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Oliva OA, Giugno L, Moroni A, Sturla F, Piazza L, Saracino A, Micheletti A, d'Aiello AF, Reali M, Chessa M, Carminati M. Right disc thrombosis of the new Gore Cardioform ASD Occluder. Catheter Cardiovasc Interv 2024; 103:741-750. [PMID: 38451154 DOI: 10.1002/ccd.31002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 02/04/2024] [Accepted: 02/25/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND The GCA is a well performing device in terms of efficacy despite complex anatomies (aortic rim <5 mm and ASD diameter >17 mm) with a good safety profile. AIMS To evaluate atrial septal defect (ASD) features impacting on right disc device thrombosis in patients who underwent Gore Cardioform ASD Occluder (GCA) implantation. METHODS A total of 44 consecutive patients undergoing percutaneous ASD with GCA device from January 2020 to September 2022 at our tertiary care Center were evaluated. The minimum follow-up was 6 months. RESULTS The patients were stratified in two groups according to a cut-off value of ASD diameter equal to 20 mm at sizing balloon, derived from ROC analysis (AUC = 0.894; p = 0.024). Baseline characteristics were comparable between groups in terms of age, sex, weight, height, and interatrial septum dimensions. Patients with ASD > 20 mm (n = 9) had a higher ASD/device dimension ratio, both at echocardiography (p = 0.009) and at sizing balloon (p = 0.001), longer fluoroscopic time (p = 0.022), and higher incidence of device thrombosis (0.006). Right disc thrombosis was observed in three patients of the ASD > 20 mm group, always in the inferior portion of the right disc. On univariate analysis, ASD diameter at sizing balloon (OR 1.360; p = 0.036) was the only positive predictor of device thrombosis. CONCLUSIONS Right disc thrombosis of the GCA device may be under-recognized at follow-up, hence deserving clinical attention, especially in those patients with larger ASD diameters.
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Affiliation(s)
- Omar A Oliva
- Pediatric and Adult Congenital Heart Center, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Luca Giugno
- Pediatric and Adult Congenital Heart Center, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Alice Moroni
- Pediatric and Adult Congenital Heart Center, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Francesco Sturla
- 3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Luciane Piazza
- Pediatric and Adult Congenital Heart Center, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Antonio Saracino
- Pediatric and Adult Congenital Heart Center, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Angelo Micheletti
- ACHD Unit - Pediatric and Adult Congenital Heart Center, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Angelo Fabio d'Aiello
- ACHD Unit - Pediatric and Adult Congenital Heart Center, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Matteo Reali
- Congenital Cardiac Surgery Unit, IRCCS-Policlinico San Donato, San Donato Milanese, Italy
| | - Massimo Chessa
- ACHD Unit - Pediatric and Adult Congenital Heart Center, IRCCS Policlinico San Donato, San Donato Milanese, Italy
- Faculty of Medicine and Surgery, Vita Salute San Raffaele University, Milan, Italy
| | - Mario Carminati
- Pediatric and Adult Congenital Heart Center, IRCCS Policlinico San Donato, San Donato Milanese, Italy
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Lucarelli K, Acquaviva T, Ferrero P, De Cillis E, Casamassima V, Basile E, Cacciapaglia E, Iorio E, Martimucci M, Cecere G, Petti P, Caruso R, Langialonga T, Bortone A, Grimaldi M, Chessa M. Transcatheter closure of atrial septal defect using intracardiac echocardiography: a two-center, retrospective study. J Cardiovasc Med (Hagerstown) 2024; 25:311-317. [PMID: 38488065 DOI: 10.2459/jcm.0000000000001603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
AIMS We present the experience and long-term results of intracardiac echocardiography (ICE)-guided closure of ostium secundum atrial septal defects (ASDs) in two Italian centers and investigate its systematic applicability as the gold standard in routine clinical practice. METHODS We retrospectively evaluated all consecutive patients who underwent an ASD percutaneous closure procedure from March 2008 to February 2020. All patients underwent a preprocedural transesophageal echocardiography (TEE) evaluation. The closures were carried out under fluoroscopic and ICE guidance. A follow-up visit was performed at 1, 3 and 12 months, followed by telephone evaluations approximately every 2 years. RESULTS Sixty-six patients (29% male individuals), mean age 43 ± 16 years, were treated. In 15 cases, the TEE defect diameter was less than 10 mm, and in 8 of these patients, the ICE intraprocedural sizing increased the maximum diameter by more than 5 mm. Sizing balloon of the defect was performed in 51 cases; 2 patients received an ASD 38 mm device. Eight patients had multiple defects; in three of these, it was necessary to apply two devices. Four patients showed nonsignificant residual shunt; no complications related to the use of ICE were observed. One patient presented the migration of the ASD device into the abdominal aorta, percutaneously retrieved with a snare. No major complications were recorded during the entire follow-up period. CONCLUSION This study confirms that ICE monitoring during ASD percutaneous closure is well tolerated and effective; it might be achievable as a routine gold standard by operators willing to use ICE systematically in all transcatheter closure interventions of interatrial communications.
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Affiliation(s)
- Katya Lucarelli
- Department of Cardiology, 'F. Miulli' Hospital, Acquaviva delle Fonti
| | - Tommaso Acquaviva
- Interdepartmental Unit of Hemodynamics, Policlinico Hospital, University of Bari, Bari
| | | | - Emanuela De Cillis
- Interdepartmental Unit of Hemodynamics, Policlinico Hospital, University of Bari, Bari
| | - Vito Casamassima
- Department of Cardiology, 'F. Miulli' Hospital, Acquaviva delle Fonti
| | - Eloisa Basile
- Department of Cardiology, 'F. Miulli' Hospital, Acquaviva delle Fonti
| | | | - Elia Iorio
- Department of Cardiology, 'F. Miulli' Hospital, Acquaviva delle Fonti
| | | | - Giacomo Cecere
- Department of Cardiology, 'F. Miulli' Hospital, Acquaviva delle Fonti
| | - Pierpaolo Petti
- Department of Cardiology, 'F. Miulli' Hospital, Acquaviva delle Fonti
| | - Rosa Caruso
- Department of Cardiology, 'F. Miulli' Hospital, Acquaviva delle Fonti
| | | | - Alessandro Bortone
- Interdepartmental Unit of Hemodynamics, Policlinico Hospital, University of Bari, Bari
| | - Massimo Grimaldi
- Department of Cardiology, 'F. Miulli' Hospital, Acquaviva delle Fonti
| | - Massimo Chessa
- ACHD Unit Head, IRCCS Policlinico San Donato & Vita Salute San Raffaele University, Milan, Italy
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Abdul Jabbar A, Jaradat M, Hasan M, Yoo JW, Jenkins JS, Crittendon I, Lucas VS, Ramee S, Collins T. Systematic review of multiple versus single device closure of Secundum atrial septal defects in adults. Cardiovasc Revasc Med 2024; 58:90-97. [PMID: 37596193 DOI: 10.1016/j.carrev.2023.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/24/2023] [Accepted: 07/31/2023] [Indexed: 08/20/2023]
Abstract
INTRODUCTION Multiple device closure (MDC) strategy has been used in treating of complex Atrial septal defects (ASDs) in adults. The safety profile of MDC compared to conventional single device closure (SDC) is unknown in this population. This report represents the first review examining the outcomes of single versus multiple device ASD closure in adults with ostium secundum defects. METHODS Literature databases and manual search from their inception until June 30th, 2017 followed the Preferred Reporting Items of Systemic Review and Meta-Analysis (PRISMA) guideline. Main outcomes are 1) overall complication incidence, 2) arrhythmia incidence, 3) residual shunt rate. Each outcome profile was pooled by MDC and SDC, respectively and chi-square analysis was applied to examine statistical significance between MDC and SDC strategies (two-sided and p < .050). RESULTS A total of 1806 + studies were initially screened, and 20 studies were finally selected (MDC group, 147 patients; SDC group, 1706 patients). There was no difference in overall complication incidence (χ2 = 1.269; p = .259) and arrhythmia incidence (χ2 = 0.325; p = .568) between MDC and SDC. There was no difference in residual shunt rate between the SDC (4.10 %; 70/1706) and MDC groups (6.80 %; 10/147; χ2 = 2.387; p = .122). CONCLUSIONS The outcomes of percutaneous multiple ASD closure (MDC) seem to be safe and effective as compared to conventional single ASD (SDC) closure in terms of device - related complications and technical success of the procedure. Prospective registry data and randomized trials are needed to determine the long-term outcomes of percutaneous ASD closure using MDC.
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Affiliation(s)
- Ali Abdul Jabbar
- Section of Interventional Cardiology, Cardiology Department, John Ochsner Heart and vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, United States of America; The Tampa Bay Heart Institue at HCA Florida Northside Hospital, University of South Florida Morsani College of Medicine, HCA West FL Division GME Program, St. Petersburg, FL, United States of America
| | - Mohammad Jaradat
- Department of Internal Medicine, University of Nevada School of Medicine, Las Vegas, NV, United States of America
| | - Mohanad Hasan
- Section of Interventional Cardiology, Cardiology Department, John Ochsner Heart and vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, United States of America
| | - Ji Won Yoo
- Department of Internal Medicine, University of Nevada School of Medicine, Las Vegas, NV, United States of America
| | - J Stephen Jenkins
- Section of Interventional Cardiology, Cardiology Department, John Ochsner Heart and vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, United States of America
| | - Ivory Crittendon
- Section of Pediatric Cardiology, Cardiology Department, John Ochsner Heart and vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, United States of America
| | - Victor S Lucas
- Section of Pediatric Cardiology, Cardiology Department, John Ochsner Heart and vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, United States of America
| | - Stephen Ramee
- Section of Interventional Cardiology, Cardiology Department, John Ochsner Heart and vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, United States of America
| | - Tyrone Collins
- Section of Interventional Cardiology, Cardiology Department, John Ochsner Heart and vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, United States of America; Section of Pediatric Cardiology, Cardiology Department, John Ochsner Heart and vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, United States of America.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Batteux C, Ciobotaru V, Arditi W, Decante B, Karsenty C, Combes N, Hascoet S. Transcatheter correction of sinus venosus defect in a patient with a challenging anatomical configuration: From bench testing to clinical success. Catheter Cardiovasc Interv 2023; 102:1265-1270. [PMID: 37975208 DOI: 10.1002/ccd.30898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 04/04/2023] [Accepted: 10/22/2023] [Indexed: 11/19/2023]
Abstract
We report successful transcatheter correction of a sinus venosus defect in a 72-year-old woman with anomalous pulmonary venous return in a challenging anatomical configuration. The procedure was facilitated by hands-on simulation training on a newly developed, perfused, 3D-printed model.
