Can transcatheter closure of atrial septal defect be regarded as a ‘standard’ procedure? (original) (raw)
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Transcatheter Closure of Atrial Communications Using the Amplatzer? Septal Occluder
Journal of Interventional Cardiology, 1999
Certain types of atrial septal defects (ASDs) are amenable for transcatheter closure using various investigational devices. The use of the clamshell or buttoned devices is accompanied with a high incidence of residual shunt. The experience of ASD closure using the AmplatzerrM Septal Occluder (ASO) is limited. Therefore, the purpose of this article is to discuss the protocol of closure and report on the acute results using this device. Nineteen patients ( I 7 ASDL? fenestrated Fontan [FF]) underwent an attempt at catheter closure of their defects at a median age of 13.3 years (range 5.5-67.4 years) and a median weight of 49 kg (range 18-94 kg) using the ASO. The median ASD diameter measured by transesophageal echocardiography (TEE) was 12 mm (range 6-23.8 mm), and the median defect balloon stretched diameter was 17 mm (range 6-31 mm). All ASD patients had right atrial and ventricular volume overload with a mean 5 SD Qp/Qs of 2.4 2 0.9. A 7 to 8Fr catheter was used for delivery of the device in all patients. The device was placed correctly in all but one patient. There were immediate and complete closures (C)
Transcatheter device closure of atrial septal defects in patients above age 60
Transcatheter device closure of atrial septal defects guided completely by transthoracic echocardiography: A single cardiac center experience with 152 cases This resulted in better cosmetic results than those by surgical repair. Moreover, our technique was completely guided by transthoracic echocardiography (TTE), thus avoiding X-ray exposure. This study aimed to evaluate the safety and efficacy of our procedure, and the results were found to be encouraging. Methods This study was approved by the Ethics Committee of Fujian Medical University, China, and adhered to the tenets of the Declaration of Helsinki. In addition, written informed consent was obtained from the patients or parents of the patients. All patients who enrolled at our cardiac center between September 2014 and June 2017 were included in the study. They were divided into two groups based on the therapeutic method chosen. Group I included 152 patients (62 males and 90 females) undergoing transcatheter device closure guided completely by Objective: This study aimed to assess the safety and feasibility of transcatheter device closure of atrial septal defects (ASDs) guided completely by transthoracic echocardiography (TTE). Methods: A total of 152 patients underwent transcatheter device closure of ASDs guided completely by TTE in our center from September 2014 to June 2017. We used routine delivery sheaths during the procedure and then closed the ASDs by releasing a domestic occluder. Results: The closure was successful in 150 patients, and surgical repair was required in two patients. The size of the deployed occluder ranged from 10 mm to 38 mm (21.4±8.5 mm), and the procedure duration ranged from 30 to 90 min (38.2±21.4 min). No fatal complications were observed. Minor complications included transient arrhythmias (n=12) during the process of device deployment. The follow-up period was 3 months to 2 years, with no occluder dislodgment, residual fistula, or thrombus-related complications. In our comparative studies, no statistically significant differences were observed in success rates and complications. Conclusion: Transcatheter device closure of ASDs guided completely by TTE may be safe and effective and can be an alternative to traditional methods.
American Heart Journal, 2004
Background: The transcatheter closure of the atrial septal defect (ASD) has become an alternative technique to surgical procedures. The aim of this study was to assess the immediate, short, and intermediate-term results of the transcatheter closure of the secundum ASD with the Amplatzer Septal Occluder (ASO) in adult Iranian patients. Methods: Between December 2004 and July 2008, the transcatheter closure of the ASD using the ASO was attempted in 58 consecutive, adult patients. The mean age of the patients was 37.1 ± 12.7 years (range = 19 -75 years).
Transcatheter Closure of Atrial Septal Defects
Journal of Interventional Cardiology, 1995
The first transcatheter closure of an atrial septal defect (ASD) was performed by King and Mills in 1976. The Lock Cfunishell occluder and flze hi4ttooned &lice are the latest devices to undergo clitziwl trials. Successful transcaihefer closure hus been possible with minimal morbidity and mortality. Small residual shunts may remain, however. in up to 20% of patients 1 year after the procedure. The clinic-a1 signifc8unce and natural history qf these small residuul atrid commiinirutinns remains to be determined. This article reviews the history and development of the current ASD closure techniques, with emphasis on the experience with the L,ock Clumshell orl-luder and the hitttoned device. (J Interven Cardiol 1995;8:533-542) delivery system in positioning the device parallel to the atrial septum, were additional liabilities of the Rashkind devicc.
