1
|
Doğan E, Levent E. Transcatheter Closure of Secundum Atrial Septal Defects in Pediatric Patients: A 15-Year Single-Center Experience. Cureus 2024; 16:e57150. [PMID: 38681362 PMCID: PMC11055965 DOI: 10.7759/cureus.57150] [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] [Accepted: 03/28/2024] [Indexed: 05/01/2024] Open
Abstract
PURPOSE Transcatheter closure is the first-line treatment option for hemodynamically significant secundum atrial septal defects (ASDs). This study examines our center's experience with this procedure over the last 15 years. MATERIALS AND METHODS Pediatric patients aged 0-18 years with secundum ASDs who were planned for transcatheter closure in our clinic between January 2007 and January 2023 were retrospectively evaluated. RESULTS Transcatheter secundum ASD closure was planned for a total of 334 patients during the study period: 191 girls (57.2%) and 143 boys (42.8%). Their mean age was 8.08±3.9 years, and their mean weight was 30±15.6 kg. Defect diameter measured transesophageally ranged from 5 to 35 mm, with a mean of 12.56±4.02 mm. Transesophageal echocardiographic examination revealed a single secundum ASD in 319 patients (95.5%) and multiple secundum ASDs in 15 patients (4.5%). In 11 patients (3.3%), the procedure was terminated before initiating transcatheter ASD closure because of insufficient vena cava rims or a very large or multi-fenestrated defect. The 323 patients (96.7%) who underwent transcatheter ASD closure had a mean pulmonary artery pressure of 15.1±4.0 mmHg and a mean Qp/Qs ratio of 1.97±0.56. The procedure failed in four patients (1.3%) because of device embolization (n=2) or the inability to properly position the device (n=2). Major complications other than device embolization observed during or after transcatheter closure included anesthetic-induced respiratory depression (n=1) and total atelectasis of the lung (n=1). No new major complications were detected during the patients' long-term follow-up. CONCLUSION With appropriate patient and device selection, transcatheter closure is a safe and effective treatment for secundum ASD and should be the first treatment of choice.
Collapse
Affiliation(s)
- Eser Doğan
- Department of Pediatric Cardiology, Faculty of Medicine, Ege University, Izmir, TUR
| | - Ertürk Levent
- Department of Pediatric Cardiology, Faculty of Medicine, Ege University, Izmir, TUR
| |
Collapse
|
2
|
Van Praagh R. Interatrial Communications. CONGENIT HEART DIS 2022. [DOI: 10.1016/b978-1-56053-368-9.00009-3] [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: 11/29/2022]
|
3
|
Larson B, Adler DG. Endoscopic management of esophagorespiratory fistulas. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2019. [DOI: 10.1016/j.tgie.2019.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
4
|
Percutaneous Placement of Amplatzer Duct Occluder Device to Seal a Saphenous Vein Graft Pseudoaneurysm. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 20:523-527. [PMID: 30266554 DOI: 10.1016/j.carrev.2018.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 09/05/2018] [Accepted: 09/05/2018] [Indexed: 11/24/2022]
|
5
|
Hoey ETD, Lewis G, Yusuf S. Multidetector CT assessment of partial anomalous pulmonary venous return in association with sinus venosus type atrial septal defect. Quant Imaging Med Surg 2014; 4:433-4. [PMID: 25392829 DOI: 10.3978/j.issn.2223-4292.2014.07.08] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 07/03/2014] [Indexed: 11/14/2022]
Abstract
Sinus venosus defects account for 15% of all atrial septal defects. They are frequently associated with partial anomalous pulmonary venous drainage of the right superior pulmonary vein into the superior vena cava (SVC). These defects require surgical correction and accurate pre-operative imaging assessment is critical. We present a case of sinus venosus atrial septal defect in which multidetector computed tomography (MDCT) angiography identified separate sites of pulmonary venous return.