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Affiliation(s)
- Clement Batteux
- Department of congenital heart diseases, Marie Lannelongue Hospital, M3C network, Groupe Hospitalier Paris Saint Joseph, School of Medicine, Paris-Saclay University, Marie Lannelongue Hospital, Plessis-Robinson, France, France
- UMR-S 999, INSERM, Plessis-Robinson, France, France
| | - Vlad Ciobotaru
- UMR-S 999, INSERM, Plessis-Robinson, France, France
- Department of cardiology, Centre Hospitalier Universitaire de Nîmes, Nîmes, France, France
- Department of cardiology, Clinique Franciscaines, Nîmes, France, France
| | - William Arditi
- Department of biomedical engineering, CentraleSupélec, Paris-Saclay University, Gif-sur-Yvette, France, France
| | - Benoit Decante
- Department of congenital heart diseases, Marie Lannelongue Hospital, M3C network, Groupe Hospitalier Paris Saint Joseph, School of Medicine, Paris-Saclay University, Marie Lannelongue Hospital, Plessis-Robinson, France, France
| | - Clement Karsenty
- Department of pediatric cardiology, Hôpital des Enfants, M3C network, CHU Toulouse, Toulouse, France, France
| | - Nicolas Combes
- Department of congenital heart diseases, Marie Lannelongue Hospital, M3C network, Groupe Hospitalier Paris Saint Joseph, School of Medicine, Paris-Saclay University, Marie Lannelongue Hospital, Plessis-Robinson, France, France
- Department of cardiology, Clinique Pasteur, Toulouse, France, France
| | - Sebastien Hascoet
- Department of congenital heart diseases, Marie Lannelongue Hospital, M3C network, Groupe Hospitalier Paris Saint Joseph, School of Medicine, Paris-Saclay University, Marie Lannelongue Hospital, Plessis-Robinson, France, France
- UMR-S 999, INSERM, Plessis-Robinson, France, France
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Baruteau AE, Hascoet S, Malekzadeh-Milani S, Batteux C, Karsenty C, Ciobotaru V, Thambo JB, Fraisse A, Boudjemline Y, Jalal Z. Transcatheter Closure of Superior Sinus Venosus Defects. JACC Cardiovasc Interv 2023; 16:2587-2599. [PMID: 37855807 DOI: 10.1016/j.jcin.2023.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 07/12/2023] [Accepted: 07/18/2023] [Indexed: 10/20/2023]
Abstract
Superior sinus venosus defect is a communication between the right and left atrium located above the upper margin of the oval fossa, immediately inferior to the junction of the superior vena cava and the right atrium. It is systematically associated with partial anomalous pulmonary venous drainage, especially of the right upper pulmonary vein. Surgical repair has been the gold standard approach to close that defect. Introduced in 2014, percutaneous closure has gradually become a safe and effective alternative to surgery in carefully selected patients, although worldwide experience remains limited. This article provides an appraisal of the patients' selection process and a step-by-step description of the procedure as well as a comprehensive review of its outcomes.
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Affiliation(s)
- Alban-Elouen Baruteau
- Nantes Université, Centre Hospitalier Universitaire Nantes, Department of Pediatric Cardiology and Pediatric Cardiac Surgery, Nantes, France; Nantes Université, Centre Hospitalier Universitaire Nantes, Centre National de la Recherche Scientifique, Institut National de la Santé et de la Recherche Scientifique, l'institut du thorax, Nantes, France; Nantes Université, Centre Hospitalier Universitaire Nantes, Institut National de la Santé et de la Recherche Scientifique, Centre d'Investigations Cliniques Femmes-Enfants-Adolescents 1413, Nantes, France; Nantes Université, Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement, Unité Mixte de Recherche 1280, Physiologie des Adaptations Nutritionnelles, Nantes, France.
| | - Sébastien Hascoet
- Malformations Cardiaques Congénitales Complexes-Hôpital Marie Lannelongue, Department of Pediatric Cardiology and Congenital Heart Disease, Groupe Hospitalier Paris Saint Joseph, BME Lab, Institut National de la Santé et de la Recherche Scientifique UMR-S 999, Université Parsis Saclay, Le Plessis Robinson, France
| | - Sophie Malekzadeh-Milani
- Malformations Cardiaques Congénitales Complexes-Necker, Department of Congenital and Pediatric Cardiology, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Université de Paris, Paris, France
| | - Clément Batteux
- Malformations Cardiaques Congénitales Complexes-Hôpital Marie Lannelongue, Department of Pediatric Cardiology and Congenital Heart Disease, Groupe Hospitalier Paris Saint Joseph, BME Lab, Institut National de la Santé et de la Recherche Scientifique UMR-S 999, Université Parsis Saclay, Le Plessis Robinson, France
| | - Clément Karsenty
- Department of Pediatrics, Centre Hospitalier Universitaire Toulouse, Université de Toulouse, Toulouse, France; Institut des Maladies Métaboliques et Cardiovasculaires, Université de Toulouse, Toulouse, France
| | - Vlad Ciobotaru
- Malformations Cardiaques Congénitales Complexes-Hôpital Marie Lannelongue, Department of Pediatric Cardiology and Congenital Heart Disease, Groupe Hospitalier Paris Saint Joseph, BME Lab, Institut National de la Santé et de la Recherche Scientifique UMR-S 999, Université Parsis Saclay, Le Plessis Robinson, France; Clinique des Franciscaines, 3Dheartmodeling, Nîmes, France
| | - Jean-Benoit Thambo
- Department of Pediatric and Adult Congenital Cardiology, Centre Hospitalier Universitaire Bordeaux, Bordeaux, France; Electrophysiology and Heart Modeling Institute, Institut Hospital-Universitaire Liryc, Fondation Bordeaux Université, Bordeaux, France
| | - Alain Fraisse
- National Heart and Lung Institute, Imperial College London, Royal Brompton and Harefield Hospitals, London, United Kingdom
| | - Younes Boudjemline
- Sidra Heart Center, Sidra Medicine, Weil Cornell Medical College, Doha, Qatar
| | - Zakaria Jalal
- Department of Pediatric and Adult Congenital Cardiology, Centre Hospitalier Universitaire Bordeaux, Bordeaux, France; Electrophysiology and Heart Modeling Institute, Institut Hospital-Universitaire Liryc, Fondation Bordeaux Université, Bordeaux, France
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Yang H, Chen Y, Liu K, Zhao L. Case Report: A novel EPAS1 mutation in a case of paraganglioma complicated with polycythemia and atrial septal defect. Front Endocrinol (Lausanne) 2023; 14:1180091. [PMID: 37576964 PMCID: PMC10419204 DOI: 10.3389/fendo.2023.1180091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/10/2023] [Indexed: 08/15/2023] Open
Abstract
Background Paraganglioma is a rare neuroendocrine tumor and is highly associated with hereditary susceptibility genes, often occurring as part of a genetic syndrome. The genetic heterogeneity of paraganglioma poses challenges in diagnosis, counseling, and clinical management. Case summary We present the case of a 60-year-old woman with hypertension, atrial septal defect, and polycythemia, who experienced paroxysmal palpitations, sweating, headache, abdominal pain, nausea, and vomiting. Her blood pressure was severely unstable. Blood laboratory tests revealed elevated catecholamine levels, contrast-enhanced CT of her whole abdomen showed a round retroperitoneal mass with soft tissue density, and somatostatin receptor imaging (68Ga PET-CT) indicated a retroperitoneal mass with abnormally increased expression of somatostatin receptor. It is interesting to note that whole exome sequencing (WES) analyses on both blood and tumor samples revealed a novel EPAS1 mutation, specifically the c.2501A > G; p.Tyr834Cys variant, which has never been reported. The patient was diagnosed with paraganglioma and underwent successful Da Vinci robot-assisted laparoscopic resection of the retroperitoneal tumor. During a 3-month follow-up period, her blood pressure stabilized, and her symptoms significantly improved. Conclusion This case reveals that the EPSA1 mutation may be the primary driver of paraganglioma complicated by atrial septal defect and polycythemia. Additionally, the utilization of Da Vinci robot-assisted laparoscopic surgery contributed to a favorable prognosis for the patient.
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Affiliation(s)
- Haiyan Yang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Geriatrics, Chongqing General Hospital, Chongqing, China
| | - Yue Chen
- Department of Clinical Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Pharmacy, West China Tianfu Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Kai Liu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Liming Zhao
- Department of Cardiology, Hospital of Chengdu Office of People’s Government of Tibetan Autonomous Region, Chengdu, Sichuan, China
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Yamda H, Muneuchi J, Sugitani Y, Ezaki H, Koga H, Tanaka A, Watanabe M. Transcatheter atrial septal defect closure late after completion of biventricular circulation in patients with pulmonary atresia intact ventricular septum or critical pulmonary stenosis. Catheter Cardiovasc Interv 2023; 101:847-852. [PMID: 36906810 DOI: 10.1002/ccd.30623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 12/15/2022] [Accepted: 02/27/2023] [Indexed: 03/13/2023]
Abstract
OBJECTIVE This study aimed to explore anatomical and hemodynamic features of atrial septal defect, which was treated by transcatheter device closure late after completion of biventricular circulation in patients with pulmonary atresia and intact ventricular septum (PAIVS) or critical pulmonary stenosis (CPS). METHODS We studied echocardiographic and cardiac catheterization data, including defect size, retroaortic rim length, single or multiple defects, the presence of malalignment atrial septum, tricuspid and pulmonary valve diameters, and cardiac chamber sizes, in patients with PAIVS/CPS who underwent transcatheter closure of atrial septal defect (TCASD), and compared to control subjects. RESULTS A total of 173 patients with atrial septal defect, including 8 patients with PAIVS/CPS, underwent TCASD. Age and weight at TCASD were 17.3 ± 18.3 years and 36.6 ± 13.9 kg, respectively. There was no significant difference in defect size (13.7 ± 4.0 vs. 15.6 ± 5.2 mm, p = 0.317) and the retro-aortic rim length (3.7 ± 4.3 vs. 3.6 ± 0.3.1 mm, p = 0.948) between the groups; however, multiple defects (50% vs. 5%, p < 0.001) and malalignment atrial septum (62% vs. 14%. p < 0.001) were significantly frequent in patients with PAIVS/CPS compared to control subjects. The ratio of pulmonary to systemic blood flow in patients with PAIVS/CPS was significantly lower than that in the control patients (1.2 ± 0.4 vs. 2.0 ± 0.7, p < 0.001); however, four out of eight patients with atrial septal defect associated with PAIVS/CPS had right-to-left shunt through a defect, who were evaluated by the balloon occlusion test before TCASD. The indexed right atrial and ventricular areas, the right ventricular systolic pressure, and mean pulmonary arterial pressure did not differ between the groups. After TCASD, the right ventricular end-diastolic area remained unchanged in patients with PAIVS/CPS, whereas it significantly decreased in control subjects. CONCLUSIONS Atrial septal defect associated with PAIVS/CPS had more complex anatomy, which would be a risk for device closure. Hemodynamics should be individually evaluated to determine the indication for TCASD because PAIVS/CPS encompassed anatomical heterogeneity of the entire right heart.
