapsed device in 87.5% (21/24) patients without complications. It is feasible, safe and effective.
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Affiliation(s)
- Li-Chin Liao
- Department of Pediatrics, Wuri Lin Shin Hospital, Taichung, Taiwan
- Department of Pediatrics, Children’s Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Sheng-Ling Jan
- Department of Pediatrics, Children’s Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ming-Chih Lin
- Department of Pediatrics, Children’s Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ho-Hsun Lee
- Good Day Psychiatric Clinic, Taichung, Taiwan
| | - Yun-Ching Fu
- Department of Pediatrics, Children’s Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Pediatrics, School of Medicine, National Chung Hsing University, Taichung, Taiwan
- Department of Pediatrics and Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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4
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Turner ME, Bouhout I, Petit CJ, Kalfa D. Transcatheter Closure of Atrial and Ventricular Septal Defects: JACC Focus Seminar. J Am Coll Cardiol 2022; 79:2247-2258. [PMID: 35654496 DOI: 10.1016/j.jacc.2021.08.082] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 08/02/2021] [Accepted: 08/09/2021] [Indexed: 11/25/2022]
Abstract
The field of congenital interventional cardiology has experienced tremendous growth in recent years. Beginning with the development of early devices for transcatheter closure of septal defects in the 1970s and 1980s, such technologies have evolved to become a mainstay of treatment for many atrial septal defects (ASDs) and ventricular septal defects (VSDs). Percutaneous device closure is now the preferred approach for the majority of secundum ASDs. It is also a viable treatment option for selected VSDs, though limitations still exist. In this review, the authors describe the current state of transcatheter closure of ASDs and VSDs in children and adults, including patient selection, procedural approach, and outcomes. Potential areas for future evolution and innovation are also discussed.
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Affiliation(s)
- Mariel E Turner
- Division of Pediatric Cardiology, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Irving Medical Center, New York, New York, USA.
| | - Ismail Bouhout
- Division of Cardiothoracic Surgery, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Irving Medical Center, New York, New York, USA
| | - Christopher J Petit
- Division of Pediatric Cardiology, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Irving Medical Center, New York, New York, USA
| | - David Kalfa
- Division of Cardiothoracic Surgery, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Irving Medical Center, New York, New York, USA
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5
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Mahmoud HT, Gaio G, Giordano M, Pizzuto A, Cuman M, Abdel Wahab MAK, Palladino MT, Russo MG, Santoro G. Transcatheter closure of fenestrated atrial septal aneurysm in children: Feasibility and long-term results. Catheter Cardiovasc Interv 2022; 99:2043-2053. [PMID: 35420259 DOI: 10.1002/ccd.30191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 02/17/2022] [Accepted: 03/23/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND To date, extensive experience in transcatheter closure of fenestrated atrial septal aneurysm (ASA) in the pediatric population is limited. METHODS To report on procedural feasibility, efficacy, and long-term outcome, we enrolled all children submitted to an attempt of transcatheter closure of fenestrated ASA at two, large volume, pediatric cardiology units (Naples and Massa, Italy) between April 2000 to May 2020. RESULTS This retrospective study included 139 patients (median age 9 years [range 2-18] and weight 36 kg [range 10-102]); 19 (13.7%) children were ≤20 kg (range 10-20) and 14 (10.1%) were ≤5 years old. Single perforation was observed in 28 patients (20.1%), while 111 patients (79.9%) had multifenestrated ASA. The median size of the main defect was 15 mm (range 6-34) and 25 patients (18%) had a defect ≥20 mm. The procedural success rate was 99% (95% confidence interval [CI]: 94.9-99.8) using a single device in 75 (69%), two devices in 31 (28%), and three devices in 3 (3%) cases. Early minor adverse events (AEs) occurred in four patients (2.8%). Late minor AEs were recorded in one patient (0.7%) over a median follow-up of 5 years ([range 0-18 years; total 890.2 person-years, and with 30 patients (22%) followed ≥10 years). Neither mortality nor major AEs were recorded. Freedom from AEs was 99.1% at 10-15 years (95% CI: 93.5-99.8%), without any difference according to atrial septum anatomy or patient age and weight. CONCLUSION Transcatheter closure of fenestrated ASA is technically feasible and effective in children with excellent long-term outcomes.
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Affiliation(s)
- Heba Talat Mahmoud
- Pediatric Cardiology, University of Campania "Luigi Vanvitelli", "Ospedali dei Colli", Naples, Italy.,Cardiology Department, Minia University, Minia, Egypt
| | - Gianpiero Gaio
- Pediatric Cardiology, University of Campania "Luigi Vanvitelli", "Ospedali dei Colli", Naples, Italy
| | - Mario Giordano
- Pediatric Cardiology, University of Campania "Luigi Vanvitelli", "Ospedali dei Colli", Naples, Italy
| | - Alessandra Pizzuto
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Region Foundation "G. Monasterio", Massa, Italy
| | - Madgalena Cuman
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Region Foundation "G. Monasterio", Massa, Italy
| | | | - Maria Teresa Palladino
- Pediatric Cardiology, University of Campania "Luigi Vanvitelli", "Ospedali dei Colli", Naples, Italy
| | - Maria Giovanna Russo
- Pediatric Cardiology, University of Campania "Luigi Vanvitelli", "Ospedali dei Colli", Naples, Italy
| | - Giuseppe Santoro
- Pediatric Cardiology, University of Campania "Luigi Vanvitelli", "Ospedali dei Colli", Naples, Italy.,Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Region Foundation "G. Monasterio", Massa, Italy
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6
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Malzahn L, Bertog S, Sievert K, Reinhartz M, Schnelle N, Grunwald I, Franke J, Gafoor SA, Jovanovic B, Vogel A, Ilioska-Damkoehler P, Galeru N, Sievert H. Transcatheter closure of large atrial septal defects in adults. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 42:28-33. [DOI: 10.1016/j.carrev.2022.03.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 03/12/2022] [Accepted: 03/21/2022] [Indexed: 11/03/2022]
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7
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Pelzek C, Rhinehart J, Villalba M, Schober K, Winter R, Berman D. Transient high-grade second-degree atrioventricular block secondary to transvenous atrial septal defect occlusion in a dog. J Vet Cardiol 2022; 41:30-38. [DOI: 10.1016/j.jvc.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 01/06/2022] [Accepted: 01/13/2022] [Indexed: 11/29/2022]
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8
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Mahmoud HT, Gaio G, Giordano M, Pizzuto A, Cuman M, Asklany HT, Palladino MT, Russo MG, Santoro G. Transcatheter closure of fenestrated atrial septal aneurysm: feasibility and long-term results. J Cardiovasc Med (Hagerstown) 2022; 23:49-59. [PMID: 34366401 DOI: 10.2459/jcm.0000000000001239] [Citation(s) in RCA: 2] [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
AIM To report on the feasibility, efficacy and long-term outcome of transcatheter closure of fenestrated Atrial Septal Aneurysm (ASA). METHODS Between April 2000 and May 2020, 568 patients with fenestrated ASA underwent transcatheter closure at two large-volume Pediatric Cardiology and GUCH Units (Naples and Massa, Italy). Procedural indications were cardiac volume overload in 223 patients (39%) or prophylaxis of paradoxical embolization in 345 patients (61%). Patients' median age and weight were 42 years (range 19-52) and 66 kg (range 54-79), respectively. One-hundred and thirty-nine patients (25%) were younger than 18 years. RESULTS Single fenestration was found in 311 patients (55%) (Group 1), whereas 257 patients (45%) had multifenestrated ASA (Group 2). The procedure was successful in all but seven patients (1.2%). In Group 1, closure was achieved with a single device. In Group 2, one device was used in 168 patients (67%), two devices in 74 patients (28%), three devices in 12 patients (5%), and four devices in 1 patient (0.3%). The early complication rate was 3%, without any difference according to anatomy or patient's age. At discharge, complete shunt closure was higher in Group 1 (92% vs. 72%, P < 0.0001), without any difference between groups at the last follow-up evaluation (100% vs. 99%, P = 0.12). Procedural safety was persistent during the long-term follow-up (mean 7.2 ± 5.4, range 0-19 years): freedom from adverse events was 97% at 10-15 years. Seventeen patients (3%) were submitted to reintervention, mostly as prophylaxis of paradoxical embolization. CONCLUSION Transcatheter closure of perforated ASA is technically feasible in a high percentage of cases, with excellent long-term outcomes.
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Affiliation(s)
- Heba Talat Mahmoud
- Pediatric Cardiology, University of Campania 'Luigi Vanvitelli', Former Second University of Naples, Monaldi Hospital-AORN Ospedali dei Colli, Naples
- Cardiology Department, Minia University, Minia, Egypt
| | - Gianpiero Gaio
- Pediatric Cardiology, University of Campania 'Luigi Vanvitelli', Former Second University of Naples, Monaldi Hospital-AORN Ospedali dei Colli, Naples
| | - Mario Giordano
- Pediatric Cardiology, University of Campania 'Luigi Vanvitelli', Former Second University of Naples, Monaldi Hospital-AORN Ospedali dei Colli, Naples
| | - Alessandra Pizzuto
- Pediatric Cardiology and GUCH Unit, Heart Hospital 'G. Pasquinucci', National Research Council-Tuscany Region Foundation 'G. Monasterio', Massa, Italy
| | - Madgalena Cuman
- Pediatric Cardiology and GUCH Unit, Heart Hospital 'G. Pasquinucci', National Research Council-Tuscany Region Foundation 'G. Monasterio', Massa, Italy
| | | | - Maria Teresa Palladino
- Pediatric Cardiology, University of Campania 'Luigi Vanvitelli', Former Second University of Naples, Monaldi Hospital-AORN Ospedali dei Colli, Naples
| | - Maria Giovanna Russo
- Pediatric Cardiology, University of Campania 'Luigi Vanvitelli', Former Second University of Naples, Monaldi Hospital-AORN Ospedali dei Colli, Naples
| | - Giuseppe Santoro
- Pediatric Cardiology, University of Campania 'Luigi Vanvitelli', Former Second University of Naples, Monaldi Hospital-AORN Ospedali dei Colli, Naples
- Pediatric Cardiology and GUCH Unit, Heart Hospital 'G. Pasquinucci', National Research Council-Tuscany Region Foundation 'G. Monasterio', Massa, Italy
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9
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Bakhshaliyev N, Çelikkale İ, Enhoş A, Karaçöp E, Uluganyan M, Özdemir R. Impact of atrial flow regulator (AFR) implantation on 12-month mortality in heart failure : Insights from a single site in the PRELIEVE study. Herz 2021; 47:366-373. [PMID: 34459929 DOI: 10.1007/s00059-021-05063-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/10/2021] [Accepted: 07/22/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Implantation of the atrial flow regulator (AFR) to create an interatrial left-to-right shunt has been shown to be safe and feasible to reduce intracardiac filling pressures in patients with heart failure (HF). OBJECTIVES We aimed to assess the effect of AFR implantation on 12-month mortality and hospitalization rates in patients with reduced (HFrEF) or preserved HF (HFpEF). METHODS One-year follow-up data from 34 subjects enrolled at a single PRELIEVE center were analyzed. The 12-month predicted mortality was calculated using the Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) risk score. Patients were divided into two groups, according to their history of hospitalizations for HF. RESULTS Study data of 34 patients (HFrEF: 24 [70.6%]; HFpEF: 10 [29.4%]) were assessed. Median follow-up duration was 355 days. In total, 14 (41.2%) patients were hospitalized during the follow-up period and 6 (17.6%) of these patients were hospitalization for HF (HHF). A total of 24 hospitalizations occurred in this period and 8 (33%) hospitalizations were for HHF. The median baseline MAGGIC score was 23 and the median predicted mortality was 13.4/100 patient years. Observed mortality was 3.1/100 patient years. The observed survival (97%) was 10.3% (95% confidence interval 3.6-17.5%, p = 0.004) better than the predicted survival (86.6%). CONCLUSION Our results suggest that AFR implantation has favorable effects on mortality in patients with heart failure, regardless of ejection fraction. Furthermore, compared to baseline, left ventricular filling pressure (assessed by echocardiography) decreased significantly without right side volume overload at the 1‑year follow-up.