Collapse
Affiliation(s)
- Edward T D Hoey
- 1 Department of Radiology, 2 Department of Cardiology, Heart of England NHS Trust, Birmingham, UK
| | - Gareth Lewis
- 1 Department of Radiology, 2 Department of Cardiology, Heart of England NHS Trust, Birmingham, UK
| | - Shamil Yusuf
- 1 Department of Radiology, 2 Department of Cardiology, Heart of England NHS Trust, Birmingham, UK
| |
Collapse
|
6
|
Komar M, Przewłocki T, Olszowska M, Sobień B, Stępniewski J, Podolec J, Mleczko S, Tomkiewicz-Pająk L, Żmudka K, Podolec P. Conduction Abnormality and Arrhythmia After Transcatheter Closure of Atrial Septal Defect. Circ J 2014. [DOI: 10.1253/circj.cj-14-0456] [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: 11/09/2022]
Affiliation(s)
- Monika Komar
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University
| | - Tadeusz Przewłocki
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University
| | - Maria Olszowska
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University
| | - Bartosz Sobień
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University
| | - Jakub Stępniewski
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University
| | - Jakub Podolec
- Department of Haemodynamics and Angiocardiography, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital
| | - Szymon Mleczko
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University
| | - Lidia Tomkiewicz-Pająk
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University
| | - Krzysztof Żmudka
- Department of Haemodynamics and Angiocardiography, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital
| | - Piotr Podolec
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University
| |
Collapse
|
7
|
|
8
|
Abaci A, Unlu S, Alsancak Y, Kaya U, Sezenoz B. Short and long term complications of device closure of atrial septal defect and patent foramen ovale: Meta-analysis of 28,142 patients from 203 studies. Catheter Cardiovasc Interv 2013; 82:1123-38. [DOI: 10.1002/ccd.24875] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 01/27/2013] [Accepted: 02/09/2013] [Indexed: 01/15/2023]
Affiliation(s)
- Adnan Abaci
- Department of Cardiology; School of Medicine; Gazi University; Ankara Turkey
| | - Serkan Unlu
- Department of Cardiology; School of Medicine; Gazi University; Ankara Turkey
| | - Yakup Alsancak
- Department of Cardiology; School of Medicine; Gazi University; Ankara Turkey
| | - Ulker Kaya
- Department of Cardiology; School of Medicine; Gazi University; Ankara Turkey
| | - Burak Sezenoz
- Department of Cardiology; School of Medicine; Gazi University; Ankara Turkey
| |
Collapse
|
9
|
Roy D, Sharma R, Bunce N, Ward D, Brecker SJ. Selecting the optimal closure device in patients with atrial septal defects and patent foramen ovale. Interv Cardiol 2012. [DOI: 10.2217/ica.11.90] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
10
|
McManus B. Adult congenital heart disease—challenges and opportunities for pathologists. Cardiovasc Pathol 2010; 19:281-5. [DOI: 10.1016/j.carpath.2009.10.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2009] [Revised: 10/10/2009] [Accepted: 10/28/2009] [Indexed: 11/30/2022] Open
|
11
|
Hoey ETD, Gopalan D, Agrawal SKB, Screaton NJ. Cardiac causes of pulmonary arterial hypertension: assessment with multidetector CT. Eur Radiol 2009; 19:2557-68. [DOI: 10.1007/s00330-009-1460-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2008] [Revised: 03/19/2009] [Accepted: 04/27/2009] [Indexed: 11/29/2022]
|
12
|
Lysitsas DN, Wrigley B, Banerjee P, Glennon PE, Parmar JM, Shiu MF, Been M. Presentation of an embolised Amplatzer septal occluder to the main pulmonary artery 2 years after implantation. Int J Cardiol 2009; 131:e106-7. [DOI: 10.1016/j.ijcard.2007.07.072] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2007] [Accepted: 07/07/2007] [Indexed: 11/28/2022]
|
13
|
Spies C, Timmermanns I, Schräder R. Transcatheter closure of secundum atrial septal defects in adults with the Amplatzer septal occluder: Intermediate and long-term results. Clin Res Cardiol 2007; 96:340-6. [PMID: 17323009 DOI: 10.1007/s00392-007-0502-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2006] [Accepted: 01/10/2007] [Indexed: 10/23/2022]
Abstract
AIMS Transcatheter closure of secundum atrial septal defects (ASD) with the Amplatzer septal occluder (ASO) has become a standard procedure in most pediatric and adult patients. However, data addressing success rates and outcome in adults is limited. We sought to define the safety profile of the ASO in the community setting and identify the percentage of adults with ASD amenable to percutaneous closure with the ASO. METHODS We performed a retrospective analysis of patients' records referred for transcatheter ASD closure from 1999 through 2005 at a single institution. Patients were evaluated with right heart catheterization and underwent closure of the ASD according to standard indications under transesophageal and fluoroscopic guidance. RESULTS Two hundred and seven consecutive patients were taken to the catheterization laboratory for hemodynamic evaluation and possible interventional closure of an ASD. Of those patients, 18 were excluded because the defect and the left-to-right shunt were hemodynamically insignificant (n = 7) or because there was no distinct defect, but instead a multi-perforated septum (n = 11). Nineteen cases were excluded for anatomic reasons. Of the remaining 170 patients, ASO implantation was attempted and successfully performed in 166 (83% of 200 patients with hemodynamically significant ASD). Complications occurred in 11 cases (6.5%) (device dislocation = 4, transient ST-segment elevation = 4, TIA = 1, hemoptysis = 1, pericardial effusion = 1); none of these events were associated with long-term sequelae. During a median follow-up period of 13 months (range 6-80) there were no major clinical events. CONCLUSIONS More than 80% of adults with a distinct, hemodynamically significant secundum ASD can be successfully treated with the ASO. The immediate success rates are excellent and follow-up data suggest that the ASO is a safe device well suited for transcatheter ASD closure.
