Management of ostium secundum atrial septal defect in the era of percutaneous trans-catheter device closure: 7-Year experience at a single institution

Optimization of Echo Views for Percutaneous Device Closure of Pediatric Atrial Septal Defect through the Femoral Vein Guided by Transthoracic Echocardiography without Radiation

Objectives

This study aimed to explore the selection of views for transthoracic echocardiography-guided transfemoral puncture for the device closure of pediatric atrial septal defect (ASD) without radiation.

Methods

Sixty children (29 males and 31 females) were diagnosed with a central ASD, normal heart function, and no other intracardiac deformity. All procedures were performed in a surgical operating room (without radiological equipment) under basic anesthesia; the femoral vein pathway and guidance by only transthoracic echocardiography were used to complete the device closure of the ASD. The subcostal acoustic window and parasternal aorta short-axis views were used to guide the extra stiff wire and catheter into the left atrium. All procedures were performed under the subcostal biatrial section. The sheath entered the left atrium, and the apical four-chamber view was used to monitor the delivery and release of the occluder.

Results

Successful closure of the ASD was achieved in all cases. The operating time from the end of the puncture to the release of the occluder was 10.36 ± 3.57 minutes. No other incisions were needed in 60 cases. No occluders were removed, and no residual shunt or pericardial effusions were detected after the procedures, during the non-ICU stay time. The average hospital stay was 2.19 ± 0.58 days.

Conclusion

The accurate selection of transthoracic echocardiographic views can better ensure the safety and effectiveness of ASD closure through the femoral vein without radiation in children.

Quality of Life in Adults Undergoing Percutaneous Device Closure of Atrial Septal Defect

To assess changes in the quality of life in adult patients undergoing percutaneous device closure of atrial septal defect (ASD).We used a standard Medical Outcome Study Short Form 36 (SF-36) that includes psychological and physiological aspects to assess and analyze the quality of life of 73 adult patients who underwent percutaneous device closure of ASD.Of the 73 patients who were investigated in this study, 67 completed questionnaires successfully. The following findings were revealed after analyzing the preoperative results and postoperative results. In some dimensions ( "physical functioning," "vitality," "general health" ), the postoperative perception was better than the preoperative status. Some differences were found in the quality of life feedback between the case group and the control group. Among the different subgroups, older patients scored lower than younger patients on most dimensions, and men seemed to perform better on "role-physical" factors than women. Unmarried people performed worse on "role-physical" and "bodily pain" than married people. Among people with different academic degrees, those with higher degrees demonstrated better scores on multiple dimensions ( "role-physical," "mental health," "social functioning," and "general health" ) than those with lower degrees.After percutaneous device closure of ASD, most adult patients feel that the quality of life is improved compared with that during the preoperative status. With the change of patients' own conditions, their quality of life seems to change differently. In order to better help patients integrate into life, psychological and physical support is still needed.

Long-Term Outcome After Transcatheter Atrial Septal Defect Closure in Adults: A Systematic Review and Meta-Analysis

AIMS

We performed a systematic review and meta-analysis of published studies to characterize the current literature and help determine the long-term outcomes after transcatheter ASD closure in adults.

METHODS AND RESULTS

Two investigators searched the manuscript databases for all eligible studies in accordance with the considered keywords. The pooled prevalence of each event according to the meta-analysis and considering the weight calculated for each study included 10.1% (for arrhythmia), 1.8% (for emboli), 2.3% (for stroke), 12.5% (for residual shunt), 1.8% (for erosion), and 2.5% (for death).

CONCLUSION

The present meta-analysis show high long-term successfulness of transcatheter ASD closure in adults.

Transcatheter device closure of atrial septal defects guided completely by transthoracic echocardiography: A single cardiac center experience with 152 cases

Objective:

This study aimed to assess the safety and feasibility of transcatheter device closure of atrial septal defects (ASDs) guided completely by transthoracic echocardiography (TTE).

Methods:

A total of 152 patients underwent transcatheter device closure of ASDs guided completely by TTE in our center from September 2014 to June 2017. We used routine delivery sheaths during the procedure and then closed the ASDs by releasing a domestic occluder.

