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Wong T, Pressat-Laffouilhère T, Fresse KW, Bejar S, Michelin P, Bauer F, Dacher JN. Role of MDCT in evaluating prothesis size prior to percutaneous transcatheter closure of ostium secundum atrial septal defect. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:1133-1143. [PMID: 34971420 DOI: 10.1007/s10554-021-02481-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/20/2021] [Indexed: 11/26/2022]
Abstract
To investigate the feasibility and accuracy of cardiac multidetector computed tomography (MDCT) prosthesis sizing prior to ostium secundum atrial septal defect (ASD) percutaneous closure. Seventy consecutive patients were included in this retrospective bicentric study between May 2012 and June 2018. All underwent cardiac MDCT (primarily performed to rule out abnormal venous pulmonary return and coronary anomaly) and transesophageal echocardiography (TEE) before transcatheter closure: dimensions of the defect and peripheral rims were measured. Measurements of the defect obtained at TEE and MDCT were compared to prosthesis size. Our primary objective was the comparison of ASD maximal diameter obtained at MDCT (CT-Dmax) to prosthesis size. Intraclass correlation coefficient (ICC), Bland Altman plots and linear regression were calculated. Intra- and inter-observer agreements were calculated for MDCT defect measurements. Forty-three patients were finally included for defect measurements: 17 patients did not undergo transcatheter closure, and 10 had incomplete data. For CT-Dmax, ICC was 0.88 (CI 95% = [0.78-0.93]; p = 0.06); mean difference was - 0.8 ± 5.7 mm; regression linear equation was 0.9 × + 3.2 (p < 0.001). For maximal diameter at TEE versus prosthesis size, ICC was 0.46 (CI 95% = [0.21-0.61]; p = 0.003); mean difference was-6.0 ± 8.2 mm; regression linear equation was 0.91 × + 7.6 (p < 0.001). Intra- and inter-observer agreement for CT-Dmax were 0.97 (CI 95% = [0.95-0.98]) and 0.86 (CI 95% = [0.73-0.93]) respectively. MDCT is a reliable tool for sizing the defect of ostium secundum ASD, making it a complement or even an alternative to pre-procedural TEE.
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Affiliation(s)
- Tatiana Wong
- Cardiac MR/CT Unit, Department of Radiology, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014, Paris, France.
| | | | - Karine Warin Fresse
- Cardiac MR/CT Unit, Department of Radiology, Nantes University Hospital, Boulevard Professeur Jacques Monod, 44800, Saint-Herblain, France
| | - Sofiane Bejar
- Cardiac MR/CT Unit, Department of Radiology, Rouen University Hospital, 37 Boulevard Gambetta, 76000, Rouen, France
| | - Paul Michelin
- Cardiac MR/CT Unit, Department of Radiology, Rouen University Hospital, 37 Boulevard Gambetta, 76000, Rouen, France
| | - Fabrice Bauer
- Normandie Univ., UNIROUEN, INSERM U1096, 22 Boulevard Gambetta, 76000, Rouen, France
- Department of Cardiology, Rouen University Hospital, 37 Boulevard Gambetta, 76000, Rouen, France
| | - Jean-Nicolas Dacher
- Cardiac MR/CT Unit, Department of Radiology, Rouen University Hospital, 37 Boulevard Gambetta, 76000, Rouen, France
- Normandie Univ., UNIROUEN, INSERM U1096, 22 Boulevard Gambetta, 76000, Rouen, France
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Naser N, Hadziomerovic N, Avdic S. Transcatheter Device Closure of Secundum Atrial Septal Defect in Adult Patient. Acta Inform Med 2021; 29:65-68. [PMID: 34012216 PMCID: PMC8116089 DOI: 10.5455/aim.2021.29.65-70] [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] [Indexed: 11/05/2022] Open
Abstract
Background: Atrial septal abnormalities are common congenital lesions remaining asymptomatic until adulthood in a great number of patients. The most frequent atrial septal defects in adults are ostium secundum atrial septal defect (ASD). Complications from untreated, hemodynamically significant ASD are atrial arrhythmia, paradoxical embolization, Eisenmenger’s syndrome, pulmonary hypertension, and right ventricular failure. Objective: We present a case report of secundum ASD in adult female patient who underwent transcatheter device closure with Amplatzer occluder. Methods and Results: The case of female Bosnian patient 50 years old who lives in Belgium for 20 years ago and during her visit to Bosnia she came to our polyclinic for cardiological exam. Echocardiographic exam showed enlargement of left atrium (LAD 51mm), right atrium and ventricle (RAD 46mm, RVd 33mm), atrial septal defect 9mm with left right shunt Qp:Qs 2,3:1. Several months later transcatheter device closure with Amplatzer occluder was performed and subsequent symptomatic improvement reported after closure. Conclusion: Echocardiography has superior role for precise evaluation of ASD type secundum who are suitable for transcatheter device closure as primary treatment option. Transcatheter techniques has now become preferable to surgical repair and provide valid option of treatment for this type of CHD.
