P1800The benefit of atrial septal defect closure in patients with borderline shunt

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Komar ◽  
T Przewlocki ◽  
B Sobien ◽  
P Prochownik ◽  
U Gancarczyk ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Atrial Septal Defect ◽  
Septal Defect ◽  
Transcatheter Closure ◽  
Color Doppler ◽  
Percutaneous Treatment ◽  
Right Atrial ◽  
P Value ◽  
Atrial Septal Defect Closure ◽  
Asd Closure

Abstract Objective Closure of atrial septal defect in patients with borderline shunt is controversial. The aim of the study was to evaluate the outcomes of transcatheter closure of secundum atrial septal defect (ASD) in the patients with the borderline shunt. Methods 215 pts (126 F,89 M) with a mean age of 31.9±18.2 (16–58) years with a small ASD who underwent transcatheter closure were analyzed. All patients had an isolated secundum ASD with pulmonary to systemic blood flow Qp:Qs ratio≤1.5, mean 1.2±0.6 (1.1–1.5). A symptom-limited treadmill exercise test with respiratory gas exchange analysis, transthoracic color Doppler echocardiographic study and Quality of life (QoL) (using the SF36 questionnaire (SF36q)) were repeated in all pts before and 36 months after the procedure. Results The device was successfully implanted in all pts (procedure time 19.1±5.2 (8–38) minutes, fluoroscopy time 8.1±4.4 (6–13) minutes). There were no major complications. The defect echo diameter was 7.7±3.9 (5 - 15) mm. The diameter of the implanted devices ranged from 6 to 18 mm. After 36 months of ASD closure, all the pts showed a significant improvement of exercise capacity. 7 QoL parameters (except mental health) improved at 36 months of follow-up compared with baseline. The mean SF36q scale increased in 168 (78.1%) pts of mean 40.2±20.1 (9–72). The right ventricular dimension decreased in 173 pts (80.4%) (Table 1). Table 1 Parameter Before ASD closure 36 months after ASD closure p value Time of exercise (min) 12.1±5.2 18.6±4.3 <0.001 VO2 peak (ml/kg/min) 10.2±4.7 14.8±4.2 <0.001 SF36q scale 0–100 37.3±22.3 79±29.5 <0.001 Right atrial area (cm2) 20.1±1.7 14.7±1.5 <0.001 Right ventricular area (cm2) 18.1±1.4 12.2±1.5 <0.001 Conclusions ASD closure in patients with borderline shunt resulted in a significant and long-term clinical and hemodynamic improvement after percutaneous treatment.

scholarly journals The benefit of atrial septal defect closure in the elderly patients

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P.J Prochownik ◽  
T Przewlocki ◽  
B Sobien ◽  
U Gancarczyk ◽  
M Olszowska ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Atrial Septal Defect ◽  
Septal Defect ◽  
Transcatheter Closure ◽  
Color Doppler ◽  
The Elderly ◽  
Atrial Septal Defect Closure ◽  
Exercise Tests ◽  
The Mean

Abstract Objective Closure of the atrial septal defect in the elderly patients is controversial. The aim of the study was to evaluate the outcomes of transcatheter closure of secundum atrial septal defect (ASD) in elderly patients. Methods From a total of 650 pts with ASD who underwent transcatheter closure 120 pts over 60 years (70 F, 50 M) with a mean age of 66.7±18.1 (60–78) were analyzed. All patients had an isolated secundum ASD with a mean Qp:Qs: 2.79±1.8 (1.5–3.9). A symptom-limited treadmill exercise tests with respiratory gas exchange analysis and transthoracic color Doppler echocardiographic study as well as Quality of life (QoL) measured using the SF36 questionnaire (SF36q) were repeated in all pts before procedure and after 12 months of follow-up. Results The device was successfully implanted in all pts (procedure time 30.1±9.9 (10–59) minutes, fluoroscopy time 10.1±7.2 (6–40) minutes). There were no major complications. The defect echo diameter was 19.5±15.4 (12 - 34) mm. The mean balloon stretched diameter of ASD was 22.0±7.8 (14 - 36) mm. The diameter of the implanted devices ranged 16 - 38 mm. After 12 months of ASD closure, all the pts showed a significant improvement of exercise capacity parameters. Seven QoL parameters (except mental health) improved at 12 months follow up compared to their baseline data. The mean SF36q scale increased significantly in 96 (80.2%) pts of mean 41.6±26.1 (4–71). The right ventricular dimension decreased in 101 pts (84.2%) (Table 1). Conclusions Closure of ASD in elderly patients caused a significant clinical and hemodynamic improvement after percutaneous treatment, which is maintained to long-term follow-up what justified this procedure in old age. Funding Acknowledgement Type of funding source: None

scholarly journals Cobrahead Deformity in the Right Atrial Disc of a New-Generation Occlutech Figulla Flex II Atrial Septal Defect Occluder Device

