Atrial Septal Defect Device Closure in Patients with Metabolic Diseases or Genetic Syndromes

Concomitant metabolic or genetic syndromes can make atrial septal defect device closure difficult. We searched our database and found eight. The cohort consists of patients with different metabolic and genetic disease . Thromboembolic events and device embolization occurred in some patients. Careful attention is recommended in patients with special diseases.

Predictors of transcatheter closure cancellation in children with ventricular septal defect

Background Ventricle septal defect (VSD) is the most common type of congenital heart disease in children. If definitive therapy delayed, failure to thrive and developmental delays can lead to decreased quality of life. The options for VSD closure include surgical and minimally invasive procedures with transcatheterization. Although transcatheterization is considered to be the safest therapy, the risk of complications can lead to cancellation of procedure. Objective To determine whether nutritional status, body height, VSD type and size, and type of device used were predictors of cancellation of transcatheter closure of VSD. Methods A retrospective cohort study using medical records was performed for all children who underwent transcatheter closure of VSD at Dr. Sardjito Hospital, Yogyakarta, Central Java, between January 2017 to March 2020. Cancellation of closure was defined as complications occurring during the procedure, such as cardiac conduction problems, valve regurgitation, and device embolization. Multivariate logistic regression analysis was done to determine independent predictors of closure cancellation. Results One hundred thirty-four children were enrolled. Independent variables that were significant predictors were doubly committed subarterial (DCSA) VSD type (OR 5.98; 95%CI 1.52 to 23.61; P=0.045), moderate VSD size (OR 15.59; 95%CI 4.67 to 52.06; P=0.001), and types of devices used: symmetric (OR 27.06; 95%CI 2.75 to 266.17; P=0.001), asymmetric (OR 16.46; 95%CI 2.15 to 210.0; P=0.001), and coil (OR 21.26; 95%CI 2.15 to 210.0; P=0.001). Taller body height was a protective factor against cancellation of the procedure (OR 0.98; 95%CI 0.96 to 1.00; P=0.008). Conclusion Significant predictors of cancellation of transcatheter VSD closure are DCSA VSD, moderate VSD size, as well as coil, symmetric, and asymmetric devices, and increased body height.

Very large Atrial Septal Defect Device Closure: Feasibility and safety

Objectives: There is limited data regarding feasibility and safety of very large ASD devices deployment. Percutaneous closure of very large atrial septal defect (ASD) is a valid alternative to surgical approach. But complications like erosion, cardiac perforation, atrioventricular block, pericardial effusion, infective endocarditis, or cardiac arrhythmias may occur following ASD device closure. Methods: Forty four patients with very large ostium secundum ASD were studied in a tertiary medical centre. Adult patients with defect size of 38 mm or more and device size of 40 mm or more were selected for device closure. Patients having suitable anatomy, significant left to right shunt(>1.5:1) ,right ventricular volume overload and without significant pulmonary arterial hypertension were chosen for device closure. Results : There were thirty six female patients and eight male patients in our study. Majority of our patients (twenty four) were in forty to fifty years age group. Device could be deployed successfully in forty two (95.5%). Twelve patients had device size of 46 mm (27%). Eight patients had 44 mm devices(18%). Forty two millimeter devices were used in sixteen patients (36%). Eight patients had device size of 40 mm(18%).Device embolization occurred in two patients. There were two cases of pericardial effusion and pericardiocentesis was needed in one patients. Transient complete heart block was seen in one patient. Four patients had suffered from transient and self terminating atrial arrhythmias. There was no mortality or erosion in our study. Conclusion: Percutaneous closure of very large ASD is feasible and associated with low complication rate

Incidence, Predictor, and Clinical Outcomes of Multiple Resheathing With Self‐Expanding Valves During Transcatheter Aortic Valve Replacement

Background No study has evaluated the impact of the additional manipulation demanded by multiple resheathing (MR) in patients undergoing transcatheter aortic valve replacement with repositionable self‐expanding valves. Methods and Results This study included a real‐world, multicenter registry involving 16 centers from Canada, Germany, Latin America, and Spain. All consecutive patients who underwent transcatheter aortic valve replacement with the Evolut R, Evolut PRO, and Portico valves were included. Patients were divided according to the number of resheathing: no resheathing, single resheathing (SR), and MR. The primary end point was device success. Secondary outcomes included procedural complications, early safety events, and 1‐year mortality. In 1026 patients, the proportion who required SR and MR was 23.9% and 9.3%, respectively. MR was predicted by the use of Portico and moderate/severe aortic regurgitation at baseline (both with P <0.01). Patients undergoing MR had less device success (no resheathing=89.9%, SR=89.8%, and MR=80%; P =0.01), driven by more need for a second prosthesis and device embolization. At 30 days, there were no differences in safety events. At 1 year, more deaths occurred with MR (no resheathing=10.5%, SR=8.0%, and MR=18.8%; P =0.014). After adjusting for baseline differences and center experience by annual volume, MR associated with less device success (odds ratio, 0.42; P =0.003) and increased 1‐year mortality (hazard ratio, 2.06; P =0.01). When including only the Evolut R/PRO cases (N=837), MR continued to have less device success ( P <0.001) and a trend toward increased mortality ( P =0.05). Conclusions Repositioning a self‐expanding valve is used in a third of patients, being multiple in ≈10%. MR, but not SR, was associated with more device failure and higher 1‐year mortality, regardless of the type of valve implanted.