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Affiliation(s)
- Nabil Naser
- Polyclinic "Dr. Nabil", Sarajevo, Bosnia and Herzegovina
| | | | - Sevleta Avdic
- Medical Institute Bayer, Tuzla, Bosnia and Herzegovina
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Kalra DK. Cardiac CT: A Sine Qua Non for Structural Heart Interventions. Cardiology 2020; 145:663-665. [PMID: 32829334 DOI: 10.1159/000509466] [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: 06/12/2020] [Accepted: 06/15/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Dinesh K Kalra
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois, USA,
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Zhang X, Huang Y, Wang L, Ye L, Tang J. Transcatheter Closure of Atrial Septal Defects with Cardiac Computed Tomography Sizing: Eight-Year Single-Center Practice. Cardiology 2020; 145:654-662. [PMID: 32814316 DOI: 10.1159/000508650] [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: 02/17/2020] [Accepted: 05/08/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION An accurate evaluation of atrial septal defect (ASD) is important for the success of interventional treatment. Cardiac computed tomography (CT) has unique advantages for ASD assessment, although transesophageal echocardiography (TEE) remains the accepted method. OBJECTIVE This study aimed to evaluate the safety and feasibility of transcatheter closure of ASD with cardiac CT sizing but without TEE measurement. METHODS Among 134 patients undergoing transcatheter closure, 13 underwent TEE in addition to a cardiac CT examination, and 121 underwent only cardiac CT. Propensity score matching was used to analyze the outcomes of the groups treated with (group 1) or without (group 2) TEE examinations. The success rate and complications among the 121 ASD patients with only cardiac CT sizing were recorded and analyzed. The maximal diameters of the defects remeasured on CT images were compared to the echocardiography results and correlated with the device size by Student t test and Pearson's linear regression analysis, respectively. RESULTS No significant differences (p > 0.05) were found between groups 1 and 2 in the success rate, complications, or ratio of the device size to the maximum diameter of the defect measured by cardiac CT. In group 1, the maximum diameters of the ASD derived from cardiac CT and TEE were comparable (22.08 ± 9.68 vs. 21.50 ± 10.24; p = 0.351). The success rate among the 121 patients who underwent transcatheter closure with only cardiac CT sizing was 99.2%; however, within 1 month of follow-up, 2 patients had arrhythmia, 1 patient had residual shunting, 1 patient had an infection, and 1 patient had a hematoma, but all patients recovered within a short time. CONCLUSIONS Cardiac CT seems to be comparable to TEE in the assessment of ASD, and transcatheter closure of ASD based on CT sizing alone is safe and feasible.
