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Olejnik P, Tittel P, Venczelova Z, Kardos M, Tomko J, Bartova M, Masura J. Long-term follow-up of percutaneous secundum-type atrial septal defect closure using Amplatzer Septal Occluder since 1995: a single-centre study. Cardiol Young 2024; 34:643-646. [PMID: 37694546 DOI: 10.1017/s1047951123003190] [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: 09/12/2023]
Abstract
INTRODUCTION The goal of this single-centre study was to evaluate long-term results of percutaneous closure of secundum-type atrial septal defect using Amplatzer Septal Occluder with the follow-up to 25 years. METHODS A retrospective analysis of patients who underwent percutaneous closure of secundum-type atrial septal defect between September 1995 and October 2012 in our institution was performed. All procedures were performed after fulfilling strict indication criteria. More than 5 years follow-up was reached in 651/803 patients (81%) with median follow-up time of 12 (5-25) years. RESULTS The mean stretched defect diameter was 14,0 ± 5,2 mm. Early reintervention due to moderate or severe residual atrial septal defect had to be performed in 3/803 patients (0,03%). The incidence of long-term moderate or severe residual atrial septal defect was 0,0%. The complete closure rate at 10-year follow-up was 98,5%, as trivial residual shunts persisted in 8/508 patients (1,5%). A significant rate of the echocardiographic right ventricular end-diastolic diameter post-procedural normalisation (p < 0,05) was encountered. The rate of major complications was 0,5%. One device embolisation, one thrombus formation at the occluder surface, and one cardiac erosion in periprocedural or short post-procedural course were experienced. Only one late complication of infective endocarditis at the region of implanted occluder and the aortic valve was detected. The survival rate of all followed patients was 100%. CONCLUSIONS Percutaneous closure of secundum-type atrial septal defect using Amplatzer Septal Occluder is a safe and effective procedure accounting for a very low incidence of major complications in the long-term follow-up.
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Affiliation(s)
- Peter Olejnik
- National Institute of Cardiovascular Diseases, Pediatric Cardiac Center, Bratislava, Slovakia
- Department of Pediatric Cardiology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Peter Tittel
- National Institute of Cardiovascular Diseases, Pediatric Cardiac Center, Bratislava, Slovakia
| | - Zuzana Venczelova
- National Institute of Cardiovascular Diseases, Pediatric Cardiac Center, Bratislava, Slovakia
| | - Marek Kardos
- National Institute of Cardiovascular Diseases, Pediatric Cardiac Center, Bratislava, Slovakia
| | - Jaroslav Tomko
- National Institute of Cardiovascular Diseases, Pediatric Cardiac Center, Bratislava, Slovakia
- Department of Pediatric Cardiology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Maria Bartova
- National Institute of Cardiovascular Diseases, Pediatric Cardiac Center, Bratislava, Slovakia
- Department of Pediatric Cardiology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Jozef Masura
- National Institute of Cardiovascular Diseases, Pediatric Cardiac Center, Bratislava, Slovakia
- Department of Pediatric Cardiology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
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Bou-Chaaya RG, Zhu Z, Duarte VE, Lin CH. Percutaneous Structural Interventions in Adult Congenital Heart Disease: State-of-the-Art Review. Methodist Debakey Cardiovasc J 2023; 19:78-90. [PMID: 37213883 PMCID: PMC10198245 DOI: 10.14797/mdcvj.1219] [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: 02/16/2023] [Accepted: 04/12/2023] [Indexed: 05/23/2023] Open
Abstract
Structural interventions play a crucial role in the management of adult congenital heart disease (ACHD). In recent years, this field has seen significant advancements in catheter-based procedures despite limited investment from industry and lack of device development specific to this population. Because each patient is unique in their anatomy, pathophysiology, and surgical repair, many devices are used off-label with a "best fit" strategy. Therefore, continuous innovation is needed to adapt what is available to ACHD and to increase collaboration with industry and regulatory bodies to develop dedicated equipment. These innovations will further advance the field and offer this growing population less invasive options with fewer complications and faster recovery times. In this article, we summarize some of the contemporary structural interventions performed in adults with congenital defects and present cases performed at Houston Methodist to better illustrate them. We aim to offer a greater understanding of the field and stimulate interest in this rapidly growing specialty.
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Affiliation(s)
- Rody G. Bou-Chaaya
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, US
- *Rody G. Bou Chaaya and Zhihao Zhu contributed equally
| | - Zhihao Zhu
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, US
- *Rody G. Bou Chaaya and Zhihao Zhu contributed equally
| | - Valeria E. Duarte
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, US
| | - Chun Huie Lin
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, US
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Kim AY, Woo W, Lim BJ, Jung JW, Young Choi J, Kim YJ. Assessment of Device Neoendothelialization With Cardiac Computed Tomography Angiography After Transcatheter Closure of Atrial Septal Defect. Circ Cardiovasc Imaging 2022; 15:e014138. [PMID: 35861980 PMCID: PMC9298151 DOI: 10.1161/circimaging.122.014138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although the transcatheter closure of atrial septal defect was established as the treatment of choice several decades ago, the process of device neoendothelialization (NE) in humans is not well understood. We aimed to measure the extent of device NE using cardiac computed tomography angiography and analyze its risk factors.
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Affiliation(s)
- Ah Young Kim
- Division of Pediatric Cardiology, Department of Pediatrics, Severance Hospital (A.Y.K., J.W.J., J.Y.C.), Yonsei University College of Medicine, Seoul, Korea
| | - Wongi Woo
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital (W.W.), Yonsei University College of Medicine, Seoul, Korea
| | - Beom Jin Lim
- Department of Pathology, Gangnam Severance Hospital (B.J.L.), Yonsei University College of Medicine, Seoul, Korea
| | - Jo Won Jung
- Division of Pediatric Cardiology, Department of Pediatrics, Severance Hospital (A.Y.K., J.W.J., J.Y.C.), Yonsei University College of Medicine, Seoul, Korea
| | - Jae Young Choi
- Division of Pediatric Cardiology, Department of Pediatrics, Severance Hospital (A.Y.K., J.W.J., J.Y.C.), Yonsei University College of Medicine, Seoul, Korea
| | - Young Jin Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital (Y.J.K)
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Nishioka M, Hoshino K, Ugaki S. Late bacterial endocarditis after percutaneous atrial septal defect closure. Cardiol Young 2022; 33:1-3. [PMID: 35481493 DOI: 10.1017/s1047951122001366] [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
Percutaneous atrial septal defect closure is widely used as an alternative to surgical repair in many hospitals. Infective endocarditis related to occluding devices is commonly known, but following that atrial septal defect closure with a device in a child is rare. This report describes an 11-year-old girl who developed late-stage bacterial endocarditis following incomplete endothelialisation after a percutaneous procedure.
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Affiliation(s)
- Makiko Nishioka
- Department of Pediatric Cardiology, Saitama Children's Medical Center, Saitama330-8777, Japan
| | - Kenji Hoshino
- Department of Pediatric Cardiology, Saitama Children's Medical Center, Saitama330-8777, Japan
| | - Shinya Ugaki
- Department of Pediatric Cardiovascular Surgery, Saitama Children's Medical Center, Saitama330-8777, Japan
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Effectiveness and Safety of Transcatheter Atrial Septal Defect Closure in Adults with Systemic Essential Hypertension. J Clin Med 2022; 11:jcm11040973. [PMID: 35207245 PMCID: PMC8879914 DOI: 10.3390/jcm11040973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/24/2022] [Accepted: 02/10/2022] [Indexed: 12/27/2022] Open
Abstract
Concomitant systemic essential hypertension (HTN) in adults with a secundum atrial septal defect (ASD) can unfavorably affect the hemodynamics and transcatheter ASD closure (ASDC) effects. This study aims to assess the effectiveness and safety of ASDC in adults with HTN in real-world clinical practice. Right ventricular (RV) reverse remodeling (RVR) and the lack of a left-to-right interatrial residual shunt (NoRS) in echocardiography 24 h and 6 months (6 M) post-ASDC, and ASDC-related complications within 6 M were evaluated in 184 adults: 79 with HTN (HTN+) and 105 without HTN (HTN−). Compared to HTN−, HTN+ patients were older and had a greater RV size and the prevalence of atrial arrhythmias, chronic heart failure, nonobstructive coronary artery disease, diabetes, hyperlipidemia, and left ventricular diastolic dysfunction. ASDC was successful and resulted in RVR, NoRS, and a lack of ASDC-related complications in the majority of HTN+ patients both at 24 h and 6 M. HTN+ and HTN− did not differ in ASD size, a successful implantation rate (98.7% vs. 99%), RVR 24 h (46.8% vs. 46.7%) and 6 M (59.4% vs. 67.9%) post-ASDC, NoRS 24 h (79% vs. 81.5%) and 6 M (76.6% vs. 86.9%) post-ASDC, and the composite of RVR and NoRS at 6 M (43.8% vs. 57.1%). Most ASDC-related complications in HTN+ occurred within 24 h and were minor; however, major complications such as device embolization within 24 h and mitral regurgitation within 6 M were observed. No differences between HTN+ and HTN− were observed in the total (12.7% vs. 9.5%) and major (5.1% vs. 4.8%) complications. Transcatheter ASDC is effective and safe in adults with secundum ASD and concomitant HTN in real-world clinical practice; however, proper preprocedural management and regular long-term follow-up post-ASDC are required.
