scholarly journals Transcatheter Closure of PFO and ASD: Multimodality Imaging for Patient Selection and Perioperative Guidance

2021 ◽  
Vol 8 (7) ◽  
pp. 78
Author(s):  
Gabriele Egidy Assenza ◽  
Luca Spinardi ◽  
Elisabetta Mariucci ◽  
Anna Balducci ◽  
Luca Ragni ◽  
...  
Keyword(s):  
Patient Selection ◽  
Transcatheter Closure ◽  
Multimodality Imaging ◽  
Deep Understanding ◽  
Volume Overload ◽  
Arterial Embolization ◽  
Ventricular Volume ◽  
Intracardiac Echocardiography ◽  
Technical Details ◽  
Asd Closure

Transcatheter closure of patent foramen ovale (PFO) and secundum type atrial septal defect (ASD) are common transcatheter procedures. Although they share many technical details, these procedures are targeting two different clinical indications. PFO closure is usually considered to prevent recurrent embolic stroke/systemic arterial embolization, ASD closure is indicated in patients with large left-to-right shunt, right ventricular volume overload, and normal pulmonary vascular resistance. Multimodality imaging plays a key role for patient selection, periprocedural monitoring, and follow-up surveillance. In addition to routine cardiovascular examinations, advanced neuroimaging studies, transcranial-Doppler, and interventional transesophageal echocardiography/intracardiac echocardiography are now increasingly used to deliver safely and effectively such procedures. Long-standing collaboration between interventional cardiologist, neuroradiologist, and cardiac imager is essential and it requires a standardized approach to image acquisition and interpretation. Periprocedural monitoring should be performed by experienced operators with deep understanding of technical details of transcatheter intervention. This review summarizes the specific role of different imaging modalities for PFO and ASD transcatheter closure, describing important pre-procedural and intra-procedural details and providing examples of procedural pitfall and complications.

scholarly journals Recent advances in managing septal defects: atrial septal defects

F1000Research ◽  
2017 ◽  
Vol 6 ◽  
pp. 2042 ◽  
Author(s):  
P Syamasundar Rao ◽  
Andrea D Harris
Keyword(s):  
Volume Overload ◽  
Ventricular Volume ◽  
Paradoxical Embolism ◽  
Cardiac Complications ◽  
Surgical Closure ◽  
Septal Defects ◽  
Atrial Septal Defects ◽  
Asymptomatic Patients ◽  
Recent Developments ◽  
Asd Closure

The purpose of this review is to discuss the management of atrial septal defects (ASD), paying particular attention to the most recent developments. There are four types of ASDs: ostium secundum, ostium primum, sinus venosus, and coronary sinus defects. The fifth type, patent foramen ovale—which is present in 25 to 30% of normal individuals and considered a normal variant, although it may be the seat of paradoxical embolism, particularly in adults—is not addressed in this review. The indication for closure of the ASDs, by and large, is the presence of right ventricular volume overload. In asymptomatic patients, the closure is usually performed at four to five years of age. While there was some earlier controversy regarding ASD closure in adult patients, currently it is recommended that the ASD be closed at the time of presentation. Each of the four defects is briefly described followed by presentation of management, whether by surgical or percutaneous approach, as the case may be. Of the four types of ASDs, only the ostium secundum defect is amenable to percutaneous occlusion. For ostium secundum defects, transcatheter closure has been shown to be as effective as surgical closure but with the added benefits of decreased hospital stay, avoidance of a sternotomy, lower cost, and more rapid recovery. There are several FDA-approved devices in use today for percutaneous closure, including the Amplatzer® Septal Occluder (ASO), Amplatzer® Cribriform device, and Gore HELEX® device. The ASO is most commonly used for ostium secundum ASDs, the Gore HELEX® is useful for small to medium-sized defects, and the cribriform device is utilized for fenestrated ASDs. The remaining types of ASDs usually require surgical correction. All of the available treatment modes are safe and effective and prevent the development of further cardiac complications.

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.

scholarly journals Regional shape, global function and mechanics in right ventricular volume and pressure overload conditions: a three-dimensional echocardiography study

2021 ◽  
Author(s):  
Jurate Bidviene ◽  
Denisa Muraru ◽  
Francesco Maffessanti ◽  
Egle Ereminiene ◽  
Attila Kovács ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Interventricular Septum ◽  
Three Dimensional ◽  
Pressure Overload ◽  
Volume Overload ◽  
Ventricular Volume ◽  
Longitudinal Contraction ◽  
Convex Shape ◽  
Dimensional Echocardiography ◽  
Three Dimensional Echocardiography