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Affiliation(s)
- Hiromu Yamda
- Department of Pediatrics, Kyushu Hospital, Japan Community Healthcare Organization, Kitakyushu, Japan
| | - Jun Muneuchi
- Department of Pediatrics, Kyushu Hospital, Japan Community Healthcare Organization, Kitakyushu, Japan
| | - Yuichiro Sugitani
- Department of Pediatrics, Kyushu Hospital, Japan Community Healthcare Organization, Kitakyushu, Japan
| | - Hiroki Ezaki
- Department of Pediatrics, Kyushu Hospital, Japan Community Healthcare Organization, Kitakyushu, Japan
| | - Hirotaka Koga
- Department of Pediatrics, Kyushu Hospital, Japan Community Healthcare Organization, Kitakyushu, Japan
| | - Atsushi Tanaka
- Department of Pediatrics, Kyushu Hospital, Japan Community Healthcare Organization, Kitakyushu, Japan
| | - Mamie Watanabe
- Department of Pediatrics, Kyushu Hospital, Japan Community Healthcare Organization, Kitakyushu, Japan
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Saha SK, Ahmed CM, Haque T, Al Mamun MA, Hussain MZ. Assessment of atrial septal defects using 3-dimensional transthoracic echocardiography prior to percutaneous device closure: first report from Bangladesh. Ther Adv Cardiovasc Dis 2023; 17:17539447231193290. [PMID: 37697803 PMCID: PMC10496463 DOI: 10.1177/17539447231193290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 07/18/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Secundum atrial septal defect (ASD) is treated following trans-catheter closure in alternative to surgical treatment. Per-intervention selection of device size with balloon occlusive diameter (BOD) often cause tearing or enlarging, causing arrhythmias and hypotension. We assessed the suitability of percutaneous device closure for ASD using 3-dimensional transthoracic echocardiography (3DTTE). OBJECTIVES This study was conducted to investigate if 3DTTE could be an alternative of balloon sizing for selection of device size in atrial septal defect device closure. DESIGN It was a cross-sectional comparative study. METHODS This study was conducted at the department of Pediatric Cardiology, Bangabandhu Sheikh Mujib Medical University for a period of 2 years. Thirty-three purposively selected secundum ASD patients suitable for device closure were included in the study. Ethical permission was taken from the Institutional Review Board and written consent was taken from each patient's guardian. In this study, 3DTTE derived ASD diameter and BOD were compared with that of deployed device size using correlation analysis. RESULTS Out of 33 patients, 63.6% were female and 36.4% were males had a mean age of 18.07 ± 14.58 years (range 2-55 years). Mean diameter of ASD measured by 2-dimensional (2D) and 3-dimensional (3D) echocardiography were 17.09 ± 6.08 mm and 21.30 ± 6.56 mm, respectively, yielding a significant difference (p < 0.001). 3D echocardiography derived ASDs diameter were highly correlated with device size than BOD and 2D echocardiography derived diameter (2D echocardiography: r = 0.796, p = <0.001, 3D echocardiography: r = 0.960, p = <0.001, BOD: r = 0.840, p = <0.001). CONCLUSION 3DTTE can accurately measure ASD diameter and can be used as an alternate, effective, and safe method to select device size.
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Affiliation(s)
- Santosh Kumar Saha
- Department of Pediatric Cardiology, National Institute of Cardiovascular Diseases and Hospital, Sher-e- Bangla Nagar, Dhaka 1207, Bangladesh
| | | | - Tuhin Haque
- Department of Cardiology, National Heart Foundation Hospital and Research Institute, Dhaka, Bangladesh
| | - Mohammad Abdullah Al Mamun
- Department of Epidemiology and Research, National Heart Foundation Hospital and Research Institute, Dhaka, Bangladesh
| | - Mohd. Zahid Hussain
- Department of Pediatric Cardiology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
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Johny D, Subramanyam K, Bhandary RM, Rao A. Non-surgical treatment of Lutembacher syndrome: combined percutaneous transcatheter therapy. BMJ Case Rep 2022; 15:15/5/e247984. [PMID: 35584855 DOI: 10.1136/bcr-2021-247984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A woman in her 30s presented with progressive worsening of dyspnoea for 6 months. On evaluation, she was diagnosed with severe rheumatic mitral stenosis (mitral valve area of 0.6 cm2) and a large ostium secundum atrial septal defect (21 mm) with a left to right shunt and severe pulmonary artery hypertension. She was diagnosed with Lutembacher syndrome and was evaluated for suitability of a percutaneous approach. She was subjected to a combined procedure of percutaneous transluminal mitral commissurotomy followed by device closure of the atrial septal defect. The patient tolerated the procedure, remained haemodynamically stable and was discharged after 4 days. This procedure can prevent the morbidity and mortality associated with anaesthesia and cardiac surgery and the psychological trauma of a thoracotomy scar particularly in a female patient, as well as obviate the need for prolonged hospital stay.
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Affiliation(s)
- Dilip Johny
- Cardiology, KS Hegde Medical Academy, Mangalore, Karnataka, India
| | | | - Ram Mohan Bhandary
- Internal Medicine, KS Hegde Medical Academy, Mangalore, Karnataka, India
| | - Amita Rao
- Periodontology, AB Shetty Memorial Institute of Dental Sciences, Mangalore, Karnataka, India
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Heaton JN, Okoh AK, Suh S, Ozturk E, Salemi A, Waxman S, Tayal R. Safety and Efficacy of the Amplatzer Septal Occluder: A Systematic Review and Meta-Analysis. Cardiovasc Revasc Med 2022; 37:52-60. [PMID: 34183276 PMCID: PMC10909392 DOI: 10.1016/j.carrev.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/12/2021] [Accepted: 06/01/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To assess the safety and efficacy of the Amplatzer Septal Occluder in the closure of secundum type atrial septal defects. BACKGROUND The Amplatzer Septal Occluder (ASO; Abbott, St. Paul, MN) is an FDA-approved device for percutaneous closure of secundum type atrial septal defects (ASD). Previous small cohort trials have shown a favorable safety and technical efficacy profile. METHODS We conducted a systemic review and meta-analysis of all prospective case series and controlled trials that evaluated the ASO's safety and implant efficacy. The primary endpoint was the technical success rate of implantations. Secondary outcomes included proportions of arrhythmias and embolism specific-adverse events. RESULTS We included a total of 12 studies with 2972 patients. The ratio of device implantation was 2:1 by sex [female: male]. Pooled technical success rate of implantation was 98% (95% CI: 0.968-0.990, P < 0.01). The cumulative adverse event rate was 5.1% (95% CI: 0.035-0.068, P < 0.01), which included arrhythmia and embolism specific adverse event rates of 1.8% (95% CI: 0.007-0.032, P < 0.01) and 0.7% (95% CI: 0.002-0.013, P < 0.01), respectively. Sensitivity analysis did not significantly affect pooled outcomes for success rate and adverse events; both forest plot and Begg's and Egger's regression tests supported symmetricity. CONCLUSION A high likelihood of technical success can be expected when implanting the ASO in secundum type ASDs. Adverse event rates are expected for one in twenty patients, and thus, our results support the safe use of ASO in secundum type ASDs closure. CONDENSED ABSTRACT The AMPLATZER Septal Occluder is an FDA-approved device for percutaneous closure of secundum type atrial septal defects (ASD). We conducted a systemic review and meta-analysis of all prospective case series and controlled trials that evaluated the ASO's safety and implant efficacy. We included a total of 12 studies with 2972 patients. Pooled technical success rate of implantation was 98% (P < 0.01). The cumulative adverse event rate was 5.1% (P < 0.01), 1.8% (P < 0.01) rate of arrhythmias, and 0.7% (P < 0.01) rate of embolisms. A high likelihood of technical success can be expected with a low rate of adverse events.
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Affiliation(s)
- Joseph N Heaton
- Department of Medicine, The Brooklyn Hospital Center, Brooklyn, NY, United States of America; Cardiovascular Research Unit, RWJ Barnabas Health. NBIMC, Newark, NJ, United States of America.
| | - Alexis K Okoh
- Cardiovascular Research Unit, RWJ Barnabas Health. NBIMC, Newark, NJ, United States of America
| | - Seungmo Suh
- Department of Medicine, The Brooklyn Hospital Center, Brooklyn, NY, United States of America
| | - Ebru Ozturk
- Cardiovascular Research Unit, RWJ Barnabas Health. NBIMC, Newark, NJ, United States of America
| | - Arash Salemi
- Cardiovascular Research Unit, RWJ Barnabas Health. NBIMC, Newark, NJ, United States of America
| | - Sergio Waxman
- Cardiovascular Research Unit, RWJ Barnabas Health. NBIMC, Newark, NJ, United States of America
| | - Rajiv Tayal
- Cardiovascular Research Unit, RWJ Barnabas Health. NBIMC, Newark, NJ, United States of America
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Latson L, Briston D. Atrial Septal Defect: Transcatheter Closure Is Not Bad, But There Is More to the Story. JACC Cardiovasc Interv 2021; 14:576-577. [PMID: 33663786 DOI: 10.1016/j.jcin.2021.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 01/05/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Larry Latson
- ACHD Center, Cardiac and Vascular Institute, Memorial Healthcare System, Hollywood, Florida, USA.
| | - David Briston
- ACHD Center, Cardiac and Vascular Institute, Memorial Healthcare System, Hollywood, Florida, USA
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14
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Miki T, Yamano T, Yamano M, Nakamura T, Takamatsu K, Ma C, Wakana N, Nakanishi N, Zen K, Shiraishi H, Shirayama T, Matoba S. Favorable changes of left ventricular function in the circumferential direction following transcatheter atrial septal defect closure: a strain imaging study. Int J Cardiovasc Imaging 2020; 37:903-912. [PMID: 33047179 DOI: 10.1007/s10554-020-02064-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 10/05/2020] [Indexed: 11/26/2022]
Abstract
To clarify the impact on left ventricular (LV) function of percutaneous atrial septal defect (ASD) closure in adult patients. Echocardiograms of 46 patients (52 ± 18 years) who underwent ASD closure with a significant left-to-right shunt obtained before and 1 month after the procedure were retrospectively analyzed. Functional parameters were obtained by 2-dimensional speckle-tracking imaging. Global longitudinal strain and strain rate at early diastole (SRe) was calculated from the three standard apical views, while circumferential and radial parameters were calculated from basal, middle, and apical LV short-axis views. Along with a diminished right ventricular (RV) volume, the LV volume and ejection fraction increased (end-diastolic volume: 61 ± 12 to 76 ± 15 mL, p < 0.001; and 63% ± 4 to 64% ± 4% p = 0.03; respectively). Both global strain and SRe was augmented only in the circumferential direction (- 16.2% ± 2.9% to - 19.8% ± 2.8%; and 1.07 ± 0.29 to 1.34 ± 0.28 s-1, both p < 0.001). Augmentation of circumferential SRe correlated with both the changes in and the pre-procedural value of diastolic LV eccentricity index (r = - 0.57, p < 0.001; and r = 0.37, p = 0.01; respectively), a morphological parameter of RV volume overload. Following ASD closure in adults, both LV systolic and diastolic function could favorably change in the circumferential direction, and the degree of diastolic functional change is associated with RV volume overload, i.e., severity of ventricular interdependence.