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Edlinger C, Paar V, Kheder SH, Krizanic F, Lalou E, Boxhammer E, Butter C, Dworok V, Bannehr M, Hoppe UC, Kopp K, Lichtenauer M. Endothelialization and Inflammatory Reactions After Intracardiac Device Implantation. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1401:1-22. [DOI: 10.1007/5584_2022_712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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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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Tanabe Y, Suzuki T, Kuwata S, Izumo M, Kawaguchi H, Ogoda S, Kotoku N, Sato Y, Nishikawa H, Kaihara T, Koga M, Mitarai T, Okuyama K, Kamijima R, Ishibashi Y, Yoneyama K, Higuma T, Harada T, Akashi YJ. Angioscopic Evaluation of Atrial Septal Defect Closure Device Neo-Endothelialization. J Am Heart Assoc 2021; 10:e019282. [PMID: 34533044 PMCID: PMC8649546 DOI: 10.1161/jaha.120.019282] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Current guidelines recommend at least 6 months of antithrombotic therapy and antibiotic prophylaxis after septal‐occluding device deployment in transcatheter closure of atrial septal defect. It has been estimated that it takes ≈6 months for complete neo‐endothelialization; however, neo‐endothelialization has not previously been assessed in vivo in humans. Methods and Results The neointimal coverage of septal occluder devices was evaluated 6 months after implantation in 15 patients by angioscopy from the right atrium. Each occluder surface was divided into 9 areas; the levels of endothelialization in each area were semiquantitatively assessed by 4‐point grades. Device neo‐endothelialization was sufficient in two thirds of patients, but insufficient in one third. In the comparison between patients with sufficiently endothelialized devices of average grade score ≥2 (good endothelialization group, n=10) and those with poorly endothelialized devices of average grade score <2 (poor endothelialization group, n=5), those in the poor endothelialization group had larger devices deployed (27.0 mm [25.0–31.5 mm] versus 17.0 mm [15.6–22.5 mm], respectively) and progressive right heart dilatation. The endothelialization was poorer around the central areas. Moreover, the prevalence of thrombus formation on the devices was higher in the poorly endothelialized areas than in the sufficiently endothelialized areas (Grade 0, 94.1%; Grade 1, 63.2%; Grade 2, 0%; Grade 3, 1.6%). Conclusions Neo‐endothelialization on the closure devices varied 6 months after implantation. Notably, poor endothelialization and thrombus attachment were observed around the central areas and on the larger devices.
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Affiliation(s)
- Yasuhiro Tanabe
- Division of Cardiology Department of Internal Medicine St. Marianna University School of Medicine Kanagawa Japan
| | - Tomomi Suzuki
- Division of Cardiology Department of Internal Medicine St. Marianna University School of Medicine Kanagawa Japan
| | - Shingo Kuwata
- Division of Cardiology Department of Internal Medicine St. Marianna University School of Medicine Kanagawa Japan
| | - Masaki Izumo
- Division of Cardiology Department of Internal Medicine St. Marianna University School of Medicine Kanagawa Japan
| | - Hiromasa Kawaguchi
- Department of Clinical Engineering St. Marianna University School of Medicine Kanagawa Japan
| | - Shun Ogoda
- Department of Clinical Engineering St. Marianna University School of Medicine Kanagawa Japan
| | - Nozomi Kotoku
- Division of Cardiology Department of Internal Medicine St. Marianna University School of Medicine Kanagawa Japan
| | - Yukio Sato
- Division of Cardiology Department of Internal Medicine St. Marianna University School of Medicine Kanagawa Japan
| | - Haruka Nishikawa
- Division of Cardiology Department of Internal Medicine St. Marianna University School of Medicine Kanagawa Japan
| | - Toshiki Kaihara
- Division of Cardiology Department of Internal Medicine St. Marianna University School of Medicine Kanagawa Japan
| | - Masashi Koga
- Division of Cardiology Department of Internal Medicine St. Marianna University School of Medicine Kanagawa Japan
| | - Takanobu Mitarai
- Division of Cardiology Department of Internal Medicine St. Marianna University School of Medicine Kanagawa Japan
| | - Kazuaki Okuyama
- Division of Cardiology Department of Internal Medicine St. Marianna University School of Medicine Kanagawa Japan
| | - Ryo Kamijima
- Division of Cardiology Department of Internal Medicine St. Marianna University School of Medicine Kanagawa Japan
| | - Yuki Ishibashi
- Division of Cardiology Department of Internal Medicine St. Marianna University School of Medicine Kanagawa Japan
| | - Kihei Yoneyama
- Division of Cardiology Department of Internal Medicine St. Marianna University School of Medicine Kanagawa Japan
| | - Takumi Higuma
- Division of Cardiology Department of Internal Medicine St. Marianna University School of Medicine Kanagawa Japan
| | - Tomoo Harada
- Division of Cardiology Department of Internal Medicine St. Marianna University School of Medicine Kanagawa Japan
| | - Yoshihiro J Akashi
- Division of Cardiology Department of Internal Medicine St. Marianna University School of Medicine Kanagawa Japan
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Takaya Y, Akagi T, Sakamoto I, Kanazawa H, Nakazawa G, Murakami T, Yao A, Nanasato M, Saji M, Hirokami M, Fuku Y, Hosokawa S, Tada N, Matsumoto K, Imai M, Nakagawa K, Ito H. Efficacy of treat-and-repair strategy for atrial septal defect with pulmonary arterial hypertension. Heart 2021; 108:382-387. [PMID: 34415851 PMCID: PMC8862039 DOI: 10.1136/heartjnl-2021-319096] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/21/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Therapeutic strategies for atrial septal defect (ASD) with severe pulmonary arterial hypertension (PAH) are controversial. This study aimed to evaluate the efficacy of PAH-specific medications and subsequent transcatheter closure (ie, treat-and-repair strategy) on clinical outcomes. METHODS We enrolled 42 patients who were referred to 13 institutions for consideration of ASD closure with concomitant PAH and underwent the treat-and-repair strategy. The endpoint was cardiovascular death or hospitalisation due to heart failure or exacerbated PAH. RESULTS At baseline prior to PAH-specific medications, pulmonary to systemic blood flow ratio (Qp:Qs), pulmonary vascular resistance (PVR), and mean pulmonary artery pressure (PAP) were 1.9±0.8, 6.9±3.2 Wood units and 45±15 mm Hg. Qp:Qs was increased to 2.4±1.2, and PVR and mean PAP were decreased to 4.0±1.5 Wood units and 35±9 mm Hg at the time of transcatheter ASD closure after PAH-specific medications. Transcatheter ASD closure was performed without any complications. During a median follow-up period of 33 months (1-126 months) after transcatheter ASD closure, one older patient died and one patient was hospitalised due to heart failure, but the other patients survived with an improvement in WHO functional class. PAP was further decreased after transcatheter ASD closure. CONCLUSIONS The treat-and-repair strategy results in low complication and mortality rates with a reduction in PAP in selected patients with ASD complicated with PAH who have a favourable response of medical therapy.
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Affiliation(s)
- Yoichi Takaya
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Teiji Akagi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Ichiro Sakamoto
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Hideaki Kanazawa
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Gaku Nakazawa
- Department of Cardiology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Tsutomu Murakami
- Department of Cardiology, Tokai University Hospital, Isehara, Japan
| | - Atsushi Yao
- Division for Health Service Promotion, University of Tokyo, Tokyo, Japan
| | - Mamoru Nanasato
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Mike Saji
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Mitsugu Hirokami
- Department of Cardiology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Yasushi Fuku
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Shinobu Hosokawa
- Department of Cardiology, Tokushima Red Cross Hospital, Komatsushima, Japan
| | - Norio Tada
- Department of Cardiology, Sendai Kousei Hospital, Sendai, Japan
| | - Kensuke Matsumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masao Imai
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Koji Nakagawa
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Cobra-head and other shape-memory abnormalities of nitinol atrial septal occluders: incidence, predisposing factors, and outcomes. Cardiol Young 2021; 31:949-956. [PMID: 33441216 DOI: 10.1017/s1047951120004771] [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
BACKGROUND Shape-memory abnormalities are seen in some nitinol atrial septal occluders. Variably described as cobra-head, tulip, and others, their incidence, mechanisms, clinical impact, and outcome have not been systematically analysed. METHODS We retrospectively reviewed all consecutive device closures in the last 6 years for deformations. Type and size of the occluder, deployment technique, size, and angulation/kinking of the delivery sheath were analysed. Procedural success, duration, and other complications were studied. RESULTS A total of 112 devices (11.8%) among 950 occluders used in 936 patients showed deformities. Fourteen of 936 received 2 devices. Deformities were transient and self-correcting in 40%. Multivariate analysis showed significant associations with oversized sheaths (p = 0.004), kinked/angulated sheaths (p < 0.001), special deployment techniques (p < 0.001), and twist in the device waist (p = 0.011). Despite more frequent deformities with Figulla (15.6%) and Amplatzer (13.9%) occluders than Cera occluders (6.6%) and larger devices (>24 mm - 14.6%) than smaller devices (less than or equal to 24 mm - 9.7%), they were not significant on multivariate analysis. In vivo manipulations corrected most deformities; nineteen needed in vitro reformations and four needed a change of device. Despite prolongation of the procedure, repeated attempts (mean 2.76 ± 1.7 attempts, with a range from 1 to 9 attempts), and supraventricular tachycardia in two patients, there were no serious adverse effects. CONCLUSIONS Deformations were frequent in 11.8% of atrial septal occluders on a targeted search. Oversized and angulated/kinked sheaths, special techniques like pulmonary vein deployment and twist in device waist during procedure predisposed to deformities. While most deformities were corrected with manipulations, removal of the device was infrequently needed and change of device was rarely required. Long procedural time and multiple attempts for deployment did not affect procedural success.
