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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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Lee JS, Kim GB, Lee WJ, Song SH, An HS, Lee SY, Song MK, Kwon HW, Bae EJ. Association between the Use of Diuretics and Size Reduction in Pediatric Atrial Septal Defect. Korean Circ J 2021; 51:1017-1029. [PMID: 34595884 PMCID: PMC8636757 DOI: 10.4070/kcj.2021.0076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 07/24/2021] [Accepted: 08/18/2021] [Indexed: 11/17/2022] Open
Abstract
The effect of diuretics on ASD size reduction remains unclear. In pediatric patients with a large secundum ASD (≥10 mm), diuretic administration seemed to be associated with changes in ASD size. There seemed to be a little possibility of ASD size reduction in case of rim deficiency other than the aortic rim. The patients receiving diuretics may have a lower possibility to undergo surgical closure. The diuretics administration may be associated with the use of smaller ASD devices. Background and Objectives While diuretics are sometimes used in atrial septal defect (ASD) treatment, their effect on ASD size reduction remains unclear. We aimed to evaluate the efficacy of diuretics in ASD size reduction in pediatric patients. Methods We retrospectively reviewed the medical records of patients with secundum ASD (size ≥10 mm), between 2005 and 2019. Patients were divided into two groups based on the diuretic administration. Results Of the 73 enrolled patients, 40 received diuretics. The initial age at ASD diagnosis (2.8±1.7 vs. 2.5±2.0 years, p=0.526) and follow-up duration (22.3±11.4 vs. 18.7±13.2 months, p=0.224) were not significantly different between the groups. The ASD diameter at the initial diagnosis (13.7±2.0 vs. 13.5±3.4 mm, p=0.761) and the indexed ASD diameter (25.5±5.9 vs. 26.9±10.3 mm/m2, p=0.493) were also not significantly different between two groups. The ASD diameter significantly increased in the non-diuretic group during follow-up (0.0±2.9 vs. +2.6±2.0 mm, p<0.001). The indexed ASD diameter significantly decreased in the diuretic group during follow-up (−5.7±6.5 vs. +0.2±3.9 mm/m2, p<0.001). In the linear mixed model analysis, diuretic use was associated with ASD diameter decrease (p<0.001) and indexed ASD diameter reduction (p<0.001) over time. Device closure was more frequently performed in the diuretic (75.0%) than in the non-diuretic group (39.4%). Conclusions Patients receiving diuretics are less likely to undergo surgery. The diuretics administration may be associated with the use of smaller ASD devices for transcatheter treatment through ASD size reduction.
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Affiliation(s)
- Jue Seong Lee
- Department of Pediatrics, Korea University College of Medicine and Korea University Medical Center, Seoul, Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Children's Hospital, Seoul, Korea
| | - Gi Beom Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Children's Hospital, Seoul, Korea.
| | - Won Jung Lee
- Seoul National University College of Medicine, Seoul, Korea
| | - Seok Hyun Song
- Seoul National University College of Medicine, Seoul, Korea
| | - Hyo Soon An
- Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Children's Hospital, Seoul, Korea
| | - Sang Yun Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Children's Hospital, Seoul, Korea
| | - Mi Kyoung Song
- Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Children's Hospital, Seoul, Korea
| | - Hye Won Kwon
- Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Children's Hospital, Seoul, Korea
| | - Eun Jung Bae
- Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Children's Hospital, Seoul, Korea
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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] [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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Santoro G, Castaldi B, Cuman M, Di Candia A, Pizzuto A, Sirico D, Cantinotti M, Garibaldi S, Pak V, Di Salvo G. Trans-catheter atrial septal defect closure with the new GORE® Cardioform ASD occluder: First European experience. Int J Cardiol 2020; 327:68-73. [PMID: 33220363 DOI: 10.1016/j.ijcard.2020.11.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/25/2020] [Accepted: 11/09/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND This perspective, observational study evaluated safety and efficacy of the GORE® Cardioform ASD Occluder (WL Gore & Associates, Flagstaff, AZ), compliant and potentially innovative prosthesis recently approved for closure of ostium secundum atrial septal defects (ASD). METHODS Between January and June 2020, 43 unselected patients with -significant ASD were submitted to trans-catheter closure with GORE® Cardioform ASD Occluder at two high-volume Italian Pediatric Cardiology centers. Primary endpoints were procedural success and safety. Secondary endpoints were closure rate and clinical safety at 1-month follow-up. RESULTS Patients' age and weight were 8.2 ± 3.9 years (range 3-21, median 9.9) and 29.6 ± 15.3 kg (range 16-57, median 33.3), respectively. ASD diameter was 16.6 ± 4.5 mm (median 10), resulting in QP/QS of 1.7 ± 0.7 (median 1.6). Seventeen pts. (39.5%) were considered "surgical" candidates due to challenging septum morphology, ASD rim deficiency or ASD diameter/patient weight ratio ≥ 1.2. Device placement was successfully achieved in all but one patient (97.7%), in whom it embolized early after deployment, resulting in rescue surgical repair. No cross-over with different devices was recorded. Median procedure and fluoroscopy times were 40 and 6.8 min, respectively. Major adverse events were recorded in 7.0% (3 pts). Complete closure rate was 78.5% at discharge, rising to 92.9% (39/42 pts) at 1 month evaluation, without cardiac or extra-cardiac adverse events. "Challenging" procedures were more time-consuming but as effective and safe as the "simple" ones. CONCLUSIONS The GORE® Cardioform ASD Occluder device was highly effective and versatile in closure of ASDs with different anatomy and size, even in challenging settings.
