Mechanophysiologically active patch for closure of atrial septal defect

2020 ◽  
Vol 13 (12) ◽  
pp. e237785
Author(s):  
Raja Lahiri ◽  
Namrata Gaur
Keyword(s):  
Septal Defect ◽  
Developed Countries ◽  
Right Atrial ◽  
Device Closure ◽  
Atrial Wall ◽  
Direct Closure ◽  
Surgical Closure ◽  
Septal Defects ◽  
Patch Closure ◽  
Asd Closure

Closure of atrial septal defects (ASDs) can be achieved by various methods right from direct closure to patch closure using various materials viz. pericardium, Dacron and Teflon, to device closure using percutaneous techniques. Although percutaneous techniques are the most commonly practised method in developed countries, a subset of patients will require surgical closure. Various patch materials have been used for long, but all of them have some complications and risks associated with them. We report a case of novel technique of ASD closure done using a pedicled, vascularised and contractile right atrial wall flap.

scholarly journals Unusual Hybrid Closure of Ventricular Septal Defects

2018 ◽  
Vol 11 (4) ◽  
pp. NP158-NP160
Author(s):  
Thomas Krasemann ◽  
Ingrid van Beynum ◽  
Pieter van de Woestijne
Keyword(s):  
Ventricular Septal Defect ◽  
Septal Defect ◽  
Open Heart ◽  
Ventricular Septal Defects ◽  
Device Closure ◽  
Surgical Closure ◽  
Septal Defects ◽  
Perimembranous Ventricular Septal Defect ◽  
Patch Closure ◽  
Technical Fault

A planned combined perventricular and “open heart” surgical closure of multiple ventricular septal defects had to be modified intraoperatively due to a technical fault disabling echocardiographic guidance. Through an atriotomy, device closure of a muscular defect and patch closure of a perimembranous ventricular septal defect were performed. In unusual situations, collaboration of the surgical and interventional team is crucial.

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.

scholarly journals Early results of total endoscopic closure for atrial septal defect in children at Cardiovascular Center, E Hospital, Hanoi, Viet Nam

2021 ◽  
Vol 33 ◽  
pp. 16-19
Author(s):  
Nguyen Ba Phong ◽  
Do Anh Tien ◽  
Le Ngoc Minh ◽  
Tran Thuy Nguyen ◽  
Luu Phuong Linh ◽  
...  
Keyword(s):  
Atrial Septal Defect ◽  
Septal Defect ◽  
Peripheral Circulation ◽  
Residual Shunt ◽  
Direct Closure ◽  
Endoscopic Closure ◽  
Early Results ◽  
Cardiovascular Center ◽  
Patch Closure ◽  
Asd Closure

Introduction: Atrial Septal Defect is the most common congenital heart disease. Minimally invasive cardiac surgery is being perfomed routinely at several cardiovascular centers in Vietnam. At E Cardiovascular Center, from 2016 to 2019, we performed total endoscopic closure for atrial septal defect in children using 4 trocars. From 2020 to present, we have reduced the number of trocars to three. This report was to evaluate the effectiveness and early results of total endoscopic closure with 3 trocars for atrial septal defect in children. Method: Twelve children underwent ASD closure from 1/2020 to 5/2021, with mean age of 7.7 years old (range from 2.5 to 11); mean weight was 20.8 kilograms (range from 12 to 40). All the patients underwent the operation with peripheral cardiopulmonary bypass (CPB). Result: The mean peripheral circulation time was 70 minutes (range from 56 to100 minutes) on beating hearts. There were 8 cases with patch-closure and 4 cases with direct-closure. After operations, we reexamined by echocardiography, the atrial septal defects were closed completely with no residual shunt, the common femoral arteries at the cannula position were normal and no stenosis were present. Conclusion: Totally endoscopic closure for ASD on beating hearts with 3 trocars is save with a very good short-term results.

scholarly journals Closure of a large upper muscular ventricular septal defect in a 2.3 kg baby using a duct occluder

2021 ◽  
Vol 8 (3) ◽  
pp. 165-169
Author(s):  
Mirza Mohd Kamran ◽  
◽  
Shaad Abqari ◽  
Azam Haseen ◽  
Mayank Yadav ◽  
...  
Keyword(s):  
Ventricular Septal Defect ◽  
Septal Defect ◽  
Failure To Thrive ◽  
Ventricular Septal Defects ◽  
Device Closure ◽  
Weight Category ◽  
Surgical Closure ◽  
The Past ◽  
Septal Defects ◽  
Younger Age