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Affiliation(s)
- Nijad Bakhshaliyev
- Cardiology Department, Bezmialem Vakif University, Adnan Menderes bulvari, Fatih/Istanbul, Turkey.
| | - İlke Çelikkale
- Cardiology Department, Bezmialem Vakif University, Adnan Menderes bulvari, Fatih/Istanbul, Turkey
| | - Asım Enhoş
- Cardiology Department, Bezmialem Vakif University, Adnan Menderes bulvari, Fatih/Istanbul, Turkey
| | - Erdem Karaçöp
- Cardiology Department, Bezmialem Vakif University, Adnan Menderes bulvari, Fatih/Istanbul, Turkey
| | - Mahmut Uluganyan
- Cardiology Department, Bezmialem Vakif University, Adnan Menderes bulvari, Fatih/Istanbul, Turkey
| | - Ramazan Özdemir
- Cardiology Department, Bezmialem Vakif University, Adnan Menderes bulvari, Fatih/Istanbul, Turkey
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Cha SG, Kim MJ, Baek JS, Yu JJ, Kim YH. Procedural Predictors and Outcomes of Percutaneous Secundum Atrial Septal Defect Closure in Children Aged <6 Years. Circ J 2021; 85:1527-1534. [PMID: 33883381 DOI: 10.1253/circj.cj-20-1023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Percutaneous atrial septal defect (ASD) closure is the treatment of choice for patients with a suitable ASD anatomy; however, the procedural characteristics and outcomes in children aged <6 years are unclear. The feasibility and safety of percutaneous ASD closure in children aged <6 years was evaluated and the predictors of procedural failure and challenging cases were identified. METHODS AND RESULTS Patients from a single center between 2006 and 2018 (n=407) were retrospectively evaluated. There were 265 (65.1%) female patients. The median age at the time of the procedure and ASD size were 3.4 (0.9-5.9) years and 13.3 (3.8-27.0) mm, respectively. Medical records and echocardiographic images were analyzed. A challenging case was indicated by the use of non-conventional techniques. The procedure was completed in 399 patients (98.0%). Post-procedural acute complications occurred in 5 patients, including 1 with device embolization. Two patients underwent surgical device removal. During the follow up (30.3 [3.6-140.8] months), aggravated mitral regurgitation occurred in 5 patients. A multivariate logistic regression revealed large-sized ASD as a predictor of procedural failure (odds ratio=1.828, 95% confidence interval: 1.139-2.934, P=0.012) and challenging cases (odds ratio=1.371, 95% confidence interval: 1.180-1.593, P<0.001). CONCLUSIONS Percutaneous ASD closure is feasible and safe in children aged <6 years; however, patients with large-sized ASD are at high risk of procedural failure and becoming a challenging case.
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Affiliation(s)
- Seul Gi Cha
- Division of Pediatric Cardiology, Asan Medical Center, University of Ulsan College of Medicine
| | - Mi Jin Kim
- Division of Pediatric Cardiology, Asan Medical Center, University of Ulsan College of Medicine
| | - Jae Suk Baek
- Division of Pediatric Cardiology, Asan Medical Center, University of Ulsan College of Medicine
| | - Jeong Jin Yu
- Division of Pediatric Cardiology, Asan Medical Center, University of Ulsan College of Medicine
| | - Young-Hwue Kim
- Division of Pediatric Cardiology, Asan Medical Center, University of Ulsan College of Medicine
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11
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Jian WY, Lin SM, Tsai SK, Hwang B. Transthoracic echocardiography monitoring during atrial septal defect and ventricular septal defect device closures using a three-dimensional printed transducer holder. J Chin Med Assoc 2021; 84:550-554. [PMID: 33770054 DOI: 10.1097/jcma.0000000000000524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Transthoracic echocardiography (TTE) is noninvasive but can only be performed intermittently during fluoroscopy. In a prior study, we created a transducer holder device to allow for hemodynamic monitoring in the intensive care unit. The current study is the first instance of the use of a three-dimensional (3D)-printed TTE transducer holder, which is easily customized and personalized to a previous transducer holder at relatively low cost and short production time, to enable continuous TTE monitoring during device closure of an atrial septal defect (ASD) and ventricular septal defect (VSD). There were 14 ASD patients and 9 VSD patients scheduled to undergo device closure. The study's real-time TTE monitoring was performed by using a 3D-printed transducer holder over the course of the entire implantation procedure. There were 23 patients who successfully underwent septal closures using the 3D-printed holder that enabled real-time images over the entire procedure. The median duration for real-time TTE guidance was 15 minutes for the ASD and 36 minutes for the VSD and the median fluoroscopy time was 11 minutes for the ASD and 30 minutes for the VSD. One migrating VSD occluder and one case of aortic regurgitation after occluder deployment were noted by real-time TTE monitoring during the procedure. Our novel 3D-printed transducer holder can provide transesophageal echocardiography-like real-time imaging during device closure of an ASD and a VSD and may become a new alternative method in ASD and VSD closures. It can also prevent radiation exposure for the intervention team who would otherwise need to perform TTE during live fluoroscopy.
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Affiliation(s)
- Wen-Yen Jian
- Pediatric Cardiology, Heart center, Cheng-Hsin General Hospital, Taipei, Taiwan, ROC
| | - Su-Man Lin
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shen-Kou Tsai
- Pediatric Cardiology, Heart center, Cheng-Hsin General Hospital, Taipei, Taiwan, ROC
- Department of Anesthesiology, Cheng-Hsin General Hospital and National Taiwan University, Taipei, Taiwan, ROC
| | - Betau Hwang
- Pediatric Cardiology, Heart center, Cheng-Hsin General Hospital, Taipei, Taiwan, ROC
- Pediatric Cardiology, Heart Center, Cheng-Hsin General Hospital, Pediatric Cardiac Medical Center, Tungs' Taichung MetroHarbor Hospital, Taipei, Taiwan, ROC
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12
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Use of Mullins sheath to prevent prolapse of Gore Cardioform ASD Occluder in a child with severe scoliosis. Cardiol Young 2021; 31:504-506. [PMID: 33261692 DOI: 10.1017/s1047951120004242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Transcatheter device closure of an atrial septal defect (ASD) may require an additional supportive technique in challenging cases. We report a 15-year-old male with moderate-sized ASD and severe scoliosis. In spite of adequate positioning of the Gore Cardioform ASD occluder, the device was pulled into the right atrium by a retrieval cord due to the acute release of strong tension between the delivery catheter and its device upon locking. This phenomenon was prevented by the use of Mullins sheath, resulting in a successful release of the device. The use of a Mullins sheath may be considered to deliver a Gore Cardioform ASD device in selected cases.
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13
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Aparisi A, Arnold RJ, Gutiérrez H, Revilla A, Serrador A, Ramos B, Rodriguez-Gabella T, Campo A, Baladrón C, Gómez I, Carrasco-Moraleja M, San Roman JA, Amat-Santos IJ. Comparison of Figulla Flex® and Amplatzer™ devices for atrial septal defect closure: A meta-analysis. Cardiol J 2020; 27:524-532. [PMID: 32329042 DOI: 10.5603/cj.a2020.0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 06/30/2019] [Accepted: 07/04/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Atrial septal defect (ASD) is one of the most common congenital heart diseases. Percutaneous closure is the preferred treatment, but certain complications remain a concern. The most common devices are AMPLATZER™ (ASO) (St. Jude Medical, St. Paul, MN, USA) and Figulla Flex® septal occluders (FSO) (Occlutech GmbH, Jena, Germany). The present study aimed to assess main differences in outcomes. METHODS A systematic search in Pubmed and Google scholarship was performed by two independent reviewers for any study comparing ASO and FSO. Searched terms were "Figulla", "Amplatzer", and "atrial septal defect". A random-effects model was used. RESULTS A total of 11 studies including 1770 patients (897 ASO; 873 FSO) were gathered. Baseline clinical and echocardiographic characteristics were comparable although septal aneurysm was more often reported in patients treated with ASO (32% vs. 25%; p = 0.061). Success rate (94% vs. 95%; OR: 0.81; 95% CI: 0.38-1.71; p = 0.58) and peri-procedural complications were comparable. Procedures were shorter, requiring less fluoroscopy time with an FSO device (OR: 0.59; 95% CI: 0.20-0.97; p = 0.003). Although the global rate of complications in long-term was similar, the ASO device was associated with a higher rate of supraventricular arrhythmias (14.7% vs. 7.8%, p = 0.009). CONCLUSIONS Percutaneous closure of ASD is a safe and effective, irrespective of the type of device. No differences exist regarding procedural success between the ASO and FSO devices but the last was associated to shorter procedure time, less radiation, and lower rate of supraventricular arrhythmias in follow-up. Late cardiac perforation did not occur and death in the follow-up was exceptional.