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Takaya Y, Akagi T, Nakagawa K, Nakayama R, Miki T, Toh N, Ito H. Feasibility of transcatheter closure for absent aortic rim in patients with atrial septal defect. Catheter Cardiovasc Interv 2021; 97:859-864. [PMID: 33458916 DOI: 10.1002/ccd.29457] [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] [Received: 10/13/2020] [Revised: 12/15/2020] [Accepted: 12/24/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVES This study aimed to assess the feasibility of transcatheter atrial septal defect (ASD) closure in patients with absent aortic rim. BACKGROUND The indication of transcatheter closure for ASD with absent aortic rim is controversial. METHODS We enrolled 547 patients with ASD who were scheduled for transcatheter closure. Morphologies of aortic rim were evaluated using transesophageal echocardiography (TEE). RESULTS Aortic rim of <5 mm was observed in 396 (72%) patients; 128 (23%) had absent aortic rim of 0 mm, and 268 (49%) had deficient aortic rim of >0 to <5 mm. Patients with absent aortic rim frequently had aortic rim absence at an angle of 0° on TEE and septal malalignment. Of the 128 patients with absent aortic rim, 126 (98%) successfully underwent transcatheter closure, while 2 (2%) failed transcatheter closure due to a large defect with severe septal malalignment. The success rate of transcatheter closure was similar between patients with absent aortic rim and those with deficient aortic rim (98% vs. 99%, p = .45). After the procedure, no patients had erosion or device embolization during a median follow-up of 24 months. CONCLUSIONS Transcatheter closure was successfully performed without adverse events in patients with absent aortic rim, as well as in those with deficient aortic rim. Our findings can be valuable to determine the indication of transcatheter closure in patients with ASD.
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Affiliation(s)
- Yoichi Takaya
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Teiji Akagi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Koji Nakagawa
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Rie Nakayama
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Takashi Miki
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Norihisa Toh
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Okayama, Japan
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12
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Ogiso M, Ejima K, Shoda M, Sugiyama H, Kato K, Tanaka H, Ohki H, Miura M, Hagiwara N. Efficacy of catheter ablation for patients with atrial fibrillation and atrial septal defect. J Cardiovasc Electrophysiol 2021; 32:279-286. [PMID: 33382508 DOI: 10.1111/jce.14862] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/14/2020] [Accepted: 12/04/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Given that few studies investigated the efficacy of catheter ablation (CA) in patients with paroxysmal atrial fibrillation (AF) and atrial septal defect (ASD), this study evaluated its effectiveness in patients with paroxysmal AF and ASD. METHODS AND RESULTS Of the 216 patients who underwent ASD device closure at two hospitals, 36 patients had paroxysmal AF. After April 2012, CA for AF was performed before ASD device closure (ASD-CA group; n = 20). The ASD-CA group had a significantly higher AF-free survival rate after ASD device closure compared to patients without CA for AF before ASD device closure (ASD-non-CA group; n = 16) (ASD-CA group: 2 patients vs. ASD-non-CA group: 9 patients; follow-up period: 4.2 ± 2.5 years; log-rank p = .01). In addition, the AF-free survival rates were similar between the ASD-CA group and 80 paroxysmal AF patients who underwent CA without any detectable structural heart disease (non-SHD-CA group). The two groups were matched by propensity scores for age, sex, and left atrium dimension (ASD-CA group: 2 patients vs. non-SHD-CA group: 5 patients; follow-up period: 3.3 ± 1.8 years; log-rank p = .28). CONCLUSION CA for AF before ASD device closure might be an effective treatment option for patients with paroxysmal AF and ASD.
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Affiliation(s)
- Masataka Ogiso
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.,Department of Pediatric Cardiology and Adult Congenital Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Koichiro Ejima
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Morio Shoda
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hisashi Sugiyama
- Department of Pediatric Cardiology and Adult Congenital Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Ken Kato
- Department of Cardiology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Hiroyuki Tanaka
- Department of Cardiology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Hirotaka Ohki
- Department of Cardiology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Masaru Miura
- Department of Cardiology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Nobuhisa Hagiwara
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
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Nakayama R, Takaya Y, Akagi T, Watanabe N, Miki T, Nakagawa K, Toh N, Ito H. Efficacy and safety of atrial septal defect closure using Occlutech Figulla Flex II compared with Amplatzer Septal Occluder. Heart Vessels 2021; 36:704-709. [PMID: 33386412 DOI: 10.1007/s00380-020-01739-1] [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] [Received: 08/21/2020] [Accepted: 11/20/2020] [Indexed: 11/25/2022]
Abstract
Few studies have reported the efficacy of Occlutech Figulla Flex II (FFII) device compared with Amplatzer Septal Occluder (ASO) device. The aim of this study was to examine the efficacy and safety of FFII compared with ASO for transcatheter atrial septal defect (ASD) closure. We retrospectively evaluated 190 patients using FFII and 190 patients using ASO who underwent transcatheter ASD closure. ASD characteristics were evaluated by transesophageal echocardiography. The prevalence of procedural complications, including erosion, device embolization, stroke, and new-onset atrial arrhythmia, and the presence of a residual shunt were evaluated between the two groups during 12-month follow-up. FFII was used more frequently than ASO in patients with a deficient aortic rim or septal malalignment (P = 0.02, P < 0.01, respectively). The procedural complications of erosion, device embolization, and stroke did not occur in any patients. New-onset atrial arrhythmia occurred in 3 patients of the FFII group and 4 patients of the ASO group, and the difference between the two groups was not significant (P = 0.70). A large residual shunt (≥ 3 mm) was observed in 6 patients of the FFII group and 5 patients of the ASO group, and the difference between the two groups was not significant (P = 0.76). FFII was used frequently in patients with high-risk ASD morphology; however, there was no difference in the prevalence of procedural complications or efficacy between patients using FFII and those using ASO.
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Affiliation(s)
- Rie Nakayama
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Yoichi Takaya
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
| | - Teiji Akagi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Nobuhisa Watanabe
- Division of Medical Support, Okayama University Hospital, Okayama, Japan
| | - Takashi Miki
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Koji Nakagawa
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Norihisa Toh
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
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14
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Takaya Y, Akagi T, Nakagawa K, Nakayama R, Miki T, Toh N, Ito H. Morphological assessments of deficient posterior-inferior rim for transcatheter closure of atrial septal defect. Catheter Cardiovasc Interv 2021; 97:135-141. [PMID: 32790128 DOI: 10.1002/ccd.29182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/26/2020] [Accepted: 07/19/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES This study aimed to determine morphological characteristics of deficient posterior-inferior rim for transcatheter atrial septal defect (ASD) closure success. BACKGROUND The feasibility of transcatheter closure of ASD with deficient posterior-inferior rim remains unclear. METHODS Of 869 patients with ASD who were scheduled transcatheter closure, 121 with posterior-inferior rim of <5 mm were included. Posterior-inferior rim morphologies were evaluated by transesophageal echocardiography. RESULTS One hundred six patients successfully underwent transcatheter closure, while 15 patients failed. These 15 patients had complete deficient posterior-inferior rim of 0 mm and/or a large defect of ≥38 mm. Multivariate logistic regression analysis showed that transcatheter closure failure was independently related to complete deficient posterior-inferior rim and a large defect of ≥38 mm. Incomplete deficient posterior-inferior rim of >0 to <5 mm was observed in 84 patients. All these patients successfully underwent transcatheter closure, except two patients with a large defect of ≥38 mm. Complete deficient posterior-inferior rim was observed in 37 patients. The frequency of complete deficient posterior-inferior rim was higher in patients who failed transcatheter closure (87% vs. 23%, p < .01), but transcatheter closure was performed successfully if the range of complete deficient rim was ≤30°. After the procedure, no adverse events occurred during a median follow-up of 24 months. CONCLUSIONS Most patients with deficient posterior-inferior rim successfully underwent transcatheter closure. Transcatheter closure could be performed even in patients with complete deficient posterior-inferior rim if the range was partial. Our findings can help to identify candidates for transcatheter closure.