Surgical closure of the ventricular septal defect is a time tested and well-accepted procedure to dateespecially in smaller babies with failure to thrive and severe pulmonary hypertension. Surgicalclosure is regarded as the gold standard treatment. However over the past 10 years percutaneoustrans-catheter device closure has emerged as a safer alternative especially in the case of muscularVSD. Transcatheter closure of ventricular septal defects (VSD) has not yet received generalacceptance. It is not well-established in the younger age group with a weight category of less than5kg. Occasionally, a hybrid procedure has been proposed. We believe that certain types of VSD canbe closed safely by the transcatheter approach even if weight is less than 5kg, especially if the trendof miniaturizing devices continues. This approach should be considered as a valid alternative to asurgical option. We are reporting such a VSD baby with a weight of 2.3 Kg at the age of 6 months,which was closed with a duct occluder

scholarly journals Changes of Cardiac Rhythm after Closure of Secundum Atrial Septal Defect in Children

2020 ◽  
pp. 84-96
Author(s):  
Esraa A. Sorour ◽  
Elatafy E. Elatafy ◽  
Wael N. Lotfy ◽  
Amr M. Zoair
Keyword(s):  
Risk Factors ◽  
Atrial Septal Defect ◽  
Pediatric Patients ◽  
Septal Defect ◽  
Hemodynamic Instability ◽  
Right Atrial ◽  
Surgical Closure ◽  
Septal Defects ◽  
Atrial Septal Defects

Background: Arrhythmias may complicate congenital heart diseases, such as secundum atrial septal defects. We aimed at following up the rhythm changes in children after closure of ostiumsecundum atrial septal defects. Methods: The current study was conducted in the Pediatric Cardiology Unit, Tanta University, on 60 pediatric patients who had undergone either trans-catheter or surgical closure of secundum atrial septal defects. Complete history taking and full clinical assessment were done. Echocardiographic assessment was performed to detect any residual defects, and assess chamber dimensions, and cardiac functions. Electrocardiographic assessment including Holter monitoring was performed within two months after the procedure, after six months, and after one year. Arrhythmias were classified into major and minor types. All results were statistically analyzed and tabulated. Results: There were no significant differences between the pre-closure rhythm and the rhythm after closure of the defects throughout the follow-up. The percentage of patients with major arrhythmias has increased from 6.7% of the total sample to 13.3%, 11.6%, and 11.6% in the early, midterm and late follow up respectively. The significant risk factors for postoperative arrhythmias were; pre-closure arrhythmia, right atrial dilatation, and serious hemodynamic instability in the early follow up. Conclusions: We concluded that arrhythmias were common before and after atrial septal defect closure, without significant differences. Pre-closure arrhythmia, right atrial dilatation, and serious hemodynamic instability are considered important risk factors of arrhythmias after secundum atrial septal defect’s closure in pediatric patients.

scholarly journals Assessment of atrial septal defects rims on transesophageal echocardiogram at Shahid Gangalal National Heart Centre, Kathmandu, Nepal

2017 ◽  
Vol 14 (2) ◽  
pp. 35-36
Author(s):  
Chandra Mani Adhikari ◽  
Manish Shrestha ◽  
Urmila Shakya
Keyword(s):  
Short Axis ◽  
Device Closure ◽  
Transesophageal Echocardiogram ◽  
Morphological Variations ◽  
Surgical Closure ◽  
Septal Defects ◽  
Atrial Septal Defects ◽  
Chamber View ◽  
National Heart ◽  
Asd Closure

Background and Aims: Transcatheter Atrial septal defects (ASD) closure has become the better alternative to surgical closure. Morphological variations of ASD are frequent. We aim to study the rims of ASD in Transesophageal echocardiogram (TEE).Methods: It was a retrospective single center audit done at Shahid Gangalal National Heart Centre, Kathmandu, Nepal. TEE clips of all the patients who underwent TEE evaluation for ASD device closure in our centre between June to August 2017 were studied.Results: During the study period 49 patients underwent TEE to evaluate the rims of ASD for device closure. Atrioventricular rim was good in all patients but it was floppy in one patient. In four chamber view, posterior rim was good in 21(42.8%) patients, floppy in 19 (38.7%) patients and absent in nine (18.5%) patients. Aortic rim was good in 15 (30.6%) patients, floppy in three (6.1%) patients and absent in 31(63.3%) patients. Posterior rim in short axis was good in 17 (34.6%) patients, floppy in 24 (48.9%) patients while it was absent in eight (16.3%) patients. Inferior venacava rim was good in 16 (32.6%) patients, floppy in 23 (46.9%) patients, while absent in ten (20.4%) patients. Superior venacava rim was good in 45 (91.8%) patients, floppy in one (2.1%) patient and absent in three (6.1%) patients. Two (4.1%) patients had two ASDs.Conclusion: Most of the ASD patients have absent rims which makes the procedure more demanding and challenging.Nepalese Heart Journal 2017; 14(2): 35-36

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.

