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Qiu HF, Chen Q, Hong ZN, Chen LW, Huang XS. Transcatheter and intraoperative device closure and surgical repair for atrial septal defect. J Cardiothorac Surg 2019; 14:136. [PMID: 31324190 PMCID: PMC6642487 DOI: 10.1186/s13019-019-0957-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 07/15/2019] [Indexed: 11/10/2022] Open
Abstract
Background Transcatheter and intraoperative device closure for atrial septal defect (ASD) are widely applied to reduce the incision size and the potential for injury during cardiopulmonary bypass (CPB) in conventional surgical repair. No studies had been conducted to compare the safety and efficiency of these three treatments. Methods From January 2018 to April 2018, 87 patients with an isolated ASD who had undergone transcatheter device closure (n = 45), intraoperative device closure (n = 22) and surgical repair (n = 20) were retrospectively reviewed and further analyzed to compare these three treatments. Results The successful closure rate was similar in the three groups. There was a significant difference in aortic cross-clamping time, CPB duration and operative time between the surgical group and the device groups. The length of intensive care unit stay, postoperative mechanical ventilation time and length of hospital stay were shorter in the two device groups than in the surgical group. The incision was the most extended in the surgical group. Regarding major adverse events, no significant differences were found among the three groups. Conclusions Transcatheter and intraoperative device closure and surgical repair for ASD are all safe and effective. Considering their respective disadvantages and advantages, the transcatheter approach may be the first choice for an isolated secundum ASD, the intraoperative approach may be the second choice, and surgical repair may be the last resort.
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Affiliation(s)
- Han-Fan Qiu
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, People's Republic of China
| | - Qiang Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, People's Republic of China
| | - Zhi-Nuan Hong
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, People's Republic of China
| | - Liang-Wan Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, People's Republic of China
| | - Xue-Shan Huang
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, People's Republic of China.
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Farooqi M, Stickley J, Dhillon R, Barron DJ, Stumper O, Jones TJ, Clift PF, Brawn WJ, Drury NE. Trends in surgical and catheter interventions for isolated congenital shunt lesions in the UK and Ireland. Heart 2019; 105:1103-1108. [PMID: 30772822 PMCID: PMC6613741 DOI: 10.1136/heartjnl-2018-314428] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/11/2019] [Accepted: 01/15/2019] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To evaluate time trends in the use of catheter and surgical procedures, and associated survival in isolated congenital shunt lesions. METHODS Nationwide, retrospective observational study of the UK National Congenital Heart Disease Audit database from 2000 to 2016. Patients undergoing surgical or catheter procedures for atrial septal defect (including sinus venosus defect), patent foramen ovale, ventricular septal defect and patent arterial duct were included. Temporal changes in the frequency of procedures, and survival at 30 days and 1 year were determined. RESULTS 40 911 procedures were performed, 16 604 surgical operations and 24 307 catheter-based interventions. Transcatheter procedures increased over time, overtaking surgical repair in 2003-2004, while the number of operations remained stable. Trends in interventions differed according to defect type and patient age. Catheter closure of atrial septal defects is now more common in children and adults, although surgical interventions have also increased. Patent foramen ovale closure in adults peaked in 2009-2010 before falling significantly since. Surgery remains the mainstay for ventricular septal defect in infants and children. Duct ligation is most common in neonates and infants, while transcatheter intervention is predominant in older children. Excluding duct ligation, survival following surgery was 99.4% and ≈98.7%, and following catheter interventions was 99.7% and ≈99.2%, at 30 days and 1 year, respectively. CONCLUSIONS Trends in catheter and surgical techniques for isolated congenital shunt lesions plot the evolution of the specialty over the last 16 years, reflecting changes in clinical guidelines, technology, expertise and reimbursement, with distinct patterns according to lesion and patient age.