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Affiliation(s)
- Tomonori Miki
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Tetsuhiro Yamano
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Michiyo Yamano
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Takeshi Nakamura
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Kazuaki Takamatsu
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Chao Ma
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Noriyuki Wakana
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Naohiko Nakanishi
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Kan Zen
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Hirokazu Shiraishi
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Takeshi Shirayama
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Satoaki Matoba
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
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Affiliation(s)
- Azeem Latib
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
| | - Kusha Rahgozar
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
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Lelakowska M, Matusik PT, Podolec PS, Olszowska M, Nessler JM, Podolec N, Przewłocki T, Komar M. Transcatheter closure of atrial septal communication: Impact on quality of life in mid-term follow-up. ADV CLIN EXP MED 2019; 28:1079-1085. [PMID: 31237120 DOI: 10.17219/acem/102440] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Atrial septal defect (ASD) and patent foramen ovale (PFO) are specific types of atrial septal communications (ASC). OBJECTIVES We aimed to assess quality of life (QoL) in patients before and after percutaneous closure of ASC and determine the factors influencing QoL in this group of patients. MATERIAL AND METHODS We performed a clinical assessment and conducted an SF-36 questionnaire, electrocardiography and echocardiography studies in patients before and 6 months after percutaneous ASC closure. RESULTS Patients with ASD (n = 56) had a lower SF-36 total score than those with PFO (n = 73), before and after percutaneous ASC occlusion (both p < 0.001). After the procedure, the improvement of SF-36 total score in patients with ASD or atrial fibrillation was greater (p < 0.001 and p = 0.005, respectively). We observed correlations between improvement of QoL and baseline supraventricular extrasystolic beats (rs = 0.28; p = 0.002), but not ventricular extrasystolic beats (rs = 0.03; p = 0.76). Quality of life improvement was predicted in patients with ASD by higher baseline tricuspid annular plane systolic excursion (TAPSE) and right ventricular longitudinal dimension R2 = 0.38; p < 0.001. However, in patients with PFO, this was predicted by TAPSE, lack of arterial hypertension and usage of angiotensin-converting enzyme inhibitors, R2 = 0.30; p < 0.001. CONCLUSIONS Patients with ASD have lower QoL than those with PFO before and after percutaneous ASC occlusion. Six months after the procedure, the improvement of QoL in patients with ASD was higher than in those with PFO. The change in QoL self-assessed by patients after the procedure was associated with episodes of arrhythmia and was predicted with echocardiographic and clinical parameters.
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Affiliation(s)
- Maria Lelakowska
- Department of Coronary Disease and Heart Failure, John Paul II Hospital, Kraków, Poland
| | - Paweł Tomasz Matusik
- Department of Electrocardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland
| | - Piotr Stanisław Podolec
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland
| | - Maria Olszowska
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland
| | - Jadwiga Maria Nessler
- Department of Coronary Disease and Heart Failure, John Paul II Hospital, Kraków, Poland
| | - Natalia Podolec
- Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Tadeusz Przewłocki
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland
| | - Monika Komar
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland
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Lelakowska M, Olszowska M, Matusik PT, Przewłocki T, Nessler J, Podolec N, Podolec P, Komar M. [Przezskórne zamknięcie ubytku w przegrodzie międzyprzedsionkowej: wpływ na prawy przedsionek, dyspersję załamka P i zaburzenia rytmu serca w obserwacji średnioterminowej]. Pol Merkur Lekarski 2019; 46:109-114. [PMID: 30912518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
UNLABELLED The size of the right atrium (RA) reduces after transcatheter closure of the atrial septal defect (ASD). Inverse structural and electrical remodeling is observed. AIM The aim of study was to analyze the parameters predisposing to the lack of normalization of enlarged RA after transcatheter closure of ASD during 6-month follow-up. MATERIALS AND METHODS A prospective study included 56 consecutive adult patients (12 men) aged from 23 to 76 years (49.8±13.3 years) with ASD, in whom transcatheter ASD closure was performed. Each patient was assessed before and 6 months after the treatment using standard 12-lead resting electrocardiogram (ECG), 24-hour Holter monitoring and echocardiography. RESULTS Before the procedure in 37 patients with ASD enlarged RA was observed, while after transcatheter ASD closure in 24 patients normalization of enlarged RA was noted. Patients in whom 6 months after the procedure there was no normalization of the enlarged RA were older, characterized by higher right ventricular systolic pressure (RVSP), pulmonary to systemic blood flow ratio (Qp/Qs), larger size of the occluder, interatrial septal defect, longer fluoroscopy time and lower left ventricular ejection fraction. P-wave dispersion (Pdysp) was found to be a destimulant i.e. increased Pdysp (>67 ms, P<0.000) decreased the chance of RA normalization after procedure. On the other hand, minimum P-wave duration (Pmin) was a stimulant, therefore, increased Pmin (>72ms, P<0.000) increased the chance of RA normalization. A significant association was found between the reduction of supraventricular extrasystolic beats and RA area normalization (P<0.001), and there was no association between the incidence of atrial fibrillation episodes and RA area normalization. CONCLUSIONS Evaluation of the duration of the P-wave and its dispersion may help to assess the prognosis of the right atrium size normalization in the mid-term follow-up after transcatheter closure of ASD. There is a significant relationship between normalization of the right atrium size and reduction of supraventricular extrasystolic beats.
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Affiliation(s)
- Maria Lelakowska
- Jagiellonian University Medical College, the John Paul II Hospital, Kraków, Poland: Department of Coronary Disease and Heart Failure
| | - Maria Olszowska
- Jagiellonian University Medical College, the John Paul II Hospital, Kraków, Poland: Department of Cardiac and Vascular Diseases, Institute of Cardiology
| | - Paweł Tomasz Matusik
- Jagiellonian University Medical College, the John Paul II Hospital, Kraków, Poland: Department of Electrocardiology, Institute of Cardiology
| | - Tadeusz Przewłocki
- Jagiellonian University Medical College, the John Paul II Hospital, Kraków, Poland: Department of Cardiac and Vascular Diseases, Institute of Cardiology
| | - Jadwiga Nessler
- Jagiellonian University Medical College, the John Paul II Hospital, Kraków, Poland: Department of Coronary Disease and Heart Failure, Institute of Cardiology
| | - Natalia Podolec
- Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Piotr Podolec
- Jagiellonian University Medical College, the John Paul II Hospital, Kraków, Poland: Department of Cardiac and Vascular Diseases, Institute of Cardiology
| | - Monika Komar
- Jagiellonian University Medical College, the John Paul II Hospital, Kraków, Poland: Department of Cardiac and Vascular Diseases, Institute of Cardiology
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Msaad H, Drissa M, Mahfoudhi H, Hakim K, Ouarda F. Particularities of neonatal isthmic aortic coarctation (A Tunisian study). Tunis Med 2018; 96:514-519. [PMID: 30430531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
METHODS This is a retrospective study including 47 patients with isthmic coarctation (CoA) diagnosed in ante et postnatal périod, hospitalized in pediatric cardiology departement of la Rabta Hospital-Tunisia during the period from 2000 to 2017. RESULTS They were 36 girls and 11 boys with an average age of 14 days. The diagnosis of CoA was suspected during the anténatalperiod in eight cases. In postnatal period heart failure was observed in (38.5%), abolition of femoral pulse (74%), a tension asymetry was found in all patients. Antenatal echocardiography suspected indicators of fetal coarctation especially ventriculo-arterial asymmetryechocardiography confirmed the diagnosis of CoA ,The ejection fraction was impaired in 31% of the cases.The abnormalities associated with coarctation were dominated by the patent ductus arteriosus (68%), atrial septal defect (55.5%), aortic hypoplasia, bicuspidia in respectively in 34% and 31% coarctation syndrome in (23.4%). Prostaglandin wasneccessary in (89.3%). forty two patients were operated with good immédiaterésults. the early postoperative mortality was 12.5%. In the long term, we deplored two late deaths, six cases of recoarctation with a follow-up of 14 months treated by percutaneous angioplasty with a result considered good in all cases. CONCLUSION Coarctation of the aorta in neonates is a special form of aorticcoarctaion that differs from the child and adult forms in clinical, echocardiographic, and therapeutic characteristics . His clinical diagnosis must be early, if possible in antenatal , to asssure optimal management.
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MESH Headings
- Angioplasty
- Aortic Coarctation/diagnosis
- Aortic Coarctation/epidemiology
- Aortic Coarctation/therapy
- Echocardiography
- Female
- Gestational Age
- Heart Septal Defects, Atrial/diagnosis
- Heart Septal Defects, Atrial/epidemiology
- Heart Septal Defects, Atrial/therapy
- Humans
- Infant, Newborn
- Infant, Newborn, Diseases/diagnosis
- Infant, Newborn, Diseases/epidemiology
- Infant, Newborn, Diseases/therapy
- Male
- Pregnancy
- Prenatal Diagnosis/statistics & numerical data
- Retrospective Studies
- Tunisia/epidemiology
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19
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Amin S, Madsen PL. [Background, diagnosis and treatment of platypnoea-orthodeoxia]. Ugeskr Laeger 2018; 180:V11170823. [PMID: 29804568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Platypnoea-orthodeoxia (PO) is a condition with dyspnoea and arterial deoxygenation during orthostasis, which is relieved in the supine position. This is a review of the background of PO, which is always an orthostasis-related right-to-left shunt of deoxygenated blood either across a persistent foramen ovale/atrial septal defect or an anatomical or functional pulmonary shunt, and diagnosis and management is discussed. PO is considered to be rare but will presumably be diagnosed increasingly frequently with increased use of pulse oximetry and functional imaging including echocardiography with bubble-contrast.
