Cerebral microemboli detection and differentiation during transcatheter closure of atrial septal defect in a paediatric population

AbstractIntroduction: The aim of this prospective study was to determine the frequency and composition of cerebral microemboli in a paediatric population during transcatheter atrial septal defect closure. Methods: Multi-frequency transcranial Doppler was used to detect microembolic signals in the middle cerebral artery of 24 patients. Embolic signals were automatically identified and differentiated according to their composition, gaseous or solid. The procedure was divided into five periods: right cardiac catheterisation; left cardiac catheterisation; pulmonary angiography; balloon sizing; and device placement. Results: Microemboli were detected in all patients. The median number of signals was 63 and over 95% gaseous. The total number of microembolic signals detected during two periods – balloon sizing and sheath placement and device placement – was not significantly different (median: 18 and 25, respectively) but was significantly higher than each of the other three periods (p<0.001). In eight patients, the device was opened more than once and the number of embolic signals decreased with each successive device deployment. There was no correlation between the number of microembolic signals and fluoroscopic time, duration of procedure, age, or device size. Conclusion: This is the first study to investigate the timing and composition of cerebral microemboli in a paediatric population during cardiac catheterisation. Microembolic signals were related to specific catheter manipulations but were not associated with fluoroscopic time or duration of procedure.

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Microembolic signals measured by transcranial Doppler during transcatheter closure of atrial septal defect using the Amplatzer septal occluder

Cardiology in the Young ◽

10.1017/s1047951110001733 ◽

2010 ◽

Vol 21 (2) ◽

pp. 182-186 ◽

Cited By ~ 5

Author(s):

Shinich Itoh ◽

Kenji Suda ◽

Shintaro Kishimoto ◽

Hiroshi Nishino ◽

Yoshiyuki Kudo ◽

...

Keyword(s):

Atrial Septal Defect ◽

Transcranial Doppler ◽

Septal Defect ◽

Transcatheter Closure ◽

Cardiac Catheterisation ◽

Amplatzer Septal Occluder ◽

Factors Associated ◽

Fluoroscopic Time ◽

Device Placement ◽

Mean Size

AbstractPurposeTo determine the frequency and factors associated with increase in microembolic signals during transcatheter closure of atrial septal defect using the Amplatzer septal occluder.MethodsDuring the procedure in 16 patients, we measured microembolic signals using transcranial Doppler. Procedure time was divided into five periods: right cardiac catheterisation; left cardiac catheterisation; left cardiac angiocardiography; sizing and long sheath placement; device placement and release. We compared numbers of microembolic signals among the five periods and identified factors associated with them.ResultsMean size of septal occluder was 16 millimetres in diameter. Total number of microembolic signals was a median of 31.5, ranging from 3 to 113. Microembolic signals in three periods, left cardiac catheterisation; sizing, and long sheath placement; and device placement and release, were not significantly different from one another, but were significantly higher than those in the remaining two periods, right cardiac catheterisation and left cardiac angiocardiography (median was 9 in left cardiac catheterisation; 6 in sizing and long sheath placement; 6.5 in device placement and release, versus 0 in right cardiac catheterisation and 1 in left cardiac angiocardiography, p less than 0.05, respectively). Importantly, the time for device manipulation positively correlated with total number of microembolic signals (r equals 0.77, p less than 0.001), although fluoroscopic time, age, or size of septal occluder did not.ConclusionsTranscatheter closure of atrial septal defect using the Amplatzer septal occluder produces microemboli, especially during device placement. To minimise the risk of systemic embolism, we must decrease the time for device manipulation.