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Affiliation(s)
- Mehreen Farooqi
- Paediatric Cardiac Surgery, Birmingham Children's Hospital, Birmingham, UK
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - John Stickley
- Paediatric Cardiac Surgery, Birmingham Children's Hospital, Birmingham, UK
| | - Rami Dhillon
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Paediatric Cardiology, Birmingham Children's Hospital, Birmingham, UK
| | - David J Barron
- Paediatric Cardiac Surgery, Birmingham Children's Hospital, Birmingham, UK
| | - Oliver Stumper
- Paediatric Cardiology, Birmingham Children's Hospital, Birmingham, UK
| | - Timothy J Jones
- Paediatric Cardiac Surgery, Birmingham Children's Hospital, Birmingham, UK
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Paul F Clift
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Adult Congenital Cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - William J Brawn
- Paediatric Cardiac Surgery, Birmingham Children's Hospital, Birmingham, UK
| | - Nigel E Drury
- Paediatric Cardiac Surgery, Birmingham Children's Hospital, Birmingham, UK
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
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Liu Y, Li S, Wang R, Han X, Su M, Cao X, Wang G, Cao F, Yu S. A New Perspective of Migraine Symptoms in Patients With Congenital Heart Defect. Headache 2018; 58:1601-1611. [PMID: 30444273 DOI: 10.1111/head.13453] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2018] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To investigate the association between congenital heart defects (CHDs) and migraine and evaluate the efficacy of transcatheter defect closure from a new perspective. METHODS The patients with CHDs who underwent transcatheter defect closure were screened in the medical database of Chinese PLA General Hospital from January 2006 to January 2017. The assessment included basic admission information, the 3-item ID Migraine Screener, and a detailed questionnaire administered by telephone or in an outpatient clinic. Patients were divided into ventricular septal defect (VSD) group and AP group (ie, patients with ASD or PFO) based on the type of defects. The latter group could be further divided into right-to-left shunt (RLS) group and left-to-right (LRS) shunt group. Each group contained 4 subgroups according to their migraine diagnosis before and after defect closure: persistent migraine (PM), relieved migraine (RM), without migraine (WM), and new-onset migraine (NM). RESULTS The study recruited total 441 CHDs patients. Most patients in RLS group had migraine before and/or after surgery (76.4%, 42/55) and the proportion of them in NM group was higher than that of in LRS group (23.5%, 4/17 vs 6.8%, 18/266, P = .0418). Although the size of closure device or defect did not show significant differences, the ratios (R = size of closure/size of defect) were significantly higher in NM group than those in WM group (1.40 [1.26, 1.80] vs 1.22 [1.13, 1.38] in AP group, P = .00238; 1.38 [1.23, 1.50] vs 1.22 [1.13, 1.37] in LRS group, P = .024934, respectively). Further logistic regression analysis illustrated that larger R value was a risk factor for NM in AP group (OR 1.48, 95% CI 1.07-2.05, P = .0188). Besides, migraine symptoms decreased significantly after defect closure in PM group among patients with ASD and PFO. CONCLUSION This study revealed several associations between migraine and CHDs, especially the large ratio of closure device size to defect size. High-quality randomized controlled trials and animal studies are needed to further investigate and clarify the underlying association between CHDs and migraine.