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Affiliation(s)
- Giuseppe Santoro
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Region Foundation "G. Monasterio", Massa, Italy.
| | - Biagio Castaldi
- Pediatric Cardiology, University of Padua, Padua, Italy; Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Region Foundation "G. Monasterio", Massa, Italy
| | - Magdalena Cuman
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Region Foundation "G. Monasterio", Massa, Italy
| | | | - Alessandra Pizzuto
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Region Foundation "G. Monasterio", Massa, Italy
| | | | - Massimiliano Cantinotti
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Region Foundation "G. Monasterio", Massa, Italy
| | - Silvia Garibaldi
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Region Foundation "G. Monasterio", Massa, Italy
| | - Vitali Pak
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Region Foundation "G. Monasterio", Massa, Italy
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Qi H, Zhao J, Tang X, Wang X, Chen N, Lv W, Bian H, Wang S, Yuan B. Open heart surgery or echocardiographic transthoracic or percutaneous closure in secundum atrial septal defect: a developing approach in one Chinese hospital. J Cardiothorac Surg 2020; 15:212. [PMID: 32762705 PMCID: PMC7409692 DOI: 10.1186/s13019-020-01216-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 07/07/2020] [Indexed: 11/18/2022] Open
Abstract
Background To study the clinical manifestations and advantages of open-heart surgery and echocardiographic transthoracic or percutaneous closure with secundum atrial septal defect (ASD). The surgeon’s learning curve was also analyzed. Methods In all, 115 consecutive patients with ASD from May 2013 to May 2019 were enrolled. According to the operative procedure, patients were divided into three groups: group one (open repair group) (n = 24), where patients underwent ASD repair (ASDR) under cardiopulmonary bypass (CPB); group two (closed surgical device closure group) (n = 69), where patients (six patients ≤1 y and sixteen ≤10 kg) underwent transthoracic ASD occlusion under transesophageal echocardiographic (TEE) guidance; and group three (transcatheter occlusion group) (n = 22), where patients underwent percutaneous ASD occlusion under echocardiography. The clinical features and results of each group were analyzed. All patients were telephonically followed-up after 3 months. Results All the three methods treating ASD were successfully performed in our hospital. It was also a typical developing history of congenital heart disease (CHD) surgery in China. One patient in the group two was transferred to emergency surgery for occluder retrieval and CPB-ASDR. Eight patients experienced failed transthoracic or percutaneous occlusion, two of whom underwent unsuccessful percutaneous closure at another hospital. Two patients each in the groups two and three were intraoperatively converted to CPB-ASDR. Two patient in the group three was converted to transthoracic occlusion surgery. All patients were discharged without any residual shunt. The three-month follow-up also did not show any residual shunt and occluder displacement. Conclusion In low-weight, infants, or huge ASDs with suitable rim for device occlusion, transthoracic ASD closure was successfully performed. Based on knowledge of ASD anatomy and skilled transthoracic occlusion of ASD, surgeons can perform percutaneous occlusion of ASD under echocardiographic guidance.
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Affiliation(s)
- Hongwei Qi
- Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, No. 1, Dong Jiao Min Xiang, Dongcheng District, Beijing, 100730, China
| | - Jiangang Zhao
- Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, No. 1, Dong Jiao Min Xiang, Dongcheng District, Beijing, 100730, China
| | - Xiujie Tang
- Department of Cardiovascular Center, The 1st Hospital, Tsinghua University, Beijing, 100016, China
| | - Xizheng Wang
- Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, No. 1, Dong Jiao Min Xiang, Dongcheng District, Beijing, 100730, China
| | - Nan Chen
- Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, No. 1, Dong Jiao Min Xiang, Dongcheng District, Beijing, 100730, China
| | - Wenqing Lv
- Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, No. 1, Dong Jiao Min Xiang, Dongcheng District, Beijing, 100730, China
| | - Hong Bian
- Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, No. 1, Dong Jiao Min Xiang, Dongcheng District, Beijing, 100730, China
| | - Shumin Wang
- Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, No. 1, Dong Jiao Min Xiang, Dongcheng District, Beijing, 100730, China
| | - Biao Yuan
- Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, No. 1, Dong Jiao Min Xiang, Dongcheng District, Beijing, 100730, China.
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Sharma B, Pinto R, Dalvi B. Transcatheter closure of atrial septal defect in symptomatic children weighing ≤10 kg: Addressing unanswered issues from a decade of experience. Ann Pediatr Cardiol 2020; 13:4-10. [PMID: 32030029 PMCID: PMC6979027 DOI: 10.4103/apc.apc_66_19] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 08/19/2019] [Accepted: 10/08/2019] [Indexed: 11/04/2022] Open
Abstract
Background and Objectives Device closure of secundum atrial septal defect is shown to be feasible and effective in children weighing ≤10 kg. Issues such as how large is too large, how to choose device size, does the length of the interatrial septum (IAS) matter, and need for technical modifications for successful device delivery have not been systematically addressed. Materials and Methods This is a retrospective study, comprising 45 patients weighing ≤10 kg, who were chosen for device closure between January 2010 and June 2018. Patient selection was done on basis of transthoracic echocardiography. Device closure was done using Amplatzer septal occluder. The device size was selected primarily based on transesophageal echocardiography (TEE)-measured defect diameter. Although IAS length was taken into consideration, adequate rim size was the key factor in deciding device closure of the defect. Results Forty-three out of 45 patients had successful device closure. The mean age and weight were 25.71 ± 8.62 months and 8.99 ± 1.24 kg, respectively. The defect measuring as large as 27 mm (14.89 ± 3.89) on TEE was closed and device as big as 28 mm was successfully deployed (16.7 ± 4.31). Regular technique of device deployment was successful in only 15 cases. In the remaining 28, one of the modified techniques was used. There was no mortality, failure of the procedure, device embolization, thromboembolism, or pericardial effusion. One patient developed moderate mitral regurgitation and two patients had transient atrioventricular block. At follow-up, all patients showed significant improvement in symptoms and growth without any complications. Conclusions Defect size as large as three times the weight in kg can be closed in small children. Devices as large as 28 mm can be deployed in these hearts provided the surrounding rims are adequate. In majority of cases, one of the modified techniques is essential for successful deployment. IAS length is not a limiting factor for deciding the size of the device used.
