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Cinteza E, Vasile CM, Busnatu S, Armat I, Spinu AD, Vatasescu R, Duica G, Nicolescu A. Can Artificial Intelligence Revolutionize the Diagnosis and Management of the Atrial Septal Defect in Children? Diagnostics (Basel) 2024; 14:132. [PMID: 38248009 PMCID: PMC10814919 DOI: 10.3390/diagnostics14020132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/26/2023] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
Atrial septal defects (ASDs) present a significant healthcare challenge, demanding accurate and timely diagnosis and precise management to ensure optimal patient outcomes. Artificial intelligence (AI) applications in healthcare are rapidly evolving, offering promise for enhanced medical decision-making and patient care. In the context of cardiology, the integration of AI promises to provide more efficient and accurate diagnosis and personalized treatment strategies for ASD patients. In interventional cardiology, sometimes the lack of precise measurement of the cardiac rims evaluated by transthoracic echocardiography combined with the floppy aspect of the rims can mislead and result in complications. AI software can be created to generate responses for difficult tasks, like which device is the most suitable for different shapes and dimensions to prevent embolization or erosion. This paper reviews the current state of AI in healthcare and its applications in cardiology, emphasizing the specific opportunities and challenges in applying AI to ASD diagnosis and management. By exploring the capabilities and limitations of AI in ASD diagnosis and management. This paper highlights the evolution of medical practice towards a more AI-augmented future, demonstrating the capacity of AI to unlock new possibilities for healthcare professionals and patients alike.
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Affiliation(s)
- Eliza Cinteza
- Department of Pediatrics, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (E.C.)
- Pediatric Cardiology Department, “Marie Skolodowska Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania; (I.A.); (A.N.)
| | - Corina Maria Vasile
- Department of Pediatric and Adult Congenital Cardiology, University Hospital of Bordeaux, F-33600 Bordeaux, France;
| | - Stefan Busnatu
- Cardio-Thoracic Department, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Cardiology Department, “Prof. Dr. Bagdasar Arseni” Clinical Hospital, 041915 Bucharest, Romania
| | - Ionel Armat
- Pediatric Cardiology Department, “Marie Skolodowska Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania; (I.A.); (A.N.)
| | - Arsenie Dan Spinu
- “Dr. Carol Davila” Central Emergency University Military Hospital, 010825 Bucharest, Romania;
- Department 3, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Radu Vatasescu
- Cardio-Thoracic Department, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Emergency Clinical Hospital, 014461 Bucharest, Romania
| | - Gabriela Duica
- Department of Pediatrics, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (E.C.)
- Pediatric Cardiology Department, “Marie Skolodowska Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania; (I.A.); (A.N.)
| | - Alin Nicolescu
- Pediatric Cardiology Department, “Marie Skolodowska Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania; (I.A.); (A.N.)
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Hascoet S, Baruteau AE, Jalal Z, Demkow M, de Winter R, Gaio G, Clerc JM, Sabiniewicz R, Eberli F, Santoro G, Dauphin C, Schubert S, Smolka G, Lutz M, Moreno R, Pan M, Gutierrez-Larraya F, Godart F, Carminati M, Ovaert C, Batteux C, Guerin P, Thambo JB, Ewert P. Safety and efficacy of the Amplatzer™ Trevisio™ intravascular delivery system: Post-approval study results. Arch Cardiovasc Dis 2023; 116:580-589. [PMID: 37951755 DOI: 10.1016/j.acvd.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND The Amplatzer™ Trevisio™ Intravascular Delivery System (Trevisio DS; Abbott Laboratories, Chicago, IL, USA) facilitates the delivery of Amplatzer™ Occluders and features an ultraflexible tip, which improves assessment of occluder position before release. AIMS To assess the safety and efficacy of the Trevisio DS for transcatheter closure of patent foramen ovale and atrial septal defect. METHODS The Amplatzer™ Trevisio™ Intravascular Delivery System Post-Approval Study was a prospective, postmarket, single-arm, multicentre, observational study of the Trevisio DS. Enrolled patients were indicated for transcatheter closure of patent foramen ovale or atrial septal defect. In all procedures, the Trevisio DS was used to deliver Amplatzer™ Occluders. Technical success was defined as successful deployment and release of at least one occluder. Device- or procedure-related serious adverse events were tracked until discharge or day 7, whichever occurred earlier. RESULTS The study enrolled 144 patients with patent foramen ovale and 107 patients with atrial septal defect at 22 European sites; 53 patients with atrial septal defect (49.6%) were aged<18years. The rate of technical success was 98.4% (97.2% for atrial septal defect, 99.3% for patent foramen ovale). There was one serious adverse event (0.4%), an acute periprocedural device embolization that occurred after occluder release in a patient with atrial septal defect; the device was retrieved percutaneously. This was determined by the implanter to be unrelated to the performance of the Trevisio DS. CONCLUSIONS The Trevisio DS exhibited a high rate of technical success and an excellent safety profile during transcatheter closure of patent foramen ovale and atrial septal defect.