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Affiliation(s)
- Xin Zhang
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China.,Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Yangyang Huang
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China.,Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Lihong Wang
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China, .,Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China,
| | - Lifang Ye
- Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Jun Tang
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China.,Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
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Yan C, Wang C, Pan X, Li S, Song H, Liu Q, Xu N, Wang J. Three‐dimensional printing assisted transcatheter closure of atrial septal defect with deficient posterior–inferior rim. Catheter Cardiovasc Interv 2018; 92:1309-1314. [PMID: 30251437 DOI: 10.1002/ccd.27799] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 06/27/2018] [Accepted: 06/30/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Chaowu Yan
- Department of Structural Heart Disease, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Cheng Wang
- Department of CardiologyAffiliated Hospital of Xuzhou Medical University Xuzhou Jiangsu China
| | - Xiangbin Pan
- Department of Structural Heart Disease, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Shiguo Li
- Department of Structural Heart Disease, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Huijun Song
- Department of Structural Heart Disease, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Qiong Liu
- Department of Structural Heart Disease, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Nan Xu
- Department of Structural Heart Disease, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Jianpeng Wang
- Department of Structural Heart Disease, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical College Beijing China
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Cao H, Chen Q, Zhang GC, Chen LW, Qiu ZH, Lu H. Percutaneous device closure of atrial septal defect with totally transthoracic echocardiography guide, without x-ray machine. Medicine (Baltimore) 2016; 95:e5256. [PMID: 27858888 PMCID: PMC5591136 DOI: 10.1097/md.0000000000005256] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The present study investigated the feasibility of totally transthoracic echocardiography-guided percutaneous device occlusion of atrial septal defects (ASDs) without using x-ray equipment.Between September and December 2014, we performed totally transthoracic echocardiography-guided percutaneous device occlusion for 20 patients with secundum ASD without using x-ray equipment. We carried out percutaneous femoral vein puncture, used a specialized delivery sheath during operation, and closed the ASD by releasing an occluder.All 20 patients experienced successful occlusion and smoothly went through the perioperative period. The average procedure time ranged from 30 to 40 minutes (32.4 ± 3.5 minutes), and the size of the implanted occluder ranged from 20 to 38 mm (25.4 ± 5.8 mm). No occluder displacements, residual fistula, or thrombus-related complications after the procedure. There was no clinical death, no arrhythmia, no hemolysis, no infection, or embolism during patients' hospitalization and the follow-up period.Totally transthoracic echocardiography-guided percutaneous device occlusion of ASDs without the use of x-ray equipment may be safe and feasible.
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Affiliation(s)
- Hua Cao
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, P.R. China
- Correspondence: Hua Cao, Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Xinquan Road, Fuzhou, P. R. China, (e-mail: )
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Das S, Kumar P, Bhardwaj V, Palleti R. Anesthetic management of Amplatzer atrial septal defect closure device embolization to right ventricular outflow tract. Saudi J Anaesth 2016; 10:335-8. [PMID: 27375392 PMCID: PMC4916821 DOI: 10.4103/1658-354x.174911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Percutaneous device closure of atrial septal defect (ASD) is an alternative treatment to surgery with advantages of avoidance of surgery, short procedure time, early discharge from hospital, and lower rates of complications. However, percutaneous device closure is associated with infrequent life-threatening complications such as device embolization. We report a case device embolization of the ASD occlude device into right ventricular outflow tract resulting progressive hypoxia. The role of anesthesiologist as a team leader in managing such emergency is discussed.
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Affiliation(s)
- S Das
- Department of Cardiac Anesthesia, All India Institute of Medical Sciences, New Delhi, India
| | - P Kumar
- Department of Cardiac Anesthesia, All India Institute of Medical Sciences, New Delhi, India
| | - V Bhardwaj
- Department of Cardiac Anesthesia, All India Institute of Medical Sciences, New Delhi, India
| | - R Palleti
- Department of Cardiothoracic Surgery, All India Institute of Medical Sciences, New Delhi, India
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Kulkarni A, Hsu HH, Ou P, Kutty S. Computed Tomography in Congenital Heart Disease: Clinical Applications and Technical Considerations. Echocardiography 2015; 33:629-40. [DOI: 10.1111/echo.13147] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Aparna Kulkarni
- Division of Pediatric Cardiology; Albert Einstein College of Medicine; Bronx New York
