We report the results of a prospective multicenter pilot study performed in germany, sweden, and switzerland with a new self. Background pfo has been linked with cryptogenic strokes, recurrent transient neurologic deficits, sleep apnea, decompression illness, and migraines. Closure of secundum atrial septal defects with the. Atrial septal defect asd and patent ductus arteriosus pda are both common congenital heart diseases, but the combination of these two common cardiac defects is extremely rare. However, if the asd is in an unusual position within the heart, or if there are other heart defects such. A 4yearold girl had small ventricular septal defect vsd and atrial septal defect asd status post closure with figulla flex ii septal occluder 1 year ago. Atrial septal defect asd is one of the more commonly recognized congenital cardiac anomalies presenting in adulthood. Device closure has become the treatment of choice for closing asds 1, 2 with approximately 80% of secundum defects being suitable for device closure.
Such leadership is one reason physicians can rely on amplatzer tm since as an industryleading design, it facilitates easy closure. Complication rates in this group of smaller patients are not. Intraoperative device closure of atrial septal defect is a safe and feasible technique for infants. Patients were divided into two groups, 27 of which in group i with. Atrial septal defect asd is one of the most common congenital heart diseases, and secundum asd accounts for approximately 80% of cases. Device closure of secundum atrial septal defects in.
Device closure of diverse layout of multihole secundum atrial septal. Many adult patients with secundumtype atrial septal defects asds are able to have these defects fixed percutaneously. Pagani,2 md, phd, and mauro moscucci,1 md the use of the tandem hearttm percutaneous ventricular assist device tandem heart pvad, cardiac assist technologies, pittsburgh, pa. Using cox regression, we compared asd patients risk of af and. Transcatheter closure of atrial septal defect asd is an established procedure in children and young adults, but the benefit of this procedure in older. Intraoperative device closure of atrial septal defect in. A patent foramen ovale pfo may need to be closed because of transient shunt reversal resulting in transient ischaemic events or stroke. Rtol shunt through the pfoasd due to functional tricuspid stenosis. Atrial septal defect closure has been shown to result in a significant reduction in rv and an increase in left ventricular volumes.
An unexpected stumbling block, journal of cardiothoracic and vascular anesthesia on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. Assessment of atrial septal defects in adults comparing. Outcomes after device closure of atrial septal defect in children. However, the wide use of asd closure devices and the growing experience worldwide brought some delayed and rare complications to light. However, the percutaneous asd closure fully entered the clinical arena with the introduction of amplatzer septal occluder devices aso 6. Closure devices for patent foramen ovale, and atrial.
The amplatzer septal occluder aso is commonly used to close asds. We present a case of a 36 years old male, who had secundum type. Pdf percutaneous closure of an iatrogenic atrial septal. Atrial septal defect is characterized by a defect in the interatrial septum allowing pulmonary venous return from the left atrium to pass directly to the right atrium. Only few cases of device closure of atrial septal defect in dextrocardia with situs inversus totalis has been reported previously. The amplatzer pfo occluder set the standard, pioneering treatment with a device developed specifically for pfo closure. An asymptomatic atrial septal defect asd is often closed at the age of 35 years using a transcatheter or surgical technique. Device closure of secundum atrial septal defects in children pdf 353 kb cite. Although transcatheter closure of asd is considered safe and effective in pediatric patients, there are limited data regarding the efficacy and safety of device asd closure in smaller infants. Methods all adult danish patients 18 years diagnosed with asd from 1977 to 2009 n1168 were identified through populationbased registries. Atrial septal defects asds are the third most common congenital heart disease, comprising 610% of congenital heart defects. However, the percutaneous asd closure fully entered the clinical arena with the introduction of.
Patients with other source of righttoleft shunts, including an atrial septal defect andor fenestrated septum. From january 2006 to december 2009, 47 patients aged 50 years or more and suffered from atrial septal defect were enrolled in our institution. Device closure of atrial septal defect in patients of age more than. Longterm complications after transcatheter atrial septal defect. Percutaneous closure of an asd is currently only indicated for the closure of secundum asds with a sufficient rim of tissue around the septal defect so that the closure device does not impinge upon the superior vena cava, inferior vena cava, or the tricuspid or mitral valves. Difficulties in advancing the sheath over the av circuit. Follow up examinations showed a good result but an increasing enlargement of aortic root, so the. Fenestrated amplatzer atrial septal defect occluder in an. Previously, we reported a rare case of an adult patient with both asd and pda and. Techniques and devices for transcatheter treatment have been evolved and refined. Several randomized trials are in progress to determine whether pfo closure is preferable to.