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Affiliation(s)
- Sebastien Hascoet
- Hôpital Marie-Lannelongue, Groupe Hospitalier Paris Saint-Joseph, Faculté de Médecine Paris-Saclay, Université Paris-Saclay, Centre Constitutif Réseau Maladies Rares Cardiopathies Congénitales Complexes (M3C), BME Lab, 92350 Le Plessis-Robinson, France.
| | - Alban-Elouen Baruteau
- Nantes Université, CHU de Nantes, Department of Paediatric Cardiology and Paediatric Cardiac Surgery, FHU PRECICARE, 44000 Nantes, France; Nantes Université, CHU de Nantes, Inserm, CIC FEA 1413, 44000 Nantes, France; Nantes Université, CHU de Nantes, CNRS, Inserm, l'Institut du Thorax, 44000 Nantes, France
| | - Zakaria Jalal
- Department of Paediatric and Adult Congenital Cardiology, CHU de Bordeaux, 33000 Bordeaux, France; Centre Constitutif Réseau Maladies Rares Cardiopathies Congénitales Complexes (M3C), 92350 Le Plessis-Robinson, France; Electrophysiology and Heart Modelling Institute, IHU Liryc, Fondation Bordeaux Université, 33000 Bordeaux, France
| | - Marcin Demkow
- The Cardinal Stefan Wyszynski Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland
| | - Robbert de Winter
- Amsterdam Academic Medical Centre (AMC), 1105 AZ Amsterdam, The Netherlands
| | | | | | | | | | | | | | - Stephan Schubert
- Deutsches Herzzentrum Berlin, 13353 Berlin, Germany; Herz-und Diabetes Zentrum NRW, University Clinic of Ruhr-University Bochum, 32545 Bad Oeynhausen, Germany
| | | | - Matthias Lutz
- Universitätsklinikum Schleswig-Holstein Campus Kiel, 24105 Kiel, Germany
| | - Raul Moreno
- Hospital Universitario de la Paz, 28046 Madrid, Spain
| | - Manuel Pan
- Hospital Universitario Reina Sofia, 14004 Cordoba, Spain
| | | | | | | | | | - Clement Batteux
- Hôpital Marie-Lannelongue, Groupe Hospitalier Paris Saint-Joseph, Faculté de Médecine Paris-Saclay, Université Paris-Saclay, Centre Constitutif Réseau Maladies Rares Cardiopathies Congénitales Complexes (M3C), BME Lab, 92350 Le Plessis-Robinson, France
| | | | - Jean-Benoit Thambo
- Centre Constitutif Réseau Maladies Rares Cardiopathies Congénitales Complexes (M3C), 92350 Le Plessis-Robinson, France; Electrophysiology and Heart Modelling Institute, IHU Liryc, Fondation Bordeaux Université, 33000 Bordeaux, France
| | - Peter Ewert
- Deutsches Herzzentrum München des Freistaates Bayern, 80636 München, Germany
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Santoro G, Pizzuto A, Cuman M, Haxhiademi D, Marchese P, Franchi E, Marrone C, Pak V, Assanta N, Cantinotti M. Transcatheter closure of "Surgical" ostium secundum atrial septal defects with GORE® Cardioform ASD Occluder. J Card Surg 2022; 37:3200-3206. [PMID: 35900295 DOI: 10.1111/jocs.16786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/12/2022] [Accepted: 06/22/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the GORE® Cardioform ASD Occluder (GCA)(WL Gore & Associates) device for closure of ostium secundum atrial septal defects (ASDs) with predicted indication for surgical correction. BACKGROUND Closure of large ASD in small children by transcatheter approach is still challenging. This study evaluated the results of GCA in this subset of patients in a tertiary referral center. METHODS Between January 2020 and March 2022, 97 children underwent transcatheter ASD closure at our Institution. Of them, 38 had a large defect (diameter/weight > 1.2 or diameter/body surface area > 20 mm/m2 ), predicted suitable for surgery and underwent closure with GCA. Procedure results and midterm outcome are reported. RESULTS Patients' age and weight were 5.5 ± 1.5 years and 19.7 ± 4.7 kg, respectively. Absolute and relative ASD size was 21.5 ± 3.6 mm, 1.1 ± 0.2 mm/kg, and 27.7 ± 4.6 mm/m2 , respectively, resulting in QP/QS of 2.0 ± 0.8. Three patients were sent to surgery after balloon sizing. Four of the remaining 35 patients who underwent device deployment, needed rescue or elective surgery due to device embolization (n = 1), device instability (n = 2) or new-onset tricuspid valve regurgitation (n = 1). Procedure feasibility was 88.6%. Major complications were recorded in two patients (5.7%). Minor complications were recorded in five patients (14.3%). Complete closure at discharge was 90.3% (28/31 pts) rising to 100% at the last follow-up evaluation. Wireframe fracture rate at the 6 months examination was 52%, without clinical and instrumental consequences. CONCLUSIONS Percutaneous treatment with GCA device is effective and safe in a high percentage of ASD children with predicted indications for surgical correction.