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Affiliation(s)
- Alvaro Aparisi
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario de Valladolid, Valladolid, Spain, Spain
| | - Roman J Arnold
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario de Valladolid, Valladolid, Spain, Spain
| | - Hipólito Gutiérrez
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario de Valladolid, Valladolid, Spain, Spain
| | - Ana Revilla
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario de Valladolid, Valladolid, Spain, Spain
| | - Ana Serrador
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario de Valladolid, Valladolid, Spain, Spain
| | - Benigno Ramos
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario de Valladolid, Valladolid, Spain, Spain
| | - Tania Rodriguez-Gabella
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario de Valladolid, Valladolid, Spain, Spain
| | - Alberto Campo
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario de Valladolid, Valladolid, Spain, Spain
| | - Carlos Baladrón
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario de Valladolid, Valladolid, Spain, Spain
| | - Itziar Gómez
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario de Valladolid, Valladolid, Spain, Spain
| | - Manuel Carrasco-Moraleja
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario de Valladolid, Valladolid, Spain, Spain
| | - José A San Roman
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario de Valladolid, Valladolid, Spain, Spain
| | - Ignacio J Amat-Santos
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario de Valladolid, Valladolid, Spain, Spain.
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Rat N, Muntean I, Opincariu D, Gozar L, Togănel R, Chițu M. Cardiovascular Imaging for Guiding Interventional Therapy in Structural Heart Diseases. Curr Med Imaging 2020; 16:111-122. [DOI: 10.2174/1573405614666180612081736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 10/05/2017] [Accepted: 03/19/2018] [Indexed: 11/22/2022]
Abstract
Development of interventional methods has revolutionized the treatment of structural
cardiac diseases. Given the complexity of structural interventions and the anatomical variability of
various structural defects, novel imaging techniques have been implemented in the current clinical
practice for guiding the interventional procedure and for selection of the device to be used. Three–
dimensional echocardiography is the most used imaging method that has improved the threedimensional
assessment of cardiac structures, and it has considerably reduced the cost of complications
derived from malalignment of interventional devices. Assessment of cardiac structures with
the use of angiography holds the advantage of providing images in real time, but it does not allow
an anatomical description. Transesophageal Echocardiography (TEE) and intracardiac ultrasonography
play major roles in guiding Atrial Septal Defect (ASD) or Patent Foramen Ovale (PFO)
closure and device follow-up, while TEE is the procedure of choice to assess the flow in the Left
Atrial Appendage (LAA) and the embolic risk associated with a decreased flow. On the other hand,
contrast CT and MRI have high specificity for providing a detailed description of structure, but
cannot assess the flow through the shunt or the valvular mobility. This review aims to present the
role of modern imaging techniques in pre-procedural assessment and intraprocedural guiding of
structural percutaneous interventions performed to close an ASD, a PFO, an LAA or a patent ductus
arteriosus.
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Affiliation(s)
- Nora Rat
- Department of Cardiology, University of Medicine and Pharmacy of Targu Mures, Targu Mures, Romania
| | - Iolanda Muntean
- Clinic of Pediatric Cardiology, Institute of Cardiovascular Disease and Transplantation, University of Medicine and Pharmacy of Targu Mures, Targu Mures, Romania
| | - Diana Opincariu
- Department of Cardiology, University of Medicine and Pharmacy of Targu Mures, Targu Mures, Romania
| | - Liliana Gozar
- Clinic of Pediatric Cardiology, Institute of Cardiovascular Disease and Transplantation, University of Medicine and Pharmacy of Targu Mures, Targu Mures, Romania
| | - Rodica Togănel
- Clinic of Pediatric Cardiology, Institute of Cardiovascular Disease and Transplantation, University of Medicine and Pharmacy of Targu Mures, Targu Mures, Romania
| | - Monica Chițu
- Department of Cardiology, University of Medicine and Pharmacy of Targu Mures, Targu Mures, Romania
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15
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Caracciolo A, Mazzone P, Laterra G, Garcia-Ruiz V, Polimeni A, Galasso S, Saporito F, Carerj S, D’Ascenzo F, Marquis-Gravel G, Giustino G, Costa F. Antithrombotic Therapy for Percutaneous Cardiovascular Interventions: From Coronary Artery Disease to Structural Heart Interventions. J Clin Med 2019; 8:E2016. [PMID: 31752292 PMCID: PMC6912795 DOI: 10.3390/jcm8112016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 11/05/2019] [Accepted: 11/15/2019] [Indexed: 02/02/2023] Open
Abstract
Percutaneous cardiovascular interventions have changed dramatically in recent years, and the impetus given by the rapid implementation of novel techniques and devices have been mirrored by a refinement of antithrombotic strategies for secondary prevention, which have been supported by a significant burden of evidence from clinical studies. In the current manuscript, we aim to provide a comprehensive, yet pragmatic, revision of the current available evidence regarding antithrombotic strategies in the domain of percutaneous cardiovascular interventions. We revise the evidence regarding antithrombotic therapy for secondary prevention in coronary artery disease and stent implantation, the complex interrelation between antiplatelet and anticoagulant therapy in patients undergoing percutaneous coronary intervention with concomitant atrial fibrillation, and finally focus on the novel developments in the secondary prevention after structural heart disease intervention. A special focus on treatment individualization is included to emphasize risk and benefits of each therapeutic strategy.
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Affiliation(s)
- Alessandro Caracciolo
- Department of Clinical and Experimental Medicine, Policlinic “G. Martino”, University of Messina, 98100 Messina, Italy; (A.C.); (P.M.); (G.L.); (S.G.); (F.S.); (S.C.)
| | - Paolo Mazzone
- Department of Clinical and Experimental Medicine, Policlinic “G. Martino”, University of Messina, 98100 Messina, Italy; (A.C.); (P.M.); (G.L.); (S.G.); (F.S.); (S.C.)
| | - Giulia Laterra
- Department of Clinical and Experimental Medicine, Policlinic “G. Martino”, University of Messina, 98100 Messina, Italy; (A.C.); (P.M.); (G.L.); (S.G.); (F.S.); (S.C.)
| | - Victoria Garcia-Ruiz
- UGC del Corazón, Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Victoria, 29010 Málaga, Spain;
| | - Alberto Polimeni
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, 88100 Catanzaro, Italy;
| | - Salvatore Galasso
- Department of Clinical and Experimental Medicine, Policlinic “G. Martino”, University of Messina, 98100 Messina, Italy; (A.C.); (P.M.); (G.L.); (S.G.); (F.S.); (S.C.)
| | - Francesco Saporito
- Department of Clinical and Experimental Medicine, Policlinic “G. Martino”, University of Messina, 98100 Messina, Italy; (A.C.); (P.M.); (G.L.); (S.G.); (F.S.); (S.C.)
| | - Scipione Carerj
- Department of Clinical and Experimental Medicine, Policlinic “G. Martino”, University of Messina, 98100 Messina, Italy; (A.C.); (P.M.); (G.L.); (S.G.); (F.S.); (S.C.)
| | - Fabrizio D’Ascenzo
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, 10124 Turin, Italy;
| | - Guillaume Marquis-Gravel
- Duke Clinical Research Institute, Durham, NC 27708, USA;
- Montreal Heart Institute, Montreal, QC H1T 1C8, Canada
| | - Gennaro Giustino
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029-6574, USA;
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029-6574, USA
| | - Francesco Costa
- Department of Clinical and Experimental Medicine, Policlinic “G. Martino”, University of Messina, 98100 Messina, Italy; (A.C.); (P.M.); (G.L.); (S.G.); (F.S.); (S.C.)
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16
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Gold BM, Parekh DR, Kearney DL, Silva GV, Fish RD, Stainback RF. Forme Fruste Cor Triatriatum Dexter by Transesophageal Echocardiography and Its Impact on Percutaneous Heart Procedures: A Case Series. ACTA ACUST UNITED AC 2019; 3:189-199. [PMID: 31709369 PMCID: PMC6833460 DOI: 10.1016/j.case.2019.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cor triatriatum dexter (CTD) can complicate percutaneous atrial septal interventions. Clinically silent (forme fruste) CTD is detectable by new echocardiography techniques. Using these techniques could improve patient selection and guide interventions.
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Affiliation(s)
- Benjamin M Gold
- Department of Internal Medicine, Baylor College of Medicine, Houston, Texas
| | - Dhaval R Parekh
- Department of Cardiology, Texas Heart Institute, Houston, Texas.,Department of Cardiology, Baylor St. Luke's Medical Center, Houston, Texas.,Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Debra L Kearney
- Department of Pathology, Texas Children's Hospital, Houston, Texas.,Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas
| | - Guilherme V Silva
- Department of Cardiology, Texas Heart Institute, Houston, Texas.,Department of Cardiology, Baylor St. Luke's Medical Center, Houston, Texas.,Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - R David Fish
- Department of Cardiology, Texas Heart Institute, Houston, Texas.,Department of Cardiology, Baylor St. Luke's Medical Center, Houston, Texas
| | - Raymond F Stainback
- Department of Cardiology, Texas Heart Institute, Houston, Texas.,Department of Cardiology, Baylor St. Luke's Medical Center, Houston, Texas.,Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
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17
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Nusca A, Bressi E, Colaiori I, Miglionico M, Di Sciascio G. Antiplatelet therapy in valvular and structural heart disease interventions. Cardiovasc Diagn Ther 2018; 8:678-693. [PMID: 30498690 DOI: 10.21037/cdt.2018.06.08] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Transcatheter interventions for valvular and structural heart diseases are rapidly expanding due to greater operators' experience and development of new generation devices associated with increased procedural safety. They represent the standard strategy for patients with prohibitive risk for open surgery. These procedures are associated with a significant occurrence of both thrombotic and bleeding complications, thus in this setting, even more than in other percutaneous procedures, the balance between thrombotic and bleeding risk is critical. This review describes the current data available on the antithrombotic management of patients undergoing transcatheter aortic valve implantation (TAVI), percutaneous mitral valve repair with the MitraClip system, percutaneous left atrial appendage occlusion and percutaneous patent foramen ovale (PFO)/atrial septal defects (ASD) closure.
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Affiliation(s)
- Annunziata Nusca
- Unit of Cardiac Sciences, Campus Bio-Medico University of Rome, Rome, Italy
| | - Edoardo Bressi
- Unit of Cardiac Sciences, Campus Bio-Medico University of Rome, Rome, Italy
| | - Iginio Colaiori
- Unit of Cardiac Sciences, Campus Bio-Medico University of Rome, Rome, Italy
| | - Marco Miglionico
- Unit of Cardiac Sciences, Campus Bio-Medico University of Rome, Rome, Italy
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18
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Jung SY, Choi JY. Transcatheter closure of atrial septal defect: principles and available devices. J Thorac Dis 2018; 10:S2909-S2922. [PMID: 30305951 DOI: 10.21037/jtd.2018.02.19] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
There has been a remarkable improvement in the treatment strategy of secundum atrial septal defect (ASD) over the last few decades. Indebted to the improvement in device technology and procedural techniques, transcatheter closure of ASD is currently accepted as the treatment of choice in most patients with secundum ASD. Recent generation devices enable easy and safe deployment of device with the properties of adequate flexibility, re-capturability and repositioning. Use of biocompatible materials with improved device design and refined equipment finish may promote re-endothelialization and reduce potential damage to nearby structures. Most of currently available devices show excellent efficacy and comparable outcome with its own advantages and disadvantages. In addition to improvement of device properties and performance, there has been distinct improvement in procedural technique from numerous experiences of device closure of ASD. Nowadays there are well established principles regarding patient selection, pre-procedural evaluation, step-by-step details of procedure as well as post-procedural follow-up. However, an operator may encounter pitfalls in closing complex lesions such as large defect, rim deficiencies and multiple defects, so every operator has to be familiar with each available device, general principle as well as special issues for complex lesions.