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Evaluation of Different Approaches for Atrial Septal Defect Closure

10.1055/s-0040-1705572 ◽

2020 ◽

Author(s):

D. Hackner ◽

S. Eichhorn ◽

P. Merkle ◽

P. Ewert ◽

N. Lang

Keyword(s):

Atrial Septal Defect ◽

Septal Defect ◽

Defect Closure ◽

Atrial Septal Defect Closure

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Two- and Three-Dimensional Transesophageal Echocardiography in Patient Selection and Assessment of Atrial Septal Defect Closure by the New DAS–Angel Wings Device

Circulation ◽

10.1161/01.cir.96.6.1722 ◽

1997 ◽

Vol 96 (6) ◽

pp. 1722-1728 ◽

Cited By ~ 82

Author(s):

Giuseppina Magni ◽

Ziyad M. Hijazi ◽

Natesa G. Pandian ◽

Alain Delabays ◽

Lissa Sugeng ◽

...

Keyword(s):

Atrial Septal Defect ◽

Transesophageal Echocardiography ◽

Patient Selection ◽

Septal Defect ◽

Three Dimensional ◽

Defect Closure ◽

Atrial Septal Defect Closure ◽

Selection And Assessment

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Atrial Septal Defect Closure via Left Subclavian Vein Approach in a Patient With Absent Inferior Vena Cava

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135120983807 ◽

2021 ◽

pp. 215013512098380

Author(s):

Yusuke Enta ◽

Shunsuke Tatebe ◽

Yoshikatsu Saiki ◽

Norio Tada

Keyword(s):

Inferior Vena Cava ◽

Atrial Septal Defect ◽

Subclavian Vein ◽

Septal Defect ◽

Inferior Vena ◽

Transcatheter Closure ◽

Vena Cava ◽

Atrial Septal Defect Closure ◽

Azygos Continuation ◽

Left Subclavian Vein

Without the femoral venous approach, transcatheter closure of an atrial septal defect is challenging. We performed percutaneous closure via the left subclavian vein in a patient with absence of the inferior vena cava with azygos continuation. Considering that inferior vena cava anomalies are not extremely rare among those with congenital heart disease, the left subclavian vein approach can be an alternative to the femoral approach.

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Triport periareolar thoracoscopic surgery versus right minithoracotomy for repairing atrial septal defect in adults

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivaa246 ◽

2020 ◽

Author(s):

Xiang-Xiang Zheng ◽

Ze-Yu Wang ◽

Lu-Yao Ma ◽

Hong- Liu ◽

Huan- Liu ◽

...

Keyword(s):

Atrial Septal Defect ◽

Septal Defect ◽

Rating Scale ◽

Thoracoscopic Surgery ◽

Operation Time ◽

Numeric Rating Scale ◽

Hospital Death ◽

Aortic Cross Clamp Time ◽

Atrial Septal Defect Closure ◽

Satisfaction Scale

Abstract OBJECTIVES Our goal was to investigate the safety and feasibility of triport periareolar thoracoscopic surgery (TPTS) and its advantages in repairing adult atrial septal defect. METHODS Between January 2017 and January 2020, a total of 121 consecutive adult patients underwent atrial septal defect closure in our institution. Of these, 30 patients had TPTS and 31 patients had a right minithoracotomy (RMT). Operational data and clinical outcomes were compared between the 2 groups. RESULTS The total operation time, cardiopulmonary bypass time and aortic cross-clamp time in the TPTS group were slightly longer than those in the RMT group, but there were no differences between the 2 groups. Compared with the RMT group, the TPTS group showed a decrease in the volume of chest drainage in 24 h (98.6 ± 191.2 vs 222.6 ± 217.2 ml; P = 0.032) and a shorter postoperative hospital stay (6.5 ± 1.5 vs 8.0 ± 3.7 days; P = 0.042). The numeric rating scale on postoperative day 7 was significantly less in the TPTS group than in the RMT group (2.82 ± 1.14 vs 3.56 ± 1.42; P = 0.034). The patient satisfaction scale for the cosmetic results in the TPTS group was significantly higher than in the RMT group (4.68 ± 0.55 vs 4.22 ± 0.76; P = 0.012). No differences were found in postoperative complications. No in-hospital death or major adverse events occurred in the 2 groups. CONCLUSIONS TPTS is safe and feasible for the closure of adult atrial septal defect. Compared with RMT, it has been associated with less pain and better cosmetic outcomes.

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