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Affiliation(s)
- Giuseppe Santoro
- Pediatric Cardiology and Cardiac Surgery, Heart Hospital "G. Pasquinucci," National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Alessandra Pizzuto
- Pediatric Cardiology and Cardiac Surgery, Heart Hospital "G. Pasquinucci," National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Magdalena Cuman
- Pediatric Cardiology and Cardiac Surgery, Heart Hospital "G. Pasquinucci," National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Dorela Haxhiademi
- Anesthesia and Intensive Care Unit, Heart Hospital "G. Pasquinucci," National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Pietro Marchese
- Pediatric Cardiology and Cardiac Surgery, Heart Hospital "G. Pasquinucci," National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Eliana Franchi
- Pediatric Cardiology and Cardiac Surgery, Heart Hospital "G. Pasquinucci," National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Chiara Marrone
- Pediatric Cardiology and Cardiac Surgery, Heart Hospital "G. Pasquinucci," National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Vitali Pak
- Pediatric Cardiac Surgery, Heart Hospital "G. Pasquinucci," National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Nadia Assanta
- Pediatric Cardiology and Cardiac Surgery, Heart Hospital "G. Pasquinucci," National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Massimiliano Cantinotti
- Pediatric Cardiology and Cardiac Surgery, Heart Hospital "G. Pasquinucci," National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
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Mahmoud HT, Gaio G, Giordano M, Pizzuto A, Cuman M, Abdel Wahab MAK, Palladino MT, Russo MG, Santoro G. Transcatheter closure of fenestrated atrial septal aneurysm in children: Feasibility and long-term results. Catheter Cardiovasc Interv 2022; 99:2043-2053. [PMID: 35420259 DOI: 10.1002/ccd.30191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 02/17/2022] [Accepted: 03/23/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND To date, extensive experience in transcatheter closure of fenestrated atrial septal aneurysm (ASA) in the pediatric population is limited. METHODS To report on procedural feasibility, efficacy, and long-term outcome, we enrolled all children submitted to an attempt of transcatheter closure of fenestrated ASA at two, large volume, pediatric cardiology units (Naples and Massa, Italy) between April 2000 to May 2020. RESULTS This retrospective study included 139 patients (median age 9 years [range 2-18] and weight 36 kg [range 10-102]); 19 (13.7%) children were ≤20 kg (range 10-20) and 14 (10.1%) were ≤5 years old. Single perforation was observed in 28 patients (20.1%), while 111 patients (79.9%) had multifenestrated ASA. The median size of the main defect was 15 mm (range 6-34) and 25 patients (18%) had a defect ≥20 mm. The procedural success rate was 99% (95% confidence interval [CI]: 94.9-99.8) using a single device in 75 (69%), two devices in 31 (28%), and three devices in 3 (3%) cases. Early minor adverse events (AEs) occurred in four patients (2.8%). Late minor AEs were recorded in one patient (0.7%) over a median follow-up of 5 years ([range 0-18 years; total 890.2 person-years, and with 30 patients (22%) followed ≥10 years). Neither mortality nor major AEs were recorded. Freedom from AEs was 99.1% at 10-15 years (95% CI: 93.5-99.8%), without any difference according to atrial septum anatomy or patient age and weight. CONCLUSION Transcatheter closure of fenestrated ASA is technically feasible and effective in children with excellent long-term outcomes.