| | - Hao Hua Hsu
- University of Nebraska/Creighton University Joint Division of Pediatric Cardiology; Children's Hospital and Medical Center; Omaha Nebraska
| | - Phalla Ou
- Department of Radiology; Hospital Bichat; University Paris Diderot; APHP; Paris France
| | - Shelby Kutty
- University of Nebraska/Creighton University Joint Division of Pediatric Cardiology; Children's Hospital and Medical Center; Omaha Nebraska
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10
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Computed Tomography Imaging in Patients with Congenital Heart Disease Part I: Rationale and Utility. An Expert Consensus Document of the Society of Cardiovascular Computed Tomography (SCCT). J Cardiovasc Comput Tomogr 2015; 9:475-92. [DOI: 10.1016/j.jcct.2015.07.004] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 07/17/2015] [Indexed: 12/16/2022]
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11
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Comprehensive assessment of morphology and severity of atrial septal defects in adults by CT. J Cardiovasc Comput Tomogr 2015; 9:354-61. [PMID: 26088383 DOI: 10.1016/j.jcct.2015.04.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 03/20/2015] [Accepted: 04/18/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cardiac CT is an excellent tool for evaluating the anatomy of a secundum atrial septal defect (ASD). However, a comprehensive assessment of its usefulness, including measurement of the pulmonary to systemic blood flow ratio in secundum ASD patients, has not been performed. OBJECTIVE Therefore, this study was designed to evaluate the usefulness of CT for assessing the hemodynamics of secundum ASD in adults compared with transesophageal echocardiography (TEE), transthoracic echocardiography, and invasive catheterization. METHODS Fifty adult patients with secundum ASD were enrolled. Cardiac CT scans (128-slice multidetector CT instrument) were acquired. These were followed by 2-dimensional reconstruction of the secundum ASDs to determine the defect size, the rim length between the outer edge of the defect, and the pulmonary to systemic blood flow (Qp/Qs) ratio. RESULTS The maximum sizes of the secundum ASDs derived from CT and TEE studies were comparable (21.2 ± 8.0 vs. 20.0 ± 7.3 mm; P = .41; r = 0.960; P < .001). The rim lengths for the aortic, mitral, and tricuspid valves; the inferior vena cava; and posterior atrium were also comparable between CT and TEE measurements. The mean Qp/Qs ratio that was derived from CT measurements was comparable with that found by invasive catheterization (2.3 ± 0.7 vs. 2.3 ± 0.8; P = .73; r = 0.786; P < .001). CONCLUSION Cardiac CT is feasible for assessing pathology and the severity of secundum ASD in adults.
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Thériault-Lauzier P, Spaziano M, Vaquerizo B, Buithieu J, Martucci G, Piazza N. Computed Tomography for Structural Heart Disease and Interventions. Interv Cardiol 2015; 10:149-154. [PMID: 29588693 DOI: 10.15420/icr.2015.10.03.149] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Transcatheter cardiac interventions are a fast evolving field. The past decade has seen the development of transcatheter aortic valve replacement, transcatheter mitral valve repair and replacement, septal defect closure devices and left atrial appendage closure devices for thromboprophylaxis. More than ever, medical imaging is taking a central role in the care of patients with structural heart disease. In this review article we outline the use of MSCT as a tool for diagnosis of structural heart interventions, as well as patient selection, pre-procedural planning, device sizing and post-procedural assessment. We focus on procedures targeting the aortic valve, the mitral valve, the inter-atrial septum and the left atrial appendage.
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Affiliation(s)
| | - Marco Spaziano
- McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Jean Buithieu
- McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Nicolo Piazza
- McGill University Health Centre, Montreal, Quebec, Canada.,German Heart Centre Munich, Munich, Germany
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Preoperative cardiac computed tomography for demonstration of congenital cardiac septal defect in adults. Eur Radiol 2014; 25:1614-22. [DOI: 10.1007/s00330-014-3547-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 11/26/2014] [Accepted: 12/01/2014] [Indexed: 02/06/2023]
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Song J. Comprehensive understanding of atrial septal defects by imaging studies for successful transcatheter closure. KOREAN JOURNAL OF PEDIATRICS 2014; 57:297-303. [PMID: 25114689 PMCID: PMC4127391 DOI: 10.3345/kjp.2014.57.7.297] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 05/31/2014] [Indexed: 02/05/2023]
Abstract
Transcatheter closure of atrial septal defects has become a popular procedure. The availability of a preprocedural imaging study is crucial for a safe and successful closure. Both the anatomy and morphology of the defect should be precisely evaluated before the procedure. Three-dimensional (3D) echocardiography and cardiac computed tomography are helpful for understanding the morphology of a defect, which is important because different defect morphologies could variously impact the results. During the procedure, real-time 3D echocardiography can be used to guide an accurate closure. The safety and efficiency of transcatheter closures of atrial septal defects could be improved through the use of detailed imaging studies.
