Assessment of atrial septal defects in adults comparing. Infective endocarditis involving atrial septal occluder. Echocardiographic assessment and percutaneous closure of. Antithromboticantiplatelet treatment in transcatheter. Atrial septal defect asd american heart association. Explantation of patent foramen ovale closure devices. Irccs policlinico san donato amplatzer perimembranous vsd occluder tips, tricks, hints and pitfalls. Staged transcatheter closure for atrial septal defect and. 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. Intraoperative device closure of atrial septal defect in. Background pfo has been linked with cryptogenic strokes, recurrent transient neurologic deficits, sleep apnea, decompression illness, and migraines. Rtol shunt through the pfoasd due to functional tricuspid stenosis. It has the advantages of cost savings, better cosmetic results, and less trauma than surgical. Atrial septal defect asd is one of the more commonly recognized congenital cardiac anomalies presenting in adulthood.
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. Isolated asd results from abnormal development of the septa that partition the common atrium of the developing heart into right. Tte and tee assessment for asd closure 2 slideshare. However, the percutaneous asd closure fully entered the clinical arena with the introduction of. Percutaneous device closure of secundum atrial septal defect asd has been increasingly developed and applied clinically with optimal. 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. Percutaneous transcatheter device closure of secundum atrial septal defects asd has now largely replaced surgical closure in most centres.
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. 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. Echocardiography demonstrated a saclike vegetation near the tricuspid valve tv and the occluder figure 1 a,b. Longterm complications after transcatheter atrial septal defect. Complications in atrial septal defect device closure pdf. The amplatzer tm pfo occluder set the standard, pioneering treatment with a device developed specifically for pfo closure. State of the art asd closure devices for congenital heart. Final page is signature page and is kept on file, but not issued with policy. 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.
Device closure of atrial septal defect in patients of age more than. Intraoperative device closure of atrial septal defect is a safe and feasible technique for infants. An atrial septal defect is the most common type of congenital heart disease among adults. Atrial fibrillation and stroke in adult patients with. However, if the asd is in an unusual position within the heart, or if there are other heart defects such. Transcatheter closure of atrial septal defect and patent foramen ovale in adult patients using the amplatzer occlusion device. Device closure of diverse layout of multihole secundum atrial septal. We present a case of a 36 years old male, who had secundum type. Patients were divided into two groups, 27 of which in group i with. The risk factors for cardiac erosion after device closure are not.
Pdf percutaneous closure of an iatrogenic atrial septal. Outcomes after device closure of atrial septal defect in children. The occlutech figulla occluder has been proven safe and effective at midterm followup after percutaneous atrial septal defect asd closure. Atrial septal defect asd free download as powerpoint presentation. Transcatheter closure of atrial septal defect asd is an established procedure in children and young adults, but the benefit of this procedure in older. Predictors of the need for an atrial septal defect closure. Decisionmaking about whether closure is required typically relates to patient symptoms and. And its the leading pfo closure device to date, with over 100,000 devices implanted worldwide. Using cox regression, we compared asd patients risk of af and. Patients with other source of righttoleft shunts, including an atrial septal defect andor fenestrated septum. Techniques and devices for transcatheter treatment have been evolved and refined. The device was embolized into the distal part of the right pulmonary artery. Pdf device closure of secundum asds and the risk of cardiac. Pdf cardiac erosion related to transcatheter atrial septal defect closure devices is of increasing concern.
Asd and pfo closure with the solysafe septal occluder. Offpump atrial septal defect closure using the universal. Cardiac erosion related to transcatheter atrial septal defect closure devices is of. Transcatheter closure of atrial septal defect journal of thoracic. 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. Device closure of secundum atrial septal defects in children pdf 353 kb cite. The amplatzer septal occluder aso is commonly used to close asds. Individuals with asds and a history of cryptogenic stroke are typically treated with antiplatelet. However, the wide use of asd closure devices and the growing experience worldwide brought some delayed and rare complications to light. Intraoperative device closure of atrial septal defects in. Atrial septal defect asd is a common congenital cardiac anomaly. Atrial septal defect closure is now routinely performed using a percutaneous approach under echocardiographic guidance. 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. Methods all adult danish patients 18 years diagnosed with asd from 1977 to 2009 n1168 were identified through populationbased registries.
A third device from the gore family, the gore cardioform asd occluder, designed to close larger defects, is currently in. Penetration of left and right atrial wall and aortic root. Device closure has become the treatment of choice for closing asds 1, 2 with approximately 80% of secundum defects being suitable for device closure. Conclusionsclosure of atrial septal defect with the amplatzer septal occluder is safe and. However, the percutaneous asd closure fully entered the clinical arena with the introduction of amplatzer septal occluder devices aso 6.