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Affiliation(s)
- Yinglu Liu
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Sulei Li
- Department of Cardiology & National Clinical Research Center of Geriatric Disease, Chinese PLA General Hospital, Beijing, China
| | - Rongfei Wang
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Xun Han
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Min Su
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Xiutang Cao
- Department of Medical Statistics, Chinese PLA General Hospital, Beijing, China
| | - Guangyi Wang
- Department of Cardiology & National Clinical Research Center of Geriatric Disease, Chinese PLA General Hospital, Beijing, China
| | - Feng Cao
- Department of Cardiology & National Clinical Research Center of Geriatric Disease, Chinese PLA General Hospital, Beijing, China
| | - Shengyuan Yu
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
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Xie ZF, Wang SS, Zhang ZW, Zhuang J, Liu XD, Chen XM, Zhang G, Zhang D. A Novel-Design Poly-L-Lactic Acid Biodegradable Device for Closure of Atrial Septal Defect: Long-Term Results in Swine. Cardiology 2016; 135:179-187. [DOI: 10.1159/000446313] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 04/20/2016] [Indexed: 11/19/2022]
Abstract
Objectives: The aim of this study is to evaluate the long-term effectiveness and safety of a self-expandable, double-disk biodegradable device made of poly-L-lactic acid (PLLA) for closure of atrial septal defects (ASDs) in swine. Methods: ASDs were created by transseptal needle puncture followed by balloon dilatation in 20 piglets. The experimental group comprised 18 animals, while the remaining 2 animals were used as controls. Effectiveness and safety were evaluated by rectal temperature, leukocyte count, chest radiography, electrocardiogram, transthoracic echocardiography (TTE), intracardiac echocardiography (ICE), and histologic studies. Animals were followed up at 1, 3, 6, and 12 months. Results: An ASD model was successfully created in 19 animals; 1 piglet died during the procedure. The ASD diameters that were created ranged from 5 to 6.4 mm. Devices were successfully implanted in 17 animals. No animal died during the follow-up studies. Rectal temperatures and electrocardiograms were normal at follow-up, while leukocyte counts transiently increased from 1 to 6 months. Radiography, TTE, ICE, and macroscopic studies demonstrated that PLLA occluders were positioned well, with no shifting, mural thrombus formation, or atrioventricular valve insufficiency. Histologic evaluations showed that PLLA devices were partially degraded in the follow-up study. Conclusions: ASD closure with the novel PLLA biodegradable device is safe and effective. Longer-term studies are needed to evaluate long-term biodegradability.
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Nassif M, Abdelghani M, Bouma BJ, Straver B, Blom NA, Koch KT, Tijssen JGP, Mulder BJM, de Winter RJ. Historical developments of atrial septal defect closure devices: what we learn from the past. Expert Rev Med Devices 2016; 13:555-68. [PMID: 27112301 DOI: 10.1080/17434440.2016.1182860] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Since King and Mills' pioneering work in percutaneous closure devices of secundum atrial septal defects (ASD) four decades ago, developments in device shape, material and implantation technique led to adoption of percutaneous ASD closure as current treatment of choice. Not only was the feasibility of such a percutaneous procedure tested altogether, but pursuing the ideal device in terms of safety and efficacy became priority. AREAS COVERED In this review we present the historical development of ASD devices in design, material and technique with clinical data, and provide the future perspectives in percutaneous ASD closures. EXPERT OPINION An 'ideal device' requires complete defect closure with negligible risk of complications using a safe, straightforward delivery technique with repositioning and retrieving properties. Some of the devices currently at hand come close to fulfilling these criteria, however none seem to provide those prerequisites completely. By understanding how challenges in device development were overcome in the past, new insights into future improvements are given.
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Affiliation(s)
- Martina Nassif
- a Department of Cardiology, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
| | - Mohammad Abdelghani
- a Department of Cardiology, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
| | - Berto J Bouma
- a Department of Cardiology, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
| | - Bart Straver
- b Department of Pediatric Cardiology, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
| | - Nico A Blom
- b Department of Pediatric Cardiology, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
| | - Karel T Koch
- a Department of Cardiology, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
| | - Jan G P Tijssen
- a Department of Cardiology, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