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Affiliation(s)
- Yoichi Takaya
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Teiji Akagi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Koji Nakagawa
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Rie Nakayama
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Takashi Miki
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Norihisa Toh
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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15
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Shape Memory Biomaterials and Their Clinical Applications. Biomed Mater 2021. [DOI: 10.1007/978-3-030-49206-9_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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16
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Outcomes of Device Closure of Atrial Septal Defects. CHILDREN-BASEL 2020; 7:children7090111. [PMID: 32854325 PMCID: PMC7552712 DOI: 10.3390/children7090111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 02/07/2023]
Abstract
Several devices have been designed and tried over the years to percutaneously close atrial septal defects (ASDs). Most of the devices were first experimented in animal models with subsequent clinical testing in human subjects. Some devices were discontinued or withdrawn from further clinical use for varied reasons and other devices received Food and Drug Administration (FDA) approval with consequent continued usage. The outcomes of both discontinued and currently used devices was presented in some detail. The results of device implantation are generally good when appropriate care and precautions are undertaken. At this time, Amplatzer Septal Occluder is most frequently utilized device for occlusion of secundum ASD around the world.
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Umemoto S, Sakamoto I, Abe K, Ishikita A, Yamasaki Y, Hiasa KI, Ide T, Tsutsui H. Preoperative Threshold for Normalizing Right Ventricular Volume After Transcatheter Closure of Adult Atrial Septal Defect. Circ J 2020; 84:1312-1319. [PMID: 32554952 DOI: 10.1253/circj.cj-20-0136] [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] [Indexed: 11/09/2022]
Abstract
BACKGROUND The latest guidelines recommend early intervention in adult atrial septal defect (ASD) patients with signs of right ventricular (RV) enlargement. However, the criteria of RV enlargement for optimal intervention remain unclear. We investigated the preoperative determinants for normalizing the RV volume after transcatheter closure of ASD in adults.Methods and Results:We retrospectively analyzed 52 ASD patients who underwent transcatheter closure. Cardiac magnetic resonance imaging (CMR) measured RV volume before and 1 year after the closure. The patients were divided into normalized (postoperative RV end-systolic volume index [RVESVI] <47 mL/m2and end-diastolic volume index [RVEDVI] <108 mL/m2) and non-normalized (postoperative RVESVI ≥47 mL/m2or RVEDVI ≥108 mL/m2) groups. Preoperative RVESVI was significantly smaller (72 mL/m2vs. 80 mL/m2) and RVEF was higher (56% vs. 51%) in the normalized group compared with the non-normalized group. Receiver-operating characteristic analysis for the normalization of postoperative RV volume showed that the preoperative threshold value of RVESVI was 75 mL/m2. In addition, multivariate analysis showed that preoperative RVESVI was an independent predictor for normalization of RV volume. CONCLUSIONS Preoperative RVESVI is an independent predictor for normalization of RV volume at 1 year after transcatheter closure of ASD in adults. Early intervention before RVESVI reaches 75 mL/m2may confer optimal timing for normalizing RV volume.
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Affiliation(s)
- Shintaro Umemoto
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | - Ichiro Sakamoto
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | - Kohtaro Abe
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | - Ayako Ishikita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | - Yuzo Yamasaki
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University
| | - Ken-Ichi Hiasa
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | - Tomomi Ide
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
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18
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Abstract
This article provides a detailed review of the current practices and future directions of transcatheter interventions in adults with congenital heart disease. This includes indications for intervention, risks, and potential complications, as well as a review of available devices and their performance.
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19
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Fu YC, Tsai SK, Jian WY, Shyu TC, Chuang CM, Hwang B. Transthoracic echocardiography monitoring during ASD closure using an artificial hand system. Cardiovasc Ultrasound 2020; 18:21. [PMID: 32552906 PMCID: PMC7302396 DOI: 10.1186/s12947-020-00202-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 05/27/2020] [Indexed: 11/21/2022] Open
Abstract
Aim Continuous real-time echocardiographic monitoring is essential for guidance during ASD closure. However, transthoracic echocardiography (TTE) can only be implemented intermittently during fluoroscopy. We evaluate a novel approach to provide real-time imaging during the entire procedure. Finding We developed a custom-made TTE monitoring apparatus using artificial hand (AH-TTE) that enables real-time TTE images during atrial septal defect (ASD) closure. Thirty-two patients underwent successful device implantation using AH-TTE monitoring without complications. The median duration for real-time AH-TTE monitoring was 22 min and the median fluoroscopy time was 7.2 min. One case of pericardial effusion and one of transient bradycardia event due to air embolism was detected. All patients had uneventful recoveries. Conclusions Our simple and novel monitoring technique with AH-TTE provides TEE-like monitoring and may be a new alternative method for ASD closure. It gives real-time stable TTE images and minimizes radiation exposure for the interventional team during fluoroscopy.
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Affiliation(s)
- Yun-Ching Fu
- Pediatric Cardiology, Department of Pediatrics, Children's Hospital, China Medical University, No. 2, Yude Road, North District, Taichung, Taiwan, ROC
| | - Shen Kou Tsai
- Cheng-Hsin General Hospital and National Taiwan University, No 45, Cheng Hsin St., Beitou, Taipei, Taiwan, ROC.
| | - Wen-Yen Jian
- Pediatric Cardiology, Heart Center, Cheng-Hsin General Hospital, No 45, Cheng Hsin St., Beitou, Taipei, Taiwan (ROC)
| | - Tsung-Cheng Shyu
- Pediatric Cardiology, Department of Pediatrics, Children's Hospital, China Medical University, No. 2, Yude Road, North District, Taichung, Taiwan, ROC
| | - Chieh-Mao Chuang
- Pediatric Cardiology, Department of Pediatrics, Children's Hospital, China Medical University, No. 2, Yude Road, North District, Taichung, Taiwan, ROC
| | - Betau Hwang
- Pediatric Cardiology, Heart Center, Cheng-Hsin General Hospital, No 45, Cheng Hsin St., Beitou, Taipei, Taiwan (ROC).,Pediatric Cardiac Medical Center, Tung's Taichung MetroHarbor Hospital, No 45, Cheng Hsin St., Beitou, Taichung, Taiwan (ROC)
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20
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Clinical Significance of Septal Malalignment for Transcatheter Closure of Atrial Septal Defect. J Interv Cardiol 2020; 2020:6090612. [PMID: 32206044 PMCID: PMC7072101 DOI: 10.1155/2020/6090612] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 01/29/2020] [Indexed: 11/28/2022] Open
Abstract
Background Septal malalignment is related to erosion and device embolization in transcatheter closure of atrial septal defect (ASD), but limited information is available. Objectives This study aimed to assess clinical significance of septal malalignment and to determine appropriate evaluation of ASD diameter, including the selection of device size. Methods Four hundred and seventeen patients with ASD who underwent transcatheter closure were enrolled. Septal malalignment was defined as separation between the septum primum and the septum secundum on transesophageal echocardiography. Results One hundred and eighty-four patients had septal malalignment. The frequency of septal malalignment increased with age reaching around 50% in adult patients. Septal malalignment was related to aortic rim deficiency. The distance of separation between the septum primum and the septum secundum was 5 ± 2 mm (range, 1–11 mm). In patients with septal malalignment, the ASD diameter measured at the septum primum was 19 ± 6 mm, while the ASD diameter measured at the septum secundum was 16 ± 6 mm. There was a difference of 4 ± 2 mm (range, 0–8 mm) between the ASD diameter measured at the septum primum and that measured at the septum secundum. For transcatheter closure, the Amplatzer Septal Occluder device size 2-3 mm larger and the Occlutech Figulla Flex II device size 4–7 mm larger than the ASD diameter measured at the septum primum were frequently used. During the study period, erosion or device embolization did not occur in all of the patients. Conclusions Septal malalignment is highly prevalent in adult patients with aortic rim deficiency. The measurement of ASD diameter at the septum primum can be valuable for the selection of device size in patients with septal malalignment.