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Affiliation(s)
- Se Yong Jung
- Division of Pediatric Cardiology, Center for Congenital Heart Disease, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Jae Young Choi
- Division of Pediatric Cardiology, Center for Congenital Heart Disease, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
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19
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Baruteau AE, Hascoët S, Fraisse A. Transthoracic echocardiography is a safe alternative for assessment and guidance of transcatheter closure of secundum atrial septal defect in children. J Thorac Dis 2017; 9:1247-1256. [PMID: 28616275 DOI: 10.21037/jtd.2017.04.47] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND 2D-transesophageal echocardiography (TEE) is routinely performed to guide percutaneous ASD closure in children. We aimed to assess whether two-dimensional (2D)-transthoracic echocardiography (TTE) is a safe alternative for assessment and guidance of atrial septal defect (ASD) closure in unselected children. METHODS We performed a retrospective single-center study including 389 consecutive children aged less than 15-year-old who underwent percutaneous ASD closure under 2D-TEE (1998-2005, n=133) or 2D-TTE (2005-2014, n=256). A balloon calibration was performed in all cases for the Amplatz Septal Occluder choice. RESULTS ASDs were larger and rims deficiencies were more frequent in the TTE-guided group. The procedure was successful in 376 patients [96.7%; 95% confidence interval (CI), 94.4-98.2%]. The success rate tended to be higher in the TTE- versus TEE-guided group (98.0% versus 94.0%, P=0.069). Device migration occurred in 4 patients (1.0%; 95% CI: 0.3-1.6%), all after TEE-guided procedure (P=0.013). Early major adverse events were observed in 5 patients (1.3%; 95% CI: 0.4-3.0%), all in the TEE group (P=0.004). Fluroroscopic time and irradiation dose were not different among the 2 groups (P=0.450 and P=0.130 respectively). After a median follow-up of 7 years (range, 1-16 years), no adverse events was reported. One (0.3%, 95% CI: 0-1.4%) 12-year-old patient developed atrial fibrillation 5 years after the procedure. Pregnancies were uneventful in 72 cases. CONCLUSIONS When a balloon sizing is performed, 2D-TTE imaging is as efficient as 2D-TEE to guide percutaneous ASD closure in children. The procedure can safely be done in spontaneously breathing children under TTE guidance alone in experienced centers.
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Affiliation(s)
- Alban-Elouen Baruteau
- Department of Congenital Cardiology, Evelina London Children's Hospital, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Sébastien Hascoët
- Department of Paediatric Cardiac Surgery, Marie-Lannelongue Hospital, Paris Sud University, Paris, France
| | - Alain Fraisse
- Department of Paediatric Cardiology, Royal Brompton Hospital and Harefield NHS Foundation Trust, Imperial College London, London, UK
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Erkal Z, Bayar N, Çağırcı G, Arslan Ş. Percutaneous closure of a postoperative residual atrial septal defect. INTERNATIONAL JOURNAL OF THE CARDIOVASCULAR ACADEMY 2017. [DOI: 10.1016/j.ijcac.2017.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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22
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Dong HJ, Fan TB, Li B, Liang WJ, Song SB, Han Y, Wu KY, Zhou SJ. Transjugular closure of secundum atrial septal defects. J Card Surg 2016; 32:151-153. [PMID: 27990684 DOI: 10.1111/jocs.12930] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Hao-ju Dong
- Department of Cardiovascular Surgery; Henan Provincial People's Hospital; Zhengzhou Henan China
| | - Tai-bing Fan
- Department of Cardiovascular Surgery; Henan Provincial People's Hospital; Zhengzhou Henan China
| | - Bin Li
- Department of Cardiovascular Surgery; Henan Provincial People's Hospital; Zhengzhou Henan China
| | - Wei-jie Liang
- Department of Cardiovascular Surgery; Henan Provincial People's Hospital; Zhengzhou Henan China
| | - Shu-bo Song
- Department of Cardiovascular Surgery; Henan Provincial People's Hospital; Zhengzhou Henan China
| | - Yu Han
- Department of Cardiovascular Surgery; Henan Provincial People's Hospital; Zhengzhou Henan China
| | - Kai-yuan Wu
- Department of Cardiovascular Surgery; Henan Provincial People's Hospital; Zhengzhou Henan China
| | - Si-jie Zhou
- Department of Cardiovascular Surgery; Henan Provincial People's Hospital; Zhengzhou Henan China
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23
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Coronary air embolism during transcatheter closure of atrial septal defect. Indian Heart J 2016; 68 Suppl 2:S79-S80. [PMID: 27751336 PMCID: PMC5067790 DOI: 10.1016/j.ihj.2016.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 12/20/2015] [Accepted: 01/06/2016] [Indexed: 11/21/2022] Open
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Alternative methods for the measurement of the minimal ductal diameter of a patent ductus arteriosus in a dog. J Vet Cardiol 2016; 18:372-376. [PMID: 27665538 DOI: 10.1016/j.jvc.2016.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 07/26/2016] [Accepted: 08/02/2016] [Indexed: 11/21/2022]
Abstract
A two and half-year-old, 24 kg, spayed female German Shepherd was presented for evaluation of a suspected patent ductus arteriosus (PDA). Transthoracic echocardiographic examination confirmed a left to right shunting PDA. Closure of the PDA was recommended, and the owners elected to have minimally invasive transcatheter closure of the PDA performed. Standard ductal angiography failed to provide adequate measurements of the minimal ductal diameter (MDD). Alternative methods of measuring the MDD using an angiography catheter and a balloon catheter were performed. The PDA was occluded using an Amplatz® Canine Ductal Occluder without complication. Further evaluation of these techniques is needed to determine the accuracy, overall clinical efficacy, and safety of using alternative methods for the measurement of the MDD of a PDA.
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25
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Deficient Surrounding Rims in Patients Undergoing Transcatheter Atrial Septal Defect Closure. J Am Soc Echocardiogr 2016; 29:768-776. [DOI: 10.1016/j.echo.2016.04.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Indexed: 11/22/2022]
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26
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Yang Y, Xu Z, Jiang S, Zhao S, Zhang G, Jin J, Hu H, Yang K, Zheng H, Zhou XL. Simultaneous Transcatheter Closure of Multiple Atrial Septal Defects Using Dual Amplatzer Septal Occluder Devices. Am J Med Sci 2016; 352:245-51. [PMID: 27650227 DOI: 10.1016/j.amjms.2016.05.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 05/16/2016] [Accepted: 05/20/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Transcatheter closure has been a recognised treatment strategy for multiple atrial septal defects (mASDs). This study aimed to examine the feasibility, effectiveness, and safety of transcatheter closure of mASDs using dual Amplatzer septal occluder (ASO) devices. METHODS We retrospectively reviewed 34 patients who underwent transcatheter closure of mASDs using dual ASO devices from April 2005 to December 2014. RESULTS Eight men and 26 women who successfully underwent transcatheter closure of mASDs were included. Ten (29.4%) patients had 3 defects or more. The mean diameters of the larger and smaller defects were 14.0±3.9 mm (8-20 mm) and 9.1±2.6 mm (4-15 mm), respectively. The mean diameters of the larger and smaller devices were 22.2±4.8 mm (13-30 mm) and 17.3±4.1 mm (10-26 mm), respectively. Devices were deployed by the "sandwiches" technique or an interleaved pattern. Immediately after the procedure, 23 (67.6%) patients had complete closure and 11 patients had a residual shunt (6 trivial, 3 small, 1 moderate, 1 large). During the 6 months of follow-up, 30 (88.2%) patients had complete closure of the shunt and 4 patients had a residual shunt (1 large, 3 small). Complications included 2 cases of pericardial effusion, which disappeared at 3 months. CONCLUSIONS Simultaneous device implantation in transcatheter closure of mASDs is feasible and effective. The incidence rate of residual shunts is slightly high in the short term, but tends to decrease during mid-term follow-up.
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Affiliation(s)
- Yankun Yang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhongying Xu
- Department of Radiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shiliang Jiang
- Department of Radiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shihua Zhao
- Department of Radiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Gejun Zhang
- Department of Radiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jinglin Jin
- Department of Radiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haibo Hu
- Department of Radiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kunqi Yang
- Department of Radiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hong Zheng
- Department of Radiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Xian-Liang Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Emren SV, Duygu H, Ergene AO, Gediz RB, Nazli C. Successful closure of atrial septal defect by retrograde transarterial approach after unsuccessful transfemoral venous approach. INTERNATIONAL JOURNAL OF THE CARDIOVASCULAR ACADEMY 2016. [DOI: 10.1016/j.ijcac.2016.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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28
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Zuñiga Luna M, Gallego Muñoz C, Vásquez Villegas S, Rendón Isaza JC, Uribe CE. [Very late erosion of the right atrium with Amplatzer(®) device]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2016; 86:271-5. [PMID: 27177959 DOI: 10.1016/j.acmx.2016.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 04/06/2016] [Accepted: 04/07/2016] [Indexed: 10/21/2022] Open
Abstract
UNLABELLED Late atrial wall and aorta erosion is a rare cause of potential fatallity in patients who have undergone percutaneous closure of an atrial septal defect, especially when a high ratio device to defect is chosen, and an insufficient aortic rim is present. We report the case of a 70 year old male with an episode of hemodinamic collapse secondary to cardiac tamponade due to a late erosion of a 4 years ago implanted Amplatzer(®) used to close an atrial septal defect. CONCLUSION Very late wall erosion of an atrial septal closure device, although uncommon, should be suspected in patients presenting with hemodynamic collapse.