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20
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Adam AM, Godil A, Ali Mallick MS, Khan F, Rizvi AH, Makhdoom IUHM. Lutembacher syndrome with mitral valve calcification in a 31-year old male. J PAK MED ASSOC 2018; 68:340-342. [PMID: 29786701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Lutembacher syndrome is characterized by a congenital ostium secundum atrial septal defect and an acquired mitral valve stenosis. We present a similar case in a 31-year old male who came in with orthopnoea, central cyanosis and pedal oedema. Examination revealed cardiac murmurs in tricuspid and apical regions. Chest x-ray showed signs of pulmonary congestion and ventricular enlargement. Electrocardiogaphy (ECG) revealed right axis deviation and right bundle branch block along with atrial fibrillation and Transthoracic Echocardiography (TTE) showed abnormal valves (mitral stenosis with calcification and tricuspid regurgitation) and dilated cardiac chambers. The patient was consequently treated with beta-blockers and diuretics and scheduled for valvular and septal repair via open heart surgery. The purpose of this case report is to assist cardiologists in diagnosing this syndrome accurately on the basis of symptoms and investigations.
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Affiliation(s)
| | | | | | - Fahad Khan
- Dow University of Health Sciences, Karachi
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21
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Nir-David Y, Mainzer G, Tal R, Lorber A. Comparing the Performance of Amplatzer® and Occlutech® Figulla® Septal Occluders: The Pediatric Point of View. A Retrospective Study. Isr Med Assoc J 2017; 19:557-561. [PMID: 28971639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND The closure of an atrial septal defect is procedure that is frequently performed in both adults and children. Currently, the most commonly used devices are the Amplatzer® and Occlutech® Figulla® atrial septal occluders. Studies conducted in adults have shown that these devices all have similar performance efficiency for the closure of secundum atrial septal defects. No study to date has examined their performance in the pediatric population. OBJECTIVES To evaluate and compare the performance of Amplatzer® and Occlutech® Figulla® atrial septal occluders in the pediatric population. METHODS A consecutive retrospective study of exclusively pediatric patients who underwent percutaneous closure of atrial septal defect with these devices was conducted at our institute. RESULTS The study comprised 110 children, 50 in the Amplatzer® device group and 60 in the Occlutech® Figulla® device group. The groups had similar demographic and defect characteristics, except for defect size per transesophageal echocardiography (TEE), which was 2.1 mm larger in the Amplatzer® device group (P = 0.02). No adverse events were recorded in either of the study groups. Complete defect closure at 12 months follow-up (procedural success) was achieved in all but one of the patients in the Amplatzer® group and all but two in the Figulla® group (P = 1). The residual shunt rates of fenestrated defects were similar in the two groups. CONCLUSIONS For children with an isolated secundum atrial septal defect, percutaneous closure is equally safe and effective with either Amplatzer® or Occlutech® Figulla® devices.
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Affiliation(s)
- Yifat Nir-David
- Department of Pediatrics, Carmel Medical Center, Haifa, Israel
| | - Gur Mainzer
- Department of Pediatric Cardiology and Adults with Congenital Heart Disease, Meyer Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Roie Tal
- Department of Pediatric Cardiology and Adults with Congenital Heart Disease, Meyer Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Avraham Lorber
- Department of Pediatric Cardiology and Adults with Congenital Heart Disease, Meyer Children's Hospital, Rambam Health Care Campus, Haifa, Israel
- Department of Pediatric Cardiology, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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22
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Azhar AS. Safety and efficacy of transthoracic versus transesophageal echocardiography in transcatheter closure of atrial septal defects. Reporting a single center experience from Saudi Arabia. Saudi Med J 2017; 37:1196-1205. [PMID: 27761557 PMCID: PMC5303796 DOI: 10.15537/smj.2016.11.15617] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Objectives: To assess the safety and effectiveness of transthoracic echocardiography (TTE) in monitoring transcatheter closure of atrial septal defect (ASD), in comparison with conventional technique using transesophageal echocardiography (TEE). Methods: A retrospective review of all cases of transcatheter closure of isolated ostium secundum ASDs operated from 2005 to 2015, at the Pediatric Interventional Cardiology Department, King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia. Exclusion criteria included age ≤3 years at the time of the procedure and rim size ≤3 mm. Patients were divided into 2 groups: TTE and TEE group. Demographic and clinical baseline data, procedure data, and outcomes were compared between the 2 groups. Results: We included 77 cases: 45 in TTE group and 28 in TEE (mean ± standard deviation age=8.18 ± 5.85 versus 17.68 ± 14.88), with no significant difference in ASD size, rim adequacy, or other anatomical difficulties. All (100%) patients in TEE group underwent general anesthesia, versus 8.9% in TTE group. Device deployment was comparably successful (97.8% versus 92.9%, p=0.554); while procedure time (76.27 ± 31.80 versus 119.85 ± 19.90 minutes, p<0.001) and fluoroscopy time (11.29 ± 9.04 versus 18.73 ± 11.54 minutes, p=0.003) were significantly reduced in TTE versus TEE. Prevalence of postprocedural complications was comparable in the 2 groups. Conclusion: Transthoracic echocardiography has non-inferior efficacy in device deployment with reference to TEE and superior safety features including significant reduction of procedure and fluoroscopy times and lesser use of general anesthesia.
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Affiliation(s)
- Ahmad S Azhar
- Department of Pediatric, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia. E-mail.
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Kazawa S, Enomoto T, Suzuki N, Koshikawa T, Okubo Y, Yoshii S, Sato M, Okabe M, Yamashina A, Aizawa Y. Platypnea-orthodeoxia Syndrome in a Patient with an Atrial Septal Defect: The Diagnosis and Choice of Treatment. Intern Med 2017; 56:169-173. [PMID: 28090047 PMCID: PMC5337462 DOI: 10.2169/internalmedicine.56.7728] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
A 77-year-old woman developed dyspnea over three years which occurred during sitting, standing or walking. Her physical examination, chest X-ray, ECG and cardiac catheterization results were all normal. A marked fall in arterial oxygen saturation was observed on sitting or standing. Transesophageal echocardiography showed an increase of right to left shunt flow on sitting. The patient was diagnosed with platypnea-orthodeoxia syndrome and underwent the surgical closure of an atrial septal defect of 19 mm in diameter. After the surgery, the patient's POS symptoms were completely resolved. She was discharged and followed at the outpatient clinic. Her post-treatment course was uneventful.
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Abstract
Transcatheter device implantation has become an attractive alternative to surgery in the closure of atrial septal defects in selected patients. However, it can lead to early and late sequelae, some of them life threatening. For example, 79 days before her admission to our emergency department with sudden-onset respiratory distress and respiratory arrest (leading to cardiac tamponade and rupture), a 22-year-old woman had undergone percutaneous closure of an atrial septal defect. We describe the damage and its treatment. Although the adverse effects of transcatheter device implantation are rare, physicians should know that these events can be life threatening. Further data are needed to prevent such sequelae and to design new devices. It is of utmost importance that patients and their family members be informed both of possible sequelae and of life-saving interventions to be administered at early diagnosis.
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Zuin M, Rigatelli G. Secundum atrial septal defects and methylenetetrahydrofolate reductase C677T polymorphism: A special category of ASDs? Int J Cardiol 2016; 223:139-140. [PMID: 27537741 DOI: 10.1016/j.ijcard.2016.08.212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 08/11/2016] [Indexed: 11/20/2022]
Affiliation(s)
- Marco Zuin
- Department of Cardiology, Rovigo General Hospital, Rovigo, Italy; Section of Internal and Cardiopulmonary Medicine, Department of Medical Science, University of Ferrara, Ferrara, Italy
| | - Gianluca Rigatelli
- Section of Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Italy.
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26
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Kim HD, Kim MS, Yun KJ, Bae SM, Her SH, Lee JH. Successful transcatheter closure of an inferior sinus venosus atrial septal defect. Korean J Intern Med 2016; 31:176-8. [PMID: 26767872 PMCID: PMC4712423 DOI: 10.3904/kjim.2016.31.1.176] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 11/01/2013] [Accepted: 11/01/2013] [Indexed: 11/27/2022] Open
Affiliation(s)
- Hyung Duk Kim
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Moon Sung Kim
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyung-Jin Yun
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang Mook Bae
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung-Ho Her
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Correspondence to Sung-Ho Her, M.D. Division of Cardiology, Department of Internal Medicine, College of Medicine, Daejeon St. Mary’s Hospital, The Catholic University of Korea, 64 Daeheung-ro, Jung-gu, Daejeon 34943, Korea Tel: +82-42-220-9504 Fax: +82-42-226-9686 E-mail:
| | - Jae-Hwan Lee
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
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27
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Kilic T, Ural E, Sahin T. Cobrahead Deformity in the Right Atrial Disc of a New-Generation Occlutech Figulla Flex II Atrial Septal Defect Occluder Device. Tex Heart Inst J 2015; 42:454-7. [PMID: 26504440 DOI: 10.14503/thij-14-4179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Cobrahead deformity is a known (but uncommon) phenomenon associated with the left atrial disc of the Amplatzer or Occlutech Figulla septal occluder device during percutaneous transcatheter atrial septal defect closure. It has also been postulated that the right atrial disc of the Amplatzer septal occluder device might upon occasion exhibit the cobrahead malformation. To date, only one case report concerning the cobrahead deformity in the right atrial disc of an Amplatzer septal occluder has been published, if we discount a report published as a letter to the manufacturer. Here we present the first report (known to us) of a cobrahead deformity in the right atrial disc of an Occlutech Figulla Flex II atrial septal defect occluder device during transcatheter closure of a complex atrial septal defect.
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Henkin S, Negrotto S, Pollak PM, Cullen MW, O'Cochlain DF, Wright RS. Platypnea-Orthodeoxia Syndrome: Diagnostic Challenge and the Importance of Heightened Clinical Suspicion. Tex Heart Inst J 2015; 42:498-501. [PMID: 26504452 DOI: 10.14503/thij-14-4596] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Platypnea-orthodeoxia syndrome is an uncommon condition of positional dyspnea and hypoxemia; symptoms occur when the patient is upright and resolve with recumbency. Causes can be broadly categorized into 4 groups: intracardiac shunting, pulmonary shunting, ventilation-perfusion mismatch, or a combination of these. Platypnea-orthodeoxia syndrome should be suspected when normal arterial oxygen saturations are recorded while an individual is supine, followed by abrupt declines in those saturations when upright. Further investigations with use of imaging and cardiac catheterization aid in the evaluation. When platypnea-orthodeoxia syndrome is due to intracardiac shunting without pulmonary hypertension, intracardiac shunt closure can be curative. In this article, we report a case of platypnea-orthodeoxia syndrome in an 83-year-old woman who was successfully treated by means of percutaneous transcatheter closure of an atrial septal defect.
