Effects of reducing frame rate from 7.5 to 4 frames per second on radiation exposure in transcatheter atrial septal defect closure

2018 ◽  
Vol 28 (11) ◽  
pp. 1323-1328 ◽  
Author(s):  
Younes Boudjemline
Keyword(s):  
Atrial Septal Defect ◽  
Radiation Exposure ◽  
Septal Defect ◽  
Frame Rate ◽  
Atrial Septal Defect Closure ◽  
Dose Area Product ◽  
Air Kerma ◽  
Septal Defects ◽  
Atrial Septal Defects ◽  
Area Product

AbstractObjectivesThe aim of this study was to evaluate the reduction of frame rate from 7.5 to 4 frames per second on radiation exposure and to provide new standards of radiation exposure.BackgroundFrame rate is a large contributor to radiation exposure. The use of 4 frames per second for closure of atrial septal defects has been reported not to affect the level of radiation exposure.MethodsWe retrospectively reviewed radiation data from all patients referred to our catheterisation laboratory for closure of an atrial septal defect between January, 2015 and June, 2017. Fluoroscopic time, dose area product (μGy.m2), and total air kerma (mGy) were collected. These values were compared according to the frame rate used for closure of atrial septal defects.ResultsA total of 49 atrial septal defects were closed using 7.5 frames per second and 85 using 4 frames per second. Baseline characteristics were similar in both groups. Procedural success was similar in both groups (100 versus 98.8%). Median total air kerma and dose area product were statistically lower in the 4 frames per second group (4 versus 1.3 mGy [p=0.00012]), 43.7 versus 13.1 μGy.m2 [p<0.00001]). There was no increase in median procedure and fluoroscopic times (respectively, 10 and 1.1 min for 7.5 and 4 frames per second), or complications (4.1 versus 2.3%, p>0.05).ConclusionReduction of frame rate allows reducing significantly the radiation exposure while maintaining excellent clinical results in transcatheter closure of atrial septal defects. We recommend implementing this little change in every laboratory in order to achieve drastic reduction of radiation exposure to the patients and laboratory personnel.

Adverse events within 1 year after surgical and percutaneous closure of atrial septal defects in preterm children

2019 ◽  
Vol 29 (5) ◽  
pp. 626-636 ◽  
Author(s):  
Gustaf Tanghöj ◽  
Petru Liuba ◽  
Gunnar Sjöberg ◽  
Annika Rydberg ◽  
Estelle Naumburg
Keyword(s):  
Adverse Events ◽  
Atrial Septal Defect ◽  
Septal Defect ◽  
Survival Curve ◽  
Percutaneous Closure ◽  
Defect Closure ◽  
Atrial Septal Defect Closure ◽  
Preterm Children ◽  
Septal Defects ◽  
Atrial Septal Defects

AbstractIntroduction:Atrial septal defect is the third most common CHD. A hemodynamically significant atrial septal defect causes volume overload of the right side of the heart. Preterm children may suffer from both pulmonary and cardiac comorbidities, including altered myocardial function. The aim of this study was to compare the rate of adverse events following atrial septal defect closure in preterm- and term-born children.Method:We performed a retrospective cohort study including children born in Sweden, who had a surgical or percutaneous atrial septal defect closure at the children’s hospitals in Lund and Stockholm, between 2000 and 2014, assessing time to the first event within 1 month or 1 year. We analysed differences in the number of and the time to events between the preterm and term cohort using the Kaplan–Meier survival curve, a generalised model applying zero-inflated Poisson distribution and Gary-Anderson’s method.Results:Overall, 413 children were included in the study. Of these, 93 (22.5%) were born prematurely. The total number of adverse events was 178 (110 minor and 68 major). There was no difference between the cohorts in the number of events, whether within 1 month or within a year, between major (p = 0.69) and minor (p = 0.84) events or frequencies of multiple events (p = 0.92).Conclusion:Despite earlier procedural age, larger atrial septal defects, and higher comorbidity than term children, preterm children appear to have comparable risk for complications during the first year after surgical or percutaneous closure.

Radiation exposure in transcatheter patent ductus arteriosus closure: time to tune?