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Affiliation(s)
- Mauricio Zuñiga Luna
- Servicio de Cardiología Intervencionista, Clínica Cardio VID, Universidad Pontificia Bolivariana, Medellín, Colombia.
| | - Catalina Gallego Muñoz
- Servicio de Cardiología Clínica, Clínica Cardio VID, Universidad Pontificia Bolivariana, Medellín, Colombia
| | | | - Juan Camilo Rendón Isaza
- Servicio de Cirugía Cardiovascular, Clínica Cardio VID, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Carlos Esteban Uribe
- Servicio de Cardiología Intervencionista, Clínica Cardio VID, Universidad Pontificia Bolivariana, Medellín, Colombia
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Kypta A, Blessberger H, Lichtenauer M, Kammler J, Lambert T, Kellermair J, Nahler A, Kiblboeck D, Schwarz S, Steinwender C. Subcutaneous Double "Purse String Suture"-A Safe Method for Femoral Vein Access Site Closure after Leadless Pacemaker Implantation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:675-9. [PMID: 27062484 DOI: 10.1111/pace.12867] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Revised: 02/16/2016] [Accepted: 03/26/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Leadless cardiac pacemaker (LCP) requires large-caliber venous sheaths for device placement. Sheath sizes for these procedures vary from 18- to 23-French (F). The most common complications are hematomas, pseudoaneurysms, and arteriovenous fistulas. Complete and secure closure of the venous access is an important step at the end of such a procedure. METHODS We performed a retrospective analysis of all patients who had undergone LCP implantation at our institution. Patients and procedural characteristics as well as groin complications at 30 days and 3 months were evaluated. After sheath removal venous access sites were closed performing a so-called "purse-string" suture (PSS). RESULTS Seventy-seven patients received an LCP at our institution. In 27 (35%) of these patients a heparin bolus was given at the beginning of the procedure. Anticoagulation therapy with phenprocoumon was present in 32 (40%) of patients. In 76 (98.7%) patients, the LCP was implanted without complications. In one (1.3%) patient a perforation occurred during implantation, which required surgical intervention. Access site complications occurred in three (3.9%) patients, two (2.6%) groin hematomas, and one (1.3%) arteriovenous fistula. The hematomas disappeared completely after 3 weeks, and the fistula was not detectable by ultrasound anymore after 4 weeks. CONCLUSION Use of subcutaneous absorbable double PSS closure after removal of large-caliber venous sheaths is a safe technique to achieve immediate postprocedural hemostasis. Especially for sheath sizes with an inner diameter of 23F, this technique creates a very secure and also cosmetically appealing closure.
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Affiliation(s)
- Alexander Kypta
- Department of Internal Medicine I - Cardiology, Linz General Hospital, Johannes Kepler University School of Medicine, Linz, Austria
| | - Hermann Blessberger
- Department of Internal Medicine I - Cardiology, Linz General Hospital, Johannes Kepler University School of Medicine, Linz, Austria
| | - Michael Lichtenauer
- Department of Cardiology, Clinic of Internal Medicine II, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Juergen Kammler
- Department of Internal Medicine I - Cardiology, Linz General Hospital, Johannes Kepler University School of Medicine, Linz, Austria
| | - Thomas Lambert
- Department of Internal Medicine I - Cardiology, Linz General Hospital, Johannes Kepler University School of Medicine, Linz, Austria
| | - Joerg Kellermair
- Department of Internal Medicine I - Cardiology, Linz General Hospital, Johannes Kepler University School of Medicine, Linz, Austria
| | - Alexander Nahler
- Department of Internal Medicine I - Cardiology, Linz General Hospital, Johannes Kepler University School of Medicine, Linz, Austria
| | - Daniel Kiblboeck
- Department of Internal Medicine I - Cardiology, Linz General Hospital, Johannes Kepler University School of Medicine, Linz, Austria
| | - Stefan Schwarz
- Department of Internal Medicine I - Cardiology, Linz General Hospital, Johannes Kepler University School of Medicine, Linz, Austria
| | - Clemens Steinwender
- Department of Internal Medicine I - Cardiology, Linz General Hospital, Johannes Kepler University School of Medicine, Linz, Austria
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Haas NA, Soetemann DB, Ates I, Baspinar O, Ditkivskyy I, Duke C, Godart F, Lorber A, Oliveira E, Onorato E, Pac F, Promphan W, Riede FT, Roymanee S, Sabiniewicz R, Shebani SO, Sievert H, Tin D, Happel CM. Closure of Secundum Atrial Septal Defects by Using the Occlutech Occluder Devices in More Than 1300 Patients: The IRFACODE Project: A Retrospective Case Series. Catheter Cardiovasc Interv 2016; 88:571-581. [DOI: 10.1002/ccd.26497] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 02/13/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Nikolaus A. Haas
- Department for Congenital Heart Defects; Heart and Diabetes Centre North Rhine Westphalia, Ruhr University Bochum; Germany
- Department of Pediatric Cardiology and Intensive Care; Ludwig Maximilians University Munich Campus; Munich Germany
| | - Dagmar B. Soetemann
- Department for Congenital Heart Defects; Heart and Diabetes Centre North Rhine Westphalia, Ruhr University Bochum; Germany
| | - Ismail Ates
- Department of Cardiology; Asfendiyarov Kazakh National Medical University; Almaty Kazakhistan
| | - Osman Baspinar
- Department of Pediatric Cardiology; Faculty of Medicine, University of Gaziantep; Turkey
| | | | | | - Francois Godart
- Département De Cardiologie Infantile Et Congénitale; Centre Hospitalier Régional Et Universitaire De Lille, Faculté De Médecine Lille 2; France
| | - Avraham Lorber
- Division of Pacing and Electrophysiology; Rambam Health Care Campus and Bruce Rappaport, Faculty of Medicine; Haifa Israel
| | - Edmundo Oliveira
- Hospital Das Clinicas, Universida De Federal De Minas Gerais, Belo Horizonte; Minas Gerais Brazil
| | - Eustaquio Onorato
- Cardiovascular Department; Humanitas Gavazzeni Institute; Bergamo Italy
| | - Feyza Pac
- Department of Pediatric Cardiology; Türkiye, Yüksekİhtisas, Training and Research Hospital; Ankara Turkey
| | - Worakan Promphan
- Pediatric Cardiology Unit, Queen Sirikit National Institute of Child Health (QSNICH); Bangkok Thailand
| | - Frank-Thomas Riede
- Department of Pediatric Cardiology; Heart Center, University of Leipzig; Leipzig Germany
| | - Supaporn Roymanee
- Department of Pediatrics; Pediatric Cardiology Unit, Prince of Songkla University; Thailand
| | - Robert Sabiniewicz
- Department of Pediatric Cardiology and Congenital Heart Diseases; Medical University Gdansk; Poland
| | | | | | - Do Tin
- Department of Cardiology, Children's Hospital and, Department of Pediatric; Medicine and Pharmacy University of Ho Chi Minh City; Vietnam
| | - Christoph M. Happel
- Department for Congenital Heart Defects; Heart and Diabetes Centre North Rhine Westphalia, Ruhr University Bochum; Germany
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31
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Haas NA, Happel CM, Soetemann DB, Hanslik A, Moysich A, Kececioglu D, Laser KT. Optimal septum alignment of the Figulla® Flex occluder to the atrial septum in patients with secundum atrial septal defects. EUROINTERVENTION 2016; 11:1153-60. [DOI: 10.4244/eijy14m12_09] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Senna KMSE, Sarti FM, Costa MGSD, Nita ME, Santos MDS, Tura BR, Correia MG. Budget impact analysis of the percutaneous septal occluder for treatment of ostium secundum atrial septal defects in the Brazilian Unified National Health System. CAD SAUDE PUBLICA 2015; 31:1756-64. [PMID: 26375653 DOI: 10.1590/0102-311x00039014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The aim of this study was to perform a budget impact analysis on the adoption of percutaneous occlusion of ostium secundum atrial septal defects in the Brazilian Unified National Health System. Costs were collected using micro-costing technique from medical records for each treatment technique (conventional surgery versus percutaneous septal occluder) at a public federal hospital specialized in high-complexity cardiology. The analysis showed that expenditures associated with percutaneous occlusion were lower than with conventional surgery, and sensitivity analysis confirmed the cost reduction in several scenarios, showing a significant budget impact with a 30% adoption rate for the percutaneous occluder (savings of approximately 1.5 million dollars per year). The study indicates that the adoption of the percutaneous septal occluder would mean cost savings of approximately 3.5 million dollars for the Brazilian public health system.
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Chen TH, Hsiao YC, Cheng CC, Mao CT, Chen DY, Tsai ML, Yang TY, Lin YS. In-Hospital and 4-Year Clinical Outcomes Following Transcatheter Versus Surgical Closure for Secundum Atrial Septal Defect in Adults: A National Cohort Propensity Score Analysis. Medicine (Baltimore) 2015; 94:e1524. [PMID: 26402807 PMCID: PMC4635747 DOI: 10.1097/md.0000000000001524] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Atrial septal defect (ASD) closure is major therapy for patients with secundum ASD. Although surgical closure (SC) and transcatheter closure (TC) are usually performed in such patients, data on the long-term outcomes comparing TC and SC in adults are limited. Data on the participants of this cohort study were retrieved from Taiwan's National Health Insurance Research Database from 2004 to 2011. Secundum ASD patients > 18 years of age who underwent TC or SC were initially enrolled, and those with associated comorbidities were excluded. After propensity score matching, the clinical outcomes between the TC and SC groups were analyzed. There were 595 patients recruited in the TC group and 308 patients in the SC group. The SC group had a higher incidence of systemic thromboembolism (P < 0.001), ischemic stroke (P = 0.002), and all-cause mortality (P = 0.013) when compared with those of the TC group at the index hospitalization, and similar phenomena could also be seen in a around 4-year follow-up period after the procedures (systemic thromboembolism (P < 0.001, HR = 11.48, 95% CI: 3.29-40.05), ischemic stroke (P = 0.005, HR = 9.28, 95% CI: 1.94-44.39), and all-cause mortality (P = 0.035, HR = 2.28, 95% CI: 1.06-4.89). In addition, atrial fibrillation (P = 0.005) and atrial flutter (P = 0.049) more frequently developed in the SC group than in the TC group at the index hospitalization. The adult secundum ASD patients had lower incidence rates of systemic thromboembolism, ischemic stroke, and all-cause mortality after TC than those after SC in the 4-year follow-up after procedures. Transcatheter ASD closure should therefore be given priority.