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29
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Chen TH, Hsiao YC, Cheng CC, Mao CT, Chen DY, Tsai ML, Yang TY, Lin YS. In-Hospital and 4-Year Clinical Outcomes Following Transcatheter Versus Surgical Closure for Secundum Atrial Septal Defect in Adults: A National Cohort Propensity Score Analysis. Medicine (Baltimore) 2015; 94:e1524. [PMID: 26402807 PMCID: PMC4635747 DOI: 10.1097/md.0000000000001524] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Atrial septal defect (ASD) closure is major therapy for patients with secundum ASD. Although surgical closure (SC) and transcatheter closure (TC) are usually performed in such patients, data on the long-term outcomes comparing TC and SC in adults are limited. Data on the participants of this cohort study were retrieved from Taiwan's National Health Insurance Research Database from 2004 to 2011. Secundum ASD patients > 18 years of age who underwent TC or SC were initially enrolled, and those with associated comorbidities were excluded. After propensity score matching, the clinical outcomes between the TC and SC groups were analyzed. There were 595 patients recruited in the TC group and 308 patients in the SC group. The SC group had a higher incidence of systemic thromboembolism (P < 0.001), ischemic stroke (P = 0.002), and all-cause mortality (P = 0.013) when compared with those of the TC group at the index hospitalization, and similar phenomena could also be seen in a around 4-year follow-up period after the procedures (systemic thromboembolism (P < 0.001, HR = 11.48, 95% CI: 3.29-40.05), ischemic stroke (P = 0.005, HR = 9.28, 95% CI: 1.94-44.39), and all-cause mortality (P = 0.035, HR = 2.28, 95% CI: 1.06-4.89). In addition, atrial fibrillation (P = 0.005) and atrial flutter (P = 0.049) more frequently developed in the SC group than in the TC group at the index hospitalization. The adult secundum ASD patients had lower incidence rates of systemic thromboembolism, ischemic stroke, and all-cause mortality after TC than those after SC in the 4-year follow-up after procedures. Transcatheter ASD closure should therefore be given priority.
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Affiliation(s)
- Tien-Hsing Chen
- From the Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan, R.O.C. (THC, CTM); Department of Medical Education, Chang Gung Memorial Hospital, Keelung, Taiwan, R.O.C (YCH, CCC); Division of Cardiology, Chang-Gung Memorial Hospital, Linkou (DYC, MLT); and Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan, R.O.C. (TYY, YSL)
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30
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Yang F, Zheng H, Lyu J, Yang X, Yang Y, Pang Y, Liang F, Zhang G, Xu Z, Jiang S, Lyu B, Meng F, Hao B. [A case of transcatheter closure of inferior vena cava type atrial septal defect with patent ductus arteriosus occlusion device guided by 3D printing technology]. Zhonghua Xin Xue Guan Bing Za Zhi 2015; 43:631-633. [PMID: 26420326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Grignani RT, Tolentino KM, Rajgor DD, Quek SC. Longitudinal evaluation of P-wave dispersion and P-wave maximum in children after transcatheter device closure of secundum atrial septal defect. Pediatr Cardiol 2015; 36:1050-6. [PMID: 25628159 DOI: 10.1007/s00246-015-1119-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 01/14/2015] [Indexed: 11/25/2022]
Abstract
Transcatheter device closure of the secundum atrial septal defect (ASD) in children prevents atrial arrhythmias in older age. However, the benefits of favourable atrial electrocardiographic markers in these children remain elusive. We aimed to review the electrocardiographic markers of atrial activity in a longitudinal fashion. We retrospectively reviewed longitudinal data of all children who underwent transcatheter device closure at the National University Hospital between 2004 and 2013. The inclusion criteria included the presence of a secundum-type ASD with left to right shunt and evidence of increased right ventricular volume load (Q p/Q s ratio >1.5 and/or right ventricular dilatation). A total of 25 patients with a mean follow-up of 44.7 ± 33.47 (7.3-117.4) months were included. P maximum and P dispersion decreased at 2 months, P amplitude at 1 week and remained so until last follow-up. A positive trend was seen with a correlation coefficient of +0.12 for P maximum, +0.08 for P dispersion and 0.34 for P amplitude. There was a higher baseline P amplitude and P dispersion in patients who were older than 10 years and a non-significant trend to support an increase in both P maximum (71.0 ± 8.8 vs. 73.2 ± 12.7), P dispersion (17.0 ± 6.5 vs. 22.0 ± 11.3) and P amplitude (0.88 ± 0.25 vs. 1.02 ± 0.23) in patients with an ASD more than 15 mm compared with an ASD <15 mm. There is reduction in both P maximum and P dispersion as early as 2 months, which persisted on follow-up. Earlier closure may result in more favourable electrocardiographic results.
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Affiliation(s)
- Robert Teodoro Grignani
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Wilmshurst PT, Morrison WL, Walsh KP. Comparison of the size of persistent foramen ovale and atrial septal defects in divers with shunt-related decompression illness and in the general population. Diving Hyperb Med 2015; 45:89-93. [PMID: 26165530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 05/01/2015] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Decompression illness (DCI) is associated with a right-to-left shunt, such as persistent foramen ovale (PFO), atrial septal defect (ASD) and pulmonary arteriovenous malformations. About one-quarter of the population have a PFO, but considerably less than one-quarter of divers suffer DCI. Our aim was to determine whether shunt-related DCI occurs mainly or entirely in divers with the largest diameter atrial defects. METHODS Case control comparison of diameters of atrial defects (PFO and ASD) in 200 consecutive divers who had transcatheter closure of an atrial defect following shunt-related DCI and in an historic group of 263 individuals in whom PFO diameter was measured at post-mortem examination. RESULTS In the divers who had experienced DCI, the median atrial defect diameter was 10 mm and the mean (standard deviation) was 9.9 (3.6) mm. Among those in the general population who had a PFO, the median diameter was 5 mm and mean was 4.9 (2.6) mm. The difference between the two groups was highly significant (P < 0.0001). Of divers with shunt-related DCI, 101 (50.5%) had an atrial defect 10 mm diameter or larger, but only 1.3% of the general population studied had a PFO that was 10 mm diameter of larger. CONCLUSIONS The risk of a diver suffering DCI is related to the size of the atrial defect rather than just the presence of a defect.
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Affiliation(s)
| | | | - Kevin P Walsh
- Our Lady's Hospital for Sick Children, Dublin, Ireland
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Elliott EJ. Atrial septal defect: a coincidental finding on a screening medical. Diving Hyperb Med 2015; 45:121-123. [PMID: 26165535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 04/11/2015] [Indexed: 06/04/2023]
Abstract
An otherwise fit, healthy medical practitioner who was a recreational diver underwent a medical assessment for a remote posting as an Antarctic Medical Practitioner at which a coincidental finding of an atrial septal defect (ASD) was made. ASDs can have health implications in extreme environments such as high altitude and is contraindicated in scuba diving. ASDs are common, being present in 1:1,500 live births and comprise 10% of all cardiac abnormalities. In this case, a percutaneous occlusive device was inserted under general anaesthetic with subsequent improvements in the practitioner's exercise capacity, return to diving and full employment, including Antarctic deployment, and right-sided heart remodelling 18 months post closure.
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Affiliation(s)
- Elizabeth J Elliott
- Department of Diving and Hyperbaric Medicine, Royal Hobart Hospital, PO Box 744, North Hobart , Tasmania 7002, Australia, Phone: +61-(0)3-6222-8193, E-mail:
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Rashkind WJ. Balloon atrioseptostomy. A palliative measure for transposition of the great arteries and certain other critical congenital cardiac defects. Adv Cardiol 2015; 11:2-10. [PMID: 4137554 DOI: 10.1159/000395197] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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35
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Flaherty MP, Sayfo S, Resar J. Transcatheter closure of five atrial septal communications in the presence of severe pulmonary arterial hypertension and severe left ventricular non-compliance. J Invasive Cardiol 2015; 27:E51-E55. [PMID: 25840408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Closure of congenital atrial communications in the presence of either severe pulmonary arterial hypertension (PAH) with pulmonary-to-systemic (right-to-left) shunting, or severe left ventricular (LV) non-compliance with left-to-right shunting is often considered prohibitive. Thus, the recognition of durable reversibility of these physiologic conditions is crucial. We describe a hemodynamic conundrum in a patient with five septal communications in whom the coexistence of unmasked bidirectional physiologic shunting, severe PAH, and worsening left-sided overload dissuaded initial closure. We report our strategy for hemodynamic evaluation and successful closure of all defects.
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Affiliation(s)
- Michael P Flaherty
- Division of Cardiovascular Medicine, University of Louisville School of Medicine, Rudd Heart and Lung Center, 201 Abraham Flexner Way, Suite 800, Louisville, KY 40202 USA.
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Abstract
BACKGROUND It is unclear whether medical or invasive (surgical or catheter interventional) treatment is preferable to prevent recurrence of cerebral ischemia in patients with patent foramen ovale (PFO) as the suspected cause of stroke and what the role of concomitant risk factors is in stroke recurrence. METHODS Over a period of ten years, 124 patients (mean age 51 +/- 15 years) with cryptogenic cerebral ischemia and PFO were included into the study and prospectively followed over a mean of 52 +/- 32 months. Of these, 83 were treated medically, 34 underwent transcatheter closure, and seven had surgical closure of the foramen. Of the medically treated patients, 11 stopped medication during follow-up. Recurrent ischemic events and risk factors for recurrence were analyzed. RESULTS Annual stroke recurrence rates were generally low and comparable in catheter and medically treated patients, and in patients who had stopped medication (2.9%/2.1%2.2%/year). Patients suffering from recurrence after transcatheter closure (n = 2) both had residual shunts. No stroke recurrence was observed in the few surgically treated patients. An atrial septal aneurysm was not a predictor of recurrent or multiple strokes (p > 0.05, OR = 0.31, and OR = 0.74). Large shunts and a history of previous ischemic events were considerably more frequent in patients with recurrent strokes (p < 0.05, OR = 5.0, and OR = 4.4). Pulmonary embolism and case fatality rates were significantly higher in patients with stroke recurrence (p < 0.001, and p < 0.01). CONCLUSIONS The absolute risk of recurrent cerebrovascular events in patients with PFO receiving medical or catheter interventional therapy is low. The small group of untreated patients had a comparably low rate of stroke recurrences. Previous ischemic events and shunt size were risk factors in this observational study. Given conflicting findings across multiple studies, enrollment into a randomized controlled trial would be the optimal choice.