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Affiliation(s)
| | - Robin Pinto
- Glenmark Cardiac Centre, Mumbai, Maharashtra, India
| | - Bharat Dalvi
- Glenmark Cardiac Centre, Mumbai, Maharashtra, India
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Tanghöj G, Liuba P, Sjöberg G, Naumburg E. Predictors of the Need for an Atrial Septal Defect Closure at Very Young Age. Front Cardiovasc Med 2020; 6:185. [PMID: 31998753 PMCID: PMC6965016 DOI: 10.3389/fcvm.2019.00185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 12/09/2019] [Indexed: 12/15/2022] Open
Abstract
An asymptomatic Atrial Septal Defect (ASD) is often closed at the age of 3–5 years using a transcatheter or surgical technique. Symptomatic ASD or ASD associated with pulmonary hypertension (PHT) may require earlier closure, particularly in combination with other non-cardiac risk factors for PHT, but the indications for early closure and the potential risk for complications are largely unknown. The aim of this study was to assess risk factors for needing ASD closure during the first and second years of life. This case-control study included all children treated with surgical or percutaneous ASD closure between 2000 and 2014 at two out of three pediatric heart centers in Sweden. “Cases” were children with ASD closure at ≤1 or ≤2 years of age. Clinical data were retrieved from medical journals and national registries. Overall, 413 children were included. Of these, 131 (32%) were ≤2 years, and 50 (12%) were ≤1 year. Risk factors associated with a ≤2 years ASD closure were preterm birth, OR = 2.4 (95% CI: 1.5–3.9); additional chromosomal abnormalities, OR = 3.4 (95% CI: 1.8–6.5); pulmonary hypertension, OR = 5.8 (95% CI: 2.6–12.6); and additional congenital heart defects, OR = 2.6 (95% CI: 1.7–4.1). These risk associations remained after adjustments for confounding factors, such as need for neonatal respiratory support, neonatal pulmonary diseases, neonatal sepsis, additional congenital heart defects (CHD) and chromosomal abnormalities. ASD size:body weight ratio of 2.0, as well as a ratio of 0.8 (upper and lower limit of the ASD size:body weight ratios), was associated with increased risk of an early ASD closure. Risk factors such as very premature birth, very low birth weight, congenital, and chromosomal abnormalities, neonatal pulmonary disease and need for ventilation support, as well as pulmonary hypertension, were associated with very early (<1 year of age) ASD closure. Several independent neonatal risk factors were associated with an increased risk of early ASD closure at 2 and at 1 year of age. An ASD size:body weight ratio is a poor predictor for indications for ASD closure.
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Affiliation(s)
- Gustaf Tanghöj
- Department of Clinical Sciences, Unit of Pediatrics, Umeå University, Umeå, Sweden
| | - Petru Liuba
- Department of Cardiology, Pediatric Heart Center, Skåne University Hospital, Lund, Sweden
| | - Gunnar Sjöberg
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Estelle Naumburg
- Department of Clinical Sciences, Unit of Pediatrics, Umeå University, Umeå, Sweden
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Ortega MC, Ramos DBB, Novoa JCR, Suarez FJO, Ramírez FD, González MD. Impact of Transcatheter Device Closure of Atrial Septal Defect on Atrial Arrhythmias Propensity in Young Adults. Pediatr Cardiol 2020; 41:54-61. [PMID: 31673734 DOI: 10.1007/s00246-019-02221-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 10/15/2019] [Indexed: 11/29/2022]
Abstract
Atrial septal defect (ASD) is a condition that requires early intervention because of the consequences over the right-side heart. Chronic atrial stretching promotes atrial conduction delay and the imbalance of the conduction homogeneity, which lead to the propensity to atrial arrhythmias (AA). We aim to evaluate the impact of transcatheter closure of ASD on atrial vulnerability markers leading to late AA in young adults. We conducted a prospective, longitudinal study in one hundred patients (mean age 25.2 ± 5.4 years) who underwent transcatheter closure of ASD at Cardiocentro Pediátrico William Soler. P-wave maximum (Pmax) and P-wave dispersion (Pd) were analyzed from 12-lead electrocardiogram. Left-side and right-side intraatrial and interatrial electromechanical delay (EMD) were measured with tissue Doppler imaging. Both electrocardiographic and echocardiographic analyses were performed during the study period. Compared to baseline, there was a significant reduction in P max (p ≤ 0.001) and Pd (p ≤ 0.001) after 3 months of procedure. All atrial electromechanical coupling parameters significantly reduced at 6 months of ASD closure and tend to remain at lower values till the last evaluation. Over 9.2 ± 1.6 years of follow-up, 15 subjects (15%) developed AA, of which intraatrial reentrant tachycardia (66.6%) became the main rhythm disturbance. Intra-right atrial EMD ≥ 16 ms (HR 4.08, 95% CI 1.15-14.56; p = 0.03) and Pd 45 ms (HR 1.66, 95% CI 1.06-2.59; p = 0.02) were identified as predictors of late AA. Transcatheter device closure of ASD in young adults promotes a significant reduction of electrocardiographic and echocardiographic markers of AA vulnerability, which persist during the long-term follow-up. Nevertheless, Pd and interatrial EMD were identified as independent risk factors of AA.
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Affiliation(s)
- Michel Cabrera Ortega
- Section of Arrhythmia and Cardiac Pacing, Cardiocentro Pediátrico William Soler, San Francisco e/ 100 y Perla, 10800, Boyeros, La Habana, Cuba.