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Affiliation(s)
- Tien-Hsing Chen
- From the Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan, R.O.C. (THC, CTM); Department of Medical Education, Chang Gung Memorial Hospital, Keelung, Taiwan, R.O.C (YCH, CCC); Division of Cardiology, Chang-Gung Memorial Hospital, Linkou (DYC, MLT); and Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan, R.O.C. (TYY, YSL)
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Roymanee S, Promphan W, Tonklang N, Wongwaitaweewong K. Comparison of the Occlutech ® Figulla ® septal occluder and Amplatzer ® septal occluder for atrial septal defect device closure. Pediatr Cardiol 2015; 36:935-41. [PMID: 25633819 DOI: 10.1007/s00246-015-1103-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Accepted: 01/09/2015] [Indexed: 10/24/2022]
Abstract
The Occlutech(®) Figulla(®) septal occluder (OFSO) is a later-generation double-disk device with few reports of its success rates and complications compared with the Amplatzer(®) septal occluder (ASO), which is the worldwide standard device in percutaneous atrial septal defect (ASD) closure. We recruited and compared the results in 149 patients (76.5 % female) who underwent ASD device closure in our center between January 2003 and June 2012. The patients ranged in age from 2.3 to 77.2 years. There were no statistically significant differences between the two groups regarding patient baseline characteristics and procedure variables. The success rate using either device was excellent (ASO 94.4 % and OFSO 97.4 %; p = 0.43). Although the diameter of the ASD and the pulmonary arterial pressure in the OFSO group were slightly higher than in the ASO group, the median fluoroscopic time in the OFSO group was significantly shorter (ASO 13.7 min; OFSO 9.0 min; p < 0.001). The overall median follow-up time was 3.6 years (interquartile range 2.1-9.0 years). There were no significant differences between the major and minor complications when comparing the two devices. Both devices were safe and effective for percutaneous ASD closures. The OFSO had the benefit of a shorter fluoroscopic time.
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Affiliation(s)
- Supaporn Roymanee
- Pediatric Cardiology Unit, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand,
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35
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Xu B, Zaman S, Harper R. Successful closure of a large secundum atrial septal defect via the transjugular approach after failed transfemoral approach. Int J Cardiol 2015; 186:322-4. [DOI: 10.1016/j.ijcard.2015.03.321] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 03/20/2015] [Indexed: 11/16/2022]
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Hypoxia: an unusual cause with specific treatment. Case Rep Pulmonol 2015; 2015:956341. [PMID: 25722910 PMCID: PMC4334431 DOI: 10.1155/2015/956341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 01/13/2015] [Indexed: 11/29/2022] Open
Abstract
Hypoxia is a well-recognized consequence of venous admixture resulting from right to left intracardiac shunting. Right to left shunting is usually associated with high pulmonary artery pressure or alteration in the direction of blood flow due to an anatomical abnormality of the thorax. Surgical or percutaneous closure remains controversial; however it is performed frequently for patients presenting with clinical sequela presumed to be resulting from paradoxical embolization secondary to right to left shunting. We report two patients with hypoxia and dyspnea due to right to left shunting through a patent foramen ovale (PFO) and venous admixture in the absence of elevated pulmonary artery pressures or other predisposing conditions like pneumonectomy or diaphragmatic weakness. Percutaneous closures of the PFOs with the self-centering Amplatzer device resulted in resolution of hypoxia and symptoms related to it.
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37
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Akagi T. Current concept of transcatheter closure of atrial septal defect in adults. J Cardiol 2015; 65:17-25. [DOI: 10.1016/j.jjcc.2014.09.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Accepted: 08/25/2014] [Indexed: 11/30/2022]
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38
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Baruteau AE, Petit J, Lambert V, Gouton M, Piot D, Brenot P, Angel CY, Houyel L, Le Bret E, Roussin R, Ly M, Capderou A, Belli E. Transcatheter Closure of Large Atrial Septal Defects. Circ Cardiovasc Interv 2014; 7:837-43. [DOI: 10.1161/circinterventions.113.001254] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Data are needed on the safety and efficacy of device closure of large atrial septal defects.
Methods and Results—
Between 1998 and 2013, 336 patients (161 children <15 years) with large, isolated, secundum atrial septal defects (balloon-stretched diameter ≥34 mm in adults or echocardiographic diameter >15 mm/m
2
in children) were managed using the Amplatzer device, at the Marie Lannelongue Hospital. Transthoracic echocardiographic guidance was used starting in 2005 (n=219; 65.2%). Balloon-stretched diameter was >40 mm in 36 adults; mean values were 37.6±3.3 mm in other adults and 26.3±6.3 mm/m
2
in children. Amplatzer closure was successful in 311 (92.6%; 95% confidence interval, 89%–95%) patients. Superior and posterior rim deficiencies were more common in failed than in successful procedures (superior, 24.0% versus 4.8%;
P
=0.002; and posterior, 32.0% versus 4.2%;
P
<0.001). Device migration occurred in 4 adults (2 cases each of surgical and transcatheter retrieval); in the 21 remaining failures, the device was unreleased and withdrawn. After a median follow-up of 10.0 years (2.5–17 years), all patients were alive with no history of late complications.
Conclusions—
Closure of large atrial septal defects using the Amplatzer device is safe and effective in both adults and children. Superior and posterior rim deficiencies are associated with procedural failure. Closure can be performed under transthoracic echocardiographic guidance in experienced centers. Early device migration is rare and can be safely managed by device extraction. Long-term follow-up showed no deaths or major late complications in our population of 311 patients.
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Affiliation(s)
- Alban-Elouen Baruteau
- From the Marie Lannelongue Hospital-M3C, Department of Pediatric Cardiac Surgery, Paris, France (A.-E.B., J.P., V.L., M.G., D.P., P.B., C.-Y.A., L.H., E.L.B., R.R., M.L., E.B.); Université Paris Sud, Le Kremlin Bicêtre, Paris, France (A.-E.B., A.C.); l’Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM) 1087, Centre National de la Recherche Scientifique (CNRS) 6291, Université de Nantes, Nantes, France (A.-E.B.); and Institut National de la Santé et de la Recherche
| | - Jérôme Petit
- From the Marie Lannelongue Hospital-M3C, Department of Pediatric Cardiac Surgery, Paris, France (A.-E.B., J.P., V.L., M.G., D.P., P.B., C.-Y.A., L.H., E.L.B., R.R., M.L., E.B.); Université Paris Sud, Le Kremlin Bicêtre, Paris, France (A.-E.B., A.C.); l’Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM) 1087, Centre National de la Recherche Scientifique (CNRS) 6291, Université de Nantes, Nantes, France (A.-E.B.); and Institut National de la Santé et de la Recherche
| | - Virginie Lambert
- From the Marie Lannelongue Hospital-M3C, Department of Pediatric Cardiac Surgery, Paris, France (A.-E.B., J.P., V.L., M.G., D.P., P.B., C.-Y.A., L.H., E.L.B., R.R., M.L., E.B.); Université Paris Sud, Le Kremlin Bicêtre, Paris, France (A.-E.B., A.C.); l’Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM) 1087, Centre National de la Recherche Scientifique (CNRS) 6291, Université de Nantes, Nantes, France (A.-E.B.); and Institut National de la Santé et de la Recherche
| | - Marielle Gouton
- From the Marie Lannelongue Hospital-M3C, Department of Pediatric Cardiac Surgery, Paris, France (A.-E.B., J.P., V.L., M.G., D.P., P.B., C.-Y.A., L.H., E.L.B., R.R., M.L., E.B.); Université Paris Sud, Le Kremlin Bicêtre, Paris, France (A.-E.B., A.C.); l’Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM) 1087, Centre National de la Recherche Scientifique (CNRS) 6291, Université de Nantes, Nantes, France (A.-E.B.); and Institut National de la Santé et de la Recherche
| | - Dominique Piot
- From the Marie Lannelongue Hospital-M3C, Department of Pediatric Cardiac Surgery, Paris, France (A.-E.B., J.P., V.L., M.G., D.P., P.B., C.-Y.A., L.H., E.L.B., R.R., M.L., E.B.); Université Paris Sud, Le Kremlin Bicêtre, Paris, France (A.-E.B., A.C.); l’Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM) 1087, Centre National de la Recherche Scientifique (CNRS) 6291, Université de Nantes, Nantes, France (A.-E.B.); and Institut National de la Santé et de la Recherche
| | - Philippe Brenot
- From the Marie Lannelongue Hospital-M3C, Department of Pediatric Cardiac Surgery, Paris, France (A.-E.B., J.P., V.L., M.G., D.P., P.B., C.-Y.A., L.H., E.L.B., R.R., M.L., E.B.); Université Paris Sud, Le Kremlin Bicêtre, Paris, France (A.-E.B., A.C.); l’Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM) 1087, Centre National de la Recherche Scientifique (CNRS) 6291, Université de Nantes, Nantes, France (A.-E.B.); and Institut National de la Santé et de la Recherche
| | - Claude-Yves Angel
- From the Marie Lannelongue Hospital-M3C, Department of Pediatric Cardiac Surgery, Paris, France (A.-E.B., J.P., V.L., M.G., D.P., P.B., C.-Y.A., L.H., E.L.B., R.R., M.L., E.B.); Université Paris Sud, Le Kremlin Bicêtre, Paris, France (A.-E.B., A.C.); l’Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM) 1087, Centre National de la Recherche Scientifique (CNRS) 6291, Université de Nantes, Nantes, France (A.-E.B.); and Institut National de la Santé et de la Recherche
| | - Lucile Houyel
- From the Marie Lannelongue Hospital-M3C, Department of Pediatric Cardiac Surgery, Paris, France (A.-E.B., J.P., V.L., M.G., D.P., P.B., C.-Y.A., L.H., E.L.B., R.R., M.L., E.B.); Université Paris Sud, Le Kremlin Bicêtre, Paris, France (A.-E.B., A.C.); l’Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM) 1087, Centre National de la Recherche Scientifique (CNRS) 6291, Université de Nantes, Nantes, France (A.-E.B.); and Institut National de la Santé et de la Recherche
| | - Emmanuel Le Bret
- From the Marie Lannelongue Hospital-M3C, Department of Pediatric Cardiac Surgery, Paris, France (A.-E.B., J.P., V.L., M.G., D.P., P.B., C.-Y.A., L.H., E.L.B., R.R., M.L., E.B.); Université Paris Sud, Le Kremlin Bicêtre, Paris, France (A.-E.B., A.C.); l’Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM) 1087, Centre National de la Recherche Scientifique (CNRS) 6291, Université de Nantes, Nantes, France (A.-E.B.); and Institut National de la Santé et de la Recherche
| | - Régine Roussin