| | - Barbara J M Mulder
- a Department of Cardiology, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands.,c Interuniversity Cardiology Institute of the Netherlands (ICIN) , Utrecht , The Netherlands
| | - Robbert J de Winter
- a Department of Cardiology, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
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Kim HD, Kim MS, Yun KJ, Bae SM, Her SH, Lee JH. Successful transcatheter closure of an inferior sinus venosus atrial septal defect. Korean J Intern Med 2016; 31:176-8. [PMID: 26767872 PMCID: PMC4712423 DOI: 10.3904/kjim.2016.31.1.176] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 11/01/2013] [Accepted: 11/01/2013] [Indexed: 11/27/2022] Open
Affiliation(s)
- Hyung Duk Kim
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Moon Sung Kim
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyung-Jin Yun
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang Mook Bae
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung-Ho Her
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Correspondence to Sung-Ho Her, M.D. Division of Cardiology, Department of Internal Medicine, College of Medicine, Daejeon St. Mary’s Hospital, The Catholic University of Korea, 64 Daeheung-ro, Jung-gu, Daejeon 34943, Korea Tel: +82-42-220-9504 Fax: +82-42-226-9686 E-mail:
| | - Jae-Hwan Lee
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
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ARKLES JEFFREY, ZADO ERICA, SUPPLE GREGORY, FRANKEL DAVIDS, CALLANS DAVID, MARCHLINSKI FRANCIS, DIXIT SANJAY. Feasibility of Transseptal Access in Patients With Previously Scarred or Repaired Interatrial Septum. J Cardiovasc Electrophysiol 2015; 26:963-968. [DOI: 10.1111/jce.12730] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Revised: 05/09/2015] [Accepted: 05/18/2015] [Indexed: 12/18/2022]
Affiliation(s)
- JEFFREY ARKLES
- Electrophysiology Section; Cardiovascular Division, Temple University Hospital; Philadelphia Pennsylvania USA
| | - ERICA ZADO
- Electrophysiology Section, Cardiovascular Division; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania USA
| | - GREGORY SUPPLE
- Electrophysiology Section, Cardiovascular Division; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania USA
| | - DAVID S. FRANKEL
- Electrophysiology Section, Cardiovascular Division; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania USA
| | - DAVID CALLANS
- Electrophysiology Section, Cardiovascular Division; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania USA
| | - FRANCIS MARCHLINSKI
- Electrophysiology Section, Cardiovascular Division; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania USA
| | - SANJAY DIXIT
- Electrophysiology Section, Cardiovascular Division; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania USA
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Kaya MG, Akpek M, Celebi A, Saritas T, Meric M, Soylu K, Karapinar H, Lam YY. A multicentre, comparative study of Cera septal occluder versus AMPLATZER Septal Occluder in transcatheter closure of secundum atrial septal defects. EUROINTERVENTION 2014; 10:626-31. [DOI: 10.4244/eijy14m07_04] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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MacDonald ST, Carminati M, Chessa M. Managing adults with congenital heart disease in the catheterization laboratory: state of the art. Expert Rev Cardiovasc Ther 2014; 8:1741-52. [DOI: 10.1586/erc.10.165] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Shimpo H, Hojo R, Ryo M, Konuma T, Tempaku H. Transcatheter closure of secundum atrial septal defect. Gen Thorac Cardiovasc Surg 2013; 61:614-8. [DOI: 10.1007/s11748-013-0268-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Indexed: 10/26/2022]
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Saritas T, Kaya MG, Yin Lam Y, Erdem A, Akdeniz C, Demir F, Erol N, Demir H, Celebi A. A comparative study of Cardi-O-Fix septal occluder versus Amplatzer septal occluder in percutaneous closure of secundum atrial septal defects. Catheter Cardiovasc Interv 2013; 82:116-21. [DOI: 10.1002/ccd.23301] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Accepted: 06/27/2011] [Indexed: 11/11/2022]
Affiliation(s)
- Turkay Saritas
- Department of Pediatric Cardiology; Dr Siyami Ersek Thoracic and Cardiovascular Surgery Center; Istanbul; Turkey
| | - Mehmet Gungor Kaya
- Department of Cardiology; Erciyes University School of Medicine; Kayseri; Turkey
| | - Yat Yin Lam
- Division of Cardiology; SH Ho Cardiovascular and Stroke Centre; Department of Medicine and Therapeutics; Prince of Wales Hospital; The Chinese University of Hong Kong; Hong Kong; SAR
| | - Abdullah Erdem
- Department of Pediatric Cardiology; Dr Siyami Ersek Thoracic and Cardiovascular Surgery Center; Istanbul; Turkey
| | - Celal Akdeniz
- Department of Pediatric Cardiology; Dr Siyami Ersek Thoracic and Cardiovascular Surgery Center; Istanbul; Turkey
| | - Fadli Demir
- Department of Pediatric Cardiology; Dr Siyami Ersek Thoracic and Cardiovascular Surgery Center; Istanbul; Turkey