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Affiliation(s)
- J U Harrer
- Department of Neurology, Aachen University Hospital, Aachen, Germany
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Narin N, Baykan A, Argun M, Ozyurt A, Pamukcu O, Bayram A, Uzum K. New modified balloon-assisted technique to provide appropriate deployment in the closure of large secundum atrial septal defect using amplatzer septal occluder in children. J Invasive Cardiol 2014; 26:597-602. [PMID: 25364001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Transcatheter closure of secundum atrial septal defect (ASD) is accepted as a safe alternative method to surgery. However, the deployment of the device across the septum using the conventional method presents difficulties in large ASDs. METHODS In the modified balloon-assisted technique (modified BAT), a Tyshak balloon (Numed, Inc) is placed in one of the left pulmonary veins and a long sheath is placed in the right upper pulmonary vein. Through this sheath, the Amplatzer septal occluder is deployed to its proper position with the help of the Tyshak balloon, which prevents the left atrial disc from prolapsing into the right atrium. This method was implemented in the treatment of patients with a large secundum ASD. In this study, defects that measured ≥15 mm by transesophageal echocardiography (TEE) were considered to be large secundum ASDs. Between June 2011 and September 2013, the modified BAT was used in the closure procedure of 30 patients (18 females/12 males) with large ASDs (group I). Between September 2003 and September 2013, 78 patients (47 females/31 males) with large ASDs were treated with conventional methods (group II). The results of both groups were compared. RESULTS In the comparison of the results between group I and group II, there were no significant differences between mean maximal ASD sizes by transthoracic echocardiography, mean maximal ASD size by TEE, Qp/Qs ratio, mean device diameter, failure rate, embolization incidences, residual shunt, and fluoroscopy time. However, there were significant differences in the mean ages, mean body weights, and mean PAPs between group I and group II. After adjusting for age and body weight, in terms of process failure, the conventional method was found 5.6 times more risky compared to modified BAT. CONCLUSION Large secundum ASDs in children, transcatheter closure with Amplatzer septal occluder using the modified BAT is a simple, quite useful method. In addition, this method seems to reduce the procedure failure rate.
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Affiliation(s)
- Nazmi Narin
- Erciyes University Medical Faculty, Department of Pediatric Cardiology, Kayseri Turkey.
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Pan X, Li S, Hu S, Ouyang W, Zhang F, Zhang D, Tian P, Zhang Y, Pang K. [Feasibility of transcatheter closure of atrial septal defect under the guidance of transthoracic echocardiography]. Zhonghua Xin Xue Guan Bing Za Zhi 2014; 42:744-747. [PMID: 25511094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To explore the feasibility of transcatheter closure of atrial septal defect (ASD) under transthoracic echocardiography (TTE) guidance. METHODS Retrospective analysis was performed in 65 patients with simple ASD who underwent transcatheter closure under echocardiography guidance in Fuwai hospital from February to August 2013. They were divided into TTE group (n = 30) and transesophageal echocardiography (TEE) group (n = 35). The TTE group patients who underwent localized anesthesia or basal anesthesia received transcatheter closure of ASD under the guidance of TTE. The TEE group patients who underwent tracheal intubation and general anesthesia received transcatheter closure of ASD under the guidance of TEE. The patients were followed up with TTE and electrocardiogram at one month after procedure at outpatient department. RESULTS In the TTE group, 28 occluders were implanted successfully and 2 patients were subsequently switched to TEE guidance because of unclear TTE images, and the occluder implantation in these 2 patients was successful. There were no obvious differences in age, sex, body weight, ASD size, and time of hospital stay between the two groups (all P > 0.05) . Compared with TEE group, the TTE group had a significantly shorter operation time ((52.77 ± 9.00 ) min vs. (60.11 ± 9.15) min, P < 0.05), respirator ventilation duration ((0.25 ± 0.95) h vs. (3.17 ± 0.69) h, P < 0.05), and stay time in ICU ((1.50 ± 1.96) h vs. (16.43 ± 6.99) h, P < 0.05). The dose of propofol required was significantly lower in the TTE group compared to TEE group ((2.41 ± 2.97) mg/kg vs. (9.43 ± 3.70) mg/kg, P < 0.05). The patients in both groups had no complications such as residual shunt, peripheral vascular injury or cardiac perforation at the time of hospitalization.No complications, such as occluder dislocation, residual shunt, or pericardial effusion were seen during follow-up at one month post procedure in both groups. CONCLUSION Transcatheter closure of ASD under TTE guidance is feasible and has a broad application prospects.
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Affiliation(s)
- Xiangbin Pan
- Department of Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Shoujun Li
- Department of Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Shengshou Hu
- Department of Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Wenbin Ouyang
- Department of Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Fengwen Zhang
- Department of Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Dawei Zhang
- Department of Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Pengsheng Tian
- Department of Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Yanbo Zhang
- Department of Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Kunjing Pang
- Department of Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
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Maeda J, Kawamura A. [Transesophageal and intracardiac echocardiography in therapeutic cardiac catheterizations of structural heart disease]. Masui 2014; 63:982-987. [PMID: 25255660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Recently clinical indication of therapeutic cardiac catheterization (CC) is being developed in the field of structural heart disease (SHD) along with the advance and refinement of medical equipment for interventional CC. Echocardiography is an indispensable imaging tool as well as fluoroscopy as a guidance of CC. Transesophageal echocardiography (TEE) is one of the most widely used imaging modalities in diagnosis and treatment of SHD. Although TEE provides high-quality imaging of intra-cardiovascular structures including three-dimensional imaging, it requires general anesthesia when it is performed along with therapeutic CC. Intracardiac echocardiography (ICE) is a useful alternative in this setting since it can be performed intravenously only under local anesthesia during CC and displays excellent cardiovascular imaging similar to TEE. We herein discuss the clinical utility of both TEE and ICE during the procedure of device closure of atrial septal defect.
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Medford BA, Taggart NW, Cabalka AK, Cetta F, Reeder GS, Hagler DJ, Johnson JN. Intracardiac echocardiography during atrial septal defect and patent foramen ovale device closure in pediatric and adolescent patients. J Am Soc Echocardiogr 2014; 27:984-90. [PMID: 24998516 DOI: 10.1016/j.echo.2014.05.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND Intracardiac echocardiography (ICE) is commonly used during interventional cardiac catheterization in adults, but data regarding the use of ICE in children are limited. There are no data available comparing the effectiveness of preprocedural transthoracic echocardiography (TTE) with that of intraprocedural ICE in predicting atrial septal defect (ASD) size and rim adequacy for percutaneous closure in a pediatric population. The objectives of this study were to describe the investigators' experience using ICE in pediatric and adolescent patients and to compare the effectiveness of preprocedural TTE with that of ICE in predicting ASD size and rim adequacy for percutaneous closure. METHODS In this retrospective study, all cases in which ICE was used during ASD or patent foramen ovale closure in patients ≤21 years of age at a single institution from January 2002 through October 2013 were reviewed. All studies were performed using the Acuson AcuNav ICE system. RESULTS One hundred fifteen patients (65 female; mean age, 12 ± 6 years; range, 10 months to 21 years) were included. All intracardiac echocardiographic studies were performed by the interventional cardiologist performing the catheterization. ICE was used to facilitate ASD closure in 92 patients (81%) and patent foramen ovale closure in 23 (19%). Thirty-eight patients (34%) underwent cardiac catheterization and ICE without general anesthesia. ICE was correlated highly with preprocedural TTE in predicting ASD size (r(2) = 0.76, P < .0001). In nine of 92 patients (9.8%) with ASDs, ICE identified deficient septal rims (n = 8) or complex or multiple ASDs (n = 1) that necessitated surgical closure. There were no major complications. CONCLUSIONS ICE can be performed safely and effectively in a large cohort of children and adolescents undergoing percutaneous device closure. ICE may obviate the need for general anesthesia in some patients and is a reasonable alternative to transesophageal echocardiography for this catheter-based procedure in children. ASD measurements with ICE correlate well with preprocedural measurements on TTE; however, ICE more accurately identifies the absence or deficiency of critical septal rims before device closure.
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Affiliation(s)
- Beth A Medford
- Department of Pediatrics, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota.
| | - Nathaniel W Taggart
- Department of Pediatrics, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota
| | - Allison K Cabalka
- Department of Pediatrics, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota
| | - Frank Cetta
- Department of Pediatrics, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota; Department of Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Guy S Reeder
- Department of Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Donald J Hagler
- Department of Pediatrics, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota; Department of Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Jonathan N Johnson
- Department of Pediatrics, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota
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Zhang T, Zhang Y, Wan C, Cheng G, Wang J, He X, Du Y. [The effect of oversized occluder on endothelialization after percutaneous closure of experimental atrial septal defect in dogs]. Zhonghua Xin Xue Guan Bing Za Zhi 2014; 42:557-560. [PMID: 25327596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To observe the effect of oversized occluder on endothelialization post percutaneous closure of experimental atrial septal defect (ASD) in dogs. METHODS ASD was established with the help of transthoracic echocardiography in 18 dogs. ASD size was (6.0 ± 0.2) mm. Dogs were randomly divided into normal size group (implanted with 8 mm occlude, n = 9) and oversized group (implanted with 12 mm occluder, n = 9). Dogs were randomly killed at 3, 6 and 14 months after percutaneous closure. The endothelialization process on device surface was observed by scanning electron microscope. RESULTS Four animals died around 1 month post procedure. Microscopic sections from normal group showed nearly complete endothelialization at 3 months after device implantation and complete endothelialization at 6 and 14 months after device implantation. While microscopic sections showed lack of endothelialization at 3 months post implantation, nearly endothelialization at 6 months, and complete endothelialization at 14 months after device implantation in oversized group. CONCLUSION Incomplete endothelialization of occluder surface is observed at 6 months after implantation of an oversized ASD occluder device in this model.
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Affiliation(s)
- Tingting Zhang
- Second Department of Cardiology, First Hospital Affiliated to Xi'an Jiaotong University, Xi'an 710061, China
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Sadiq N, Ullah M, Sultan M, Akhtar K. Transthoracic echocardiography as a measuring and guiding tool for transcatheter device closure of secundum atrial septal defect in young children. J Invasive Cardiol 2014; 26:245-248. [PMID: 24907079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To analyze the effectiveness of transthoracic echocardiography (TTE) for device closure of secundum atrial septal defect in children ≤5 years old. STUDY DESIGN Quasiexperimental study. STUDY LOCATION AND DURATION The study was conducted at Armed Forces Institute of Cardiology and National Institute of Heart Diseases from December 1, 2010 to December 31, 2012. PATIENTS AND METHODS During the study period, a total of 48 children ≤5 years old underwent device closure of secundum atrial septal defect. The indications for closure were: elective closure in 31; parental anxiety in 10; frequent respiratory infection in 4; severe pulmonary stenosis in 2; and severe mitral stenosis in 1 patient. The procedure was carried out under general or local anesthesia with TTE and fluoroscopic guidance. TTE was the primary tool used for measurement of defect and estimation of occluder size as well as guiding equipment during device deployment in all patients. RESULTS A total of 47/48 patients (97.9%) had successful closure of secundum atrial septal defect. The mean age was 4.1 ± .68 years (range, 2.5-5 years) and 28/48 patients (58.4%) were female. The defect size and occluders used were between 5-20 mm (mean, 12 ± 3.5 mm) and 8-22 mm (mean, 15 ± 3.9 mm), respectively. Three patients had simultaneous procedures comprising pulmonary balloon valvuloplasty in 2 patients and percutaneous transmitral commissurotomy in 1 patient. The device embolization occurred in 1 patient; the device was retrieved percutaneously and the patient was referred for surgical closure. The minor complications were residual leak (n = 1), transient bradycardia (n = 4), and first-degree heart block (n = 1). The median procedure time was 30 min (range, 15-100 min) and median fluoroscopic time was 6 min (range, 1.50-45 min). There were no emergency surgical explorations, cardiac perforations, vascular injuries, or deaths during this period. CONCLUSION TTE can be used as a primary tool for the measurement of atrial septal defect and guidance during device deployment in young children by skilled and professional hands, yet more experience is awaited.