| | - Dunia Bárbara Benítez Ramos
- Department of Pediatric Cardiology, Cardiocentro Pediátrico William Soler, 100 y Perla, Boyeros, Havana, Cuba
| | - Juan Carlos Ramiro Novoa
- Laboratory of Hemodynamia, Cardiocentro Pediátrico William Soler, 100 y Perla, Boyeros, Havana, Cuba
| | | | - Francisco Díaz Ramírez
- Laboratory of Hemodynamia, Cardiocentro Pediátrico William Soler, 100 y Perla, Boyeros, Havana, Cuba
| | - Mabel Domínguez González
- Laboratory of Hemodynamia, Cardiocentro Pediátrico William Soler, 100 y Perla, Boyeros, Havana, Cuba
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Roushdy A, El Sayegh A, Ali YA, Attia H, El Fiky A, El Sayed M. A novel three-dimensional echocardiographic method for device size selection in patients undergoing ASD trans-catheter closure. Egypt Heart J 2019; 72:1. [PMID: 31893314 PMCID: PMC6938529 DOI: 10.1186/s43044-019-0038-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 12/19/2019] [Indexed: 11/10/2022] Open
Abstract
Background Proper device size selection is a crucial step for successful ASD device closure. The current gold standard for device size selection is balloon sizing. Balloon sizing can be tedious, time consuming and increase fluoroscopy and procedure times as well as risk of complications. We aimed to establish a simple and accurate method for device size selection using three-dimensional echocardiographic interrogation of the ASD.This is a prospective observational study conducted over a period of 12 months. All patients underwent 2D TTE, three-dimensional echocardiographic assessment of the IAS and transesophageal echocardiogram. Comparison between echocardiographic variables was done using independent sample t test. Linear correlation was established between three dimensional echocardiographic variables and respective variables of device size and 2D TTE and TEE measurements. Results The study included 50 patients who underwent successful ASD device closure with properly sized device. There was no significant difference between 3D ASD maximum diameter and all diameters measured by TTE and TEE. There was a strong positive correlation between device size used for closure and both 3D measured ASD area (r = 0.907, P<0.0001) and 3D measured ASD circumference (r = 0.917, P<0.0001). Two regression equations were generated to determine proper device size where Device size = 10.8 + [3.95 x 3D ASD area] and Device size = [3.85 x 3D ASD circumference] -1.02 Conclusion Three-dimensional echocardiogram can provide a simple and accurate method for device size selection in patients undergoing ASD device closure using either 3D derived ASD area or ASD circumference
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Affiliation(s)
- Alaa Roushdy
- Cardiology Department, Congenital and structural heart diseases unit, Ain Shams University hospitals, Cairo, Egypt
| | - Aya El Sayegh
- Cardiology Department, Congenital and structural heart diseases unit, Ain Shams University hospitals, Cairo, Egypt
| | - Yasmin Abdelrazek Ali
- Cardiology Department, Congenital and structural heart diseases unit, Ain Shams University hospitals, Cairo, Egypt.
| | - Hebattalla Attia
- Cardiology Department, Congenital and structural heart diseases unit, Ain Shams University hospitals, Cairo, Egypt
| | - Azza El Fiky
- Cardiology Department, Congenital and structural heart diseases unit, Ain Shams University hospitals, Cairo, Egypt
| | - Maiy El Sayed
- Cardiology Department, Congenital and structural heart diseases unit, Ain Shams University hospitals, Cairo, Egypt
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Ghaderian M, Sabri MR, Ahmadi AR, Dehghan B, Mahdavi C, Ataei ZZ. The efficacy and safety of using amplatzer for transcatheter closure of atrial septal defect in small children with less than 10 kg. ARYA ATHEROSCLEROSIS 2019; 15:27-32. [PMID: 31440282 PMCID: PMC6597800 DOI: 10.22122/arya.v15i1.1805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Atrial septal defect (ASD) accounts for about 10% of congenital heart diseases (CHDs). Self-closure of these defects in patients with defects less than 8 mm has been reported in several studies. In children, transcatheter closure of the ASD is suggested for asymptomatic patients older than two years and with weight > 15 kg. The purpose of this study was to show that transcatheter closure of ASD in small children with body weight less than 10 kg is an effective and safe method. METHODS Between July 2016 and September 2018, 35 children with body weight less than 10 kg underwent percutaneous closure of ASD using amplatzer. All patients had minimum defect size of 6 mm, pulmonary blood flow (Qp) to systemic blood flow (Qs) ratio above 1.5, right atrial and ventricular dilation, symptoms of delayed growth, and recurrent respiratory infections in their evaluation and had acceptable rims for intervention. Follow-up evaluations were done 1 day, 1 week, 1 month, 6 months, and yearly after discharge with transthoracic echocardiography (TTE) and electrocardiography (ECG). RESULTS The mean age of patients at procedure was 12.06 ± 4.47 months (range: 6 to 14 months), mean weight was 8.32 ± 0.72 kg (range: 7.5 to 9.8 kg). The mean defect size was 10.00 ± 2.32 mm (range: 6-13 mm). The mean device size used was 10.57 ± 2.57 mm (range: 7.5 to 15 mm). Mean duration of follow-up was 16.66 ± 6.93 months (range: 1-29 months). Respiratory rate, heart rate, pulmonary stenosis (PS), and Qp to Qs ratio had significant difference before and after procedure during the follow up (P < 0.001). CONCLUSION Transcatheter closure of ASD with amplatzer in symptomatic small children and infants is a safe and effective treatment associated with excellent success, but long-term follow-up in a large number of patients would be warranted.
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Affiliation(s)
- Mehdi Ghaderian
- Associate Professor, Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Reza Sabri
- Professor, Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Reza Ahmadi
- Associate Professor, Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Bahar Dehghan
- Assistant Professor, Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Chehre Mahdavi
- Assistant Professor, Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zakie Zahra Ataei
- Student of Medicine, Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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11
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Narin N, Baspinar O, Pamukcu O, Sunkak S, Tuncay A, Tasci O, Baykan A. Percutaneous ASD closure of children weighing less than 10 kg. Acta Cardiol 2019; 75:631-636. [PMID: 31379261 DOI: 10.1080/00015385.2019.1648711] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Traditionally the procedure of percutaneous ASD closure is carried out in children weighing more than 15 kg. The aim of this study was to discuss the success, efficacy and safety of the percutaneous closure of symptomatic ASD in children weighing less than 10 kg. Material and methods: This study was performed in two centres. A total of 44 patients were included. Demographic and angiographic data of these patients were gathered retrospectively from patients' records. Main indications for ASD closure were: failure to thrive, recurrent respiratory infections, bronchopulmonary dysplasia and genetic syndromes. Results: Median weight of patients was 9.0(8.12-9.50) kg. Bodyweight of 22 patients was less than 3 percentiles. In the follow-up, this number was lowered to 9 patients at 12 months. Median age of patients was 18.0(12.0-285) months. Minimum age and weight of patients was 3 months and 4.5 kg, respectively. Median mean pulmonary pressure was 24.0(20.0-29.5). The values of median defect size were measured in Cath lab as 13.0(10.75-15.3) mm. Median device size was 13(9-15) mm. Defect size was evaluated according to body weight and body surface area. The ratio of weight per defect size was 0.65(0.54-0.84) also the ratio of body surface area per defect size was 0.032(0.028-0.04). The ratio of total septum per device diameter was 2.5(2.1-3.1). Types of devices used were Amplatzer Septal Occluder, Cera Flex Septal Occluder, Figulla Flex II Atrial Septal Occluder, Memopart Septal Occluder. All cases were closed successfully, but the device had to be retrieved in one patient after successful positioning because it was detected that device compressed the aorta. No major complications were seen. Conclusion: In the experienced centres, percutaneous ASD closure can be done effectively and safely in symptomatic children weighing less than 10 kg.