After asd closure, both tee and transthoracic echocardiography showed optimal device position without residual shunt or mitral valve impingement. And its the leading pfo closure device to date, with over 100,000 devices implanted worldwide. Haemodynamically it was evaluated by test occlusion and sizing with a 24 mm amplatzer sizing balloon, monitoring left ventricular lv pressure via a pigtail catheter for 10. Percutaneous atrial septal defect closure using the. Introduction atrial septal defect asd is the second most common congenital heart disease in adults. Device deployment requires a rim of atrial septal tissue surrounding the defect to allow effective capture of the septum by the occluder. Transcatheter device closure of asd has come a long way since the first experimental closure in dogs by. Even though surgery is the gold standard, percutaneous device closure is gaining popularity because of the short learning curve, cosmetic advantage and relative safety.
Centrally located, secundum defects are ideal for device closure but there is considerable morphological variation in size and location of the defects. Individuals with asds and a history of cryptogenic stroke are typically treated with antiplatelet. Offpump atrial septal defect closure using the universal. Atrial fibrillation and stroke in adult patients with. Final page is signature page and is kept on file, but not issued with policy. The patient described improvement of chest tightness and exercise intolerance one week after asd closure, and his condition remained stable during the 4month followup period.
An asd is a hole between the upper left chamber called the left atrium and the upper right chamber called the right atrium of the heart. The aim of this study was to compare results of transcatheter and surgical asd closure in adults in latvia during the years 20022014 and to analyse longterm outcomes of transcatheter closure. Complications in atrial septal defect device closure pdf. Atrial septal defect asd free download as powerpoint presentation. Objective to estimate the risk of atrial fibrillation af and stroke and the impact of closure in patients with atrial septal defect asd compared with a general population cohort. Keywords patent foramen ovate, atrial septal defect, septal closure device, embolization of the right pulmonary artery, amplatzer device, cardiopulmonary bypass 1. All consecutive adult patients that underwent asd closure between 2008 and 2015 were included.
Catheterization and cardiovascular interventions 73. Atrial septal defect asd is a common congenital cardiac anomaly. Echocardiography demonstrated a saclike vegetation near the tricuspid valve tv and the occluder figure 1 a,b. Transcatheter closure of atrial septal defect journal of thoracic. Atrial septal defect asd closure is now commonly performed using a transcatheter, percutaneous approach and with the amplatzer septal occluder, large defects can be safely closed 1, 2. Safety and feasibility of transseptal puncture for atrial. Antithromboticantiplatelet treatment in transcatheter. A third device from the gore family, the gore cardioform asd occluder, designed to close larger defects, is currently in. The risk factors for cardiac erosion after device closure are not. Percutaneous device closure of secundum atrial septal defect asd has been increasingly developed and applied clinically with optimal. Normally blood does not flow directly between the left and right chambers of the heart. In the majority of cases, the secundum type of the asd is closed percutaneously in the catheterization laboratory.
This study sought to prove the safety and feasibility of intraoperative device closure of atrial septal defect asd with transthoracic minimal invasion in the older patients. Most large atrial septal defects now can be closed either with openheart surgery or during a cardiac catheterization using a device inserted into the opening to plug it referred to as interventional or therapeutic catheterization pdf. An atrial septal defect is the most common type of congenital heart disease among adults. After consulting patients family about his medical condition, the patient was scheduled for elective percuta neous device closure of asd along with a permanent pacemaker implantation in a single sitting. The amplatzer tm septal occluder is a percutaneous, transcatheter, atrial septal defect closure device intended for the occlusion of atrial septal defects asd in secundum position or patients who have undergone a fenestrated fontan procedure and who now require closure of the fenestration. The device was successfully implanted in 44 patients. Tte and tee assessment for asd closure 2 slideshare. Cardiac erosion related to transcatheter atrial septal defect closure devices is of. Transcatheter closure of large atrial septal defects in 18.