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Affiliation(s)
- Jinyoung Song
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Song J, Kang IS, Chang SA, Huh J, Park SW. Application of the defect area in transcatheter closure of atrial septal defect. Cardiology 2013; 127:90-5. [PMID: 24280946 DOI: 10.1159/000355362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 08/28/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVES It was our aim to evaluate whether the defect area plays a crucial role in successful device closure of atrial septal defects (ASDs). METHODS The long and short diameters of the defect were measured on en-face images. The defect area was then measured by planimetry. The device size compared to the defect length and defect area was analyzed in each group. RESULTS There were 22 patients in the circular group and 45 patients in the noncircular group. The defect area did not differ between the groups (201.6 ± 107.1 vs. 245.6 ± 127.6 mm(2)). Although the length between the device size and the long diameter differed between the groups (3.4 ± 2.0 vs. 0.8 ± 3.7 mm; p = 0.003), there was no difference in the ratio of the device area compared to the defect area, which was constant even in the noncircular defect (1.73 ± 0.41 vs. 1.72 ± 0.53 mm(2); p = 0.947). The device size was positively correlated with the defect area (p < 0.01). CONCLUSION The defect area measured by planimetry on en-face images might be useful in selecting the device size for transcatheter closure of ASDs.
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Affiliation(s)
- Jinyoung Song
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Kim KH, Song J, Kang IS, Chang SA, Huh J, Park SW. Balloon occlusive diameter of non-circular atrial septal defects in transcatheter closure with amplatzer septal occluder. Korean Circ J 2013; 43:681-5. [PMID: 24255652 PMCID: PMC3831014 DOI: 10.4070/kcj.2013.43.10.681] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 09/06/2013] [Accepted: 09/10/2013] [Indexed: 11/15/2022] Open
Abstract
Background and Objectives The aim of this study was to investigate the balloon occlusive diameter (BOD) of non-circular defects in the transcatheter closure of atrial septal defect (ASD). Subjects and Methods A total of 67 patients who had undergone transcatheter closure of an ASD were reviewed retrospectively. A non-circular defect was defined as the ratio of the short diameter to the long diameter of the defect on the en-face image less than 0.75. The BOD was compared with the long diameter of the defect and then compared between the two groups. Results There were 22 patients with circular defects and 45 patients with non-circular defects. The difference in BOD measuring from the long diameter of the defect was quite different between the two groups and significantly smaller in non-circular morphology (0.1±4.0 vs. 2.3±2.1, p=0.006). The difference in BOD measurement from the long diameter of ASD showed a positive correlation with the ratio of the short diameter to the long diameter of ASD (b/a) (r2=0.102, p=0.008). In the non-circular morphology of ASD, the difference in BOD measured from the long diameter had a significant negative correlation with the long diameter of ASD (r2=0.230, p=0.001), whereas in circular ASD, no significant correlation was found between the difference in BOD and the long diameter of ASD (p=0.201). Conclusion The BOD compared with the long diameter measured from three-dimensional transesophageal echocardiography was smaller in non-circular ASD than in circular ASD. This difference was much smaller in non-circular ASD with a large long diameter.
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Affiliation(s)
- Kwang Hoon Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Rajiah P, Schoenhagen P. The role of computed tomography in pre-procedural planning of cardiovascular surgery and intervention. Insights Imaging 2013; 4:671-89. [PMID: 23907804 PMCID: PMC3781248 DOI: 10.1007/s13244-013-0270-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Revised: 06/07/2013] [Accepted: 06/24/2013] [Indexed: 11/27/2022] Open
Abstract
Advances in our knowledge of cardiovascular disorders coupled with technological innovations have enabled the increased use of minimally invasive cardiovascular surgeries and transcatheter interventions, with resultant reduced morbidity and hospital stay. Three-dimensional imaging, particularly computed tomography (CT) is increasingly used for patient selection, providing a roadmap of the anatomy and identifying factors that may complicate these procedures. Advantages of CT are the rapid turnaround time, good spatial and temporal resolutions, wide field of view and three-dimensional multi-planar reconstruction capabilities. This pictorial review describes the role of CT in the pre-operative evaluation of patients undergoing cardiovascular surgeries and intervention. Main Messages • CT scan is valuable in pre-operative evaluation for cardiac surgeries • Cardiovascular structures, including bypass grafts should be located >10 mm from the sternum in patients for reoperative cardiothoracic surgeries • Knowledge of variations in pulmonary venous anatomy are essential for planning radiofrequency ablation.