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21
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Appropriate selection of echocardiographic guidance for transcatheter atrial septal defect closure. Int J Cardiovasc Imaging 2020; 36:855-863. [DOI: 10.1007/s10554-020-01778-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 01/24/2020] [Indexed: 01/26/2023]
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22
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Zhao C, Xu J, Cui D, Liu K. A Long-Term Complication Occurred After Transcatheter Closure of Large Atrial Septal Defect. Int Heart J 2020; 61:183-185. [DOI: 10.1536/ihj.19-161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Chenyu Zhao
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University
| | - Jinyu Xu
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University
| | - Dan Cui
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University
| | - Kexiang Liu
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University
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23
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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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Yamano M, Yamano T, Nakamura T, Zen K, Shiraishi H, Shirayama T, Matoba S. Predictors of Increased Left Ventricular Filling Pressure After Transcatheter Atrial Septal Defect Closure. Circ Rep 2020; 2:113-120. [PMID: 33693216 PMCID: PMC7929757 DOI: 10.1253/circrep.cr-19-0128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background:
The aim of this study was to identify factors of left ventricular filling pressure (LVFP) elevation following transcatheter atrial septal defect (ASD) closure. Methods and Results:
The study involved 97 adult patients with sinus rhythm who underwent both transcatheter ASD closure and transthoracic echocardiography. Elevated LVFP was diagnosed during the first month of follow-up according to the American Society of Echocardiography guidelines: that is, ratio of transmitral early filling to the lateral annular diastolic velocity (lateral E/e’) >13 was used to exclude the effect of the device on the atrial septum. Fifteen patients (15.5%) were diagnosed with increased LVFP during the 1-month follow-up period (median lateral E/e’: from 9.2, IQR, 6.6–10.8; to 15.5, IQR, 13.8–17.8; P<0.001). Independent predictors of LVFP elevation were left ventricular (LV) relative wall thickness, lateral E/e›, and peak tricuspid regurgitation pressure gradient (TRPG) at baseline (OR, 1.67; 95% CI: 1.04–2.69; OR, 1.52; 95% CI: 1.07–2.15; and OR, 1.14; 95% CI: 1.04–1.25; cut-offs: 0.42, 7.5, and 27.0 mmHg, respectively). Median lateral E/e› returned to baseline in most patients with LVFP elevation during 6 months of subsequent follow-up (1-month–6-month follow-up: 15.5, IQR, 13.8–17.8; 11.1, IQR, 8.8–14.8, respectively; P=0.001). Conclusions:
The increase in Doppler-estimated LVFP following transcatheter ASD closure may be related to LV hypertrophy, diastolic dysfunction, and peak TRPG in elderly patients.
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Affiliation(s)
- Michiyo Yamano
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine Kyoto Japan
| | - Tetsuhiro Yamano
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine Kyoto Japan
| | - Takeshi Nakamura
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine Kyoto Japan
| | - Kan Zen
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine Kyoto Japan
| | - Hirokazu Shiraishi
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine Kyoto Japan
| | - Takeshi Shirayama
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine Kyoto Japan
| | - Satoaki Matoba
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine Kyoto Japan
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Yoo JS, Kim KH. Images of Mitral Valve Perforation due to Atrial Septal Occluder Device. Korean Circ J 2019; 49:1112-1113. [PMID: 31646773 PMCID: PMC6813161 DOI: 10.4070/kcj.2019.0244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 08/22/2019] [Accepted: 09/11/2019] [Indexed: 11/11/2022] Open
Affiliation(s)
- Jae Suk Yoo
- Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Bucheon, Korea
| | - Kyung Hee Kim
- Division of Cardiovascular Disease, Sejong General Hospital, Bucheon, Korea.
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Garris R, Rana C, Ghalyoun BA, Qaqa F, Habib M, Patel R, Shamoon F. Primum Non Nocere. JACC Case Rep 2019; 1:396-400. [PMID: 34316834 PMCID: PMC8289140 DOI: 10.1016/j.jaccas.2019.07.022] [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: 04/09/2019] [Revised: 07/17/2019] [Accepted: 07/22/2019] [Indexed: 11/25/2022]
Abstract
Complications of septal-occluder devices include erosion, perforation, and embolization, which are most commonly caused by oversized devices or thin rim margins. Cardiac pseudoaneurysm is a rare phenomenon that forms as a result of device erosion into the myocardium. Although this is often an incidental finding, they are at risk for rupture. (Level of Difficulty: Intermediate.)
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Shi D, Kang Y, Zhang G, Gao C, Lu W, Zou H, Jiang H. Biodegradable atrial septal defect occluders: A current review. Acta Biomater 2019; 96:68-80. [PMID: 31158496 DOI: 10.1016/j.actbio.2019.05.073] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 05/21/2019] [Accepted: 05/29/2019] [Indexed: 01/11/2023]
Abstract
Atrial septal defect (ASD) is a common structural congenital heart disease. With the development of interventional closure devices and transcatheter techniques, interventional closure therapy has become the most well-accepted therapeutic alternative worldwide, as it offers a number of advantages over conventional therapies such as improved safety, easier operation, lower complication rates and invasiveness, and shorter anesthetic time and hospitalizations. During the past decades, various types of occluders based on nondegradable shape memory alloys have been used in clinical applications. Considering that the permanent existence of foreign nondegradable materials in vivo can cause many potential complications in the long term, the research and development of biodegradable occluders has emerged as a crucial issue for interventional treatment of ASD. This review aims to summarize partially or fully biodegradable occlusion devices currently reported in the literature from the aspects of design, construction, and evaluation of animal experiments. Furthermore, a comparison is made on the advantages and disadvantages of the materials used in biodegradable ASD occlusion devices, followed by an analysis of the problems and limitations of the occlusion devices. Finally, several strategies are proposed for future development of biodegradable cardiac septal defect occlusion devices. STATEMENT OF SIGNIFICANCE: Although occlusion devices based on nondegradable alloys have been widely used in clinical applications and saved numerouspatients, biodegradable occlusion devices may offer some advantages such as fewer complications, acceptable biocompatibility, and particularly temporary existence, thereby leaving "native" tissue behind, which will certainly become the development trend in the long term. This review summarizes almost all partially or fully biodegradable occlusion devices currently reported in the literature from the aspects of design, construction, and evaluation of animal experiments. Furthermore, a comparison is made on the advantages and disadvantages of the materials used in biodegradable ASD occlusion devices, followed by an analysis of the problems and limitations of the occlusion devices. Finally, several strategies are proposed for future development of biodegradable cardiac septal defect occlusion devices.
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Heath A, Alvensleben IV, Navarro J, Echazú G, Kozlik-Feldmann R, Freudenthal F. Developing High Medical Technology, a Challenge for Developing Countries: The Percutaneous Closure of Atrial Septal Defects Using Nit-Occlud ASD-R: Early and Mid-term Results. World J Pediatr Congenit Heart Surg 2019; 10:433-439. [DOI: 10.1177/2150135119845257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To assess the efficacy and safety of the Nit-Occlud ASD-R (PFM S.R.L, La Paz, Bolivia) in the percutaneous closure of secundum atrial septal defects (ASD). Patients and Methods: Fifty-three consecutive patients with median age of 11 years (range 3-67) and mean weight 27.1 kg (range 13-75 kg), treated in two cardiology centers between May 2007 and March 2011. Results: Mean fluoroscopy time was 14 minutes (5-53), mean procedure time was 70 minutes (45-150), mean defect size, as measured by the stop-flow technique, was 17.8 mm (5.6-31), and mean stent size of the implanted device was 18 mm (6-28), which is 0.98 times the defect size. Successful closure of the ASD without major complications was achieved in 49 of 53 patients. In 71.4% of patients in whom device implantation was accomplished, there was no evidence of a persistent shunt at the completion of the procedure. This closure rate increased to 91.7% after 24 hours, with 95.8% closure after three months and 100% closure after six months. Device embolization occurred in one patient within 24 hours of implantation and required surgical device removal and ASD closure. There were no other major complications and no deaths during the period of follow-up (average 72 months; range 59-105 months). Conclusion: The Nit-Occlud ASD-R device is safe and effective with very good closure rates.
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Affiliation(s)
| | | | - Joaquin Navarro
- Centro Médico Quirúrgico Boliviano Belga, Cochabamba, Bolivia
| | - Gabriel Echazú
- Centro Médico Quirúrgico Boliviano Belga, Cochabamba, Bolivia
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Jung SY, Kim AY, Jung JW, Choi JY. Procedural, Early and Long-term Outcomes after Percutaneous Closure of Atrial Septal Defect: Comparison between Large and Very Large Atrial Septal Defect Groups. Korean Circ J 2019; 49:975-986. [PMID: 31165594 PMCID: PMC6753025 DOI: 10.4070/kcj.2018.0391] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 03/13/2019] [Accepted: 04/10/2019] [Indexed: 12/03/2022] Open
Abstract
Background This study aimed to compare procedural, early and long-term outcome of device closure of atrial septal defect (ASD) between large ASD patients and very large ASD patients. Methods We carried a retrospective study of adult large ASD (defined as ≥25 mm) treated by percutaneous closure using Amplatzer septal occluder during 12-year period (May 2003–February 2015) at a single tertiary center. A total of 269 patients were divided into 2 groups, according to the pre-procedural maximal ASD diameter; 25 mm≤ASD<35mm, group 1 (n=216) and 35 mm≤ASD, group 2 (n=53). We compared procedural parameters, early complications and long-term follow-up results between 2 groups. Results The need of modified implantation techniques (MITs) was higher group 2 (23.6% vs. 37.7%, p=0.034). Procedural success rate was considerably high in both groups (99.1% in group 1 vs. 100% in group 2, p=0.620). Major complications were occurred in 4 (1.5%) patients (1.4% vs. 1.9%, p=0.804). Minor complication rate was not different between 2 groups. During long-term follow-up (47.2±32.0 months, range, 6.0–135.5), there was one major complication (0.4%) of stroke. Most common long-term minor event was migraine headache (3.9%) followed by arrhythmias (1.9%) without statistical difference between 2 groups. Conclusions Although MIT was more frequently required in very large ASD groups, the procedural, early and long-term outcomes after percutaneous ASD closure were similar in both groups. This suggested that percutaneous ASD closure for very large ASD could be considered a good treatment option.