Echocardiographic approach to catheter closure of atrial. Atrial septal defect asd american heart association. The amplatzer tm pfo occluder set the standard, pioneering treatment with a device developed specifically for pfo closure. Conclusionsclosure of atrial septal defect with the amplatzer septal occluder is safe and. Even though percutaneous closure seems to be less risky than surgical repair, it may result in fatal complications like device embolism, cardiac perforation and tamponade.
The device was embolized into the distal part of the right pulmonary artery. Explantation of patent foramen ovale closure devices. Intraoperative device closure of atrial septal defects in. State of the art asd closure devices for congenital heart. Patients with anatomy in which the amplatzer pfo device size required would interfere with other intracardiac or intravascular structures, such as valves or pulmonary veins. The leading pfo closure device 1 structural heart solutions. Percutaneous transcatheter device closure of secundum atrial septal defects asd has now largely replaced surgical closure in most centres. It has the advantages of cost savings, better cosmetic results, and less trauma than surgical.
To describe complications associated with amplatzer septal occluders in a patient with marfan syndrome a nineyearold boy with marfan syndrome and a 22 mm atrial septal defect asd was treated successfully by interventional closure of his asd by placing a 24 mm amplatzer septal occluder. A 76yearold man with an atrial septal defect asd had a large left to right shunt, dilated right ventricle and raised estimated pulmonary arterial pressure of 62 mmhg on echocardiography, portending high risk closure. Device closure of secundum atrial septal defects and the risk of. With an incidence of 6 to 10 per 10,000 live births, ostium secundum atrial septal defects asd are one of the most common forms of congenital heart disease. We describe the safety and efficacy at longterm followup in adults. Most common congenital heart disease in both adults and children prevalence. An asd causes an abnormal increase in blood flow in the right side of the. Asd and pfo closure with the solysafe septal occluder. King and mills developed the first device for transcatheter closure of asd tcasd in 1976. Pdf cardiac erosion related to transcatheter atrial septal defect closure devices is of increasing concern. Irccs policlinico san donato amplatzer perimembranous vsd occluder tips, tricks, hints and pitfalls.
Patent foramen ovale the foramen ovale, a component of fetal cardiovascular circulation, consists of a. Traditionally, this has involved an assessment of asd size, geometry and atrial septal margins by transoesophageal echocardiography toe prior to percutaneous closure. Echocardiographic assessment and percutaneous closure of. Decisionmaking about whether closure is required typically relates to patient symptoms and. Surgical repair or percutaneous closure of the defect is the treatment options. Symptomatic asd or asd associated with pulmonary hypertension pht may require earlier closure, particularly in combination with other noncardiac risk factors for pht, but the indications for early closure and the potential risk for complications are largely. Staged transcatheter closure for atrial septal defect and. The occlutech figulla occluder has been proven safe and effective at midterm followup after percutaneous atrial septal defect asd closure. This is a semiinvasive technique, and all of the information obtained could potentially be obtained by. Pdf transcatheter device closure of atrial septal defect.
Atrial septal defect asd device transcatheter closure. Optimal atrial septal defect asd closure should combine offpump techniques with the effectiveness and versatility of openheart techniques. We removed the device surgically and closed the pfoasd. The history of device development for tcasd is a testament to innovation in the field of congenitalstructural. Objectives the aim of this study was to examine the frequency and causes of surgical explantation of patent foramen ovale pfo closure devices. Predictors of the need for an atrial septal defect closure. Atrial septal defect closure is now routinely performed using a percutaneous approach under echocardiographic guidance. Penetration of left and right atrial wall and aortic root. Significant atrial septal defects asd are closed, surgically or through a transcatheter device, in order to avoid pulmonary hypertension in late life. Pdf device closure of secundum asds and the risk of cardiac. Isolated asd results from abnormal development of the septa that partition the common atrium of the developing heart into right. Transcatheter closure of atrial septal defect and patent foramen ovale in adult patients using the amplatzer occlusion device.