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Affiliation(s)
- Nazmi Narin
- Division of Pediatric Cardiology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Osman Baspinar
- Division of Pediatric Cardiology, Gaziantep University School of Medicine, Gaziantep, Turkey
| | - Ozge Pamukcu
- Division of Pediatric Cardiology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Suleyman Sunkak
- Division of Pediatric Cardiology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Aydin Tuncay
- Division of Cardiovascular Surgery, Erciyes University School of Medicine, Kayseri, Turkey
| | - Onur Tasci
- Division of Pediatric Cardiology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Ali Baykan
- Division of Pediatric Cardiology, Erciyes University School of Medicine, Kayseri, Turkey
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12
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O'Byrne ML, Levi DS. State-of-the-Art Atrial Septal Defect Closure Devices for Congenital Heart. Interv Cardiol Clin 2018; 8:11-21. [PMID: 30449418 DOI: 10.1016/j.iccl.2018.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This article describes current devices and indications for transcatheter device closure of atrial septal defect (TC-ASD) and patent foramen ovale in children and young adults. TC-ASD has a proven record of efficacy and safety, but device erosion raises questions about the relative safety of TC-ASD versus operative open heart surgical ASD closure. New devices for ASD closure with properties to reduce risk of erosion are being developed. Recent studies demonstrating superiority of patent foramen ovale device closure over medical therapy for cryptogenic stroke may lead to changes in practice for structural/interventional cardiologists. Care should be taken in extrapolating data to children and younger adults.
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Affiliation(s)
- Michael L O'Byrne
- Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Center for Pediatric Clinical Effectiveness, Leonard Davis Institute, University of Pennsylvania, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA.
| | - Daniel S Levi
- Division of Cardiology, UCLA Mattel Children's Hospital, University of California Los Angeles Medical School, 200 UCLA Medical Plaza #330, Los Angeles, CA 90095, USA
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13
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Successful simultaneous transcatheter treatment for a secundum atrial septal defect complicated by valvular pulmonary stenosis in an infant. Cardiol Young 2018; 28:1162-1164. [PMID: 29991370 DOI: 10.1017/s1047951118000896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Only few reports have described successful simultaneous transcatheter intervention for CHD in infants. We present an infant with secundum atrial septal defect complicated by valvular pulmonary stenosis. Percutaneous transcatheter pulmonary valvuloplasty was performed first, followed by transcatheter closure of the secundum atrial septal defect uneventfully. Simultaneous transcatheter correction is an effective therapeutic option even in infants.
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14
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Jalal Z, Hascoët S, Gronier C, Godart F, Mauri L, Dauphin C, Lefort B, Lachaud M, Piot D, Dinet ML, Levy Y, Fraisse A, Ovaert C, Pillois X, Lusson JR, Petit J, Baruteau AE, Thambo JB. Long-Term Outcomes After Percutaneous Closure of Ostium Secundum Atrial Septal Defect in the Young. JACC Cardiovasc Interv 2018; 11:795-804. [DOI: 10.1016/j.jcin.2018.01.262] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 01/16/2018] [Accepted: 01/23/2018] [Indexed: 11/24/2022]
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15
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O’Byrne ML, Glatz AC, Gillespie MJ. Transcatheter device closure of atrial septal defects: more to think about than just closing the hole. Curr Opin Cardiol 2018; 33:108-116. [PMID: 29076870 PMCID: PMC6112166 DOI: 10.1097/hco.0000000000000476] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To review current controversies in the transcatheter device closure of ostium secundum atrial septal defects (ASD). RECENT FINDINGS Transcatheter device closure of ASD (TC-ASD) has well established efficacy and safety. For most individual patients with suitable anatomy, TC-ASD is the preferred method for treating ASD. The availability of large multicenter data sets has made it possible to study practice patterns at a range of hospitals across the United States. These studies have revealed differences in practice that were not previously appreciated. Interpretation of the indications for TC-ASD, specifically the definition of right ventricular volume overload varies between hospitals. In response to concern about device erosion, an increasing proportion of patients are being referred for operative ASD closure. Over the last decade, the average age at which ASD closure occurs has decreased. These trends demonstrate previously underappreciated differences in opinion between cardiologists across the country and suggest that further research is necessary to address knowledge gaps limiting consistency of practice. SUMMARY As TC-ASD and congenital interventional cardiology mature as a field, studies of real-world practice provide increasingly valuable information about aspects of care in which there are disagreements about best practices and in which further research is necessary.