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Affiliation(s)
- Prabhakar Rajiah
- Cardiothoracic Imaging, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA,
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Song J, Lee SY, Baek JS, Shim WS, Choi EY. Outcome of transcatheter closure of oval shaped atrial septal defect with amplatzer septal occluder. Yonsei Med J 2013; 54:1104-9. [PMID: 23918558 PMCID: PMC3743189 DOI: 10.3349/ymj.2013.54.5.1104] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
PURPOSE For the successful completion of transcatheter closure of atrial septal defects with the Amplatzer septal occluder, shape of the defects should be considered prior to selecting the device. The purpose of this study is to evaluate the results of a transcatheter closure of oval shaped atrial septal defect. MATERIALS AND METHODS From November 2009 until November 2011, cardiac computed tomography was performed on 69 patients who needed a transcatheter closure of atrial septal defect. We defined an oval shaped atrial septal defect as the ratio of the shortest diameter to the longest diameter ≤ 0.75 measured using computed tomography. A trans-thoracic echocardiogram was performed one day after and six months after. RESULTS The transcatheter closure of atrial septal defect was performed successfully in 24 patients in the ovoid group and 45 patients in the circular group. There were no serious complications in both groups and the complete closure rate at 6 months later was 92.3% in the ovoid group and 93.1% in the circular group (p>0.05). The differences between the device size to the longest diameter of the defect and the ratios of the device size to the longest diameter were significantly smaller in the ovoid group (1.8 ± 2.8 vs. 3.7 ± 2.6 and 1.1 ± 0.1 vs. 1.2 ± 0.2). CONCLUSION Transcatheter closure of an oval shaped atrial septal defect was found to be safe with the smaller Amplatzer septal occluder device when compared with circular atrial septal defects.
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Affiliation(s)
- Jinyoung Song
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Korea.
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Cho EH, Song J, Choi EY, Lee SY. Device size for transcatheter closure of ovoid interatrial septal defect. Heart Surg Forum 2013; 16:E193-7. [PMID: 23958530 DOI: 10.1532/hsf98.20121131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND For successful transcatheter closure of an atrial septal defect with the Amplatzer septal occluder, the shape of the defect should be considered before selecting the device size. The purpose of this study was to evaluate the results of transcatheter closure of an ovoid atrial septal defect. METHODS Between January 2010 and February 2012, cardiac computer tomography examinations were performed in 78 patients who subsequently underwent transcatheter closure of an atrial septal defect. In this retrospective study, we reviewed these patients' medical records. We defined an ovoid atrial septal defect as a value of 0.75 for the ratio of the shortest diameter of the defect to the longest diameter, as measured in a computed tomography image. Transthoracic echocardiography examinations were made at 1 day and 6 months after the procedure. RESULTS Transcatheter closure of an atrial septal defect was successful in 26 patients in the ovoid-defect group and in 52 patients in the round-defect group. There were no serious complications in either group, and the rate of complete closure at 6 months was 92.3% in the ovoid-defect group and 93.1% in the round-defect group (P > .05). The mean (SD) difference between the device size and the defect's longest diameter, and the mean ratio of the device size to the longest diameter were significantly smaller in the ovoid-defect group (1.7 ± 2.9 versus 3.8 ± 2.5 and 1.1 ± 0.1 versus 1.3 ± 0.2, respectively). CONCLUSIONS Transcatheter closure of an atrial septal defect is indicated even for an ovoid atrial septal defect. Ovoid atrial septal defects can be closed successfully with smaller sizes of the Amplatzer septal occluder than for round atrial septal defects.