Results:

The closure was successful in 150 patients, and surgical repair was required in two patients. The size of the deployed occluder ranged from 10 mm to 38 mm (21.4±8.5 mm), and the procedure duration ranged from 30 to 90 min (38.2±21.4 min). No fatal complications were observed. Minor complications included transient arrhythmias (n=12) during the process of device deployment. The follow-up period was 3 months to 2 years, with no occluder dislodgment, residual fistula, or thrombus-related complications. In our comparative studies, no statistically significant differences were observed in success rates and complications.

Conclusion:

Transcatheter device closure of ASDs guided completely by TTE may be safe and effective and can be an alternative to traditional methods.

Successful totally transthoracic echocardiography guided transcatheter device closure of atrial septal defect in pregnant women

BACKGROUND

Transcatheter device closure of atrial septal defect (ASD) guided by fluoroscopy and/or transesophageal echocardiography is a mature technology. Little study has focused on whether the technology can be guided totally by transthoracic echocardiography (TTE), even in pregnant women with ASD.

AIM

To evaluate the safety and efficacy of totally TTE guided transcatheter device closure of ASD in pregnant women.

METHODS

Six pregnant women (gestational age 20-26 wk) with ASD underwent transcatheter device closure totally guided by TTE at our cardiac center from January 2015 to August 2017. A routine transcatheter procedure without fluoroscopy or intubation and a domestic occluder were used in this study.

RESULTS

All patients had successful closure with good clinical results, and the overall immediate complete closure rate was 100%. The size of the occluder deployed ranged from 20 to 32 mm (26.7 ± 4.3 mm), the procedure time ranged from 30 to 50 min (41.7 ± 7.5 min), and the length of hospital stay was 2-3 d (mean 2.2 ± 0.4 d). There were no serious cardiovascular related complications, and transient arrhythmias occurred in one patient during the procedure. During the follow-up period (3 mo to 2 years), no occluder dislodgement, residual fistulas, or thromboses occurred. All of the patients underwent vaginal delivery between 36 and 38 wk of gestation.

CONCLUSION

Totally TTE guided transcatheter device closure of ASD in pregnant women may be safe and effective.

Comparison of Remifentanil-Based Fast-Track and Fentanyl-Based Routine Cardiac Anesthesia for Intraoperative Device Closure of Atrial Septal Defect (ASD) in Pediatric Patients

Background

The aim of this study was to evaluate the effectiveness and safety of remifentanil-based fast-track anesthesia for intraoperative device closure of atrial septal defects (ASDs).

Material/Methods

The clinical data of 152 pediatric patients who received intraoperative device closure of ASD in our hospital from January 2015 to December 2017 were retrospectively analyzed. Patients were divided into 2 groups: group F (remifentanil-based fast-track anesthesia group, n=72) and group C (fentanyl-based routine anesthesia group, n=80). The relevant data from 2 groups were collected and analyzed.

Results

No significant differences were found in the preoperative data or intraoperative hemodynamic index between these 2 groups. Group C was significantly inferior to group F regarding the duration of mechanical ventilation, length of intensive care unit (ICU) stay, length of hospital stay, and hospitalization expenses (P<0.05). In terms of postoperative complications, no death, third-degree atrioventricular block, occluder detachment, or residual leakage was reported in either group. The incidence of lung infections and bronchospasm was significantly higher in group C than in group F. There were no anesthetic-related complications.

Conclusions

The application of remifentanil-based fast-track anesthesia for intraoperative device closure of ASD is as effective and safe as fentanyl-based routine anesthesia. Moreover, remifentanil-based fast-track anesthesia has the advantages of shorter duration of mechanical ventilation, shorter length of hospital and ICU stay, fewer postoperative complications, and lower hospitalization expenses, and is therefore worthy of promotion in clinical practice.

Late complications of an atrial septal occluder provoked by anticoagulant therapy

Late complications of an atrial septal occluder device (ASO) are rare but may be serious. We report a case with extensive hemopericardium five years after ASO implantation most likely triggered by anticoagulant therapy. Although not surgically confirmed, indirect clues for erosion of the atrial wall by the device were the exclusion of other etiologies, lack of recurrence after pericardial drainage and withdrawal of anticoagulants. In addition, multimodality imaging using echocardiography, computed tomography, and cardiac magnetic resonance imaging were helpful to elucidate this unusual cause. Initiation of anticoagulant treatment in patients with an ASO should be carefully balanced and may warrant more frequent echocardiographic follow-up. .