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Affiliation(s)
- Se Yong Jung
- Division of Pediatric Cardiology, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Ah Young Kim
- Division of Pediatric Cardiology, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Jo Won Jung
- Division of Pediatric Cardiology, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Young Choi
- Division of Pediatric Cardiology, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.
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Nicol ED, Manen O, Guettler N, Bron D, Davenport ED, Syburra T, Gray G, d'Arcy J, Rienks R. Congenital heart disease in aircrew. Heart 2019; 105:s64-s69. [PMID: 30425088 PMCID: PMC6256302 DOI: 10.1136/heartjnl-2018-313059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 07/25/2018] [Accepted: 07/26/2018] [Indexed: 11/24/2022] Open
Abstract
This article focuses i on the broad aviation medicine considerations that are required to optimally manage aircrew ii with suspected or confirmed congenital heart disease (both pilots and non-pilot aviation professionals). It presents expert consensus opinion and associated recommendations and is part of a series of expert consensus documents covering all aspects of aviation cardiology. This expert opinion was born out of a 3 year collaborative working group between international military aviation cardiologists and aviation medicine specialists, as part of a North Atlantic Treaty Organization (NATO) led initiative to address the occupational ramifications of cardiovascular disease in aircrew (HFM-251) many of whom also work with and advise civil aviation authorities.
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Affiliation(s)
- Edward D Nicol
- Royal Air Force Aviation Clinical Medicine Service, RAF Centre of Aviation Medicine, RAF Henlow, Bedfordshire, UK
| | - Olivier Manen
- Aviation Medicine Department, AeMC, Percy Military Hospital, Clamart, France, Clamart, Île-de-France, France
| | - Norbert Guettler
- German Air Force Center for Aerospace Medicine, Fuerstenfeldbruck, Germany
| | - Dennis Bron
- Aeromedical Centre, Swiss Air Force, Dubendorf, Zürich, Switzerland
| | - Eddie D Davenport
- Aeromedical Consult Service, United States Air Force School of Aerospace Medicine, Wright-PAtterson AFB, Ohio, USA
| | - Thomas Syburra
- Cardiac Surgery Department, Luzerner Kantonsspital, Luzern, LU, Switzerland
| | - Gary Gray
- Canadian Forces Environmental Medical Establishment, Toronto, Ontario, Canada
| | - Joanna d'Arcy
- Royal Air Force Aviation Clinical Medicine Service, RAF Centre of Aviation Medicine, RAF Henlow, Bedfordshire, UK
| | - Rienk Rienks
- Department of Cardiology, University Medical Center Utrecht and Central Military Hospital, Utrecht, The Netherlands
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Retrieval of large Occlutech Figula Flex septal defect occluders using a commercially available bioptome: proof of concept. Cardiol Young 2018; 28:955-960. [PMID: 29779498 DOI: 10.1017/s1047951118000586] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES This study aimed to develop a method for retrieval of the new meshed nitinol atrial septal defect occluders - Ceraflex and Occlutech. BACKGROUND The newly developed atrial septal defect occluders have potential benefits considering implantation, but concerns regarding their removal in case of embolisation have been raised. METHODS Over 21 years, 1449 patients underwent interventional atrial septal defect occlusion in our institution. We reviewed the cases of embolisation of the device, developed a strategy for device removal, and tested it on the benchside and in animal tests. RESULTS In 11 patients (0.8%), the intended atrial septal defect occlusion was complicated by an embolisation of the device. In contrast to the Amplatzer septal occluders, retrieval of Occlutech devices larger than 16 mm with snare techniques was impossible. In benchside tests, this was confirmed and a new method for removal of large meshed devices was developed. This involved the commercially available Maslanka® biopsy forceps. The feasibility of this technique in vivo was tested in a pig model. During animal tests, using the Maslanka biopsy forceps it was possible to interventionally retrieve embolised Ceraflex and Occlutech devices of different sizes - 10, 16, 30, and 40 mm - into a 12-F sheath. CONCLUSION It was impossible to retrieve Occlutech and Ceraflex devices larger than 16 mm into a large sheath in vivo and during benchside tests. However, this was feasible on the bench and in vivo using the Maslanka biopsy forceps even with the largest available devices.
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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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Takaya Y, Akagi T, Kijima Y, Nakagawa K, Ito H. Functional Tricuspid Regurgitation After Transcatheter Closure of Atrial Septal Defect in Adult Patients. JACC Cardiovasc Interv 2017; 10:2211-2218. [DOI: 10.1016/j.jcin.2017.06.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 06/05/2017] [Accepted: 06/15/2017] [Indexed: 11/26/2022]
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Lee H, Yang JH, Jun TG, Kang IS, Huh J, Park SW, Song J, Kim CS. The Mid-term Results of Thoracoscopic Closure of Atrial Septal Defects. Korean Circ J 2017; 47:769-775. [PMID: 28955395 PMCID: PMC5614953 DOI: 10.4070/kcj.2017.0059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 06/10/2017] [Accepted: 06/21/2017] [Indexed: 11/17/2022] Open
Abstract
Background and Objectives Recently, minimally invasive surgical (MIS) techniques including robot-assisted operations have been widely applied in cardiac surgery. The thoracoscopic technique is a favorable MIS option for patients with atrial septal defects (ASDs). Accordingly, we report the mid-term results of thoracoscopic ASD closure without robotic assistance. Subjects and Methods We included 66 patients who underwent thoracoscopic ASD closure between June 2006 and July 2014. Mean age was 27±9 years. The mean size of the ASD was 25.9±6.3 mm. Eleven patients (16.7%) had greater than mild tricuspid regurgitation (TR). The TR pressure gradient was 32.4±8.6 mmHg. Results Fifty-two (78.8%) patients underwent closure with a pericardial patch and 14 (21.2%) underwent direct suture closure. Concomitant procedures included tricuspid valve repair in 8 patients (12.1%), mitral valve repair in 4 patients (6.1%), and right isthmus block in 1 patient (1.5%). The mean length of the right thoracotomy incision was 4.5±0.9 cm. The mean cardiopulmonary bypass time was 159±43 minutes, and the mean aortic cross clamp time was 79±29 minutes. The mean hospital stay lasted 6.1±2.6 days. There were no early deaths. There were 2 reoperations. One was due to ASD patch detachment and the other was due to residual mitral regurgitation after concomitant mitral valve repair. However, there have been no reoperations since July 2010. There were 2 pneumothoraxes requiring chest tube re-insertion. There was one wound dehiscence in an endoscopic port. The mean follow-up duration was 33±31 months. There were no deaths, residual shunts, or reoperations during follow-up. Conclusion Thoracoscopic ASD closure without robotic assistance is feasible, suggesting that this method is a reliable MIS option for patients with ASDs.
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Affiliation(s)
- Heemoon Lee
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji-Hyuk Yang
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae-Gook Jun
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - I-Seok Kang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - June Huh
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Woo Park
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jinyoung Song
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chung Su Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Late endocarditis of Amplatzer septal occluder device in a child. Indian J Thorac Cardiovasc Surg 2017. [DOI: 10.1007/s12055-016-0480-z] [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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Transareolar Video-Assisted Approach to the Atrial Septal Defect and Tricuspid Valve. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017; 12:217-220. [PMID: 28538272 DOI: 10.1097/imi.0000000000000368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Minimally invasive atrial septal defect closure and tricuspid annuloplasty in female patients are normally performed through a right submammary anterior minithoracotomy approach. However, when the aortic root is located higher, the direction of aortic cannulation becomes not ideal through the submammary incision. In such cases, transareolar approach is useful. Through this approach, aortic cannulation and tricuspid operation can be performed with endoscopic assistance, and ASD closure can be performed under direct vision.