2015 ◽  
Vol 42 (5) ◽  
pp. 454-457 ◽  
Author(s):  
Teoman Kilic ◽  
Ertan Ural ◽  
Tayfun Sahin
Keyword(s):  
Atrial Septal Defect ◽  
Septal Defect ◽  
Transcatheter Closure ◽  
Right Atrial ◽  
Amplatzer Septal Occluder ◽  
Atrial Septal Defect Closure ◽  
Septal Occluder Device ◽  
Occluder Device ◽  
The Right ◽  
New Generation

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.

scholarly journals Percutaneous Atrial Septal Defect Closure Using the Occlutech Figulla Device in Adults: More than 800 Patient-Years of Follow-Up

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
R. J. R. Snijder ◽  
L. E. Renes ◽  
D. Bosshardt ◽  
M. J. Suttorp ◽  
J. M. ten Berg ◽  
...  
Keyword(s):  
Atrial Septal Defect ◽  
Septal Defect ◽  
Color Doppler ◽  
Atrial Septal Defect Closure ◽  
Closure Rate ◽  
Long Term Follow Up ◽  
Device Embolization ◽  
Asd Closure

Purpose. The Occlutech Figulla occluder has been proven safe and effective at midterm follow-up after percutaneous atrial septal defect (ASD) closure. We describe the safety and efficacy at long-term follow-up in adults. Methods. All consecutive adult patients that underwent ASD closure between 2008 and 2015 were included. All complications were registered. Residual left-to-right shunt (LRS) was diagnosed using color-Doppler transthoracic echocardiography (TTE). Right-to-left shunting was diagnosed using contrast TTE. Successful closure was defined as no LRS at follow-up. Results. In total, 166 patients (mean age 56.7 ± 16.1 years; 62% female) underwent percutaneous ASD closure using the Occlutech Flex I (70%) or Flex II (30%) device (diameter 24 mm; range 10–40 mm) under general anaesthesia and transoesophageal echocardiographic guidance. Long-term follow-up data were available for 144 patients (87%) with a mean follow-up of 5.9 ± 2.6 years, a total of 814 patient-years. During hospitalization, device embolization occurred in three patients (1.8%) with successful extraction in all. During the long-term follow-up, 15 patients (9.8%) suffered new-onset atrial fibrillation and stroke occurred in 2.1%. There was no residual LRS at 12-month follow-up. No device embolization occurred during the long-term follow-up. Conclusion. Percutaneous ASD closure using the Occlutech device appears to be safe at long-term follow-up with a high successful closure rate at one year.

Surgical Intervention for Embolization of Atrial Septal Defect Closure Devices: Case Report

2013 ◽  
Vol 16 (5) ◽  
pp. E274-E275
Author(s):  
Hakan Vural ◽  
Tahsin Bozat ◽  
Derih Ay ◽  
M. Çağdaş Çayir ◽  
Arif Gücü ◽  
...  
Keyword(s):  
Atrial Septal Defect ◽  
Septal Defect ◽  
Surgical Intervention ◽  
Transcatheter Closure ◽  
Atrial Septal Defect Closure ◽  
Amplatzer Device ◽  
Device Embolization ◽  
Asd Closure ◽  
The Right ◽  
Transcatheter Device

Atrial septal defect (ASD) closure using a percutaneous transcatheter device is used as an alternative to surgery. Various devices are increasingly used in clinical practice, and various types and models of septal occluder devices are available. The Amplatzer device (Amplatzer Medical, Golden Valley, MN, USA) is one with increasing popularity.We report a case of attempted percutaneous transcatheter closure of a large ASD in a 14-year-old girl, complicated by total device embolization to the right ventricle necessitating emergency surgery.

scholarly journals “The Effect of Atrial Septal Defect Closure on Cardiac Volumetric Changes in Adults, Transcatheter Versus Surgical Closure, and the Outcome of Tricuspid Regurgitation, a Pilot Cmr Study”