Intergenerational differences in the effects of transcatheter closure of atrial septal defects on cardiac function

BACKGROUND

Little is known regarding intergenerational differences in the effects of atrial sepal defect (ASD) closure on the left heart. We therefore analyzed age-related serial changes in the left heart following ASD closure.

METHODS

We studied 50 patients with an isolated ASD who underwent successful transcatheter closure using Amplatzer septal occluders (St. Jude Medical, Little Canada, MN, USA) between June 2007 and June 2013. Patients were divided into three age groups: young patients aged ≤17 years; middle-aged patients aged 18-50 years; and older patients aged >50 years. Multi-modal echocardiographic studies with different views were performed before and at 1 day, 1-3 months, and 6-12 months after ASD closure. Echocardiographic variables were compared among the groups at different time points after closure.

RESULTS

Left ventricular end-diastolic and end-systolic volume indices (EDVI and ESVI) in the older group were significantly smaller than those in the other groups before closure. EDVI and ESVI increased with time after closure in all groups with stable ejection fractions. However, EDVI and ESVI remained significantly smaller in the older group compared with the other groups. There was a significant interaction among the age groups only in terms of left atrial volume index (LAVI). LAVI increased significantly with time in the older group, but did not change in the other groups.

CONCLUSION

Although the left ventricle enlarged with time after ASD closure in all age groups, left ventricular size in older patients never reached that in younger patients. In addition to this inadequate enlargement of the left ventricle, diastolic dysfunction might also result in late left atrial enlargement in older patients following ASD closure.

[Multimodality imaging in the cardiac catheterization laboratory]

Cardiac catheterization has greatly contributed to the progress made in the management of congenital heart diseases (CHD). Initially used in diagnosis, it allowed the understanding of heart diseases, their anatomy and hemodynamics. Gradually, the development of interventional cardiology has played a major role in the management of these malformations (Patent ductus arteriosus [PDA] and atrial septal defect [ASD] closure, pulmonary dilatation, percutaneous pulmonary valve implantation…). The development of such technology was made possible through the concomitant development of imaging techniques: fluoroscopy, ultrasound, MRI and CT. Imaging should provide an accurate view of the lesions, the surrounding cardiac structures, as well as medical devices and catheters used. Here we address the field of fusion images. The principle of image fusion is based on the association by superposition of several imaging techniques: real-time fluoroscopy and slice imaging performed offline, or ultrasound imaging performed simultaneously. The goal is to improve the overall view of the organ, its surrounding structures and as the consequence to help the interventional cardiologist.

Long-term Follow-up of "Simple" Lesions--Atrial Septal Defect, Ventricular Septal Defect, and Coarctation of the Aorta

Surgery for congenital heart disease has advanced significantly in the past 50 years, such that repair of "simple" lesions, such as atrial septal defect, ventricular septal defect, and coarctation of the aorta carries minimal risk, with mortality risk much less than 1%. It was once thought successful repair of these lesions was definitively corrective. There is mounting evidence, however, that there are long-term complications after these repairs, prompting the need for continued follow-up. This review describes the current understanding of diagnosis, treatment, and long-term outcomes for these patients, with the goal of advocating for lifelong surveillance. As the perioperative care of these repairs has evolved significantly over time, so must the way in which we study these patients in the long-term.

Atrial septal defects - clinical manifestations, echo assessment, and intervention

Atrial septal defect (ASD) is a common congenital abnormality that occurs in the form of ostium secundum, ostium primum, sinus venosus, and rarely, coronary sinus defects. Pathophysiologic consequences of ASDs typically begin in adulthood, and include arrhythmia, paradoxical embolism, cerebral abscess, pulmonary hypertension, and right ventricular failure. Two-dimensional (2D) transthoracic echocardiography with Doppler is a central aspect of the evaluation. This noninvasive imaging modality often establishes the diagnosis and provides critical information guiding intervention. A comprehensive echocardiogram includes evaluation of anatomical ASD characteristics, flow direction, associated abnormalities (eg, anomalous pulmonary veins), right ventricular anatomy and function, pulmonary pressures, and the pulmonary/systemic flow ratio. The primary indication for ASD closure is right heart volume overload, whether symptoms are present or not. ASD closure may also be reasonable in other contexts, such as paradoxical embolism. ASD type and local clinical expertise guide choice of a percutaneous versus surgical approach to ASD closure.