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Affiliation(s)
- Heba Talat Mahmoud
- Pediatric Cardiology, University of Campania "Luigi Vanvitelli", "Ospedali dei Colli", Naples, Italy.,Cardiology Department, Minia University, Minia, Egypt
| | - Gianpiero Gaio
- Pediatric Cardiology, University of Campania "Luigi Vanvitelli", "Ospedali dei Colli", Naples, Italy
| | - Mario Giordano
- Pediatric Cardiology, University of Campania "Luigi Vanvitelli", "Ospedali dei Colli", Naples, Italy
| | - Alessandra Pizzuto
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Region Foundation "G. Monasterio", Massa, Italy
| | - Madgalena Cuman
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Region Foundation "G. Monasterio", Massa, Italy
| | | | - Maria Teresa Palladino
- Pediatric Cardiology, University of Campania "Luigi Vanvitelli", "Ospedali dei Colli", Naples, Italy
| | - Maria Giovanna Russo
- Pediatric Cardiology, University of Campania "Luigi Vanvitelli", "Ospedali dei Colli", Naples, Italy
| | - Giuseppe Santoro
- Pediatric Cardiology, University of Campania "Luigi Vanvitelli", "Ospedali dei Colli", Naples, Italy.,Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Region Foundation "G. Monasterio", Massa, Italy
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Mahmoud HT, Gaio G, Giordano M, Pizzuto A, Cuman M, Asklany HT, Palladino MT, Russo MG, Santoro G. Transcatheter closure of fenestrated atrial septal aneurysm: feasibility and long-term results. J Cardiovasc Med (Hagerstown) 2022; 23:49-59. [PMID: 34366401 DOI: 10.2459/jcm.0000000000001239] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIM To report on the feasibility, efficacy and long-term outcome of transcatheter closure of fenestrated Atrial Septal Aneurysm (ASA). METHODS Between April 2000 and May 2020, 568 patients with fenestrated ASA underwent transcatheter closure at two large-volume Pediatric Cardiology and GUCH Units (Naples and Massa, Italy). Procedural indications were cardiac volume overload in 223 patients (39%) or prophylaxis of paradoxical embolization in 345 patients (61%). Patients' median age and weight were 42 years (range 19-52) and 66 kg (range 54-79), respectively. One-hundred and thirty-nine patients (25%) were younger than 18 years. RESULTS Single fenestration was found in 311 patients (55%) (Group 1), whereas 257 patients (45%) had multifenestrated ASA (Group 2). The procedure was successful in all but seven patients (1.2%). In Group 1, closure was achieved with a single device. In Group 2, one device was used in 168 patients (67%), two devices in 74 patients (28%), three devices in 12 patients (5%), and four devices in 1 patient (0.3%). The early complication rate was 3%, without any difference according to anatomy or patient's age. At discharge, complete shunt closure was higher in Group 1 (92% vs. 72%, P < 0.0001), without any difference between groups at the last follow-up evaluation (100% vs. 99%, P = 0.12). Procedural safety was persistent during the long-term follow-up (mean 7.2 ± 5.4, range 0-19 years): freedom from adverse events was 97% at 10-15 years. Seventeen patients (3%) were submitted to reintervention, mostly as prophylaxis of paradoxical embolization. CONCLUSION Transcatheter closure of perforated ASA is technically feasible in a high percentage of cases, with excellent long-term outcomes.
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Affiliation(s)
- Heba Talat Mahmoud
- Pediatric Cardiology, University of Campania 'Luigi Vanvitelli', Former Second University of Naples, Monaldi Hospital-AORN Ospedali dei Colli, Naples
- Cardiology Department, Minia University, Minia, Egypt
| | - Gianpiero Gaio
- Pediatric Cardiology, University of Campania 'Luigi Vanvitelli', Former Second University of Naples, Monaldi Hospital-AORN Ospedali dei Colli, Naples
| | - Mario Giordano
- Pediatric Cardiology, University of Campania 'Luigi Vanvitelli', Former Second University of Naples, Monaldi Hospital-AORN Ospedali dei Colli, Naples
| | - Alessandra Pizzuto
- Pediatric Cardiology and GUCH Unit, Heart Hospital 'G. Pasquinucci', National Research Council-Tuscany Region Foundation 'G. Monasterio', Massa, Italy
| | - Madgalena Cuman
- Pediatric Cardiology and GUCH Unit, Heart Hospital 'G. Pasquinucci', National Research Council-Tuscany Region Foundation 'G. Monasterio', Massa, Italy
| | | | - Maria Teresa Palladino
- Pediatric Cardiology, University of Campania 'Luigi Vanvitelli', Former Second University of Naples, Monaldi Hospital-AORN Ospedali dei Colli, Naples
| | - Maria Giovanna Russo
- Pediatric Cardiology, University of Campania 'Luigi Vanvitelli', Former Second University of Naples, Monaldi Hospital-AORN Ospedali dei Colli, Naples
| | - Giuseppe Santoro
- Pediatric Cardiology, University of Campania 'Luigi Vanvitelli', Former Second University of Naples, Monaldi Hospital-AORN Ospedali dei Colli, Naples
- Pediatric Cardiology and GUCH Unit, Heart Hospital 'G. Pasquinucci', National Research Council-Tuscany Region Foundation 'G. Monasterio', Massa, Italy