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Affiliation(s)
- Eun Hyun Cho
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
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Cavalcante JL, Schoenhagen P. Role of Cross-Sectional Imaging for Structural Heart Disease Interventions. Cardiol Clin 2013; 31:467-78. [DOI: 10.1016/j.ccl.2013.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Son JW, Park JS. Subacute, silent embolization of amplatzer atrial septal defect closure device to the pulmonary artery. J Cardiovasc Ultrasound 2012; 20:201-4. [PMID: 23346291 PMCID: PMC3542515 DOI: 10.4250/jcu.2012.20.4.201] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2012] [Revised: 08/20/2012] [Accepted: 11/21/2012] [Indexed: 11/22/2022] Open
Abstract
Embolization of the closure device is a rare but potentially fatal complication of percutaneous atrial septal defect (ASD) closure. We report a case of 45-year-old woman who underwent ASD device closure with 32 mm Amplatzer device, which was embolized to the pulmonary artery without symptom one day after successful device implantation.
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Affiliation(s)
- Jang-Won Son
- Division of Cardiology, Severance Cardiovascular Hospital, Seoul, Korea
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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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Marini D, Ou P, Boudjemline Y, Kenny D, Bonnet D, Agnoletti G. Midterm results of percutaneous closure of very large atrial septal defects in children: role of multislice computed tomography. EUROINTERVENTION 2012; 7:1428-34. [PMID: 22222860 DOI: 10.4244/eijv7i12a223] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of this study was to assess the midterm results of percutaneous closure of very large atrial septal defects (ASD) in children with transthoracic echocardiography (TTE) and multislice computed tomography (MSCT). METHODS AND RESULTS Among 142 children who underwent percutaneous ASD closure with the AMPLATZER® Septal Occluder (ASO) (AGA Medical Corporation, Plymouth, MN, USA) during an eight year period, 51 patients with very large defects, were evaluated by TTE and MSCT after a period of at least two years following ASD closure. Median age at ASD closure was six years (range 4-10), with mean ASD size 20.9±2.9 mm. Median device size was 20 mm (range 15-26) and median device: septal length ratio 0.95 (range 0.8-1). Early complications included one transient complete atrioventricular block and one device embolisation. At a median follow-up of 55 months (range 25-92) all patients were clinically asymptomatic and had a normal ECG. TTE did not demonstrate device protrusion across the lumen of either the systemic or pulmonary veins. The mean device: septal length ratio had decreased from 0.96±0.05 to 0.8±0.02 (p<0.001). There was good correlation between the measure of atrial septum length by TTE and MSCT (r: 0.79, p<0.001). MSCT identified moderate dynamic device protrusion into the lumen of systemic or pulmonary veins in five patients and partial device malpositioning in two patients. CONCLUSIONS Occlusion of very large ASD in children can be performed with low complications rate. MSCT provides detailed information regarding the location of the device with respect to surrounding anatomic structures and reveals anomalies not evident by TTE.
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Light ED, Lindsey BD, Upchurch JA, Smith SW. Ring array transducers for real-time 3-D imaging of an atrial septal occluder. ULTRASOUND IN MEDICINE & BIOLOGY 2012; 38:1483-1487. [PMID: 22698504 PMCID: PMC3434960 DOI: 10.1016/j.ultrasmedbio.2012.03.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 03/19/2012] [Accepted: 03/30/2012] [Indexed: 06/01/2023]
Abstract
We developed new miniature ring array transducers integrated into interventional device catheters such as used to deploy atrial septal occluders. Each ring array consisted of 55 elements operating near 5 MHz with interelement spacing of 0.20 mm. It was constructed on a flat piece of copper-clad polyimide and then wrapped around an 11 French O.D. catheter. We used a braided cabling technology from Tyco Electronics Corporation to connect the elements to the Volumetric Medical Imaging (VMI) real-time 3-D ultrasound scanner. Transducer performance yielded a -6 dB fractional bandwidth of 20% centered at 4.7 MHz without a matching layer vs. average bandwidth of 60% centered at 4.4 MHz with a matching layer. Real-time 3-D rendered images of an en face view of a Gore Helex septal occluder in a water tank showed a finer texture of the device surface from the ring array with the matching layer.