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Affiliation(s)
- Michael L O’Byrne
- Division of Cardiology The Children’s Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania Philadelphia, Philadelphia PA
- Center for Pediatric Clinical Effectiveness and Cardiac Center Research Core, The Children’s Hospital of Philadelphia, Philadelphia PA
- Leonard Davis Institute, University of Pennsylvania, Philadelphia PA
| | - Andrew C Glatz
- Division of Cardiology The Children’s Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania Philadelphia, Philadelphia PA
- Center for Pediatric Clinical Effectiveness and Cardiac Center Research Core, The Children’s Hospital of Philadelphia, Philadelphia PA
| | - Matthew J Gillespie
- Division of Cardiology The Children’s Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania Philadelphia, Philadelphia PA
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16
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Increasing propensity to pursue operative closure of atrial septal defects following changes in the instructions for use of the Amplatzer Septal Occluder device: An observational study using data from the Pediatric Health Information Systems database. Am Heart J 2017; 192:85-97. [PMID: 28938967 DOI: 10.1016/j.ahj.2017.07.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 07/12/2017] [Indexed: 11/21/2022]
Abstract
Concern for device erosion following transcatheter treatment of atrial septal defects (TC-ASD) led in 2012 to a United States Food and Drug Administration panel review and changes in the instructions for use of the Amplatzer Septal Occluder (ASO) device. No studies have assessed the effect of these changes on real-world practice. To this end a multicenter observational study was performed to evaluate trends in the treatment of ASD. METHODS A retrospective observational study was performed using data from the Pediatric Health Information Systems database of all patients with isolated ASD undergoing either TC-ASD or operative ASD closure (O-ASD) from January 1, 2007, to September 30, 2015, hypothesizing that the propensity to pursue O-ASD increased beginning in 2013. RESULTS A total of 6,392 cases from 39 centers underwent ASD closure (82% TC-ASD). Adjusting for patient factors, between 2007 and 2012, the probability of pursuing O-ASD decreased (odds ratio [OR] 0.95 per year, P = .03). This trend reversed beginning in 2013, with the probability of O-ASD increasing annually (OR 1.21, P = .006). There was significant between-hospital variation in the choice between TC-ASD and O-ASD (median OR 2.79, P < .0001). The age of patients undergoing ASD closure (regardless of method) decreased over the study period (P = .04). Cost of O-ASD increased over the study period, whereas cost of TC-ASD and length of stay for both O-ASD and TC-ASD was unchanged. CONCLUSIONS Although TC-ASD remains the predominant method of ASD closure, the propensity to pursue O-ASD has increased significantly following changes in instructions for use for ASO. Further research is necessary to determine what effect this has on outcomes and resource utilization.
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Short-Term and Midterm Follow-Up of Transthoracic Device Closure of Atrial Septal Defect in Infants. Ann Thorac Surg 2017; 104:1403-1409. [DOI: 10.1016/j.athoracsur.2017.02.085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 02/24/2017] [Accepted: 02/27/2017] [Indexed: 11/21/2022]
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18
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Early Complications After Percutaneous Closure of Atrial Septal Defect in Infants with Procedural Weight Less than 15 kg. Pediatr Cardiol 2017; 38:255-263. [PMID: 27837301 PMCID: PMC5331095 DOI: 10.1007/s00246-016-1507-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 10/31/2016] [Indexed: 02/07/2023]
Abstract
Atrial septal defect (ASD) is the most common congenital cardiac lesion accounting for 10-15% of all cardiac malformations. In the majority of cases, the secundum type of the ASD is closed percutaneously in the catheterization laboratory. Although transcatheter closure of ASD is considered safe and effective in pediatric patients, there are limited data regarding the efficacy and safety of device ASD closure in smaller infants. The aim of this study was to determine risk of complications within 72 h following device closure of ASD in children of body weight <15 kg compared to larger children. Overall 252 children who underwent transcatheter closure of ASD at Children's Heart Centre in Lund, Sweden, between 1998 and 2015 were included. Data regarding demographics, comorbidity and complications occurring during and after device procedure until discharge were retrieved from the hospital's databases. Echocardiographic data were obtained from the digital and videotape recordings. Nearly half of the study cohort (n = 112; 44%) had a procedural weight <15 (median 11.3) kg with a median procedural age of 2.02 years. Among this study group, 22 (9%) children had post-procedural in-hospital complications, of which 16 (7%) were considered as major and six (2%) considered as minor. No deaths occurred. There was no significant difference in of the occurrence of major or minor complications between the two groups (p = 0.32). Larger ASD was more often associated with minor complications, OR 1.37 (95% CI 0.99-1.89), which most often consisted of transient arrhythmias during or after the procedure. Percutaneous ASD device closure can be performed safely in low-weight infants with a risk of post-procedural in-hospital complications comparable to larger/older children. Nevertheless, careful considerations of the indications to device closure is needed, particularly in children with larger ASD, as recommended by the current international guidelines for ASD closure.
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Cao H, Chen Q, Zhang GC, Chen LW, Qiu ZH, Lu H. Percutaneous device closure of atrial septal defect with totally transthoracic echocardiography guide, without x-ray machine. Medicine (Baltimore) 2016; 95:e5256. [PMID: 27858888 PMCID: PMC5591136 DOI: 10.1097/md.0000000000005256] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The present study investigated the feasibility of totally transthoracic echocardiography-guided percutaneous device occlusion of atrial septal defects (ASDs) without using x-ray equipment.Between September and December 2014, we performed totally transthoracic echocardiography-guided percutaneous device occlusion for 20 patients with secundum ASD without using x-ray equipment. We carried out percutaneous femoral vein puncture, used a specialized delivery sheath during operation, and closed the ASD by releasing an occluder.All 20 patients experienced successful occlusion and smoothly went through the perioperative period. The average procedure time ranged from 30 to 40 minutes (32.4 ± 3.5 minutes), and the size of the implanted occluder ranged from 20 to 38 mm (25.4 ± 5.8 mm). No occluder displacements, residual fistula, or thrombus-related complications after the procedure. There was no clinical death, no arrhythmia, no hemolysis, no infection, or embolism during patients' hospitalization and the follow-up period.Totally transthoracic echocardiography-guided percutaneous device occlusion of ASDs without the use of x-ray equipment may be safe and feasible.
