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Xie LF, Lin Y, Chen MF, Zhang GC. Complete Transthoracic Echocardiography for the Assessment and Guidance of Percutaneous Atrial Septal Defect Closure in Adults without Balloon Sizing: An Observed Study with a 10-Year Follow-Up. J Cardiovasc Dev Dis 2023; 10:321. [PMID: 37623334 PMCID: PMC10455240 DOI: 10.3390/jcdd10080321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/26/2023] Open
Abstract
OBJECTIVES This study aims to determine if complete transthoracic echocardiography (TTE)-guided percutaneous atrial septal defect (ASD) closure without balloon sizing could be safe and efficacious in adult patients. METHODS A total of 551 patients with ASDs were enrolled in this study, of which 438 patients underwent percutaneous ASD closure. Patients who received TTE-guided percutaneous ASD closure were classified into group T, and those who underwent a procedure that was guided by transesophageal echocardiography (TEE) were classified into group E. The clinical characteristics and the outcomes of the patients were analyzed. RESULTS The characteristics were comparable at baseline, except for the body mass index (BMI) (21.6 ± 5.3 vs. 23.8 ± 7.1, p < 0.001) between group T and group E. No significant difference was observed between the two groups regarding in-hospital outcomes, except for the duration of the procedure (29.8 ± 15.3 min vs. 41.5 ± 20.4 min), the length of stay in the hospital (2.1 ± 2.3 d vs. 2.9 ± 2.6 d), and hospital costs (USD 6233.3 ± 312.4 vs. USD 6673.7 ± 446.9). There were no significant differences in the incidences of long-term complications, cardiac chamber sizes, and tricuspid regurgitation severity between the patients in the two groups during the 10-year follow-up period. CONCLUSION TTE may be as safe and efficacious as TEE for the assessment and guidance of percutaneous ASD closure without balloon sizing in adult patients with lower BMIs who are commonly found in East Asia.
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Affiliation(s)
- Lin-Feng Xie
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou 350000, China; (L.-F.X.); (Y.L.); (M.-F.C.)
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou 350000, China
- Fujian Provincial Center for Cardiovascular Medicine, Fuzhou 350000, China
| | - Yong Lin
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou 350000, China; (L.-F.X.); (Y.L.); (M.-F.C.)
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou 350000, China
- Fujian Provincial Center for Cardiovascular Medicine, Fuzhou 350000, China
| | - Mei-Fang Chen
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou 350000, China; (L.-F.X.); (Y.L.); (M.-F.C.)
- Fujian Provincial Center for Cardiovascular Medicine, Fuzhou 350000, China
| | - Gui-Can Zhang
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou 350000, China; (L.-F.X.); (Y.L.); (M.-F.C.)
- Fujian Provincial Center for Cardiovascular Medicine, Fuzhou 350000, China
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Transcatheter closure of a residual shunt with posteroinferior deficient rim after surgical closure of an ASD: a case report. BMC Cardiovasc Disord 2020; 20:343. [PMID: 32698795 PMCID: PMC7374861 DOI: 10.1186/s12872-020-01624-9] [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: 05/29/2020] [Accepted: 07/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are few reports in the literature of device closure of residual shunts following initial surgical closure of an atrial septal defect (ASD). This case study reports one such case. We describe here a case of secundum type ASD that was initially closed surgically, followed by device closure of a residual shunt with a posteroinferior deficient rim. CASE PRESENTATION A 7-month-old boy was admitted to our hospital for elective surgery to surgically correct a secundum type ASD. Unfortunately, a residual shunt 3.5 mm in diameter appeared before discharge and was enlarged at1-year follow-up. The cause of this residual shunt was dehiscence at the posteroinferior aspect, and the posteroinferior rim was 3.7 mm. After careful discussion and preparation, we proceeded with an interventional procedure. A 16 mm ASD occluder (AGA Medical Corp, Plymouth, Minnesota) was deployed successfully with no residual shunt. In some cases of ASD, interventional therapy is not considered due to the size and position of the defect, but we show here, a successful case of interventional therapy for a residual shunt with a deficient rim. CONCLUSION We have presented a case in which a postoperative residual shunt with a deficient rim was successfully closed with interventional therapy.