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Kitamura T, Torii S, Horai T, Sughimoto K, Kobayashi K, Irisawa Y, Hayashi H, Matsushiro T, Miyata Y, Tsuchida Y, Miyaji K. Transareolar Video-Assisted Approach to the Atrial Septal Defect and Tricuspid Valve. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017. [DOI: 10.1177/155698451701200310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Tadashi Kitamura
- From the Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Shinzo Torii
- From the Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Tetsuya Horai
- From the Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Koichi Sughimoto
- From the Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Kensuke Kobayashi
- From the Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yusuke Irisawa
- From the Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Hidenori Hayashi
- From the Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Takuya Matsushiro
- From the Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yurie Miyata
- From the Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yuta Tsuchida
- From the Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Kagami Miyaji
- From the Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
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Nishida H, Nakatsuka D, Kawano Y, Hiraiwa N, Takanashi S, Tabata M. Outcomes of Totally Endoscopic Atrial Septal Defect Closure Using a Glutaraldehyde-Treated Autologous Pericardial Patch. Circ J 2017; 81:689-693. [PMID: 28179595 DOI: 10.1253/circj.cj-16-0888] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND We evaluated the outcomes of totally endoscopic minimally invasive surgery for atrial septal defect (ASD) using a glutaraldehyde-treated autologous pericardial patch in the transcatheter interventional era.Methods and Results:We retrospectively reviewed 37 consecutive patients who underwent totally endoscopic ASD closure with a glutaraldehyde-treated autologous pericardial patch between June 2011 and April 2015. All patients had been deferred from catheter-based intervention for clinical or anatomical reasons. We analyzed operative outcomes and postoperative echocardiographic data. The mean age was 45.7±16.5 years, and 25 patients (67.6%) were women. The mean ratio of pulmonary to systemic flow was 2.4±0.7. Six patients (16.2%) underwent concomitant tricuspid valve repair, and 3 patients (8.1%) underwent concomitant atrial fibrillation surgery. There were no operative deaths, and the median length of hospital stay was 5 days. Postoperative echocardiography revealed trivial residual shunt in 1 patient. During the follow-up period, there were no re-interventions for ASD or readmission for heart failure. Follow-up echocardiography revealed no recurrent shunt or calcification of the autologous pericardial patch. CONCLUSIONS Totally endoscopic ASD closure with a glutaraldehyde-treated autologous pericardial patch demonstrated excellent outcomes. It is a useful option for patients with unfavorable anatomy or other reasons excluding transcatheter intervention.
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Affiliation(s)
- Hidefumi Nishida
- Department of Cardiovascular Surgery, Sakakibara Heart Institute
| | - Daisuke Nakatsuka
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu-Ichikawa Medical Center
| | - Yuji Kawano
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu-Ichikawa Medical Center
| | - Nobuhiko Hiraiwa
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu-Ichikawa Medical Center
| | | | - Minoru Tabata
- Department of Cardiovascular Surgery, Sakakibara Heart Institute.,Department of Cardiovascular Surgery, Tokyo Bay Urayasu-Ichikawa Medical Center
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Leger CS, DeSouza JFX. Migraine Modulation and Debut after Percutaneous Atrial Septal Defect Closure: A Review. Front Neurol 2017; 8:68. [PMID: 28373854 PMCID: PMC5357661 DOI: 10.3389/fneur.2017.00068] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 02/15/2017] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Change in migraine headache (MH)-preexisting MH change or development of de novo MH-are known potential complications following percutaneous closure of atrial septal defect (ASD), but consensus on a causal trigger remains elusive. OBJECTIVES To expose potential MH triggers linked, mainly by timing and occurrence, to the emergence of de novo MH or change in preexisting MH subsequent to percutaneous ASD closure (pASDC). METHODS The literature was systematically searched for studies available in English reporting MH status after pASDC published between January 1, 1990 and November 15, 2015. We determined the number and percentage of patients experiencing MH status change within 7 days post procedure and the cumulative total by final follow-up (Mdn = 12 months). RESULTS Twenty-five studies met the inclusion criteria, which accounted for a total of 1,646 pASDC patients. Pre-procedure MH prevalence was 8% (126/1,646). Change in preexisting MH occurred in a total of 72% (91/126), 12% (11/91) within 7-days after pASDC; within follow-up MH improved in 14% (18/126), resolved in 37% (47/126), but persisted in 63% (79/126). De novo MH incidence ranged between 10 (153/1,520) and 18.3% (153/836); 34% incipience (52/153) was within 7-days of pASDC; females accounted for 80% (63/79) of gender differentiated cases; of type distinguished cases, 42% (51/122) were MH without aura (MO) and 58% (71/122) were MH with aura (MA); MH improved in 10% (16/153), resolved in 24% (37/153) but persisted beyond final follow-up in 76% (116/153). Antiplatelet agents were effective modulators of MH in 44% (11/25) studies. Possible adverse MH-predisposing traits were scarce: larger ASD size reported in ~2% (39/1,646) of patients experiencing de novo MH or preexisting MH exacerbation; short aortic rim reported in three de novo MH patients; allergic response to occluder nickel alloy in four patients with MH status change from baseline (de novo or preexisting MH change not specified). INTERPRETATION Early intensification of MH status change but later amelioration (virtually paralleling stages of endothelialization), relatively high efficacy of antiplatelet agents, and the emergence of MA as the dominant de novo MH type favor proinflammatory triggers of MH status change after pASDC.
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Affiliation(s)
- Charles Stevens Leger
- Department of Psychology, Centre for Vision Research, York University, Toronto, ON, Canada
| | - Joseph F. X. DeSouza
- Department of Psychology, Centre for Vision Research, York University, Toronto, ON, Canada
- Neuroscience Diploma, York University, Toronto, ON, Canada
- Centre for Vision Research, York University, Toronto, ON, Canada
- Department of Biology, York University, Toronto, ON, Canada
- Canadian Action and Perception Network (CAPnet), Toronto, ON, Canada
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Takaya Y, Akagi T, Kijima Y, Nakagawa K, Watanabe N, Oe H, Taniguchi M, Ito H. Echocardiographic Estimates of Left Ventricular Diastolic Dysfunction Do Not Predict the Clinical Course in Elderly Patients Undergoing Transcatheter Atrial Septal Defect Closure: Impact of Early Diastolic Mitral Annular Velocity. J Interv Cardiol 2017; 30:79-84. [DOI: 10.1111/joic.12365] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Yoichi Takaya
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine; Dentistry and Pharmaceutical Science; Okayama Japan
| | - Teiji Akagi
- Cardiac Intensive Care Unit, Okayama University Graduate School of Medicine; Dentistry and Pharmaceutical Science; Okayama Japan
| | - Yasufumi Kijima
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine; Dentistry and Pharmaceutical Science; Okayama Japan
| | - Koji Nakagawa
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine; Dentistry and Pharmaceutical Science; Okayama Japan
| | - Nobuhisa Watanabe
- Division of Medical Support; Okayama University Hospital; Okayama Japan
| | - Hiroki Oe
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine; Dentistry and Pharmaceutical Science; Okayama Japan
| | - Manabu Taniguchi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine; Dentistry and Pharmaceutical Science; Okayama Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine; Dentistry and Pharmaceutical Science; Okayama Japan
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Jain S, Pinto R, Dalvi B. Use of contrast during echocardiography to diagnose cardiac perforation after device closure of atrial septal defect. Catheter Cardiovasc Interv 2016; 88:E209-E211. [PMID: 24407965 DOI: 10.1002/ccd.25373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 12/02/2013] [Accepted: 12/21/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Shreepal Jain
- Cardiologist, Glenmark Cardiac Centre, 10, Nandadeep, 209-D Dr. Ambedkar Road, Matunga (E), Mumbai, Maharashtra, India, 400 019
| | - Robin Pinto
- Cardiologist, Glenmark Cardiac Centre, 10, Nandadeep, 209-D Dr. Ambedkar Road, Matunga (E), Mumbai, Maharashtra, India, 400 019
| | - Bharat Dalvi
- Cardiologist, Glenmark Cardiac Centre, 10, Nandadeep, 209-D Dr. Ambedkar Road, Matunga (E), Mumbai, Maharashtra, India, 400 019
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Large single centre experience with the Cera™ and CeraFlex™ occluders for closure of interatrial communications: usefulness of the flexible rotation feature. Cardiovasc Interv Ther 2016; 33:70-76. [DOI: 10.1007/s12928-016-0440-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 11/06/2016] [Indexed: 10/20/2022]
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Amedro P, Soulatges C, Fraisse A. Infective endocarditis after device closure of atrial septal defects: Case report and review of the literature. Catheter Cardiovasc Interv 2016; 89:324-334. [PMID: 27641431 DOI: 10.1002/ccd.26784] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 08/15/2016] [Indexed: 11/08/2022]
Abstract
We report a case of late infective endocarditis in an 8-year-old boy 3 years after transcatheter closure of an atrial septal defect with the Amplatzer Atrial Septal Occluder Device. Echocardiography showed a very thick pannus lining the left atrial disc of the prosthesis, with some mobile elements. MRI showed several cerebral microemboli. The patient had dental caries and blood cultures found Staphylococcus aureus. Patient was treated with gentamicin and oxacillin before surgical removal of the prosthesis. Twenty-one cases of infective endocarditis after atrial defect device closure have been reported in the literature (13 ostium secundum ASD and 8 patent foramen ovale). Seven pediatric cases were reported. S. aureus was the most frequent bacterium. Antibiotics were administered in all cases and most patients (n = 18) underwent surgical removal of the device. Incomplete endothelialization of the prosthesis was a suggested mechanism. Two patients died after surgery. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Pascal Amedro
- Pediatric and Congenital Cardiology Department, M3C Regional Center, University Hospital, Montpellier, France.,Physiology and Experimental Biology of Heart and Muscles Laboratory - PHYMEDEXP, UMR CNRS 9214 - INSERM U1046, Montpellier, France
| | - Camille Soulatges
- Pediatric and Congenital Cardiology Department, M3C Regional Center, University Hospital, Montpellier, France
| | - Alain Fraisse
- Pediatric Cardiology Service, Royal Brompton and Harefield Hospital Trust, London, United Kingdom
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44
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Asakai H, Weskamp S, Eastaugh L, d'Udekem Y, Pflaumer A. Atrioventricular block after ASD closure. HEART ASIA 2016; 8:26-31. [PMID: 27540418 DOI: 10.1136/heartasia-2016-010745] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 07/09/2016] [Accepted: 07/11/2016] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Secundum atrial septal defect (ASD) is a common congenital heart defect. There is limited data on both early and late atrioventricular (AV) block post ASD closure. The aim of this study was to determine the incidence and risk factors of AV block associated with ASD closure. METHODS A retrospective analysis of all patients who underwent ASD closure either with a device or surgical method at the Royal Children's Hospital Melbourne between 1996 and 2010 was performed. Baseline demographics, procedural details and follow-up data were collected from medical records. RESULTS A total of 378 patients were identified; 242 in the device group and 136 in the surgical group. Fourteen patients (3.7%) had AV block (1 with second degree and 13 with first degree) at a median follow-up of 28 months; 11/242 (4.5%) in the device group and 3/135 (2.2%) in the surgical group (p=0.39). Six patients had new-onset AV block after ASD closure. In the device subgroup, patients with AV block at follow-up had a larger indexed device size compared with those without (22 (15-31) vs 18(7-38), p=0.02). Multivariate analysis revealed the presence of AV block either pre procedure or post procedure to be the only variables associated with late AV block. CONCLUSIONS Late AV block in patients with repaired ASD is rare and most likely independent of the technique used. In the device subgroup, the only risk factor identified to be associated with late AV block was the presence of either preprocedural or postprocedural AV block, so long-term follow-up for these patients should be provided.