Transcatheter closure of ventricular septal defects in children less than 10 kg: experience from a tertiary care referral hospital in Eastern India

2021 ◽  
pp. 1-7
Author(s):  
Mahua Roy ◽  
Debasree Gangopadhyay ◽  
Noopur Goyal ◽  
Savita Murthy ◽  
Debabrata Nandi ◽  
...  
Keyword(s):  
Ventricular Septal Defect ◽  
Septal Defect ◽  
Ventricular Septal Defects ◽  
Device Closure ◽  
Small Children ◽  
Surgical Closure ◽  
Septal Defects ◽  
Percutaneous Device ◽  
Transcatheter Device ◽  
Percutaneous Device Closure

Abstract Objective: To assess the feasibility of percutaneous transcatheter device closure of ventricular septal defects in children weighing less than 10 kg. Background: Although percutaneous transcatheter device closure of ventricular septal defect is a well-established method of treatment in older children and adolescents, there is limited data on device closure in small children weighing less than 10 kg. We present our institutional experience of transcatheter VSD closure in children weighing less than 10 kg. Method: Medical records were reviewed for 16 children, who were selected for device closure of ventricular septal defects based on the inclusion criteria. Results: Out of 65 patients with a diagnosis of ventricular septal defect, 16 children less than 10 kg were attempted for percutaneous device closure. In 13 patients, the device was successfully released, and 3 patients needed surgical closure of the defect. Mean age and weight of the patients were 17.3 ± 12.7 months and 6.8 ± 3.2 kg, respectively. Mean defect size was 6 mm (range 3–10). There was no incidence of device embolisation or heart block or death. Five patients had residual left-to-right shunt immediately after the device release, which got closed by the first month’s follow-up. We had one accidental perforation of right ventricular free wall at the time of crossing of the defect, which was successfully repaired surgically. Conclusion: Percutaneous device closure of ventricular septal defect in small children with weight below 10 kg is feasible with good short-term outcome. Careful patient selection is essential for procedural success and to avoid complications.

scholarly journals Retrieval and repositioning of an embolized atrial septal defect closure device using a gooseneck snare

2021 ◽  
Vol 73 (1) ◽  
Author(s):  
Akash Batta ◽  
Sanjeev Naganur ◽  
Ajay Rajan ◽  
Kunwer Abhishek Ary ◽  
Atit Gawalkar ◽  
...  
Keyword(s):  
Atrial Septal Defect ◽  
Left Atrium ◽  
Septal Defect ◽  
Right Atrial ◽  
Closure Device ◽  
Safe Procedure ◽  
Device Closure ◽  
Asd Closure ◽  
The Right ◽  
Gooseneck Snare

Abstract Background Closure of all haemodynamically significant atrial septal defects (ASDs) is recommended irrespective of symptoms. Percutaneous device closure offers a favourable alternative to surgery with lower morbidity, shorter duration of hospital stays, and avoidance of a surgical scar. Though device closure is generally a safe procedure with high success rates, certain complications can arise including device embolization which poses a significant challenge for the treating team. We report one such case in which the ASD closure device got spontaneously released and embolized from the delivery cable into the left atrium prior to its deployment. We describe our approach for its retrieval and subsequently its successful deployment across the septal defect using a gooseneck snare. Case presentation A 5-year-old asymptomatic child was found to have a murmur on a routine check-up. Evaluation revealed a haemodynamically significant, 18-mm ostium secundum ASD with normal pulmonary pressures and suitable margins for device closure. A 20-mm ASD closure device was traversed via an 8-Fr delivery system. While manipulating the left atrial (LA) disc from the right upper pulmonary vein (RUPV) approach, the device got spontaneously released. The right atrial (RA) disc was caught across the ASD, into the left atrium. This was confirmed by intraoperative transthoracic echocardiography and fluoroscopy. The haemodynamics and rhythm were stable. A 20-mm gooseneck snare was immediately passed through the delivery sheath and an attempt was made to catch the screw. With difficulty, the RA screw was caught with the snare and multiple attempts to retrieve the device into the sheath were unsuccessful. However, while negotiating, we were able to secure a favourable position of the device across the atrial septal defect, and after fluoroscopic and echocardiographic confirmation, the device was released. The child remained stable thereafter and was discharged 2 days later. Conclusions Gooseneck snare is a valuable tool in the management of embolized ASD closure device. Occasionally, like in the index case, one may be successful in retrieving the embolized device and repositioning it across the ASD using a gooseneck snare, thus obviating the need for emergency surgery.

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.

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