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.

The Rush to Atrial Septal Defect Closure: Is the Introduction of Percutaneous Closure Driving Utilization?

2008 ◽  
Vol 86 (5) ◽  
pp. 1584-1591 ◽  
Author(s):  
Tara Karamlou ◽  
Brian S. Diggs ◽  
Ross M. Ungerleider ◽  
Brian W. McCrindle ◽  
Karl F. Welke
Keyword(s):  
Atrial Septal Defect ◽  
Septal Defect ◽  
Percutaneous Closure ◽  
Defect Closure ◽  
Atrial Septal Defect Closure

scholarly journals Novel Panna Guide Wire Facilitates Percutaneous and Nonfluoroscopic Procedure for Atrial Septal Defect Closure

2020 ◽  
Vol 13 (9) ◽  
Author(s):  
Pengxu Kong ◽  
Guangzhi Zhao ◽  
Zonggang Zhang ◽  
Weimin Zhang ◽  
Taibing Fan ◽  
...  
Keyword(s):  
Adverse Events ◽  
Atrial Septal Defect ◽  
Primary Outcome ◽  
Septal Defect ◽  
Operation Time ◽  
Junior Doctors ◽  
Defect Closure ◽  
Atrial Septal Defect Closure ◽  
Safety And Efficacy ◽  
Major Adverse Events

Background: Echo-guided percutaneous procedures have been reported reliable and advantageous. However, the learning curve is difficult for junior doctors. We aimed to evaluate the safety and efficacy of a novel guidewire (Panna wire) in percutaneous atrial septal defect closure under transthoracic echocardiography guidance only. Methods: The Panna wire is designed for echo-guide procedure with a retractable spindle-shaped tip. A multicenter, randomized, controlled trial was conducted to evaluate the safety and efficacy of the Panna wire versus the conventional guidewire for junior doctors with <100 cases experience. The primary outcome was operative success rate. The secondary outcomes were incidence of major adverse events, operation time, time needed to enter the left atrium, number of arrhythmia episodes, number of misguidance to tricuspid valve, and incidence of peripheral vascular complications. Results: Between July 2018 and September 2019, 100 patients with atrial septal defect were randomized to either the Panna wire group (n=52) or the conventional wire group (n=48) at 3 centers. The baseline clinical characteristics were similarly distributed. The operative success rate (primary outcome) was 100% in the Panna wire group versus 68.75% in the conventional wire group ( P <0.001). No major adverse events occurred in either group. Significant differences in favor of the Panna wire group were found in operation time ( P =0.004), time needed to enter the left atrium ( P <0.001), number of arrhythmia episodes ( P <0.001), and number of misguidance to tricuspid valve ( P =0.005). Conclusions: The Panna wire is safe and effective and reduces the learning curve in percutaneous atrial septal defect closure under transthoracic echocardiography guidance only. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT04096924.

Transhepatic atrial septal defect closure: simple way to achieve haemostasis in a patient with important co-morbidities

2020 ◽  
Vol 30 (9) ◽  
pp. 1343-1345
Author(s):  
Raymond N. Haddad ◽  
Geert Maleux ◽  
Damien Bonnet ◽  
Sophie Malekzadeh-Milani
Keyword(s):  
Atrial Septal Defect ◽  
Septal Defect ◽  
Standard Treatment ◽  
Interatrial Septum ◽  
Gelatin Sponge ◽  
Attractive Alternative ◽  
Defect Closure ◽  
Atrial Septal Defect Closure ◽  
Septal Defects ◽  
Vascular Sheath

AbstractPercutaneous closure is the gold standard treatment for atrial septal defects, but the procedure can be complex in case of femoral thrombosis. Although unusual for congenital interventionists, transhepatic atrial septal defect closure is an attractive alternative to the internal jugular vein, especially when approaching the interatrial septum. Herein, we report the case of an adult patient with significant co-morbidities who had successful transhepatic atrial septal defect closure after a failed transjugular attempt. We describe the use of an absorbable haemostatic gelatin sponge to efficiently and safely achieve haemostasis after the use of a large vascular sheath with combined anticoagulation and antiplatelet therapy.

scholarly journals Risk factors for adverse events within one year after atrial septal closure in children: a retrospective follow-up study

2019 ◽  
Vol 30 (3) ◽  
pp. 303-312 ◽  
Author(s):  
Gustaf Tanghöj ◽  
Petru Liuba ◽  
Gunnar Sjöberg ◽  
Estelle Naumburg
Keyword(s):  
Risk Factors ◽  
Adverse Events ◽  
Atrial Septal Defect ◽  
Septal Defect ◽  
Conditional Logistic Regression ◽  
Septal Defects ◽  
Atrial Septal Defects ◽  
Increased Risk ◽  
One Year

AbstractIntroduction:Secundum atrial septal defect is one of the most common congenital heart defects. Previous paediatric studies have mainly addressed echocardiographic and few clinical factors among children associated with adverse events. The aim of this study was to identify neonatal and other clinical risk factors associated with adverse events up to one year after closure of atrial septal defect.Methods:This retrospective case–control study includes children born in Sweden between 2000 and 2014 that were treated surgically or percutaneously for an atrial septal defect. Conditional logistic regression was used to evaluate the association between major and minor adverse events and potential risk factors, adjusting for confounding factors including prematurity, neonatal sepsis, neonatal general ventilatory support, symptomatic atrial septal defects, and pulmonary hypertension.Results:Overall, 396 children with 400 atrial septal defect closures were included. The median body weight at closure was 14.5 (3.5–110) kg, and the median age was 3.0 (0.1–17.8) years. Overall, 110 minor adverse events and 68 major events were recorded in 87 and 49 children, respectively. Only symptomatic atrial septal defects were associated with both minor (odds ratio (OR) = 2.18, confidence interval (CI) 95% 1.05–8.06) and major (OR = 2.80 CI 95% 1.23–6.37) adverse events.Conclusion:There was no association between the investigated neonatal comorbidities and major or minor events after atrial septal defect closure. Patients with symptomatic atrial septal defects had a two to four times increased risk of having a major event, suggesting careful management and follow-up of these children prior to and after closure.

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.

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.

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