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Santoro G, Cuman M, Pizzuto A, Haxhiademi D, Lunardini A, Franchi E, Marrone C, Pak V, Assanta N, Cantinotti M. GORE® Cardioform ASD Occluder experience in transcatheter closure of "complex" atrial septal defects. Catheter Cardiovasc Interv 2021; 99:E22-E30. [PMID: 34652048 DOI: 10.1002/ccd.29977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 09/25/2021] [Accepted: 10/03/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To evaluate the GORE® Cardioform ASD Occluder (GCO) (WL Gore & Associates, Flagstaff, AZ) device for "complex" atrial septal defects (ASD) closure. BACKGROUND Transcatheter ASD closure is still challenging in "complex" clinical/anatomic settings. This study evaluated the results of GCO in closure of "complex" ASD in a tertiary referral center. METHODS Between January 2020 and March 2021, 72 patients with significant ASD were submitted to transcatheter closure with GCO at our Institution. Based on clinical/anatomic characteristics, they were classified as "complex" (n = 36, Group I) or "simple" (n = 36, Group II). We considered as "complex", defects with rim deficiency (< 5 mm) other than antero-superior, relatively large (diameter/patient weight > 1.2 or diameter/patient BSA > 20 mm/m2 ) or within a multifenestrated septum. Procedure results and early outcome were compared between the groups. RESULTS Absolute and relative ASD size (20 ± 4 vs. 15 ± 3 mm, p < 0.0001; 0.9 ± 0.3 vs. 0.4 ± 0.2 mm/kg, p < 0.0001; 23 ± 7 vs. 12 ± 5 mm/m2 , p < 0.0001), QP/QS (2.0 ± 0.8 vs. 1.4 ± 0.3, p < 0.001), procedure and fluoroscopy times (73 ± 36 vs. 43 ± 21 min, p < 0.0001; 16 ± 9 vs. 9 ± 4 min, p < 0.0001, procedure feasibility (94.4 vs. 100%, p < 0.0001) and overall complication rate (13.9 vs. 0%, p < 0.0001) were significantly different between the groups. Successful closure of "surgical" ASDs was achieved in 92% of cases. Complete closure at last follow-up evaluation did not significantly differ between the groups (97.1 vs. 100%, p = NS), as was wireframe fractures rate (49.1% in the overall population), without clinical, EKG and echocardiographic consequences. CONCLUSIONS Percutaneous treatment with GCO device is effective and safe in high percentage of "complex" ASDs.
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Affiliation(s)
- Giuseppe Santoro
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Magdalena Cuman
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Alessandra Pizzuto
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Dorela Haxhiademi
- Anesthesia and Intensive Care Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Alessia Lunardini
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Eliana Franchi
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Chiara Marrone
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Vitali Pak
- Pediatric Cardiac Surgery, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Nadia Assanta
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Massimiliano Cantinotti
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
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Zhao C, Xu J, Cui D, Liu K. A Long-Term Complication Occurred After Transcatheter Closure of Large Atrial Septal Defect. Int Heart J 2020; 61:183-185. [DOI: 10.1536/ihj.19-161] [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: 11/18/2022]
Affiliation(s)
- Chenyu Zhao
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University
| | - Jinyu Xu
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University
| | - Dan Cui
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University
| | - Kexiang Liu
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University
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Impact of modified techniques of transcatheter closure in large atrial septal defects (⩾30 mm) with anatomic complexities. Cardiol Young 2018; 28:1122-1133. [PMID: 30033909 DOI: 10.1017/s1047951118001099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The outcome of transcatheter closure in ostium secundum atrial septal defects is determined by the morphology of the defects. Modified techniques such as balloon assistance, pulmonary vein deployment, left atrial roof technique, and so on are used for circumventing the anatomic complexities and increasing the success rates. METHODS We planned a prospective study looking at the outcomes of transcatheter closure in secundum atrial septal defects with modified techniques in different anatomic complexities identified in transoesophageal echocardiography and their association with outcome of transcatheter closure. RESULTS Transcatheter closure was successful in 295 out of 346 (82%) patients with modified techniques. Balloon-assisted technique offered a success rate of 87%. The mean defect size was 34.7±2.78 mm (95% confidence interval (CI) 30.67-43.1 mm) with success and 40.16±4.5 mm (95% CI 32.16-44.7) with failure (p = 0.02). The mean total septal length was 38.11±0.63 (95% CI 35.21-40.56 mm) with success and 42.54±0.34 (95% CI 38.79-43.21 mm) with failure. The defect to septal ratios were 0.82 and 0.94 in success and failure groups, respectively (p=0.02). However, the absence of a retro-aortic margin, septal aneurysm, and multiple defects did not affect the success rate. Deficient inferior vena caval margin, deficient posterior margin, and size⩾40 mm had a high risk of failure with transcatheter closure. The odds ratio for procedural failure was 25.3 (4.3-143.8) in patients with malaligned septum, 8.3(1.4-48.5) with deficient inferior vena caval margin, and 4.1(2.5-19) for size⩾40 mm. CONCLUSIONS The modified techniques for device deployment offer substantial chances of success in transcatheter closure of secundum atrial septal defects with anatomical complexity (82%). Variants such as defect size of⩾40 mm and deficient inferior and posterior margins have high failure rates with a modified technique.