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Transcatheter Atrial Septal Defect Closure in Children with and without Fluoroscopy: A Comparison. J Interv Cardiol 2019; 2019:6598637. [PMID: 31772540 PMCID: PMC6739773 DOI: 10.1155/2019/6598637] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/30/2019] [Accepted: 03/04/2019] [Indexed: 12/30/2022] Open
Abstract
Objective The aim of this study was to compare feasibility, effectiveness, safety, and outcome of atrial septal defect (ASD) device closure in children with and without fluoroscopy guidance. Methods and Results Children undergoing transcatheter ASD closure between 2002 and 2016 were included into this single center, retrospective study. Patients were analysed in two groups [1: intraprocedural fluoroscopy ± transoesophageal echocardiography (TOE) guidance; 2: TOE guidance alone]. Three-hundred-ninety-seven children were included, 238 (97 male) in group 1 and 159 (56 male) in group 2. Two-hundred-twenty-nine of 238 (96%) patients underwent successful fluoroscopy guided ASD closures versus 154/159 (97%) successful procedures with TOE guidance alone. Median weight (IQR) at intervention was 20kg (16.0-35.0) in group 1 versus 19.3kg (16.0-31.2) in group 2. Mean (SD) preinterventional ASD diameter was 12.4mm (4.4) in group 1 versus 12.2mm (3.9) in group 2. There was no significant difference in number of defects or characteristics of ASD rims. Median procedure time was shorter in group 2 [60min (47-86) versus 34min (28-44)]. Device-size-to-defect-ratio was similar in both groups [group 1: 1.07 versus group 2: 1.09]. There were less technical intraprocedural events in group 2 [10 (6.3%) versus 47 (20%)]. Intraprocedural complications were less frequent in group 2 [1 (0.6%) versus 8 (3.3%)]. Conclusion Transcatheter ASD device closure with TOE guidance alone (i.e., without fluoroscopy) is as effective and safe as ASD closure with fluoroscopy guidance. As fluoroscopy remains an important adjunct to transoesophageal echocardiography, especially in complex defects and complications, procedures are always performed in a fully equipped cardiac catheterization laboratory.
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Almanla A, Charafeddine F, Abutaqa M, Mustafa H, Tabbakh A, Hussein HB, Sawaya F, El-Rassi I, Arabi M, Bulbul Z, Bitar F. Transcatheter Closure of Atrial Septal Defects: Comparable Experience and Outcomes Between Developing and Developed Countries. Pediatr Cardiol 2019; 40:610-615. [PMID: 30607441 DOI: 10.1007/s00246-018-2034-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 12/05/2018] [Indexed: 10/27/2022]
Abstract
Atrial septal defect (ASD) is one of the most common congenital heart defects. Transcatheter device closure of ASDs is safe and effective with most of the reported data being described from developed countries. To evaluate the short and mid-term results and experience of device closure of ASDs at a tertiary center in a developing country and compare it to that from developed countries. Retrospective study based on data collection from all patients who have undergone transcatheter percutaneous device closure for ASD from January 2005 until December 2017 at the Children's Heart Center at the American University of Beirut, Medical Center, Lebanon. During the study period, a total of 254 cardiac catheterizations were performed for device closure of ASDs. The mean age of the patients was 18 ± 17.9 years with 37% being less than 6 years of age. Females were 54%. Defect size ranged from 7 to 37 mm and device size ranged from 8 to 40 mm. The procedure was executed with a success rate of 96%. Five patients had device embolization (2%); in one patient the device was snared and for the remainder the devices were removed surgically. None of the study patients had thrombus formation, neurological complications, bacterial endocarditis, or cardiac erosions. There was no mortality. Device closure of ASDs at our tertiary center in a developing country has an effective and safe profile with excellent results and low complications rates, which compare favorably to those reported from centers in developed countries.
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Affiliation(s)
- Ahmad Almanla
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
| | - Fatme Charafeddine
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon.,Children's Heart Center, AUBMC, Beirut, Lebanon
| | - Mohamad Abutaqa
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon.,Children's Heart Center, AUBMC, Beirut, Lebanon
| | - Hala Mustafa
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
| | - Anas Tabbakh
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon.,Children's Heart Center, AUBMC, Beirut, Lebanon
| | - Haytham Bou Hussein
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon.,Children's Heart Center, AUBMC, Beirut, Lebanon
| | | | | | - Mariam Arabi
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon.,Children's Heart Center, AUBMC, Beirut, Lebanon
| | - Ziad Bulbul
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon.,Children's Heart Center, AUBMC, Beirut, Lebanon
| | - Fadi Bitar
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon. .,Children's Heart Center, AUBMC, Beirut, Lebanon. .,Children's Heart Center, Department of Pediatrics and Adolescent Medicine, American University of Beirut, PO Box 11-0236, 1107 2020, Riad El Solh, Beirut, Lebanon.
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Faccini A, Butera G. Atrial septal defect (ASD) device trans-catheter closure: limitations. J Thorac Dis 2018; 10:S2923-S2930. [PMID: 30305952 DOI: 10.21037/jtd.2018.07.128] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Transcatheter closure is a widespread technique used to treat secundum atrial septal defects (ASDs). When compared to surgery, it provides a less invasive approach with quicker recovery and reduced physical and psychological impact. Nowadays, almost 85-90% of all secundum ASD can be closed by using a transcatheter approach. However, several limitations may have a significant impact on the feasibility and success of percutaneous ASD closure. Limitations can be grouped as: (I) anatomical; (II) device-related; (III) associated defects and natural history associated issues; (IV) physiological; (V) complications. Physician should be aware of potential limits of percutaneous ASD closure.
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Affiliation(s)
- Alessia Faccini
- Department of Congenital Cardiology and Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Gianfranco Butera
- Department of Congenital Cardiology and Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
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