- From the Marie Lannelongue Hospital-M3C, Department of Pediatric Cardiac Surgery, Paris, France (A.-E.B., J.P., V.L., M.G., D.P., P.B., C.-Y.A., L.H., E.L.B., R.R., M.L., E.B.); Université Paris Sud, Le Kremlin Bicêtre, Paris, France (A.-E.B., A.C.); l’Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM) 1087, Centre National de la Recherche Scientifique (CNRS) 6291, Université de Nantes, Nantes, France (A.-E.B.); and Institut National de la Santé et de la Recherche
| | - Mohamedou Ly
- From the Marie Lannelongue Hospital-M3C, Department of Pediatric Cardiac Surgery, Paris, France (A.-E.B., J.P., V.L., M.G., D.P., P.B., C.-Y.A., L.H., E.L.B., R.R., M.L., E.B.); Université Paris Sud, Le Kremlin Bicêtre, Paris, France (A.-E.B., A.C.); l’Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM) 1087, Centre National de la Recherche Scientifique (CNRS) 6291, Université de Nantes, Nantes, France (A.-E.B.); and Institut National de la Santé et de la Recherche
| | - André Capderou
- From the Marie Lannelongue Hospital-M3C, Department of Pediatric Cardiac Surgery, Paris, France (A.-E.B., J.P., V.L., M.G., D.P., P.B., C.-Y.A., L.H., E.L.B., R.R., M.L., E.B.); Université Paris Sud, Le Kremlin Bicêtre, Paris, France (A.-E.B., A.C.); l’Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM) 1087, Centre National de la Recherche Scientifique (CNRS) 6291, Université de Nantes, Nantes, France (A.-E.B.); and Institut National de la Santé et de la Recherche
| | - Emre Belli
- From the Marie Lannelongue Hospital-M3C, Department of Pediatric Cardiac Surgery, Paris, France (A.-E.B., J.P., V.L., M.G., D.P., P.B., C.-Y.A., L.H., E.L.B., R.R., M.L., E.B.); Université Paris Sud, Le Kremlin Bicêtre, Paris, France (A.-E.B., A.C.); l’Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM) 1087, Centre National de la Recherche Scientifique (CNRS) 6291, Université de Nantes, Nantes, France (A.-E.B.); and Institut National de la Santé et de la Recherche
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Cost-effectiveness of procedures for treatment of ostium secundum atrial septal defects occlusion comparing conventional surgery and septal percutaneous implant. PLoS One 2014; 9:e108966. [PMID: 25302806 PMCID: PMC4193888 DOI: 10.1371/journal.pone.0108966] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 09/05/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The study performs a cost-effectiveness analysis of procedures for atrial septal defects occlusion, comparing conventional surgery to septal percutaneous implant. METHODS A model of analytical decision was structured with symmetric branches to estimate cost-effectiveness ratio between the procedures. The decision tree model was based on evidences gathered through meta-analysis of literature, and validated by a panel of specialists. The lower number of surgical procedures performed for atrial septal defects occlusion at each branch was considered as the effectiveness outcome. Direct medical costs and probabilities for each event were inserted in the model using data available from Brazilian public sector database system and information extracted from the literature review, using micro-costing technique. Sensitivity analysis included price variations of percutaneous implant. RESULTS The results obtained from the decision model demonstrated that the percutaneous implant was more cost effective in cost-effectiveness analysis at a cost of US$8,936.34 with a reduction in the probability of surgery occurrence in 93% of the cases. Probability of atrial septal communication occlusion and cost of the implant are the determinant factors of cost-effectiveness ratio. CONCLUSIONS The proposal of a decision model seeks to fill a void in the academic literature. The decision model proposed includes the outcomes that present major impact in relation to the overall costs of the procedure. The atrial septal defects occlusion using percutaneous implant reduces the physical and psychological distress to the patients in relation to the conventional surgery, which represent intangible costs in the context of economic evaluation.
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Vukovic PM, Kosevic D, Milicic M, Jovovic L, Stojanovic I, Micovic S. Cor triatriatum dexter and atrial septal defect in a 43-year-old woman. Tex Heart Inst J 2014; 41:418-20. [PMID: 25120397 DOI: 10.14503/thij-13-3366] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Cor triatriatum dexter is a rare congenital heart anomaly in which a membrane divides the right atrium into 2 chambers. We report the case of a 43-year-old woman who had cor triatriatum dexter and a large atrial septal defect. During attempted percutaneous closure, the balloon disrupted the membrane and revealed that the defect had no inferior rim, precluding secure placement of an Amplatzer Septal Occluder. Surgical treatment subsequently proved to be successful. In patients with an incomplete membrane and a septal defect with well-defined rims, percutaneous treatment can be the first choice. In patients who have cor triatriatum dexter and unfavorable anatomic features or concomitant complex heart anomalies, open-heart surgery remains the gold standard for treatment.
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Affiliation(s)
- Petar M Vukovic
- Departments of Cardiac Surgery (Drs. Micovic, Milicic, Stojanovic, and Vukovic) and Cardiology (Drs. Jovovic and Kosevic), Dedinje Cardiovascular Institute, 11040 Belgrade, Serbia
| | - Dragana Kosevic
- Departments of Cardiac Surgery (Drs. Micovic, Milicic, Stojanovic, and Vukovic) and Cardiology (Drs. Jovovic and Kosevic), Dedinje Cardiovascular Institute, 11040 Belgrade, Serbia
| | - Miroslav Milicic
- Departments of Cardiac Surgery (Drs. Micovic, Milicic, Stojanovic, and Vukovic) and Cardiology (Drs. Jovovic and Kosevic), Dedinje Cardiovascular Institute, 11040 Belgrade, Serbia
| | - Ljiljana Jovovic
- Departments of Cardiac Surgery (Drs. Micovic, Milicic, Stojanovic, and Vukovic) and Cardiology (Drs. Jovovic and Kosevic), Dedinje Cardiovascular Institute, 11040 Belgrade, Serbia
| | - Ivan Stojanovic
- Departments of Cardiac Surgery (Drs. Micovic, Milicic, Stojanovic, and Vukovic) and Cardiology (Drs. Jovovic and Kosevic), Dedinje Cardiovascular Institute, 11040 Belgrade, Serbia
| | - Slobodan Micovic
- Departments of Cardiac Surgery (Drs. Micovic, Milicic, Stojanovic, and Vukovic) and Cardiology (Drs. Jovovic and Kosevic), Dedinje Cardiovascular Institute, 11040 Belgrade, Serbia
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Komar M, Przewlocki T, Olszowska M, Sobien B, Podolec P. The benefit of atrial septal defect closure in elderly patients. Clin Interv Aging 2014; 9:1101-7. [PMID: 25075179 PMCID: PMC4106953 DOI: 10.2147/cia.s62313] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective Closure of an atrial septal defect in elderly patients is controversial. The aim of the study was to evaluate the outcomes of transcatheter closure of secundum atrial septal defects (ASDs) in elderly patients. Patients and methods From a total of 488 patients with ASDs who underwent transcatheter closure, 75 patients aged over 60 years (45 female, 30 male) with a mean age of 65.3±15.7 (60–75) years were analyzed. All patients had an isolated secundum ASD with a mean pulmonary blood flow:systemic blood flow of 2.84±1.9 (1.5–3.9). Symptom-limited treadmill exercise tests with respiratory gas-exchange analysis and transthoracic color Doppler echocardiographic study, as well as quality of life measured using the Short Form (36) Health Survey (SF-36) were repeated in all patients before the procedure and after 12 months of follow-up. Results The atrial septal device was successfully implanted in all patients (procedure time 37.7±4.5 [13–59] minutes, fluoroscopy time 11.2±9.9 [6–40] minutes). There were no major complications. The defect echo diameter was 17.7±15.8 (12–30) mm. The mean balloon-stretched diameter of ASDs was 22.4±7.9 (14–34) mm. The diameter of the implanted devices ranged from 16 to 34 mm. Significant improvement of exercise capacity was noted at 6 and 12 months after the procedure. Exercise time within 6 months of ASD closure was longer (P<0.001) compared to baseline values, and also oxygen consumption increased (P<0.001). Seven quality-of-life parameters (except mental health) improved at 12-month follow-up compared to baseline data. The mean SF-36 scale increased significantly in 66 (88%) patients, with a mean of 46.2±19.1 (5–69). As early as 1 month after the procedure, a significant decrease of the right ventricular dimension and the right atrium dimension was observed (P<0.001). The right ventricular dimension decreased in 67 patients (89.3%). Conclusion Closure of ASDs in elderly patients caused significant clinical and hemodynamic improvement after percutaneous treatment, which was maintained during long-term follow-up, justifying this procedure in old age.
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Affiliation(s)
- Monika Komar
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University, Krakow, Poland
| | - Tadeusz Przewlocki
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University, Krakow, Poland
| | - Maria Olszowska
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University, Krakow, Poland
| | - Bartosz Sobien
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University, Krakow, Poland
| | - Piotr Podolec
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University, Krakow, Poland
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Is it worth closing the atrial septal defect in patients with insignificant shunt? ADVANCES IN INTERVENTIONAL CARDIOLOGY 2014; 10:78-83. [PMID: 25061452 PMCID: PMC4108730 DOI: 10.5114/pwki.2014.43510] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 04/28/2014] [Accepted: 05/08/2014] [Indexed: 01/12/2023] Open
Abstract
Introduction Closure of the atrial septal defect in patients with insignificant shunt is controversial. Aim To evaluate the outcomes of transcatheter closure of atrial septal defect (ASD) in symptomatic patients with borderline shunt. Material and methods One hundred and sixty patients (120 female, 40 male) with a mean age of 30.1 ±16.2 (20–52) years with a small ASD who underwent transcatheter closure were analyzed. All patients had a small ASD with Qp: Qs ratio ≤ 1.5, mean 1.2 ±0.9 (1.1–1.5) in echo examination. Cardiopulmonary exercise tests, clinical study, transthoracic echocardiographic study as well as quality of life (QoL) (measured using the SF36 questionnaire (SF36q)) were repeated in all patients before and after the procedure. Results The devices were successfully implanted in all patients. After 12 months of ASD closure, all the patients showed a significant improvement of exercise capacity (oxygen consumption – 21.9 ±3.1 vs. 30.4 ±7.7, p > 0.001). The QoL improved in 7 parameters at 12-month follow-up. The mean SF36q scale increased significantly in 141 (88.1%) patients of mean 43.2 ±20.1 (7–69). A significant decrease of the right ventricular area (20.3 ±1.3 cm2 vs. 18.3 ±1.2 cm2, p < 0.001) and the right atrial area (15.2 ±1.9 cm2 vs. 12.0 ±1.6 cm2, p < 0.001) was observed at 12-month follow-up. Conclusions Closure of ASD in the patients with insignificant shunt resulted in significant durable clinical and hemodynamic improvement after percutaneous treatment.