2018 ◽  
Vol 28 (5) ◽  
pp. 653-660 ◽  
Author(s):  
Olivier Villemain ◽  
Sophie Malekzadeh-Milani ◽  
Fidelio Sitefane ◽  
Meriem Mostefa-Kara ◽  
Younes Boudjemline
Keyword(s):  
Patent Ductus Arteriosus ◽  
Radiation Exposure ◽  
Ductus Arteriosus ◽  
Frame Rate ◽  
Radiation Doses ◽  
Dose Area Product ◽  
Air Kerma ◽  
Fluoroscopic Time ◽  
Area Product ◽  
Patent Ductus

AbstractObjectivesThe aims of this study were to describe radiation level at our institution during transcatheter patent ductus arteriosus occlusion and to evaluate the components contributing to radiation exposure.BackgroundTranscatheter occlusion relying on X-ray imaging has become the treatment of choice for patients with patent ductus arteriosus. Interventionists now work hard to minimise radiation exposure in order to reduce risk of induced cancers.MethodsWe retrospectively reviewed all consecutive children who underwent transcatheter closure of patent ductus arteriosus from January 2012 to January 2016. Clinical data, anatomical characteristics, and catheterisation procedure parameters were reported. Radiation doses were analysed for the following variables: total air kerma, mGy; dose area product, Gy.cm2; dose area product per body weight, Gy.cm2/kg; and total fluoroscopic time.ResultsA total of 324 patients were included (median age=1.51 [Q1–Q3: 0.62–4.23] years; weight=10.3 [6.7–17.0] kg). In all, 322/324 (99.4%) procedures were successful. The median radiation doses were as follows: total air kerma: 26 (14.5–49.3) mGy; dose area product: 1.01 (0.56–2.24) Gy.cm2; dose area product/kg: 0.106 (0.061–0.185) Gy.cm2/kg; and fluoroscopic time: 2.8 (2–4) min. In multivariate analysis, a weight >10 kg, a ductus arteriosus width <2 mm, complications during the procedure, and a high frame rate (15 frames/second) were risk factors for an increased exposure.ConclusionLower doses of radiation can be achieved with subsequent recommendations: technical improvement, frame rate reduction, avoidance of biplane cineangiograms, use of stored fluoroscopy as much as possible, and limitation of fluoroscopic time. A greater use of echocardiography might even lessen the exposure.

Percutaneous management of coronary sinus atrial septal defect: two cases representing the spectrum for device closure and a review of the literature

2014 ◽  
Vol 24 (5) ◽  
pp. 797-806 ◽  
Author(s):  
Nefthi Sandeep ◽  
Michael C. Slack
Keyword(s):  
Atrial Septal Defect ◽  
Coronary Sinus ◽  
Septal Defect ◽  
Case Reports ◽  
Device Closure ◽  
Atrial Septal Defect Closure ◽  
Septal Defects ◽  
Atrial Septal Defects ◽  
Percutaneous Device ◽  
Percutaneous Device Closure

AbstractCoronary sinus atrial septal defects are the rarest defects of the atrial septum comprising <1% of the five different types of atrial septal defects. Despite the widespread adoption of percutaneous device closure of secundum atrial septal defects, the published experience with percutaneous device closure of coronary sinus atrial septal defects is limited to only a few isolated case reports because of uncertainty regarding safety and efficacy. Open-heart surgical repair remains the treatment of choice for coronary sinus atrial septal defects, although this may not be the only treatment option in selected cases. Herein we describe our own experience with two patients with different clinical presentations and our method of successful percutaneous coronary sinus atrial septal defect closure in each. We then present a review of the anatomic spectrum of coronary sinus atrial septal defects along with a review of contemporary surgical and percutaneous device treatment.

scholarly journals Tricuspid Regurgitation in Ostium Secundum Atrial Septal Defects: Repair or Not?

2020 ◽  
Vol 23 (2) ◽  
pp. E239-E244 ◽  
Author(s):  
Chirag Sumithra Prasanna Kumar ◽  
Bineesh K Radhakrishnan ◽  
Remya Sudevan ◽  
Jayakumar Karunakaran
Keyword(s):  
Atrial Septal Defect ◽  
Tricuspid Regurgitation ◽  
Septal Defect ◽  
Pulmonary Artery Hypertension ◽  
Tricuspid Valve Repair ◽  
Secundum Atrial Septal Defect ◽  
Atrial Septal Defect Closure ◽  
Septal Defects ◽  
Atrial Septal Defects ◽  
Functional Tricuspid Regurgitation