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Jung SY, Choi JY. Transcatheter closure of atrial septal defect: principles and available devices. J Thorac Dis 2018; 10:S2909-S2922. [PMID: 30305951 DOI: 10.21037/jtd.2018.02.19] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
There has been a remarkable improvement in the treatment strategy of secundum atrial septal defect (ASD) over the last few decades. Indebted to the improvement in device technology and procedural techniques, transcatheter closure of ASD is currently accepted as the treatment of choice in most patients with secundum ASD. Recent generation devices enable easy and safe deployment of device with the properties of adequate flexibility, re-capturability and repositioning. Use of biocompatible materials with improved device design and refined equipment finish may promote re-endothelialization and reduce potential damage to nearby structures. Most of currently available devices show excellent efficacy and comparable outcome with its own advantages and disadvantages. In addition to improvement of device properties and performance, there has been distinct improvement in procedural technique from numerous experiences of device closure of ASD. Nowadays there are well established principles regarding patient selection, pre-procedural evaluation, step-by-step details of procedure as well as post-procedural follow-up. However, an operator may encounter pitfalls in closing complex lesions such as large defect, rim deficiencies and multiple defects, so every operator has to be familiar with each available device, general principle as well as special issues for complex lesions.
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Affiliation(s)
- Se Yong Jung
- Division of Pediatric Cardiology, Center for Congenital Heart Disease, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Jae Young Choi
- Division of Pediatric Cardiology, Center for Congenital Heart Disease, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
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Pillai AA, Rangaswamy Balasubramanian V, Selvaraj R, Saktheeswaran M, Satheesh S, Jayaraman B. Utility of balloon assisted technique in trans catheter closure of very large (≥35 mm) atrial septal defects. Cardiovasc Diagn Ther 2014; 4:21-7. [PMID: 24649421 DOI: 10.3978/j.issn.2223-3652.2014.02.05] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Accepted: 01/27/2014] [Indexed: 11/14/2022]
Abstract
BACKGROUND Very few published data is available on the outcomes of balloon assisted techniques (BATs) for trans catheter closure (TCC) of very large (Defined as ≥35 mm size) ostium secundum atrial septal defect (ASD). OBJECTIVE To study the utility of BAT as against conventional techniques (CT) in TCC of very large ostium secundum ASD (≥35 mm) over the past 5-year period and to find out the association of different morphological features of the defects in relation to TCC outcomes. STUDY DESIGN AND METHODS Descriptive single center retrospective study of patients with very large ostium secundum ASD (≥35 mm size) who were subjected to TCC. RESULTS Thirty-three out of 36 patients with ≥35 mm ASD and complex morphological features underwent successful TCC. The study patients had high prevalence of absent aortic and posterior rims with posterior mal-alignment of the septum. BAT was successful in 28/31 (90.3%) patients while CT had a success rate of 16%. The mean trans-esophageal echocardiography (TEE) ASD size with BAT success 37 (SD 1.3) mm and CT failure 36.2 (SD 1.1) mm was not different (P=0.06). On univariate analysis of different morphological features, posterior mal alignment of the septum was associated failure of CT (P=0.01). There was no urgent referral for surgery and patients did well on follow up. CONCLUSIONS Balloon assisted device closure of (≥35 mm) ASD had 90% success rate. BAT helps in controlled delivery and device alignment in very large ASD with posterior malalignment of the septum and is often helpful when CT fails.