AbstractOur aim was to assess the regional right ventricular (RV) shape changes in pressure and volume overload conditions and their relations with RV function and mechanics. The end-diastolic and end-systolic RV endocardial surfaces were analyzed with three-dimensional echocardiography (3DE) in 33 patients with RV volume overload (rToF), 31 patients with RV pressure overload (PH), and 60 controls. The mean curvature of the RV inflow (RVIT) and outflow (RVOT) tracts, RV apex and body (both divided into free wall (FW) and septum) were measured. Zero curvature defined a flat surface, whereas positive or negative curvature indicated convexity or concavity, respectively. The longitudinal and radial RV wall motions were also obtained. rToF and PH patients had flatter FW (body and apex) and RVIT, more convex interventricular septum (body and apex) and RVOT than controls. rToF demonstrated a less bulging interventricular septum at end-systole than PH patients, resulting in a more convex shape of the RVFW (r = − 0.701, p < 0.0001), and worse RV longitudinal contraction (r = − 0.397, p = 0.02). PH patients showed flatter RVFW apex at end-systole compared to rToF (p < 0.01). In both groups, a flatter RVFW apex was associated with worse radial RV contraction (r = 0.362 in rToF, r = 0.482 in PH at end-diastole, and r = 0.555 in rToF, r = 0.379 in PH at end-systole, respectively). In PH group, the impairment of radial contraction was also related to flatter RVIT (r = 0.407) and more convex RVOT (r = − 0.525) at end-systole (p < 0.05). In conclusion, different loading conditions are associated to specific RV curvature changes, that are related to longitudinal and radial RV dysfunction.

Diagnosis and natural history of isolated congenital pulmonary regurgitation in fetal life

2000 ◽  
Vol 10 (2) ◽  
pp. 162-165 ◽  
Author(s):  
Kazuhiro Mori ◽  
Yasunobu Hayabuchi ◽  
Yasuhiro Kuroda
Keyword(s):  
Conservative Therapy ◽  
Pulmonary Valve ◽  
Fetal Echocardiography ◽  
Pulmonary Regurgitation ◽  
Volume Overload ◽  
Ventricular Volume ◽  
Fetal Life ◽  
History Of ◽  
Dysplastic Pulmonary Valve ◽  
Rare Instance

AbstractWe describe a rare instance of isolated pulmonary regurgitation caused by a dysplastic pulmonary valve which was detected prenatally. Fetal echocardiography demonstrated severe pulmonary regurgitation, and progressive cardiomegaly because of right ventricular volume overload. After birth, conservative therapy was successful in alleviating the pulmonary vascular resistance, and the pulmonary regurgitation gradually decreased.

Prolonged repolarization in atrial septal defect: An example of mechanoelectrical feedback due to right ventricular volume overload

Heart Rhythm ◽  
2016 ◽  
Vol 13 (6) ◽  
pp. 1303-1308 ◽  
Author(s):  
Kristina Rücklová ◽  
Karel Koubský ◽  
Viktor Tomek ◽  
Peter Kubuš ◽  
Jan Janoušek
Keyword(s):  
Right Ventricular ◽  
Atrial Septal Defect ◽  
Septal Defect ◽  
Volume Overload ◽  
Ventricular Volume ◽  
Right Ventricular Volume

scholarly journals NT pro- B-type Natriuretic Peptide in the Small Ventricular Septal Defect in Children

2021 ◽  
Vol 9 (B) ◽  
pp. 1677-1680
Author(s):  
Rahmat Budi Kuswiyanto ◽  
Putria Apandi ◽  
Dany Hilmanto ◽  
Muhammad Hasan Bashari ◽  
Sri Endah Rahayuningsih
Keyword(s):  
Natriuretic Peptide ◽  
Transcatheter Closure ◽  
Volume Overload ◽  
Ventricular Myocardium ◽  
Left Ventricular ◽  
Left Ventricular Myocardium ◽  
Natriuretic Peptide Level ◽  
Peptide Level ◽  
Before And After ◽  
Male Patients

Background: Brain natriuretic peptide is a cardiac hormone secreted from the left ventricular myocardium due to ventricular expansion and volume overload. A recent study shows that small VSD will have risk of ventricular dysfunction in adulthood. Another complications such as endocarditis, congestive heart failure, aortic regurgitation, arrhythmia also we should be aware. Evaluations of the plasma B-type natriuretic peptide level (NT pro BNP) are currently being considered as methods to identify the possible presence of ventricular dilation in small VSD. Objective: To evaluate the change in plasma B-type natriuretic peptide after transcatheter closure of VSD. Methods: A pretest-posttest design was conducted on VSD patients before and after transcatheter closure. Plasma B-type natriuretic peptide level were measured before and 30 days after the transcatheter closure of VSD. Result: A total of 32 peri membranous VSD patients were included in this study with 62.5 % female patients (n=20) and 37.5 % male patients (n=12). A significant decrease was observed in the median NT pro BNP level when the level before closure of 1.08 (0.74 – 3.47) ng/ml was compared to the level after closure of 0.91 (0.68 – 2.07) ng/ml (p<0.05). Conclusion: Significant decreases in NT pro BNP level are seen in small VSD patients 30 days after transcatheter closure. Patients with small peri membranous VSD are generally considered to need occlusion for their childhood defect.  

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