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Affiliation(s)
- Hua Cao
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, P.R. China
- Correspondence: Hua Cao, Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Xinquan Road, Fuzhou, P. R. China, (e-mail: )
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20
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Wyss Y, Quandt D, Weber R, Stiasny B, Weber B, Knirsch W, Kretschmar O. Interventional Closure of Secundum Type Atrial Septal Defects in Infants Less Than 10 Kilograms: Indications and Procedural Outcome. J Interv Cardiol 2016; 29:646-653. [DOI: 10.1111/joic.12328] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Yves Wyss
- Paediatric Heart Centre; University Children's Hospital Zurich; Steinwiesstrasse Zurich Switzerland
| | - Daniel Quandt
- Paediatric Heart Centre; University Children's Hospital Zurich; Steinwiesstrasse Zurich Switzerland
- Children's Research Centre; University Children's Hospital Zurich; Switzerland
| | - Roland Weber
- Paediatric Heart Centre; University Children's Hospital Zurich; Steinwiesstrasse Zurich Switzerland
- Children's Research Centre; University Children's Hospital Zurich; Switzerland
| | - Brian Stiasny
- Paediatric Heart Centre; University Children's Hospital Zurich; Steinwiesstrasse Zurich Switzerland
- Children's Research Centre; University Children's Hospital Zurich; Switzerland
| | - Benedikt Weber
- Clinic for Cardiovascular Surgery; University Hospital of Zurich; Zurich Switzerland
| | - Walter Knirsch
- Paediatric Heart Centre; University Children's Hospital Zurich; Steinwiesstrasse Zurich Switzerland
- Children's Research Centre; University Children's Hospital Zurich; Switzerland
| | - Oliver Kretschmar
- Paediatric Heart Centre; University Children's Hospital Zurich; Steinwiesstrasse Zurich Switzerland
- Children's Research Centre; University Children's Hospital Zurich; Switzerland
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21
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O'Byrne ML, Gillespie MJ, Kennedy KF, Dori Y, Rome JJ, Glatz AC. The influence of deficient retro-aortic rim on technical success and early adverse events following device closure of secundum atrial septal defects: An Analysis of the IMPACT Registry ®. Catheter Cardiovasc Interv 2016; 89:102-111. [PMID: 27189502 DOI: 10.1002/ccd.26585] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 04/21/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND Concern regarding aortic erosion has focused attention on the retro-aortic rim in patients undergoing device closure of atrial septal defects (ASD), but its effect on early outcomes is not well studied. METHODS A multicenter retrospective cohort study of patients undergoing device occlusion of ASD between 1/2011-10/2014 was performed, using data from the IMproving Pediatric and Adult Congenital Treatment Registry. Subjects were divided between those with retro-aortic rim <5 and ≥5 mm. Primary outcomes were technical failure and major early adverse events. Case times were measured as surrogates of technical complexity. The effect of deficient retro-aortic rim on primary outcomes was assessed using hierarchical logistic regression, adjusting for other suspected covariates and assessing whether they represent independent risk factors RESULTS: 1,564 subjects (from 77 centers) were included, with deficient retro-aortic rim present in 40%. Technical failure occurred in 91 subjects (5.8%) and a major early adverse event in 64 subjects (4.1%). Adjusting for known covariates, the presence of a deficient retro-aortic rim was not significantly associated with technical failure (OR: 1.3, 95% CI: 0.9-2.1) or major early adverse event (OR: 0.7, 95% CI: 0.4-1. 2). Total case (P = 0.01) and fluoroscopy time (P = 0.02) were greater in subjects with deficient rim, but sheath time was not significantly different (P = 0.07). Additional covariates independently associated with these outcomes were identified. CONCLUSION Deficient retro-aortic rim was highly prevalent but not associated with increased risk of technical failure or early adverse events. Studies with longer follow-up are necessary to assess other outcomes, including device erosion. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Michael L O'Byrne
- Division of Cardiology, Children's National Medical Center, George Washington University School of Medicine and Health Sciences.,Department of Pediatrics, George Washington University School of Medicine and Health Sciences
| | - Matthew J Gillespie
- Division of Cardiology, The Children's Hospital of Philadelphia.,Department of Pediatrics, Perelman School of Medicine, The University of Pennsylvania, Philadelphia
| | | | - Yoav Dori
- Division of Cardiology, The Children's Hospital of Philadelphia.,Department of Pediatrics, Perelman School of Medicine, The University of Pennsylvania, Philadelphia
| | - Jonathan J Rome
- Division of Cardiology, The Children's Hospital of Philadelphia.,Department of Pediatrics, Perelman School of Medicine, The University of Pennsylvania, Philadelphia
| | - Andrew C Glatz
- Division of Cardiology, The Children's Hospital of Philadelphia.,Department of Pediatrics, Perelman School of Medicine, The University of Pennsylvania, Philadelphia.,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania
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Xie S, Fang J, Yang C, Ma L, Kuang S, Lu G, Zhang Y, Liao S. Percutaneous trans-jugular vein closure of atrial septal defect with steerable introducer under echocardiographic guidance. J Thorac Dis 2015; 7:1850-3. [PMID: 26623109 DOI: 10.3978/j.issn.2072-1439.2015.10.37] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND The aim of this study is to discuss a novel surgical approach of percutaneous trans-jugular vein closure of atrial septal defect (ASD) with steerable introducer under echocardiographic guidance. METHODS From January 2015 to June 2015, ten ASD patients underwent percutaneous trans-jugular vein ASD closure, the occluder placement could be perpendicular to the plane of ASD using the steerable introducer. RESULTS All cases succeeded. The average procedure time was 27.4±5.6 minutes; and the average intracardiac operation time was 6.7±5.2 minutes. No patient showed the residual shunt after the procedure. There was no clinical death, no arrhythmia, no hemolysis, no infection, no jugular vein damage or occlusion during patients' hospitalization. The post-operation follow up after one month of the operation showed that there was no residual shunt, no falling off or detachment of occluders or other complications. CONCLUSIONS It is a new surgical method with easy operation, mild damage and wider indication. Compared with the traditional percutaneous and transthoracic closure of ASD, it has obvious advantages.