Collapse
Affiliation(s)
- Christian Spies
- Rush University Medical Center, Section of Cardiology, 1653 W Congress Parkway, Chicago, IL 60612, USA.
| | | | | |
Collapse
|
14
|
Post MC, Suttorp MJ, Jaarsma W, Plokker HWT. Comparison of outcome and complications using different types of devices for percutaneous closure of a secundum atrial septal defect in adults: a single-center experience. Catheter Cardiovasc Interv 2006; 67:438-43. [PMID: 16489564 DOI: 10.1002/ccd.20625] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The objective of this study was to find differences in outcome and complications using three different types of devices for percutaneous atrial septal defect (ASD) closure in adults. Percutaneous closure of a secundum-type ASD is increasingly performed in adult patients. All adult patients who underwent a percutaneous closure of a secundum-type ASD in our center between November 1996 and November 2004 were included. Failure was defined as dislocation or embolization of the device, which required surgical intervention. Periprocedural and mid-term complications were registered. Sixty-five patients, mean age 45.7+/-18.1 years (18 men, 47 women), underwent a percutaneous closure of an ASD with an ASDOS in 3, an Amplatzer in 36, and a Cardioseal/Starflex closure device in 26 patients. During an overall median follow-up of 1.2 years (range, 0.1-6.7 years), the failure occurred in four patients, all Cardioseal/Starflex (P=0.04). Within the Cardioseal/Starflex subgroup, the ASD and device diameters were significantly higher in those patients in whom the primary endpoint occurred compared to the others, 18.8+/-3.8 vs. 13.0+/-3.8 mm for ASD diameter (P=0.01) and 40 (range, 40-43) vs. 33 mm (range, 20-40) for device diameter (P=0.008). Overall complications were transient arrhythmias in 15.4%, pericardial effusion in 1.5%, and transient ischemic attack in 1.5%. Complete closure 6 months after the procedure occurred in 79.6%, without difference between the devices. Percutaneous ASD closure seems to be a relatively safe and effective procedure. However, using the larger Cardioseal/Starflex devices for closure seems to be related to a higher rate of device dislocation and embolization.
Collapse
Affiliation(s)
- Martijn C Post
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
| | | | | | | |
Collapse
|
15
|
Devuyst G, Bogousslavsky J. Patent foramen ovale: The never-ending story. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2005; 7:227-39. [PMID: 16004854 DOI: 10.1007/s11936-005-0051-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Several uncontrolled studies suggested a relationship between patent foramen ovale (PFO) and stroke. But recent data indicate that previous studies may overestimate the association between PFO and stroke. First, among patients who have had a cryptogenic stroke under treatment (with either warfarin or aspirin), the main data from the French PFO/atrial septal aneurysm (ASA) and PICSS (Patent Foramen Ovale in Cryptogenic Stroke Study), analyzed separately and in combination, indicate that PFO alone does not announce a significantly increased risk of recurrent stroke or death. But a small increase or decrease in risk cannot be excluded by this meta-analysis. Second, the data concerning the association between PFO and ASA are not clear and variable: the French PFO/ASA study found a significantly increased risk of recurrent stroke in patients with cryptogenic stroke and an association between PFO and ASA when treated medically. In contrast, PICSS found no association between the combined PFO-ASA with stroke or death, but the two populations had meaningful differences. Patients in the PICSS were much older than those in the French PFO/ASA study and had more risk factors for stroke, such as hypertension, diabetes, and history of prior stroke. Third, there were inadequate data to conclude about ASA alone. Possible practice recommendations could come from this meta-analysis: the evidence indicates that the risk of recurrent stroke or death is not different for patients with a PFO who underwent cryptogenic stroke compared to patients without a PFO who underwent a cryptogenic stroke under treatment with either aspirin or warfarin. But aspirin is more preferable (300 mg/d). However, it seems that the association between PFO and ASA confers an increased risk of recurrent stroke in medically treated patients who are less than 55 years of age. This subgroup of younger stroke patients may benefit from other treatments, such as the percutaneous closure of PFO or mini-invasive surgery to a lesser extent, but their efficacy and safety are not yet assessed by large randomized trials. However, we must also keep in mind that some stroke patients with PFO are psychologically attached to their PFO and prefer to close it.
Collapse
Affiliation(s)
- Gérald Devuyst
- Centre Hospitalier Universitaire Vaudois, Department of Neurology, Academic of Vaud, Street of Bugnon 46, Lausanne 1011, Switzerland.
| | | |
Collapse
|