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Affiliation(s)
- Hiroko Asakai
- Department of Cardiology, Royal Children's Hospital, Heart Research Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Victoria, Australia; Department of Pediatrics, University of Tokyo Hospital, Tokyo, Japan
| | - Sofia Weskamp
- Department of Cardiology, Royal Children's Hospital, Heart Research Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Lucas Eastaugh
- Department of Cardiology, Royal Children's Hospital, Heart Research Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Yves d'Udekem
- Department of Pediatrics, University of Melbourne, Melbourne, Victoria, Australia; Department of Cardiac Surgery, Royal Children's Hospital, Heart Research Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Andreas Pflaumer
- Department of Cardiology, Royal Children's Hospital, Heart Research Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Victoria, Australia
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45
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Nguyen AK, Palafox BA, Starr JP, Gates RN, Berdjis F. Endocarditis and Incomplete Endothelialization 12 Years after Amplatzer Septal Occluder Deployment. Tex Heart Inst J 2016; 43:227-31. [PMID: 27303238 PMCID: PMC4894701 DOI: 10.14503/thij-14-4949] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A 4-year-old boy had a 15-mm atrial septal defect repaired percutaneously with use of an Amplatzer Septal Occluder. At age 16 years, he presented with a week's history of fever, chills, dyspnea, fatigue, and malaise. Cultures grew methicillin-sensitive Staphylococcus aureus. A transesophageal echocardiogram showed a 1.25 × 1.5-cm pedunculated mass on the left aspect of the atrial septum just superior to the mitral valve, and a smaller vegetation on the right inferior medial aspect of the septum. At surgery, visual examination of both sides of the septum revealed granulation tissue, the pedunculated mass, the small vegetation, and exposed metal wires that suggested incomplete endothelialization of the occluder. We removed the occluder and patched the septal defect. The patient returned to full activity after 4 months and was asymptomatic 3 years postoperatively. Our report reinforces the need for further investigation into prosthetic device endothelialization, endocarditis prophylaxis, and recommended levels of physical activity in patients whose devices might be incompletely endothelialized. In addition to reporting our patient's case, we review the medical literature on this topic.
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Affiliation(s)
| | - Brian A. Palafox
- Address for reprints: Brian A. Palafox, MD, Suite 503, 1310 W. Stewart Dr., Orange, CA 92868, E-mail:
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46
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Transcatheter closure of atrial septal defect in a patient with absent inferior caval vein connection: a novel technique using a steerable guide catheter. Cardiol Young 2016; 26:1033-5. [PMID: 27161147 DOI: 10.1017/s1047951116000445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
An alternative approach for transcatheter closure of atrial septal defect is necessary in patients with absent inferior caval vein connection. In this report, we describe the successful transcatheter atrial septal defect closure via the transjugular approach using a steerable guide catheter.
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47
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Dendramis G, Paleologo C, Piraino D, Augugliaro S. Very Late Dislocation of an AMPLATZER Septal Occluder Device Suspected Thanks to a Recent Onset of Right-Axis Deviation. JACC Cardiovasc Interv 2016; 9:859-860. [DOI: 10.1016/j.jcin.2016.02.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 02/01/2016] [Accepted: 02/11/2016] [Indexed: 11/16/2022]
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48
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Incomplete endothelialisation of an Amplatzer Septal Occluder device followed by meningitis and late acute bacterial endocarditis. Cardiol Young 2016; 26:808-10. [PMID: 26707128 DOI: 10.1017/s1047951115002383] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A 19-year-old woman with atrial septal defect treated percutaneously with an Amplatzer Septal Occluder 24 months earlier, who presented with a history of bacterial meningitis, was admitted with a diagnosis of endocarditis. After 6 weeks of treatment with antibiotics, the incompletely endothelialised occluder was surgically removed. The present report illustrates the need for long-term follow-up of patients who have received nitinol wire mesh occluders.
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49
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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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50
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Pedra CAC, Pedra SF, Costa RN, Ribeiro MS, Nascimento W, Campanhã LOS, Santana MVT, Jatene IB, Assef JE, Fontes VF. Mid-Term Outcomes after Percutaneous Closure of the Secundum Atrial Septal Defect with the Figulla-Occlutech Device. J Interv Cardiol 2016; 29:208-15. [PMID: 26927945 DOI: 10.1111/joic.12284] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To evaluate the mid-term outcomes after percutaneous closure of the secundum atrial septal defects (ASD) using the Figulla-Occlutech device (FOD). BACKGROUND Transcatheter closure has become the method of choice for most patients with ASD. Although the FOD may have some advantageous characteristics there is a paucity of data on later outcomes after the use of this relatively new device. METHODS Observational, single arm study including 200 non-consecutive patients who underwent ASD closure between 04/09 and 07/15 in 2 centers. Device performance, deployment technique, and immediate and mid-term outcomes were assessed. RESULTS Median age and weight were 24 years (4-72) and 58 kg (15-92), respectively. Single defects were observed in 171 patients (median size of 19 mm). The remainder had multiple or multifenestrated defects. Implantation of FOD (median size of 24 mm) was successful in all (99%), but 2 patients (1 with deficient postero-inferior rim; 1 with a large ASD for the size of the child). Embolization with device retrieval occurred in 2 (1%). Median follow-up of 36 months was obtained in 172 patients. Serial echocardiographic assessment showed complete closure in all but 2 patients, in whom an additional small non-significant posterior defect was purposely left untouched. There have been no episodes of late arrhythmias, device embolization, cardiac erosion, endocarditis, thromboembolism, wire fracture, or death. CONCLUSIONS Transcatheter closure of ASDs in older children, adolescents, and adults using the FOD was highly successful in a wide range of anatomical scenarios with high closure rates and no complications in mid-term follow-up.
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Affiliation(s)
- Carlos A C Pedra
- Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil.,Hospital do Coração da Associação Sanatório Sírio, São Paulo, Brazil
| | - Simone F Pedra
- Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil.,Hospital do Coração da Associação Sanatório Sírio, São Paulo, Brazil
| | - Rodrigo N Costa
- Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil.,Hospital do Coração da Associação Sanatório Sírio, São Paulo, Brazil
| | - Marcelo S Ribeiro
- Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil.,Hospital do Coração da Associação Sanatório Sírio, São Paulo, Brazil
| | - Wanda Nascimento
- Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil.,Hospital do Coração da Associação Sanatório Sírio, São Paulo, Brazil
| | - Luis Otávio S Campanhã
- Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil.,Hospital do Coração da Associação Sanatório Sírio, São Paulo, Brazil
| | | | - Ieda B Jatene
- Hospital do Coração da Associação Sanatório Sírio, São Paulo, Brazil
| | - Jorge E Assef
- Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
| | - Valmir F Fontes
- Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil.,Hospital do Coração da Associação Sanatório Sírio, São Paulo, Brazil
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