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Affiliation(s)
- Nadeem Sadiq
- Pediatric Cardiology Department, Armed Forces Institute of Cardiology & National Institute of Heart Diseases (AFIC/ NIHD) Rawalpindi, Pakistan.
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Ahmad F, Sadiq MA, Chee KH, Mahmood Zuhdi AS, Wan Ahmad WA. Atrial septal defect coexistent with Sjögren's syndrome. J Coll Physicians Surg Pak 2014; 24:441-443. [PMID: 24953923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 05/22/2013] [Indexed: 06/03/2023]
Abstract
Pulmonary hypertension is frequently associated with atrial septal defect and various connective tissue disorders. This case describes a 74-year-old woman who presented with symptoms of heart failure and concomitant involvement of salivary glands and keratoconjunctivitis. An echocardiogram demonstrated ostium secundum atrial septal defect with left to right shunt and severe pulmonary hypertension. Laboratory investigations confirmed the diagnosis of Sjögren's syndrome (SS) with positive anti-nuclear factor and centromere SS-A/Ro pattern. Anti-Ro (SS-A) was found positive. Atrial septal defect was closed through transcatheter route with significant improvement in clinical outcome. This case report suggests a possible association of atrial septal defect with primary Sjögren's syndrome in an adult patient.
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Affiliation(s)
- Farook Ahmad
- Department of Medicine, University Malaya Medical Centre, 50603, Kuala Lumpur, Malaysia
| | - Muhammad Athar Sadiq
- Department of Medicine, University Malaya Medical Centre, 50603, Kuala Lumpur, Malaysia
| | - Kok Han Chee
- Department of Medicine, University Malaya Medical Centre, 50603, Kuala Lumpur, Malaysia
| | | | - Wan Azman Wan Ahmad
- Department of Medicine, University Malaya Medical Centre, 50603, Kuala Lumpur, Malaysia
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Ahn J, Kim JH, Choi JH, Oh JH. Percutaneous retrieval and redeployment of an atrial septal occluder under three-dimensional transesophageal echocardiographic guidance: a case report. J Korean Med Sci 2014; 29:871-3. [PMID: 24932092 PMCID: PMC4055824 DOI: 10.3346/jkms.2014.29.6.871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Accepted: 11/05/2013] [Indexed: 11/20/2022] Open
Abstract
Percutaneous device closure for secundum atrial septal defects (ASDs) has been performed commonly and safely with high success rates. However, it is still challenging to close ASDs that are surrounded with deficient or hypermobile rims and could be compromised with an unexpected migration of device. We report a case of percutaneous Amplazter Septal Occluder (ASO; St. Jude Medical Inc., St. Paul, Minnesota, USA) device closure for an ASD with a thin and floppy interatrial septum, which immediately migrated into the right atrium and was not pulled back into the delivery sheath. To our knowledge, this is the first report on a successful percutaneous retrieval and redeployment of the device in such a situation, preventing any vascular injury or unplanned emergency open heart surgery.
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Affiliation(s)
- Jinhee Ahn
- Department of Cardiology, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Jin Hee Kim
- Department of Cardiology, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Jung Hyun Choi
- Department of Cardiology, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Jun-Hyok Oh
- Department of Cardiology, Medical Research Institute, Pusan National University Hospital, Busan, Korea
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Baspinar O, Kervancioglu M, Koruk S, Kilinc M, Irdem A. Follow-up of P dispersion after transcatheter closure of an atrial septal defect in children. J PAK MED ASSOC 2014; 64:546-548. [PMID: 25272541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To determine in paediatric patients with atrial septal defects whether differences in P wave dispersion occurred with transcatheter closures using the Amplatzer septal occluder. METHOD A total of 31 children who had undergone transcatheter closures were evaluated. P maximum, P minimum, and P dispersion were measured with 12-lead surface electrocardiography, before the procedure and one week, one month, three months, six months and one year following the procedure. SPSS 10 was used for statistical analysis. RESULTS There were 23 (74.2%) females and 8 (25.8%) males with an overall mean age of 7.5 +/- 4.1 years and mean weight of 26.2 +/- 16.9 kg. The P maximum and P minimum measurements differed between patients during the follow-up period. Both measurements decreased with time. However, P dispersion was not significantly different throughout the follow-up period (before the procedure P maximum 95.4 +/- 15.6 ms, P minimum 64.5 +/- 15.4 ms, and P dispersion 30.8 +/- 11.4 ms; one year later, P maximum 76.1 +/- 14.6 ms, P minimum 47.1 +/- 12.1 ms, and P dispersion 29.1 +/- 9.1 ms). CONCLUSION Over time, there are no P dispersion differences in transcatheter closures using the Amplatzer septal occluder.
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Cai QZ, Liang Y, Zhu ZH, Lu XZ. Influence of percutaneous atrial septal defect closure on inter- and intra-ventricular mechanical dyssynchrony in adults: evaluation of strain pattern. Int J Cardiovasc Imaging 2014; 30:721-7. [PMID: 24504492 DOI: 10.1007/s10554-014-0385-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 01/31/2014] [Indexed: 11/30/2022]
Abstract
Previous studies using speckle-tracking echocardiography (STE) for quantifying the functions of the right and left ventricles (RV and LV, respectively) in the presence of percutaneous atrial septal defect (ASD) closure have focused on the peak systolic strain (PSS). This study investigated changes in the mechanical dyssynchrony of ventricular contraction before and after ASD closure, issues that have been little addressed in the literature. Thirty-one adults with ASD were studied using two-dimensional STE before and 24 h after ASD closure. Thirty-one healthy age- and sex-matched subjects were recruited as controls. Global and segmental PSS values from the longitudinal, circumferential, and radial directions were analyzed. The time to peak systolic strain (PSST) and the standard deviation of the time to peak strain (SDT) among segments in each direction were calculated, to investigate the inter- and intra-ventricular mechanical dyssynchrony in these patients and improvements after closure. Compared to the control group, patients with ASD had higher RV free-wall longitudinal systolic strain, with increased PSST and SDT. The SDT values of the LV longitudinal and circumferential strains were also increased. By 24 h after ASD closure, the RV free-wall longitudinal strain and its PSST and SDT had reverted to normal levels. The LV circumferential strain was increased, and its SDT was decreased. The contraction period of the RV and myocardial contraction dyssynchrony in the RV and LV were increased in ASD patients. The inter- and intra-ventricular mechanical utilities were improved after percutaneous closure of the ASD.
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MESH Headings
- Adult
- Aged
- Cardiac Catheterization
- Case-Control Studies
- Echocardiography, Doppler
- Female
- Heart Septal Defects, Atrial/complications
- Heart Septal Defects, Atrial/diagnostic imaging
- Heart Septal Defects, Atrial/physiopathology
- Heart Septal Defects, Atrial/therapy
- Humans
- Male
- Middle Aged
- Myocardial Contraction
- Recovery of Function
- Time Factors
- Treatment Outcome
- Ventricular Dysfunction, Left/diagnostic imaging
- Ventricular Dysfunction, Left/etiology
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Dysfunction, Right/diagnostic imaging
- Ventricular Dysfunction, Right/etiology
- Ventricular Dysfunction, Right/physiopathology
- Ventricular Function, Left
- Ventricular Function, Right
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Affiliation(s)
- Qi-Zhe Cai
- Department of Echocardiography, Cardiovascular Institute, Fu Wai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100037, China
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Cakır H, Acar G, Pala S. Fast track occlusion of aorta with atrial septal defect sizing balloon. Catheter Cardiovasc Interv 2014; 83:1182-4. [PMID: 24403245 DOI: 10.1002/ccd.25379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 12/06/2013] [Accepted: 12/23/2013] [Indexed: 11/07/2022]
Abstract
We describe the case of a 57-year-old woman referred to our emergency service with ruptured abdominal aneurysm. We placed a 34-mm Amplatzer sizing balloon II into the suprarenal level of aorta to immediately control the active massive bleeding and to get the patient out of hemorrhage shock into the stable condition. After the bleeding control, endovascular repair was successfully performed. This is the first case report, to our knowledge, of atrial septal defect (ASD) sizing balloon use for blocking the blood flow through aorta to control the bleeding. ASD sizing balloon has some different properties compared to aortic occlusion balloon catheter (AOBC). Due to availability of sheathless usage, ASD sizing balloon may be preferred over AOBC for some of patient groups with peripheral artery diseases and small femoral artery diameters.
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Affiliation(s)
- Hakan Cakır
- Department of Cardiology, Kosuyolu Heart and Research Hospital, Cardiology Clinic, Istanbul, Turkey
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Abstract
Transcatheter closure of atrial septal defects has evolved significantly over the last 20 years. Transcatheter closure has replaced surgical closure for the treatment of most secundum atrial septal defectsat the current time. A major reason for this is the lower morbidity of transcatheter closure procedures. Several closure devices have come into clinical use. The Amplatzer septal occluder (AGA Medical Co.) currently has the largest reported experience and subsequently the best-established safety and efficacy features. Clinically challenging situations, such as larger atrial septal defects, atrial septal defects with deficient rims and multiple atrial septal defects, are increasingly being addressed using the transcatheter approach, with improved results. The incidence of most complications has significantly reduced over time, and serious side effects are relatively uncommon. In this review, the literature is summarized regarding the current role of transcatheter closure, the evolution of the different available devices for clinical use and the complications that occur with their use. A comparison is also made with surgical closure techniques.
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Affiliation(s)
- Anuja Gupta
- KEM Hospital, 48/49 Hatkesh Society, Road number 7, Juhu Scheme, Mumbai400 049, 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Karampinis I, Pfleger S, Nowak K. Extracardial migration of an atrial septal defect occluder device. J Invasive Cardiol 2013; 25:E219-E220. [PMID: 24296396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Several complications have been reported regarding the percutaneous closure of secondary atrial septal defects such as erosion, thromboembolic events, arrhythmias, and endocarditis. In this report, we describe the case of a 75-year-old woman who underwent percutaneous closure of a secondary atrial septal defect with a 12 mm Amplatzer septal occluder. Six months after the uneventful implantation of the device, we manifested an asymptomatic late embolization of the device in the abdominal aorta. The device was surgically retrieved.
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Affiliation(s)
- Ioannis Karampinis
- Department of Surgery, Mannheim University Medical Centre, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
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