2021 ◽  
Author(s):  
Amr Mansour Mohamed ◽  
Noha Mohamed Gamal ◽  
Alaa Nady Mohamed ◽  
Amr Ibrahiem Osman ◽  
Khaled Mohamed El-maghraby
Keyword(s):  
Atrial Septal Defect ◽  
Tricuspid Regurgitation ◽  
Left Atrial ◽  
Septal Defect ◽  
Adult Patients ◽  
Right Atrial ◽  
P Value ◽  
Surgical Closure ◽  
Significant Difference ◽  
Asd Closure

Abstract BackgroundClosure of an atrial septal defect (ASD) reduces right heart volumes by eliminating shunting while improving left ventricle (LV) filling and function due to ventricular interdependence, thereby improving symptoms. Furthermore, studies on atrial volume changes following ASD closure are paucity. Functional tricuspid regurgitation (TR) is frequently seen in adult patients with ASD as a consequence of right ventricle (RV) dilatation. Cardiac magnetic resonance (CMR) is widely accepted as the gold standard method for measuring cardiac volume and mass.ObjectiveWe aimed at studying the cardiac volumetric changes preclosure and 6 months after transcatheter and surgical closure, as well as fate of TR, using CMR analysis. MethodsWe prospectively enrolled 30 adult patients with isolated secundum ASD who were referred for ASD closure. CMR evaluates the right and left atrial volumes, as well as the ventricular end diastolic and end systolic volume indexes (EDVI and ESVI), function, the mass index, and tricuspid regurgitant fraction.ResultsRV volumes decreased in both groups when compared to baseline (P value 0.001), with the device group experiencing more reduction in volumes and improvement in RV function after closure (P 0.001). In each group, the absolute value of RV mass decreased significantly from the baseline (P value (0.001)), but with no difference between groups (P value 0.31). Improvement in functional TR occurred in both groups. LVEDVI increased significantly in both groups (P values 0.001 and 0.005, respectively), with a significant improvement in the LV mass index (P value = 0.01) and a non-significant difference in LVESVI. Only device closure resulted in an improvement in LV function (63.53 ± 3.85 versus 67.13 ± 4.34, P value =0.01). There was a significant reduction in right atrial (RA) volume (P value = 0.5), with a trend to decrease in left atrial (LA) volume but it was insignificant, with no difference between groups.ConclusionOur findings revealed that both procedures resulted in normalization of ventricular volume and reduction of RA volumes, with only the device group showing improvement in ventricular function. Functional TR improved after closure with either a device or a surgical approach.

Closure of Secundum Atrial Septal Defect with Autologous Right Atrial Patch: Case Report

2005 ◽  
Vol 8 (2) ◽  
pp. 96 ◽  
Author(s):  
Osman Tansel Dar�in ◽  
Alper Sami Kunt ◽  
Mehmet Halit Andac
Keyword(s):  
Atrial Septal Defect ◽  
Right Atrium ◽  
Septal Defect ◽  
Complete Recovery ◽  
Interatrial Septum ◽  
Right Atrial ◽  
Atrial Wall ◽  
Residual Shunt ◽  
Asd Closure ◽  
The Right

Background: Although various synthetic materials and pericardium have been used for atrial septal defect (ASD) closure, investigators are continuing to search for an ideal material for this procedure. We report and evaluate a case in which autologous right atrial wall tissue was used for ASD closure. Case: In this case, we closed a secundum ASD of a 22-year-old woman who also had right atrial enlargement due to the defect. After establishing standard bicaval cannulation and total cardiopulmonary bypass, we opened the right atrium with an oblique incision in a superior position to a standard incision. After examining the secundum ASD, we created a flap on the inferior rim of the atrial wall. A stay suture was stitched between the tip of the flap and the superior rim of the defect, and suturing was continued in a clockwise direction thereafter. Considering the size and shape of the defect, we incised the inferior attachment of the flap, and suturing was completed. Remnants of the flap on the inferior rim were resected, and the right atrium was closed in a similar fashion. Results: During an echocardiographic examination, neither a residual shunt nor perigraft thrombosis was seen on the interatrial septum. The patient was discharged with complete recovery. Conclusion: Autologous right atrial patch is an ideal material for ASD closure, especially in patients having a large right atrium. A complete coaptation was achieved because of the muscular nature of the right atrial tissue and its thickness, which is a closer match to the atrial septum than other materials.