Case report of worsening of preexisting pericardial effusion after ASD device closure: is it calamitous?

Background Secundum-type atrial septal defects (ASD) constitute 8% to 10% of congenital heart defect. Secundum ASDs can be closed either percutaneously or surgically. However, ASD device closure has proven to be technically safe and feasible; it is not free of complications. These complications include device embolization/malposition which have been reported in 3.5% of cases, arrhythmia, and pericardial effusion in 2.6% and 0.5–1.5% respectively, device thrombus, residual shunting, and impingement of the device on the adjacent structures. Case presentation We introduce three patients with secundum ASD who had preexisting pericardial effusion, device closure was performed for them, and after the procedure, the effusion size progressed significantly. We used multimodality imaging to diagnose the cause of pericardial effusion (PE). Cardiac erosion was diagnosed in one of the patients that managed surgically. We did not found any specific procedure-related cause for worsening the pericardial effusion in the other two patients. Conclusion Several reasons include procedure-related complication and other systemic causes should be considered in patients who develop pericardial effusion after trans catheter closure of ASDs.

The long-term efficacy and safety of combining ablation and left atrial appendage closure: A systematic review and meta-analysis

Backgroud The long-term outcomes of this combined procedure remain elusive. This meta-analysis aimed to assess the long-term efficacy and safety of combined procedure. Methods PubMed, Embase, Cochrane Library, and Web of Science were systematically searched from the establishment of databases to 1 January 2021. Studies on the long-term (defined as a mean follow-up of approximately 12 months or longer) efficacy and safety outcomes of combined ablation and LAAC were included for meta-analysis. Results A total of 16 studies comprising 1,428 patients were included in the meta-analysis. The pooled long term freedom rate from atrial arrhythmia was 0.66 (95% confidence interval [CI], 0.59-0.71), long-term successful rate sealing of LAAC was 1.00 (95% CI, 1.00-1.00), and ischemic stroke/transient ischemic attack/systemic embolism during follow-up was 0.01 (95% CI, 0.00-0.02). Meanwhile, the rates of peri-procedural adverse events included phrenic nerve palsy, intracoronary air embolus, device embolization, peri-procedural death of 0.00 (95% CI, 0.00-0.00), procedure-related bleeding events of 0.03 (95% CI, 0.02-0.04), and pericardial effusion requiring or not requiring intervention of 0.00 (95% CI, 0.00-0.01). Moreover, the rates of long-term adverse events rate included device dislocation, intracranial bleeding, and pericardial effusion requiring or not requiring intervention, and all-cause mortality of 0.00 (95% CI, 0.00-0.00), device embolization of 0.01 (95% CI, 0.00-0.01), and other bleeding events of 0.01 (95% CI, 0.00-0.03). Conclusion This meta-analysis suggests that the strategy of combined atrial ablation and LAAC is effective and safe during long-term follow-up

Preliminary Experience With the New Amplatzer™ Trevisio™ Delivery System in Transcatheter Atrial Septal Defect Closures in Children

Objectives: To evaluate safety, efficacy, and technical advantages of Amplatzer™ Trevisio™ intravascular delivery system (ATIDS) in percutaneous atrial septal defect (ASD) closure in children.Background: The Trevisio™ is a novel delivery system designed for accurate and facilitated implantation of Amplatzer™ devices. There are no published clinical reports so far.Methods: During September 2020, 9 children with anatomically challenging ASDs underwent attempted transcatheter closure using ATIDS to deliver Amplatzer™ Septal occluders (ASO). All interventions were performed under general anesthesia, trans-esophageal echocardiography (TOE), and fluoroscopic guidance. Standard safety, immediate, and 60-days outcomes were prospectively assessed.Results: The median age was 8.1 (5.1–16.9) years and the median bodyweight was 30 (18–63) kg. Six patients had isolated secundum-type ASDs with absent anterosuperior rims including one with an aneurysmal septum. Three patients had unclassical defects associated with complex congenital heart anomalies. Eight devices were delivered from the femoral vein and the jugular vein was accessed in one patient with interrupted inferior caval vein and azygos continuation. All implantations were successful. The shape, position, and orientation of the ASO were identical before and after release on TOE and fluoroscopy. There was no device embolization or serious complication following closure. Complete shunt closure was confirmed on follow-up.Conclusions: We report the first clinical experience with ATIDS in transcatheter ASD pediatric closures. Safety and efficacy were witnessed in our case-series. The major advantage of reduced-tension deployment and reliable precision in device positioning is highly beneficial in challenging anatomies and unusual access.

A Rare Case of Embolization of a PFO Occluder Device to the Abdominal Aorta in a Patient with Bicuspid Aortic Valve and Previous Aortic Coarctation: A Case Report

Patent foramen ovale (PFO) is a common congenital defect in adults; its closure with an occluder device is usually a safe procedure. However, a rare and potentially fatal complication is the device embolization. We report a case of a 52-year-old man with bicuspid aortic valve and surgically corrected aortic coarctation in which a PFO occluder device migrated to the abdominal aorta. We recommend paying attention to the risk factors before the intervention (PFO characteristics and multiple congenital defects) and to the clinical-echocardiographic follow-up, to prevent, recognize and treat this severe complication as soon as possible.