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Affiliation(s)
- Shaobo Xie
- Department of Cardiothoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Jian Fang
- Department of Cardiothoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Chao Yang
- Department of Cardiothoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Lunchao Ma
- Department of Cardiothoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Suhua Kuang
- Department of Cardiothoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Guoliang Lu
- Department of Cardiothoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Yingyuan Zhang
- Department of Cardiothoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Shengjie Liao
- Department of Cardiothoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
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Device closure of secundum atrial septal defect in a 4.5 kilogram infant: Novel use of the Amplatzer DuctOccluder II device. Catheter Cardiovasc Interv 2015; 87:329-31. [DOI: 10.1002/ccd.25767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 11/30/2014] [Indexed: 11/07/2022]
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Crystal MA, Vincent JA. Atrial Septal Defect Device Closure in the Pediatric Population: A Current Review. CURRENT PEDIATRICS REPORTS 2015. [DOI: 10.1007/s40124-015-0086-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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25
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O'Byrne ML, Glatz AC, Goldberg DJ, Shinohara R, Dori Y, Rome JJ, Gillespie MJ. Accuracy of Transthoracic Echocardiography in Assessing Retro-aortic Rim prior to Device Closure of Atrial Septal Defects. CONGENIT HEART DIS 2015; 10:E146-54. [PMID: 25227430 PMCID: PMC4748720 DOI: 10.1111/chd.12226] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/24/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Deficient retro-aortic rim has been identified as a risk factor for device erosion following trans-catheter closure of atrial septal defects (ASDs). Transthoracic echocardiography (TTE) is the primary screening method for subjects for possible device closure of ASD, but its reliability in measuring retro-aortic rim size has not been assessed previously. DESIGN A single-institution cross-sectional analysis of children and adults referred for trans-catheter device closure of single ostium secundum ASD from January 1, 2005 to April 1, 2012 with reviewable TTE and trans-esophageal echocardiogram images was performed. Inter-rater reliability of measurements was tested in a 24% sample. Accuracy of TTE measurement of retro-aortic rim was assessed using a Bland-Altman plot with trans-esophageal echocardiogram measurement as the gold standard. Test characteristics of TTE detection of deficient retro-aortic rim were calculated. Risk factors for misclassification of deficient retro-aortic rim were assessed using receiver operator characteristic curves. Risk factors for measurement error were assessed through multivariate linear regression. RESULTS In total, 163 subjects of median age 5 years (range: 0.3-46 years) were included. Trans-thoracic echocardiography had 90% sensitivity, 84% specificity, 90% positive predictive value, and 83% negative predictive value to detect deficient retro-aortic rim. Bland-Altman plot demonstrated no fixed bias (P = .23), but errors in measurement increased on average as the aortic rim increased in size (P < .001). Prespecified patient level risk factors did not affect receiver operator characteristic curve area under the curve, nor were any patient-level risk factors independently associated with increased measurement error on TTE. CONCLUSIONS TTE is a sensitive and specific screening test for deficient retro-aortic rim across a range of patient ages and sizes.
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Affiliation(s)
- Michael L O'Byrne
- Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pa, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa, USA
| | - Andrew C Glatz
- Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pa, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa, USA
| | - David J Goldberg
- Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pa, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa, USA
| | - Russell Shinohara
- The Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa, USA
| | - Yoav Dori
- Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pa, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa, USA
| | - Jonathan J Rome
- Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pa, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa, USA
| | - Matthew J Gillespie
- Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pa, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa, USA
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26
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O'Byrne ML, Glatz AC, Sunderji S, Mathew AE, Goldberg DJ, Dori Y, Rome JJ, Gillespie MJ. Prevalence of deficient retro-aortic rim and its effects on outcomes in device closure of atrial septal defects. Pediatr Cardiol 2014; 35:1181-90. [PMID: 24823883 PMCID: PMC4167195 DOI: 10.1007/s00246-014-0914-6] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 04/25/2014] [Indexed: 12/01/2022]
Abstract
Deficient retro-aortic rim is of concern as a risk factor for aortic erosion after device closure of atrial septal defects (ASD). However, its prevalence and contribution to technical failure and adverse outcomes have not been delineated. A single-center retrospective cohort study of children and adults undergoing cardiac catheterization for device occlusion of ASD from 1 January 1999 to 1 April 2012 was performed. Risk factors for technical failure and early adverse outcome were assessed using multivariate logistic regression. During the study period, 445 consecutive subjects with a median age of 5.9 years (range, 0.8-80 years) underwent catheterization. Of the subjects with reviewable echocardiograms, 60 % had deficient retro-aortic rim. No attempt at device closure was made for 3.6 % of the subjects. Of the remaining 429 subjects, 96 % underwent successful device occlusion. Major early adverse events occurred in 1.2 % (95 % confidence interval 0.4-2.7 %) of the cases, all of them either device embolization or malposition. Deficient retro-aortic rim was not a risk factor for composite outcome of technical failure or early major adverse event. No deaths, late reinterventions, or erosion events occurred during 2,395 total person-years (median, 5.8 years) of follow-up evaluation. Deficient retro-aortic rim was associated with increased risk of device impingement on the aorta, but no association was seen between device impingement or deficient retro-aortic rim and the development of new/progressive aortic insufficiency. Deficient retro-aortic rim is highly prevalent but did not increase the risk of adverse outcomes. Its contribution to the risk of aortic erosion could not be addressed by this study.
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Affiliation(s)
- Michael L O'Byrne
- Division of Cardiology, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19147, USA,
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Impact of the Amplatzer atrial septal occluder device on left ventricular function in pediatric patients. Pediatr Cardiol 2013; 34:1645-51. [PMID: 23591799 DOI: 10.1007/s00246-013-0695-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Accepted: 03/27/2013] [Indexed: 10/26/2022]
Abstract
Percutaneous closure currently is widely considered to be the first-choice therapeutic option in the treatment of ostium secundum atrial septal defect (ASD). The Amplatzer Septal Occluder (ASO) device is the most used prosthesis, although its influence on cardiac function still is under active investigation. This study aimed to evaluate the impact of the ASO device size on left ventricular (LV) function in pediatric patients using the speckle-tracking strain imaging technology. The study enrolled 43 nonobese pediatric patients submitted to percutaneous ASD closure with the Amplatzer Septal Occluder device and grouped them according to the size of the occluding prosthesis into three groups: a small-device group (≤ 10 mm, group 1), a medium-size-device group (11-16 mm, group 2), and a large-device group (≥ 17 mm, group 3). Echocardiographic data were compared among the groups and with the data of an age-, weight-, and gender-matched control group (50 patients). The large-device group showed a significant impairment in the strain rate value of the basal LV segments. In particular, the mean basal circumferential and radial strain rate values were lower than either normal or the values of the small- and medium-device groups. However, only the absolute device diameter reached statistical significance in the multivariate analysis. The large Amplatzer Septal Occluding device significantly impaired LV systolic function, particularly that of juxtaprosthetic segments, as shown in the strain rate analysis.
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