| | - Nurdan Erol
- Department of Pediatric Cardiology; Dr Siyami Ersek Thoracic and Cardiovascular Surgery Center; Istanbul; Turkey
| | - Halil Demir
- Department of Pediatric Cardiology; Dr Siyami Ersek Thoracic and Cardiovascular Surgery Center; Istanbul; Turkey
| | - Ahmet Celebi
- Department of Pediatric Cardiology; Dr Siyami Ersek Thoracic and Cardiovascular Surgery Center; Istanbul; Turkey
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Other Cardiovascular Devices. Biomater Sci 2013. [DOI: 10.1016/b978-0-08-087780-8.00069-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Affiliation(s)
- Netanel S Berko
- Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10467, USA
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Abstract
Cardiovascular devices such as coronary artery stents, ventricular assist devices, pacemakers, automated implantable cardioverter-defibrillators and septal closure devices are life saving and improve quality of life for millions of patients each year. Complications of these devices include thrombosis/thromboembolism, infection, structural failure and adverse material-tissue interactions. These findings should be sought when these devices are encountered on the surgical pathology bench or at autopsy.
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Affiliation(s)
- Robert F Padera
- Department of Pathology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
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Double BioDisk: a new bioprosthetic device for transcatheter closure of atrial septal defects - a feasibility study in adult sheep. Radiol Oncol 2012; 46:89-96. [PMID: 23077444 PMCID: PMC3472939 DOI: 10.2478/v10019-012-0029-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2012] [Accepted: 05/02/2012] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND To evaluate the long-term effectiveness and safety of a new Double BioDisk (DBD) device for closure of atrial septal defect (ASD). MATERIALS AND METHODS.: ASD was created with transeptal needle (TS) followed by balloon dilatation in 12 sheep weighing 40.1 to 64 kg (mean 55.2 ± 7.1). The ASD diameters were measured after creation and two weeks later before DBD implantation. The DBDs consists of two nitinol rings 18 to 28 mm in diameter connected with small cannulas and covered with a porcine small intestinal submucosa (SIS). They were implanted via a 10 Fr sheath. DBD effectiveness was evaluated by angiocardiography and by intra-cardiac echogram (ICE) with Doppler studies. Two animals were acute, two were followed for 6 weeks, three for 3 months, three for 6 months and two for 12 months. RESULTS TS punctures were successful in 10 sheep. In two sheep ASD was created by existing PFO dilation. The ASD size ranged from 13-15 mm (mean 14.1± 0.73 mm) after initial balloon dilation and from 9-13 mm (mean 10.06 ± 1.37 mm) after two weeks. In all animals none of the successfully implanted DBDs spontaneously embolized on release or on follow up. ICE demonstrated no shunting around the DBDs during follows ups. Macroscopic and histologic evaluation of the 6, 12, 24 and 52 weeks animals showed that DBDs were well incorporated in the atrial septum with complete shunt closure. The SIS showed progressive remodeling with the host cells, including endothelization of the DBD devices. CONCLUSIONS ASD closure with the Double BioDisk is safe and effective in adult sheep.
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Medical image diagnostics based on computer-aided flow analysis using magnetic resonance images. Comput Med Imaging Graph 2012; 36:527-41. [PMID: 22575846 DOI: 10.1016/j.compmedimag.2012.04.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2011] [Revised: 04/10/2012] [Accepted: 04/12/2012] [Indexed: 11/24/2022]
Abstract
Most of the cardiac abnormalities have an implication on hemodynamics and affect cardiovascular health. Diagnostic imaging modalities such as computed tomography and magnetic resonance imaging provide excellent anatomical information on myocardial structures, but fail to show the cardiac flow and detect heart defects in vivo condition. The computerized technique for fluid motion estimation by pixel intensity tracking based on magnetic resonance signals represents a promising technique for functional assessment of cardiovascular disease, as it can provide functional information of the heart in addition to analysis of its anatomy. Cardiovascular flow characteristics can be measured in both normal controls and patients with cardiac abnormalities such as atrial septal defect, thus, enabling identification of the underlying causes of these flow phenomena. This review paper focuses on an overview of a flow analysis scheme based on computer-aided evaluation of magnetic resonance intensity images, in comparison with other commonly used medical imaging modalities. Details of the proposed technique are provided with validations being conducted at selected abnormal cardiovascular patients. It is expected that this new technique can potentially extend applications for characterizing cardiovascular defects and their hemodynamic behavior.