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Milev I, Idrizi S, Zimbakov Z, Ampova-Sokolov V, Zafirovska P, Nikolov S, Angjuseva T, Mitrev Z. Percutaneous Interventional Treatment of Atrial Septal Defect Secundum in Macedonia. Open Access Maced J Med Sci 2014. [DOI: 10.3889/oamjms.2014.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Atrial septal defect (ASD) is a common congenital heart disorder (CHD). While conventional open surgical treatment is the standard procedure in our country, percutaneous device closure with implantation of an atrial septal defect occluder is a promising alternative with very few peri and post procedural complications.Aim: The aim of the study was to present the rate of success and complications in percutaneous ASD closure with the implantation of an atrial septal defect occluder.Material and Methods: We treated 153 patients (ages 2-76; 65% female) with ASD secundum with percutaneous trans catheter closure using a septal occluder. Follow up was on a 3 month interval and assessment included clinical, electrophysiological and echocardiographic status. Results: The mean diameter of ASD obtained via balloon sizing was 16 ± 16 mm. Multiple ASDs were found in 20 (13%) patients and deficitary aortic and anterior rim (< 5 mm) was present in 16 (10%) patients. Due to inadequate placement and/or sizing, the device was removed and replaced in seven patients (5%). During follow up, trivial shunt was present in 4 (2.6%) patients. The diameter of the right ventricle corrected for age was reduced by an average of 20% by the first month and in 130 (86%) of patients it had normalized by one year of follow up. During follow up, 16 (10%) patients reported transient headaches and 3 (1.9%) patients had transient atrial fibrillation (AF).Conclusion: In conclusion, the implantation of a septal occluder was found to be a safe procedure that resulted in improved hemodynamic parameters that result from right ventricular volume overload with favorable short- and mid-term results.
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Transcatheter Closure of Secundum Atrial Septal Defects: Results in Patients with Large and Extreme Defects. Heart Lung Circ 2014; 23:127-31. [DOI: 10.1016/j.hlc.2013.07.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 07/10/2013] [Accepted: 07/24/2013] [Indexed: 11/22/2022]
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Loh JP, Satler LF, Slack MC. Management of a large atrial septal occluder embolized to the left ventricular outflow tract without the use of cardiac surgery. Catheter Cardiovasc Interv 2014; 84:497-502. [DOI: 10.1002/ccd.25361] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 11/24/2013] [Accepted: 12/21/2013] [Indexed: 11/08/2022]
Affiliation(s)
- Joshua P. Loh
- Interventional Cardiology; MedStar Washington Hospital Center; Washington District of Columbia
| | - Lowell F. Satler
- Interventional Cardiology; MedStar Washington Hospital Center; Washington District of Columbia
| | - Michael C. Slack
- Division of Cardiology; Children's National Heart Institute, Children's National Medical Center; Washington District of Columbia
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Kijima Y, Akagi T, Nakagawa K, Promphan W, Toh N, Nakamura K, Sano S, Ito H. Cardiac erosion after catheter closure of atrial septal defect: Septal malalignment may be a novel risk factor for erosion. J Cardiol Cases 2014; 9:134-137. [PMID: 30546783 DOI: 10.1016/j.jccase.2013.12.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 11/22/2013] [Accepted: 12/09/2013] [Indexed: 11/25/2022] Open
Abstract
Pericardial tamponade occurred 3 days after the catheter closure of an atrial septal defect (ASD) using Amplatzer Septal Occluder (St. Jude Medical, St. Paul, MN, USA). Before the closure, two-dimensional and real-time three-dimensional transesophageal echocardiography demonstrated a deficient aortic rim and atrial septal malalignment. Perforation of the right atrium toward the non-coronary sinus of the aortic root was confirmed at the emergent surgery. Cardiac erosion is one of the most catastrophic complications in ASD patients undergoing catheter closure with Amplatzer Septal Occluder. Hence, several risk factors for this complication are discussed and identified. Oversized device deployment and a deficient aortic rim are accepted factors potentially causing cardiac erosion. Besides, atrial septal malalignment, which is a morphological characteristic of ASD, may be a novel risk factor for cardiac erosion. <Learning objective: Cardiac erosion is a potentially lethal complication when catheter closure of atrial septal defects using Amplatzer Septal Occluder (St. Jude Medical, St. Paul, MN, USA) is provided to the patients. However, mechanisms of this complication remain to be completely elucidated. Atrial septal malalignment may be one of the novel risk factors for this catastrophic complication.>.
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Affiliation(s)
- Yasufumi Kijima
- Department of Cardiovascular Medicine, Okayama University Hospital, Okayama, Japan
| | - Teiji Akagi
- Division of Cardiac Intensive Care Unit, Okayama University Hospital, Okayama, Japan
| | - Koji Nakagawa
- Department of Cardiovascular Medicine, Okayama University Hospital, Okayama, Japan
| | - Worakan Promphan
- Department of Pediatrics, Prince of Songkla University, Hat Yai, Thailand
| | - Norihisa Toh
- Department of Cardiovascular Medicine, Okayama University Hospital, Okayama, Japan
| | - Kazufumi Nakamura
- Department of Cardiovascular Medicine, Okayama University Hospital, Okayama, Japan
| | - Shunji Sano
- Division of Cardiac Intensive Care Unit, Okayama University Hospital, Okayama, Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Hospital, Okayama, Japan
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Fu YC, Hijazi ZM. The Amplatzer®Septal Occluder, a transcatheter device for atrial septal defect closure. Expert Rev Med Devices 2014; 5:25-31. [DOI: 10.1586/17434440.5.1.25] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Bhaya M, Mutluer FO, Mahan E, Mahan L, Hsiung MC, Yin WH, Wei J, Tsai SK, Zhao GY, Yin WH, Pradhan M, Beniwal R, Joshi D, Nabavizadeh F, Singh A, Nanda NC. Live/Real Time Three-Dimensional Transesophageal Echocardiography in Percutaneous Closure of Atrial Septal Defects. Echocardiography 2013; 30:345-53. [DOI: 10.1111/echo.12106] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Maneesha Bhaya
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham; Alabama
| | - Ferit Onur Mutluer
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham; Alabama
| | - Edward Mahan
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham; Alabama
| | - Luke Mahan
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham; Alabama
| | - Ming C. Hsiung
- Heart Center; Division of Cardiology; Cheng Hsin General Hospital; Taipei; Taiwan
| | - Wei-Hsian Yin
- Heart Center; Division of Cardiology; Cheng Hsin General Hospital; Taipei; Taiwan
| | - Jeng Wei
- Heart Center; Division of Cardiology; Cheng Hsin General Hospital; Taipei; Taiwan
| | - Shen-Kou Tsai
- Heart Center; Division of Cardiology; Cheng Hsin General Hospital; Taipei; Taiwan
| | - Guang-Yu Zhao
- Heart Center; Division of Cardiology; Cheng Hsin General Hospital; Taipei; Taiwan
| | - Wei-Hsian Yin
- Faculty of Medicine; National Yang-Ming University; Taipei; Taiwan
| | - Manish Pradhan
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham; Alabama
| | | | - Deepak Joshi
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham; Alabama
| | - Fatemeh Nabavizadeh
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham; Alabama
| | - Amitoj Singh
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham; Alabama
| | - Navin C. Nanda
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham; Alabama
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Alizade E, Ozkan B, Acar G, Karabay CY, Bulut M, Koyuncu A, Guler A, Esen AM. Successful percutaneous closure in patients with difficult atrial septal defects: case series and review of literature. Perfusion 2012; 27:550-5. [DOI: 10.1177/0267659112452032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Atrial septal defect is a common form of congenital heart disease. Percutenous closure is an important treatment option for these patients. In this case series, we intend to share the percutaneous closure of the difficult types of secundum atrial septal defects.
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Affiliation(s)
- E Alizade
- Kartal Kosuyolu Heart Education and Research Hospital, Cardiology Clinic, Kartal, Istanbul, Turkey
| | - B Ozkan
- Kartal Kosuyolu Heart Education and Research Hospital, Cardiology Clinic, Kartal, Istanbul, Turkey
| | - G Acar
- Kartal Kosuyolu Heart Education and Research Hospital, Cardiology Clinic, Kartal, Istanbul, Turkey
| | - CY Karabay
- Kartal Kosuyolu Heart Education and Research Hospital, Cardiology Clinic, Kartal, Istanbul, Turkey
| | - M Bulut
- Kartal Kosuyolu Heart Education and Research Hospital, Cardiology Clinic, Kartal, Istanbul, Turkey
| | - A Koyuncu
- Kartal Kosuyolu Heart Education and Research Hospital, Cardiology Clinic, Kartal, Istanbul, Turkey
| | - A Guler
- Kartal Kosuyolu Heart Education and Research Hospital, Cardiology Clinic, Kartal, Istanbul, Turkey
| | - AM Esen
- Kartal Kosuyolu Heart Education and Research Hospital, Cardiology Clinic, Kartal, Istanbul, Turkey
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Masseli J, Bertog S, Stanczak L, Blankenbach K, Majunke N, Reiffenstein I, Renkhoff K, Lehn K, Wunderlich N, Sievert H. Transcatheter closure of multiple interatrial communications. Catheter Cardiovasc Interv 2012; 81:825-36. [PMID: 22907918 DOI: 10.1002/ccd.24329] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2011] [Accepted: 01/07/2012] [Indexed: 11/06/2022]
Abstract
OBJECTIVES We sought to examine acute and midterm results of closure of multiple interatrial communications with staged device deployment and to review the relevant literature. BACKGROUND Information about percutaneous methods of closure for multiple defects is limited. METHODS We treated 148 patients with multiple defects. Of these, 88 had a relevant left to right shunt ("LRS"), 52 had a presumed paradoxical embolism ("PPE"), five had both (LRS and PPE), and one patient, respectively, had migraine, decompression sickness, and a right to left shunt. After implantation of the first device, closure of additional septal defects was attempted only if indicated clinically. RESULTS Ninety-four patients received a single device and 53 more than one. In four patients, surgical defect closure followed. At the end of follow-up (FU; mean 4.5 ± 3.4 years), complete closure of all defects occurred in 67.6% (62.1% for LRS, 76.5% for PPE). Clinical success (small or trivial residual shunt) was achieved in 86.9% (83.9% for LRS, 90.2% for PPE). Complications included pericardial effusions in 2.7%, recurrent thromboembolic events in 4.8%, and new onset of atrial fibrillation in 10.1%. In a significant number of patients with multiple defects, after single device implantation, the likelihood of complete closure increased with FU time (26% complete closure at 1 month vs. 78% at 24 months). CONCLUSION Percutaneous closure of multiple interatrial communications is feasible and safe. Importantly, many residual defects close without further intervention at FU. Therefore, staged device delivery is an alternative to simultaneous device implantation, possibly requiring fewer and smaller second devices.
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