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Affiliation(s)
- Ajith Ananthakrishna Pillai
- Department of Cardiology, Jawaharlal Institute of Post graduate Medical Education and Research, Pondicherry, India
| | | | - Raja Selvaraj
- Department of Cardiology, Jawaharlal Institute of Post graduate Medical Education and Research, Pondicherry, India
| | - Maheshkumar Saktheeswaran
- Department of Cardiology, Jawaharlal Institute of Post graduate Medical Education and Research, Pondicherry, India
| | - Santhosh Satheesh
- Department of Cardiology, Jawaharlal Institute of Post graduate Medical Education and Research, Pondicherry, India
| | - Balachander Jayaraman
- Department of Cardiology, Jawaharlal Institute of Post graduate Medical Education and Research, Pondicherry, India
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Pillai AA, Satheesh S, Pakkirisamy G, Selvaraj R, Jayaraman B. Techniques and outcomes of transcatheter closure of complex atrial septal defects - single center experience. Indian Heart J 2013; 66:38-44. [PMID: 24581094 PMCID: PMC3946438 DOI: 10.1016/j.ihj.2013.12.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 09/17/2013] [Accepted: 12/04/2013] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To prospectively study the techniques and outcomes of transcatheter closure of complex Atrial septal defects (ASD). STUDY DESIGN AND SETTINGS Prospective single center study with experience in catheter closure of ASD. All patients with complex ASD suitable for device closure. OBJECTIVE Analysis of outcomes of transcatheter closure of complex ASD in JIPMER Hospital over the past 5-year period. METHODS Complex ASD was predefined and patients satisfying inclusion and exclusion criteria are included. All the patients had meticulous Transesophageal echocardiography (TEE) imaging beforehand. Modifications of the conventional techniques were allowed on a case per case basis according to operator preference. Successfully intervened patients were followed up clinically. RESULTS Out of the 75 patients enrolled, 69 patients had successful device closure (success rate 92%) despite challenging anatomy. Fifty-six (74%) patients had ASD ≥ 25 mm. Fifteen patients (20%) had defect size ≥ 35 mm and 20 patients (26.6%) had devices implanted with ≥ 35 mm waist size. Fifty percent of patients had complete absence of aortic rim and 25% had deficient posterior rim. Twenty percent of patients had malaligned septum. Mean follow up period was 3.2 years. CONCLUSIONS Trans catheter closure is feasible in anatomically complex substrates of Secundum ASD. Careful case selection, scrupulous imaging protocol, and expertise in modified techniques are mandatory for successful outcomes.
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Affiliation(s)
- Ajith Ananthakrishna Pillai
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India.
| | - Santhosh Satheesh
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Gobu Pakkirisamy
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Raja Selvaraj
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Balachander Jayaraman
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
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Masseli J, Bertog S, Stanczak L, Blankenbach K, Majunke N, Reiffenstein I, Renkhoff K, Lehn K, Wunderlich N, Sievert H. Transcatheter closure of multiple interatrial communications. Catheter Cardiovasc Interv 2012; 81:825-36. [PMID: 22907918 DOI: 10.1002/ccd.24329] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2011] [Accepted: 01/07/2012] [Indexed: 11/06/2022]
Abstract
OBJECTIVES We sought to examine acute and midterm results of closure of multiple interatrial communications with staged device deployment and to review the relevant literature. BACKGROUND Information about percutaneous methods of closure for multiple defects is limited. METHODS We treated 148 patients with multiple defects. Of these, 88 had a relevant left to right shunt ("LRS"), 52 had a presumed paradoxical embolism ("PPE"), five had both (LRS and PPE), and one patient, respectively, had migraine, decompression sickness, and a right to left shunt. After implantation of the first device, closure of additional septal defects was attempted only if indicated clinically. RESULTS Ninety-four patients received a single device and 53 more than one. In four patients, surgical defect closure followed. At the end of follow-up (FU; mean 4.5 ± 3.4 years), complete closure of all defects occurred in 67.6% (62.1% for LRS, 76.5% for PPE). Clinical success (small or trivial residual shunt) was achieved in 86.9% (83.9% for LRS, 90.2% for PPE). Complications included pericardial effusions in 2.7%, recurrent thromboembolic events in 4.8%, and new onset of atrial fibrillation in 10.1%. In a significant number of patients with multiple defects, after single device implantation, the likelihood of complete closure increased with FU time (26% complete closure at 1 month vs. 78% at 24 months). CONCLUSION Percutaneous closure of multiple interatrial communications is feasible and safe. Importantly, many residual defects close without further intervention at FU. Therefore, staged device delivery is an alternative to simultaneous device implantation, possibly requiring fewer and smaller second devices.