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Faletra FF, Nucifora G, Ho SY. Imaging the Atrial Septum Using Real-Time Three-Dimensional Transesophageal Echocardiography: Technical Tips, Normal Anatomy, and Its Role in Transseptal Puncture. J Am Soc Echocardiogr 2011; 24:593-9. [DOI: 10.1016/j.echo.2011.01.022] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Indexed: 01/29/2023]
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Cansel M, Pekdemir H, Yağmur J, Tasolar H, Ermis N, Kurtoglu E, Acıkgoz N, Atas H, Ozdemir R. Early single clinical experience with the new Figulla ASD Occluder for transcatheter closure of atrial septal defect in adults. Arch Cardiovasc Dis 2011; 104:155-60. [DOI: 10.1016/j.acvd.2010.12.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Revised: 12/17/2010] [Accepted: 12/24/2010] [Indexed: 10/18/2022]
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[Modern therapy of congenital heart defects]. Radiologe 2010; 51:10-4. [PMID: 21104224 DOI: 10.1007/s00117-010-1994-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Modern therapy of congenital heart defects consists of interventional and surgical procedures. The following report provides information about the most common congenital heart defects and the corresponding therapeutic options. Furthermore, the combined application of interventional and surgical procedures, so-called hybrid procedures, is described in detail as well as the latest developments in percutaneous valve replacement therapy.
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Quaife RA, Chen MY, Kim M, Klein AJP, Jehle A, Kay J, Groves BM, Carroll JD. Pre-procedural planning for percutaneous atrial septal defect closure: transesophageal echocardiography compared with cardiac computed tomographic angiography. J Cardiovasc Comput Tomogr 2010; 4:330-8. [PMID: 20947043 DOI: 10.1016/j.jcct.2010.08.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2010] [Revised: 07/14/2010] [Accepted: 08/09/2010] [Indexed: 11/15/2022]
Abstract
BACKGROUND The safety and efficacy of percutaneous closure of atrial septal defects (ASDs) is determined by several variables, including defect size, presence of adequate rim tissue, relationship to other cardiac structures, and associated congenital anomalies. OBJECTIVE We sought to determine the accuracy of computed tomographic angiography (CTA) in predicting a defect's size compared with pre-procedural transesophageal echocardiography (TEE) and to the current "gold standard" balloon sizing by intracardiac echocardiography (ICE). METHODS Thirty-five consecutive patients referred for possible percutaneous closure of suspected secundum ASD were evaluated with gated multislice CTA after initial TEE screening. Axial and sagittal image planes of the ASD from the CTA multiplanar reformation (MPR) images were used to measure the defect size and surface area. RESULTS Of the 35 patients with secundum-type ASDs, 5 subjects had disqualifying anatomy by CTA and 2 had an unsuccessful closure, resulting in a procedural success rate of 93%. Measurement of defect area by gated MPR images provided the strongest correlate to ICE balloon size. In large ASDs, TEE was less well correlated to the maximum defect size and identification of the inferior/inferoposterior rims than CTA. CONCLUSIONS Cardiac CTA is an accurate and useful technique for pre-procedural assessment of ASDs and may be superior to conventional TEE in large defects that have deficient inferior rims.
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Affiliation(s)
- Robert A Quaife
- Advanced Cardiac Imaging, Department of Medicine and Radiology, University of Colorado Health Sciences Center, PO Box 6511 Leprino Building 532, Cardiac and Vascular Center, 12401 E 17th Avenue, Aurora, CO 80045, USA.