Background: Longstanding ostium secundum atrial septal defects lead to functional tricuspid regurgitation. Significant functional tricuspid regurgitation associated with left heart valve disease is addressed at the time of primary left heart valve surgery. In contrast, there is no global recommendation for tricuspid regurgitation associated with atrial septal defects. This study assesses changes in tricuspid regurgitation after isolated atrial septal defect closure. Methods: Retrospectively, records were examined of 100 patients who underwent isolated ostium secundum atrial septal defect closure without tricuspid valve repair. Echocardiograms were done preoperatively and 3 days, 3 months, and 1 year after surgery. Data on tricuspid regurgitation status, right ventricle dimensions, and pulmonary artery hypertension status were collected and analyzed. Results: After surgical closure, echocardiography showed a regression of tricuspid regurgitation to mild or less in 76% of patients at 3 days, 89% at 3 months, and 93% at 1 year. Severe pulmonary artery hypertension (32% patients preoperatively) showed statistically significant regression: 14% at 3 days, 10% at 3 months, and 2% at 1 year. Preoperatively, the mean right ventricular internal diameter was 37.9 mm, which decreased to 34 ± 5.5 mm (mean ± standard deviation) at 3 days, 32.3 ± 5.3 mm at 3 months, and 31.3 ± 5.4 mm at 1 year. It was also noted that regression favored patients who were <25 years old. Conclusion: Tricuspid valve repair may not be required in patients with ostium secundum atrial septal defect with functional tricuspid regurgitation.

scholarly journals The role of three-dimensional transesophageal echocardiography in preoperative assessment of atrial septal defects

2015 ◽  
Vol 18 (1) ◽  
pp. 58 ◽  
Author(s):  
D. G. Tarasov ◽  
I. V. Tkachev ◽  
S. S. Kadrabulatova
Keyword(s):  
Atrial Septal Defect ◽  
Transesophageal Echocardiography ◽  
Septal Defect ◽  
Preoperative Evaluation ◽  
Three Dimensional ◽  
Maximum Diameter ◽  
Septal Defects ◽  
Atrial Septal Defects ◽  
Dimensional Echocardiography ◽  
Three Dimensional Echocardiography

An atrial septal defect is the most common congenital heart disease. Transcatheter defect closure has become widespread in recent times and the requirements for this procedure are rather strict. Two-dimensional echocardiography is limited in evaluating atrial septal defects because it provides planar images only. In order to preoperatively assess atrial septal defects, we applied three-dimensional transesophageal echocardiography and then compared the results with those of surgical operations. The maximum diameter, shape, area and localization of the atrial septal defect in 26 patients were estimated with three-dimensional echocardiography. It was found out that positive correlation existed between three-dimensional echocardiography findings and those measured during surgery. Three-dimensional echocardiography provides invaluable assistance in preoperative evaluation of atrial septal defects and in selection of treatment.

Transcatheter closure as standard treatment for most interatrial defects: experience in 200 patients treated with the Amplatzer ™ Septal Occluder

1999 ◽  
Vol 9 (5) ◽  
pp. 468-473 ◽  
Author(s):  
Felix Berger ◽  
Peter Ewert ◽  
Per G. Boöjrnstad ◽  
Ingo Dähnert ◽  
Gregor Krings ◽  
...  
Keyword(s):  
Atrial Septal Defect ◽  
Septal Defect ◽  
Transcatheter Closure ◽  
Paradoxical Embolism ◽  
Residual Shunt ◽  
Septal Defects ◽  
Atrial Septal Defects ◽  
Diagnostic Cardiac Catheterization ◽  
Long Term Follow Up

AbstractTo judge whether an Amplatzer™ Septal Occluder can be used as standard therapy instead of surgery for closure of atrial septal defects we report our experiences in 200 patients. Of these patients, 127 had an atrial septal defect with haemodynamically significant left-to-right shunt, 68 patients a persistent oval foramen after presumed paradoxical embolism, and 5 had a fenestration after Fontan-repair. Mean age was 29.8 years (0.8 to 77.7 years). Body weight ranged from 6.9 to 120.0 kg (mean 51.5 kg). After diagnostic cardiac catheterization, and balloon-sizing of the defect, we implanted Amplatzer™ Septal Occluders with stents of 4 to 28 mm diameter. Follow-up studies were obtained after 48hours, and one, six, and twelve months. Transcatheter closure of the atrial septal defect proved successful in all without any relevant residual shunts. In particular, complete closure was achieved in all patients after presumed paradoxical embolism. The mean period of follow-up is 9–5 months, with a range from 0.4 to 23.5 months, giving a total of 1898 patient months. The occlusion rate after three month was 98.1°. A trivial haemodynamically insignificant residual shunt remained in 1.9° of the patients. Fluoroscopy times ranged from 0 to 43.5 minutes, with a median of 8.7 minutes. The excellent results in the short and medium term in children and adults have resulted in using this device routinely at the present time for closure of central atrial septal defects up to a diameter of 28 mm. Final judgement, however, is only possible after long-term follow-up.