Journal of Interventional Cardiology, 2004
. The aim of our study is to describe the 3-year results of transcatheter ASDs closure using the Amplatzer septal occluder (ASO) and ICE as the sole imaging tool both to select the device size and to monitor the procedure. Under local anesthesia, 135 consecutive eligible patients with ASDs (male/female = 45/90; mean age 42.2 ± 19.2 years; BSA 1.71 ± 0.7 m 2 ; mean pulmonary arterial pressure 30.4 ± 11.5 mmHg; mean Qp/Qs ratio 2.1 ± 0.6) underwent transcatheter closure using ASO and ICE. A 9F-9MHz mechanical transducer was used. Two orthogonal views on the transverse aortic valve and on the longitudinal four-chamber planes were obtained for quantitative ICE measurements, from which the diameters of the implanting ASO waist were to be derived. In all cases, we obtained a proper evaluation of ICE ASDs dimensions, leading to an optimal device size selection (mean size 25.0 ± 6.7 mm). Moreover, the ICE allowed us to monitor device deployment and to verify the effectiveness of the ASDs stented by ASO. There were no complications related to the procedure or to the use of ICE. During a mean follow-up period of 21.5 ± 12 months, the cumulative complete occlusion rates were 97.7, 97.0, 97.1, and 98% at 24 hours, 3 month, and 1 and 3 years, respectively. ICE is an effective and safe alternative to TEE and balloon-sizing maneuver during ASDs transcatheter closure procedures, allowing us to avoid the need of general anesthesia and leading to a similarly high percentage of occlusion rates with respect to the conventional method. (J Interven Cardiol 2004;17:95-98)
Transcatheter Device Closure of Atrial Septal Defects
Jacc-cardiovascular Interventions, 2013
This review discusses the current safety issues related to U.S. Food and Drug Administration approved atrial septal defect devices and proposes a potential avenue to gather additional safety data including factors, which may be involved in device erosion. Atrial septal defects (ASD) are classified into ostium primum, ostium secundum, sinus venosus, and coronary sinus types. The current reported prevalence of ASD is about 10% of congenital cardiac defects (1). ASD, although recognized as a relatively benign form of cardiac disease, if left untreated can eventually contribute to significant morbidity and mortality, as borne out by the natural history studies (2,3). Unrepaired ASD can lead to right ventricular volume overload with resultant right heart failure, elevated pulmonary vascular resistance, systemic embolism, and atrial arrhythmias. Among the various types of ASDs only the ostium secundum defect is amenable to device closure, whereas all 4 types can be surgically closed. Over the years, routine closure of ASD in childhood has been justified due to the availability of low-risk, curative surgical, and transcatheter options. Transcatheter device closure of secundum ASD is a maturing technology, now more than a decade old. This therapy has become a well-accepted alternative to surgical therapy and has been regarded as generally safe and effective. Widespread use of devices and fairly From the
Circulation: Cardiovascular Interventions, 2014
An improved 10 Fr version of the atrial septal defect (ASD) occlusion system consisting of two umbrellas for transvenous introduction over the long veno-arterial guidewire was used to attempt closure in five adult patients with large defects (26-35 mm). The umbreilas are made of nitinol wire frame and a thin membrane of microporous polyurethane. Supported by the metal cannula and guided by selective left atriography, the umbrellas of 4560 mm were placed individually into the atria and screwed together at the septum level by means of a torquer catheter. Positioning and screwing on, unscrewing, separating, and repositioning the umbrellas up to 17 times were needed to anchor the prosthesis correctly in a patient. The prosthesis could be implanted primarily in all patients (in one at second session). Dislodgement of a 60 mm prosthesis and left atrial perforation with a 55 mm prosthesis required surgery in two patients 8 hours and 2 weeks post procedure, respectively. A single umbrella-arm fracture was noticed in one patient 4 months after the implantation. All five patients were free of symptoms at follow-up after 7-10 months. Transcatheter closure of large ASDs is technically feasible with this system. The morbidity is mainly associated with the implantation of very large umbrellas. GI 1995 Wiley-Liss. Inc. Address reprint requests to Priv. Doz. Dr. med. H . Sieven, Abteilung Kardiologie/Angiologie, Krankenhaus Bethanien. Im Priifling 17-23,
Echocardiographic predictors of candidacy for successful transcatheter atrial septal defect closure
Catheterization and cardiovascular diagnosis, 1995
We reviewed pre-closure echocardiograms on all patients undergoing transcatheter atrial septal defect (ASD) closure with the Bard double-umbrella occluder device aided by simultaneous transesophageal echocardiography to determine precatheterization predictors of outcome. Transesophageal echocardiograms were performed on 28 of 132 patients (22%) undergoing device closure (age = 3-72 years, mean = 14 years; weight = 15-68 kg, mean = 35 kg). Three devices were removed because of unstable position. Of the remaining 25 patients, 21 had effective closure (residual flow diameter < or = 3 mm) and 18 had favorable arm position (device arm on proper side of the septum and not in contact with an atrioventricular valve leaflet). Only ASD size predicted effective closure. All patients with a maximum defect size of < 13 mm had effective closure. Among the 17 patients with defects > or = 13 mm, 10 had effective closure, 4 had significant residual flow, and 3 had devices removed for unstab...
Transcatheter closure of atrial septal defects using the Cardio-Seal implant
British heart journal, 2000
Objective-To review the outcomes of transcatheter closure of atrial septal defects using the Cardio-Seal implant. Design-A prospective interventional study. Setting-Tertiary referral centre. Patients-The first 50 patients (median age 9.7 years) who underwent attempted percutaneous occlusion. Interventions-Procedures were done under general anaesthesia and transoesophageal guidance between December 1996 and July 1998. Main outcome measures-Success of deployment, complications, and assessment of right ventricular end diastolic diameter, septal wall motion, and occlusion status by echocardiography. Results-The median balloon stretched diameter was 14 mm. Multiple atrial septal defects were present in 11 patients (22%) and a deficient atrial rim (< 4 mm) in 19 (38%). In four patients (8%), a second device was implanted after removal of an initially malpositioned first implant. There were no significant immediate complications. All patients except one were discharged within 24 hours. At the latest follow up (mean 9.9 months) a small shunt was present in 23 patients (46%), although right ventricular end diastolic dimensions (mean (SD)) corrected for age decreased from 137 (29)% to 105 (17)% of normal, and septal motion abnormalities normalised in all but one patient. No predictors for a residual shunt were identified. Supporting arm fractures were detected in seven patients (14%) and protrusion of one arm through the defect in 16 (32%), the latter being more common in those with smaller anterosuperior rims. No untoward eVects resulted from arm fractures or protrusion. There were no complications during follow up, although five patients (10%) experienced transient headaches. Conclusions-The implantation of the Cardio-Seal device corrects the haemodynamic disturbances secondary to the right ventricular volume overload, with good early outcome.