Transcatheter Occlusion of Atrial Septal Defects for Prevention of Recurrence of Paradoxical Embolism

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.

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Transcatheter occlusion of secundum atrial septal defects with the self-centering Amplatzer Septal Occluder

Progress in Pediatric Cardiology ◽

10.1016/s1058-9813(98)00053-8 ◽

1998 ◽

Vol 9 (2) ◽

pp. 119-124 ◽

Cited By ~ 6

Author(s):

Gunther Fischer ◽

Jozef Masura ◽

Hans Heiner Kramer ◽

Pavol Gavora

Keyword(s):

The Self ◽

Amplatzer Septal Occluder ◽

Transcatheter Occlusion ◽

Septal Defects ◽

Atrial Septal Defects

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Impact of dynamic 3D transoesoesophageal echoardiography in the assessment of atrial septal defects and occlusion by the double-umbrealla device(CardioSEAL)

Cardiology in the Young ◽

10.1017/s1047951100006892 ◽

1998 ◽

Vol 8 (3) ◽

pp. 368-378 ◽

Cited By ~ 21

Author(s):

Yasuki V. Maeno ◽

Lee N. Benson ◽

Christine Boutin

Keyword(s):

Three Dimensional ◽

Transoesophageal Echocardiography ◽

Relevant Information ◽

3D Echocardiography ◽

Cross Sectional ◽

Transcatheter Occlusion ◽

Septal Defects ◽

Atrial Septal Defects ◽

Interventional Catheterization ◽

Three Dimensional Echocardiography

AbstractOcclusion of the atrial septal defects in the oval fossa by interventional catheterization has progressed, but still has limitations. Three-dimensional (3D) echocardiography can provide unique views unavailable by cross-sectional imaging. The objective of this study was to define the clinical application of 3D echocardiography in the assessment and monitoring of transcatheter occlusion of atrial septal defects. Three-dimensional echocardiography was attempted prior to occlusion of atrial septal defects in 41 patients (median age 8.6 years). Serial cross-sectional images were acquired by multiplane transoesophageal echocardiography and displayed by means of computer reconstruction. Dynamic 3D echocardiographic images of defects in the oval fossa were obtained in 40 of 41 patients (98%). Volume-rendering demonstrated the anterosuperior rim in 36 (90%) and the inferoposterior rim in 24 (60%), but failed to reveal small additional fenestrations in six. Sizes measured by 3D echocardiography were significantly larger than those provided by cross-sectional transoesophageal echocardiography (p =;0.007), but differed little from those obtained with balloon sizing (p =; 0.6). After occlusion, 3D echocardiography showed positions of all arms of the device in 20 of 24 cases. Location of any protruding arms, or residual defects, were also clearly revealed.Three-dimensional images obtained in 12 patients during deployment of the double-umbrella device were useful in monitoring its position (single-frame) and for explaining the mechanism of protrusion. Current 3D echocardiography provides clinically relevant information for selection of patients for closure of atrial septal defects by interventional catheterization and when monitoring during implantation. Information obtained by this technique can clarify the mechanism of deployment of the device and closure of the defect, therefore influencing outcomes.

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