Pacemaker and conduction disturbances in patients with atrial septal defect

2020 ◽  
Vol 30 (7) ◽  
pp. 980-985 ◽  
Author(s):  
Diana H. R. Albæk ◽  
Sebastian Udholm ◽  
Anne-Sif L. Ovesen ◽  
Zarmiga Karunanithi ◽  
Camilla Nyboe ◽  
...  
Keyword(s):  
Atrial Septal Defect ◽  
Atrioventricular Block ◽  
Right Bundle Branch Block ◽  
Septal Defect ◽  
Pacemaker Implantation ◽  
Bundle Branch Block ◽  
Conduction Disturbances ◽  
Septal Defects ◽  
Atrial Septal Defects ◽  
Background Population

AbstractObjective:To determine the prevalence of pacemaker and conduction disturbances in patients with atrial septal defects.Design:All patients with an atrial septal defect born before 1994 were identified in the Danish National Patient Registry, and 297 patients were analysed for atrioventricular block, bradycardia, right bundle branch block, left anterior fascicular block, left posterior fascicular block, pacemaker, and mortality. Our results were compared with pre-existing data from a healthy background population. Further, outcomes were compared between patients with open atrial septal defects and atrial septal defects closed by surgery or transcatheter.Results:Most frequent findings were incomplete right bundle branch block (40.1%), left anterior fascicular block (3.7%), atrioventricular block (3.7%), and pacemaker (3.7%). Average age at pacemaker implantation was 32 years. Patients with defects closed surgically or by transcatheter had an increased prevalence of atrioventricular block (p < 0.01), incomplete right bundle branch block (p < 0.01), and left anterior fascicular block (p = 0.02) when compared to patients with unclosed atrial septal defects. At age above 25 years, there was a considerably higher prevalence of atrioventricular block (9.4% versus 0.1%) and complete right bundle branch block (1.9% versus 0.4%) when compared to the background cohorts.Conclusions:Patients with atrial septal defects have a considerably higher prevalence of conduction abnormalities when compared to the background population. Patients with surgically or transcatheter closed atrial septal defects demonstrated a higher demand for pacemaker and a higher prevalence of atrioventricular block, incomplete right bundle branch block, and left anterior fascicular block when compared to patients with unclosed atrial septal defects.

Comparative effects of surgical and percutaneous repair on P-wave and atrioventricular conduction in patients with atrial septal defect – ostium secundum type

2012 ◽  
Vol 23 (1) ◽  
pp. 132-137
Author(s):  
Hassan Javadzadegan ◽  
Mehrnoush Toufan ◽  
Ali Reza Sadighi ◽  
Joyce M. Chang ◽  
Nader D. Nader
Keyword(s):  
Atrial Septal Defect ◽  
Septal Defect ◽  
P Wave ◽  
P Value ◽  
Device Closure ◽  
Wave Duration ◽  
Septal Defects ◽  
Atrial Septal Defects ◽  
P Wave Duration ◽  
Pr Interval

AbstractBoth surgical and percutaneous closures of atrial septal defects have been successful in reversal of atrial dilatation. We compared the effects of surgical and percutaneous transvenous device closure of atrial septal defect on post-operative changes of P-wave duration, PR segment, and PR interval. Electrocardiographic data were prospectively collected from 30 patients following either surgical (n equal to 16) or percutaneous (n equal to 16) repair of atrial septal defects between 2004 and 2010. A cardiologist blinded to the closure technique performed the electrocardiographic analyses. P-wave duration (98.5 plus or minus 15.4 to 86.4 plus or minus 13.2 milliseconds, p-value less than 0.05) and PR interval (162.9 plus or minus 18.5 to 140.6 plus or minus 15.2 milliseconds, p-value less than 0.05) were reduced after percutaneous transvenous device closure. P-wave duration (104.5 plus or minus 24.7 versus 83.2 plus or minus 13.3 milliseconds, p-value less than 0.05) and PR interval (173.2 plus or minus 38.7 versus 144.3 plus or minus 32.0 milliseconds, p-value less than 0.05) were also reduced after surgical closure. PR segment in the percutaneous group was significantly reduced (63.4 plus or minus 14.5 to 52.1 plus or minus 10.8 milliseconds, p-value less than 0.05), but not in the surgical group (68.6 plus or minus 18.7 versus 61.1 plus or minus 24.7 milliseconds). However, the difference in PR segment changes between the two groups was not significant (−11.3 plus or minus 15.0 versus −7.6 plus or minus 20.5 milliseconds, p-value equal to 0.18). Our analysis demonstrates that the changes between the two groups were not different and that both closure techniques reduce P-wave duration, PR segment, and PR interval within 6 months.

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