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

Percutaneous Closure of Atrial Septal Defects with the MemoPart Atrial Septal Occluder: The Early-Term Results of a Multicenter Study

Atrial septal defect (ASD) is a common congenital heart disease with left-to-right shunt that may lead to pulmonary hypertension over time. Secundum ASD closure with transcatheter technique is currently the preferred method. The aim of this study was to evaluate the clinical experience and early-term outcomes of patients treated with a MemoPart ASD occluder device between June 2013 and June 2019. Fifty-six patients (35 females) with a mean age of 9.4 ± 6.6 years (range: 2-44 years) were included in the study. The diameters of the devices used to close the ASDs were 7-28 mm. The ratio of the device/defect diameter was 1.14:1. Atrial septal defect closure was applied successfully in all patients. The MemoPart septal occluder is a safe and effective device for ASD closure. In wide ASDs and cases with more than one deficient rim, weak rims, or wide and complicated cases, it can be used carefully with sufficient experience.

Clinical evaluation of percutaneous and intra-operative device closure of atrial septal defects under transesophageal echocardiographic guidance: one center experience and mid-term follow-up

OBJECTIVE

The percutaneous closure of a single secundum atrial septal defect (ASD) under transesophageal echocardiography guidance as an accepted alternative to the transcatheter closure with fluoroscopy has been proven. However, the technique has not been routinely used. This study was to present and share our experience in comparing the clinical outcomes of the percutaneous and intra-operative device closure (IODC) of atrial septal defects without fluoroscopy.

METHODS

From January 2013 to December 2016, 103 patients with maximum diameters of ASD of less than 30 mm were allocated to groups taking either the percutaneous closure of atrial septal defects approach (PASD group, n = 53) or the intra-operative device closure approach (IODC Group, n = 50). They were operated on using the minimally invasive Amplatzer duct occluder under the guidance of transesophageal echocardiography without cardiopulmonary bypass. Echocardiography was performed to obtain an en face view of the ASD and important surrounding structures before the operation. Patient characteristics, perioperative data, and follow-up data were retrospectively documented and analyzed.

RESULTS

Patient characteristics were comparable between the two groups. These were no differences in the maximum diameters of defects and the size of the occluders in each group (16.4 ± 5.3 mm vs16.4 ± 5.2 mm, P = 0.98; 22.4 ± 5.8 mm vs 21.3 ± 6.6 mm, P = 0.38). Intracardiac manipulation time was 20.72 ± 7.70 min in the PASD group and 6.01 ± 1.03 min in the IODC group (P < 0.001). The procedure time was 28.70 ± 10.41 min in the PASD group and 39.13 ± 6.03 min in the IODC group (P < 0.001). The successful closure defect was 100% in both groups when the maximum diameter of defect less than 25 mm. Four patients the PASD groups with maximum diameters between 25 mm and 30 mm were transferred to the IOCD group after unsuccessful device implantations. The total occlusion rate was 82% immediately after deployment, 98% at 3 months, and 100% at 6 months. No cardiac-related complications occurred during the follow-up period of between 3 to 65 months (mean 21.4 ± 9.8 months).

CONCLUSIONS

Percutaneous device closures of Secundum atrial septal defects showed safety and high efficiency in patients under guidance by transesophageal echocardiography when compared with intra-operative device closures and are especially suited for women and children.

Congenital Heart Disease in Low- and Lower-Middle-Income Countries: Current Status and New Opportunities

PURPOSE OF REVIEW

The paper summarises the most recent data on congenital heart disease (CHD) in low- and lower-middle-income countries (LLMICs). In addition, we present an approach to diagnosis, management and interventions in these regions and present innovations, research priorities and opportunities to improve outcomes and develop new programs.

RECENT FINDINGS

The reported birth prevalence of CHD in LLMICs is increasing, with clear evidence of the impact of surgical intervention on the burden of disease. New methods of teaching and training are demonstrating improved outcomes. Local capacity building remains the key. There is a significant gap in epidemiological and outcomes data in CHD in LLMICs. Although the global agenda still does not address the needs of children with CHD adequately, regional initiatives are focusing on quality improvement and context-specific interventions. Future research should focus on epidemiology and the use of innovative thinking and partnerships to provide low-cost, high-impact solutions.