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Percutaneous successful closure of dual atrial septal defect with two Amplatzer septal occluder devices. Clin Res Cardiol 2010; 99:329-31. [DOI: 10.1007/s00392-010-0124-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Accepted: 01/20/2010] [Indexed: 10/19/2022]
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Brown S, Gewillig M. Perforation of the aortic sinus after closure of atrial septal defects with the Atriasept occluder. Catheter Cardiovasc Interv 2009; 74:298-301. [PMID: 19360869 DOI: 10.1002/ccd.21963] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Percutaneous atrial septal defect closure is routinely performed nowadays because of the ease of implantation as well as the low complication rate. The Atriasept ASD occluder is a low profile, double disc device; over the years several modifications have been made. We report two cases of aortic sinus perforation by the Atriasept ASD occluder (model 2007). Two asymptomatic patients, in whom the device was implanted, were noticed to have metal projecting into the aorta. Real-time fluoroscopy showed fractures of the outer metal ring with abnormal movement of one of the struts of the device. One patient is being conservatively managed and in the other the device was surgically removed due to the presence of a second ASD, which needed closure. Transesophageal echocardiography and fluoroscopy may be necessary to identify this potentially life-threatening complication of this device.
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Affiliation(s)
- Stephen Brown
- Paediatric & Congenital Cardiology, University Hospitals Leuven, Belgium
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Scott P, Wilson N, Veldtman G. Fracture of a GORE HELEX Septal Occluder following PFO closure in a diver. Catheter Cardiovasc Interv 2009; 73:828-31. [DOI: 10.1002/ccd.21901] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Kim MS, Hansgen AR, Carroll JD. Use of rapid prototyping in the care of patients with structural heart disease. Trends Cardiovasc Med 2009; 18:210-6. [PMID: 19185811 DOI: 10.1016/j.tcm.2008.11.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2008] [Revised: 11/10/2008] [Accepted: 11/13/2008] [Indexed: 11/24/2022]
Abstract
Advances in surgery, interventional techniques, and critical care have allowed more than 90% of children born with structural heart defects to survive into adulthood. In addition, advances in imaging technology continue to raise awareness of hemodynamically significant intracardiac shunt lesions in both adults and children. Adult cardiologists are now faced with the daunting task of caring for patients with complex structural heart lesions, a population subset that at one time was exclusively cared for by pediatric cardiologists and congenital heart disease specialists. Given the wide range of anatomic complexity present in patients with structural heart disease, the definition and anatomic clarification of their structural abnormalities through high-quality noninvasive imaging has become paramount. Current two-dimensional imaging techniques, however, remain limited in their ability to effectively illustrate the complex three-dimensional relationships present in structural heart disease. Rapid prototyping, a process by which three-dimensional digital surface models are converted into physical models, represents the next evolution in advanced image processing and may serve as a means to improve our understanding of the many forms of structural heart disease. Ultimately, the technology may be used to enhance the level of care provided to the growing number of patients with structural heart defects. We recently reviewed the novel cardiovascular application of rapid prototyping. This review examines the expanded applications of rapid prototyping in the care and treatment of adult patients with structural heart disease.
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Affiliation(s)
- Michael S Kim
- Division of Cardiology, University of Colorado Denver, Aurora, CO 80045, USA
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Percutaneous Transcatheter Closure of Prosthetic Mitral Paravalvular Leaks. JACC Cardiovasc Interv 2009; 2:81-90. [DOI: 10.1016/j.jcin.2008.10.012] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2008] [Revised: 08/28/2008] [Accepted: 10/10/2008] [Indexed: 11/18/2022]
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Ben Zekry S, Guthikonda S, Little SH, Nagueh SF, Garcia KM, Zoghbi WA. Percutaneous Closure of Atrial Septal Defect. JACC Cardiovasc Imaging 2008; 1:515-7. [DOI: 10.1016/j.jcmg.2008.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2008] [Accepted: 04/17/2008] [Indexed: 11/24/2022]
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