Closure of secundum atrial septal defects with the. 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. Fenestrated amplatzer atrial septal defect occluder in an. Atrial septal defect asd device transcatheter closure. Complication rates in this group of smaller patients are not. Optimal atrial septal defect asd closure should combine offpump techniques with the effectiveness and versatility of openheart techniques.
Atrial septal defect asd is one of the most common congenital heart diseases, and secundum asd accounts for approximately 80% of cases. Introduction atrial septal defect asd is the second most common congenital heart disease in adults. Even though surgery is the gold standard, percutaneous device closure is gaining popularity because of the short learning curve, cosmetic advantage and relative safety. Atrial septal defects asds are the third most common congenital heart disease, comprising 610% of congenital heart defects. From january 2006 to december 2009, 47 patients aged 50 years or more and suffered from atrial septal defect were enrolled in our institution. Traditionally, this has involved an assessment of asd size, geometry and atrial septal margins by transoesophageal echocardiography toe prior to percutaneous closure. Follow up examinations showed a good result but an increasing enlargement of aortic root, so the.
Many adult patients with secundumtype atrial septal defects asds are able to have these defects fixed percutaneously. 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. Only few cases of device closure of atrial septal defect in dextrocardia with situs inversus totalis has been reported previously. 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. 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. Most common congenital heart disease in both adults and children prevalence.
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. Pdf transcatheter device closure of atrial septal defect. 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. Several randomized trials are in progress to determine whether pfo closure is preferable to. Previously, we reported a rare case of an adult patient with both asd and pda and. Keywords patent foramen ovate, atrial septal defect, septal closure device, embolization of the right pulmonary artery, amplatzer device, cardiopulmonary bypass 1.
Atrial septal defect closure has been shown to result in a significant reduction in rv and an increase in left ventricular volumes. 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. Safety and feasibility of transseptal puncture for atrial. Percutaneous atrial septal defect closure using the. The history of device development for tcasd is a testament to innovation in the field of congenitalstructural. 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. King and mills developed the first device for transcatheter closure of asd tcasd in 1976.
We report the results of a prospective multicenter pilot study performed in germany, sweden, and switzerland with a new self. 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. Such leadership is one reason physicians can rely on amplatzer tm since as an industryleading design, it facilitates easy closure. Patent foramen ovale the foramen ovale, a component of fetal cardiovascular circulation, consists of a. Transcatheter closure of large atrial septal defects in 18. Difficulties in advancing the sheath over the av circuit. Echocardiographic approach to catheter closure of atrial. 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. 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. Open surgery for retrieval of patent foramen ovale closure. Device closure of secundum atrial septal defects and the risk of. An asd causes an abnormal increase in blood flow in the right side of the. 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.
Device closure of secundum atrial septal defects in. A patent foramen ovale pfo may need to be closed because of transient shunt reversal resulting in transient ischaemic events or stroke. The amplatzer pfo occluder set the standard, pioneering treatment with a device developed specifically for pfo closure. Normally blood does not flow directly between the left and right chambers of the heart. An asymptomatic atrial septal defect asd is often closed at the age of 35 years using a transcatheter or surgical technique.
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. After asd closure, both tee and transthoracic echocardiography showed optimal device position without residual shunt or mitral valve impingement. Centrally located, secundum defects are ideal for device closure but there is considerable morphological variation in size and location of the defects. 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. Transcatheter device closure of asd has come a long way since the first experimental closure in dogs by. Closure devices for patent foramen ovale, and atrial. In the majority of cases, the secundum type of the asd is closed percutaneously in the catheterization laboratory. 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. Feasibility of device closure for multiple atrial septal. This is a semiinvasive technique, and all of the information obtained could potentially be obtained by. All consecutive adult patients that underwent asd closure between 2008 and 2015 were included. Objectives the aim of this study was to examine the frequency and causes of surgical explantation of patent foramen ovale pfo closure devices. We describe the safety and efficacy at longterm followup in adults.
The device was successfully implanted in 44 patients. Device deployment requires a rim of atrial septal tissue surrounding the defect to allow effective capture of the septum by the occluder. Catheterization and cardiovascular interventions 73. We report our experience with offpump asd closure using the universal cardiac introducer uci in a porcine model. Surgical repair or percutaneous closure of the defect is the treatment options.
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