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Yilmaz K, Ewert P, Hetzer R, Stamm C. Surgical repair after ineffective device closure of an inferior sinus venosus defect. Interact Cardiovasc Thorac Surg 2012; 14:485-7. [PMID: 22238133 DOI: 10.1093/icvts/ivr100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
A young woman presented with severe heart failure symptoms 4 years after percutaneous device closure of an atrial septal defect (ASD). There was residual left-to-right shunting, and the device was obstructing the inferior caval vein and tricuspid valve flow. Intraoperatively, the ASD was shown to be an inferior sinus venosus defect, and reconstruction of the mitral valve and the posterior wall of the left atrium was required. This case emphasizes the importance of appropriate patient selection for interventional ASD closure and demonstrates that patients with less-than-optimal results should be referred for surgical correction early, before the device produces secondary damage to atrial structures and atrioventricular valves.
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Affiliation(s)
- Kadir Yilmaz
- Department of Thoracic and Cardiovascular Surgery, German Heart Institute Berlin, Berlin, Germany
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Rigatelli G, Dell' Avvocata F, Cardaioli P, Giordan M, Vassiliev D, Nghia NT, Chen JP. Five-year Follow-up of Intracardiac Echocardiography-assisted Transcatheter Closure of Complex Ostium Secundum Atrial Septal Defect. CONGENIT HEART DIS 2011; 7:103-10. [DOI: 10.1111/j.1747-0803.2011.00567.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Qureshi AM, Mumtaz MA, Latson LA. Partial prolapse of a HELEX device associated with early frame fracture and mitral valve perforation. Catheter Cardiovasc Interv 2009; 74:777-82. [DOI: 10.1002/ccd.22081] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Song ZY, He GX, Shu MQ, Hu HY, Tong SF, Ran BL, Liu JP, Li YH, Jing T. Clinical efficiency and safety analysis of transcatheter closure of multiple atrial septal defects in adults. Clin Cardiol 2009; 32:130-4. [PMID: 19301294 DOI: 10.1002/clc.20450] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Transcatheter closure of atrial septal defects (ASDs) is currently a reliable alternative to surgery, even though challenging in patients with multiple ASDs. HYPOTHESIS The aim of this study was to evaluate the clinical efficiency and safety of transcatheter closure in multiple ASDs. METHODS Multiple ASDs were diagnosed by transthoracic echocardiography (TTE) or transesophageal echocardiography (TEE). The occlusive condition and distance between 2 adjacent ASDs were measured by TTE examination. Then, the number and size of the occluder(s) was determined. TTE examinations were performed after transcatheter closure as follow-up. RESULTS The transcatheter procedure was successful in 15 patients with multiple ASDs, using a single occluder in 9 patients and 2 occluders in the remaining 6 patients. Overall, 21 ASD occluders were implanted. During a follow-up period of 6 mo to 5 y, a slight residual shunt was found in 1 patient without any symptoms; a moderate residual shunt was identified at the inferior vena cava and the occluder was removed by surgery 1 mo after procedure. Other complications, including endocarditis, arrhythmia, thromboembolism, and atrioventricular valve damage were not recorded in any of the 15 patients during the follow-up period. CONCLUSION Transcatheter closure of multiple ASDs is safe and efficient. Two occluders are necessary for the distance of 2 ASDs more than 7 mm, and a single occluder is sufficient for those 7 mm or less.
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Affiliation(s)
- Zhi-Yuan Song
- Department of Cardiology, Southwest Hospital, Third Military Medical University, Chongqing, People's Republic of China.
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Javois AJ, Roberson DA. Unusual atrial septal anatomy resulting in an interatrial chamber: the true triatrial heart? Pediatr Cardiol 2007; 28:224-8. [PMID: 17505865 DOI: 10.1007/s00246-006-0057-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We report two patients who were found to have nearly identical, very peculiar atrial septal anatomy. The septum actually consisted of two distinct septa with discrete defects creating an interatrial chamber. The orifice from the left atrium was unrestrictive, but the orifice to the right atrium was restrictive. Overall, there was net left-to-right shunting. This finding represents a clinical dilemma: Left untreated, the interatrial chamber might be a nidus for thrombus formation, but attempting device closure might result in incomplete obliteration of the chamber, also resulting in potential locus for clot formation. Clot formation might lead to systemic embolization. Angiographic findings are correlated with echocardiographic findings. Embryology and treatment options are considered.
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Affiliation(s)
- A J Javois
- The Heart Institute for Children, Advocate Hope Children's Hospital, Oak Lawn, IL 60453, USA.
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