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Affiliation(s)
- Edward D Light
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
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Abstract
OBJECTIVE MRI plays an important role in the morphologic and functional evaluation of cardiovascular shunts. Good spatiotemporal resolution, inherent contrast resolution, wide FOV, and multiplanar imaging capabilities make MRI an ideal tool in the investigation of cardiovascular shunts. The velocity-encoded phase-contrast sequence is used in the quantification of a shunt and the steady-state free precession (SSFP) sequence is used in the assessment of the functional impact of a shunt. In this article, the role of MRI in the evaluation of cardiovascular shunts and their respective MRI appearances are described and illustrated. CONCLUSION MRI can identify and characterize septal defects, quantify shunts and their impact on cardiac function, and help in the selection of appropriate candidates for percutaneous device placement.
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Cho MJ, Song J, Kim SJ, Choi EY, Lee SY, Shim WS. Transcatheter closure of multiple atrial septal defects with the amplatzer device. Korean Circ J 2011; 41:549-51. [PMID: 22022332 PMCID: PMC3193048 DOI: 10.4070/kcj.2011.41.9.549] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Revised: 10/25/2010] [Accepted: 12/21/2010] [Indexed: 11/11/2022] Open
Abstract
Percutaneous device occlusion of secundum atrial septal defect (ASD) has become an accepted alternative to surgical repair. A variety of devices have been used successfully. However, all of them have limitations. We report our experience with two devices used to close multiple ASDs.
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Affiliation(s)
- Mi Jin Cho
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea
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Zhang H, Chen Q, Chen LW, Cao H, Zhang GC, Chen DZ. Intraoperative device closure of atrial septal defects in the older population. J Cardiothorac Surg 2011; 6:123. [PMID: 21958758 PMCID: PMC3195093 DOI: 10.1186/1749-8090-6-123] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Accepted: 09/29/2011] [Indexed: 12/03/2022] Open
Abstract
Objective This study sought to prove the safety and feasibility of intraoperative device closure of atrial septal defect (ASD) with transthoracic minimal invasion in the older patients. Methods From January 2006 to December 2009, 47 patients aged 50 years or more and suffered from atrial septal defect were enrolled in our institution. Patients were divided into two groups, 27 of which in group I with intraoperative device closure and the other 20 in group II with surgical closure. In group I, the method involved a minimal intercostal incision, which was performed after full evaluation of the atrial septal defect by transthoracic echocardiography, and the insertion of the device through the delivery sheath to occlude the atrial septal defect. Results In group I, implantation was ultimately successful in all patients. The complete closure rate at 24 hours and 1 year were 81.5% and 100% respectively. In 6 of 27 patients, minor complications occurred: transient arrhythmia (n = 5) and blood transfusion (n = 3). In group II, all patients were closured successfully; almost all of them needed blood transfusion and suffered from various minor complications though. During a follow-up period of 1 to 5 years, no residual shunt, noticeable mitral regurgitation, significant arrhythmias, thrombosis, or device failure were found. In our comparative studies, group II had significantly longer ICU stay and hospital stay than group I (p < 0.05). The cost of group I was less than that of group II(p < 0.05). Conclusions Minimally invasive transthoracic device closure of the atrial septal defect at advanced age with a domestically made device without cardiopulmonary bypass is safe and feasible under transthoracic echocardiographic guidance. It was cost-savings, yielding better cosmetic results and leaving fewer traumas than surgical closure. Early and mid-term results are encouraging. However, it is necessary to evaluate the long-term results.
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Affiliation(s)
- Hui Zhang
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou 350001, PR China
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Rajiah P, Kanne JP. Computed tomography of septal defects. J Cardiovasc Comput Tomogr 2010; 4:231-45. [DOI: 10.1016/j.jcct.2010.05.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Revised: 04/27/2010] [Accepted: 05/20/2010] [Indexed: 11/28/2022]
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Hughes D, Siegel MJ. Computed Tomography of Adult Congenital Heart Disease. Radiol Clin North Am 2010; 48:817-35. [DOI: 10.1016/j.rcl.2010.04.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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