Acute Changes in Left Ventricular End Diastolic Pressure following the Transcatheter Closure of an Atrial Septal Defect in Adults

2016 ◽  
Vol 19 (3) ◽  
pp. 145 ◽  
Author(s):  
Young Hwa Kong ◽  
Jinyoung Song ◽  
Kyung Hee Kim ◽  
June Huh ◽  
I-Seok Kang
Keyword(s):  
Elderly Patients ◽  
Atrial Septal Defect ◽  
Septal Defect ◽  
Transcatheter Closure ◽  
Diastolic Pressure ◽  
Left Ventricular Diastolic Function ◽  
Left Ventricular ◽  
Device Closure ◽  
Acute Changes ◽  
Asd Closure

<strong>Background:</strong> Acute changes in left ventricular diastolic function shortly after ASD closure in elderly patients have not been well known. We aimed to investigate acute changes in left ventricular end diastolic pressure (LVEDP) in elderly patients following transcatheter closure of atrial septal defect (ASD). <br /><strong>Methods:</strong> All 19 adults with ASDs who underwent transcatheter closure between June 2013 and December 2014 were enrolled. LVEDP was measured prior to device closure and compared with that immediately following device closure and 15 minutes after device closure. <br /><strong>Results:</strong> The median age of the patients was 48 years old. The baseline E/e’ and LVEDP values were 8.3 ± 2.8 and 13 ± 3 mmHg. The LVEDP value immediately following closure was 19 ± 4 mmHg, and 15 minutes after closure was 16 ± 4 mmHg. The median increase in the LVEDP value immediately following closure was 6 mmHg, which significantly differed from that prior to closure. The LVEDP 15 minutes after closure decreased but remained significantly higher than the value observed immediately after closure. No significant changes were observed with regard to E/e’ at either 1 day or 3 months following closure. The LVEDP value <br />15 minutes after device closure was significantly correlated with those observed before closure and immediately following closure; however, no significant correlations were observed with regard to patient age, Qp/Qs, E/e’ before closure, or E/e’ 3 months after device closure.<br /><strong>Conclusion:</strong> LVEDP in adults with ASDs significantly increases following device closure. LVEDP before closure predicts LVEDP following device closure.

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

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.

Off-Pump Atrial Septal Defect Closure Using the Universal Cardiac Introducer®

2009 ◽  
Vol 4 (1) ◽  
pp. 20-26 ◽  
Author(s):  
Gerard M. Guiraudon ◽  
Douglas L. Jones ◽  
Daniel Bainbridge ◽  
John T. Moore ◽  
Chris Wedlake ◽  
...  
Keyword(s):  
Atrial Septal Defect ◽  
Image Guidance ◽  
Septal Defect ◽  
Tracking System ◽  
Doppler Imaging ◽  
Atrial Septal Defect Closure ◽  
Off Pump ◽  
Stapling Device ◽  
Future Design ◽  
Asd Closure

Objective Optimal atrial septal defect (ASD) closure should combine off-pump techniques with the effectiveness and versatility of open-heart techniques. We report our experience with off-pump ASD closure using the Universal Cardiac Introducer (UCI) in a porcine model. The goal was to create an ASD over the fossa ovale (FO) and position a patch over the ASD under ultrasound (US) imaging and augmented virtual reality guidance. Methods An US probe (tracked with a magnetic tracking system) was positioned into the esophagus (transesophageal echocardiographic probe) for real-time image-guidance. The right atrium (RA) of six pigs was exposed via a right lateral thoracotomy or medial sternotomy. The UCI was attached to the RA wall. A punching tool was introduced via the UCI, navigated and positioned, under US guidance, to create an ASD into the FO. A patch with its holder and a stapling device were introduced into the RA via the UCI. The patch was positioned on the ASD. Occlusion of the ASD was determined using US and Doppler imaging. Results The FO membrane was excised successfully in all animals. US image-guidance provided excellent visualization. The patch was positioned in all cases with complete occlusion of the ASD. The stapling device proved too bulky, impeding circumferential positioning. Conclusions Using the UCI, ASD closure was safe and feasible. US imaging, combined with virtual and augmented reality provided accurate navigating and positioning. This study also provided valuable information on the future design of anchoring devices for intracardiac procedures.

Sign in / Sign up

Export Citation Format

Share Document