Transcatheter closure of multiple atrial septal defects with. 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. Case 10 years old boy underwent successful transcather device closure of secundum asd in august 2011 with a 22 mm amplatzer septal occluder device. Percutaneous closure of atrial defects asd has evolved as the treatment of choice for the majority of defects and patent oval foramens. Pediatric cardiac interventions atrial septal defect asd. Closure of atrial septal defects with the amplatzer. Pediatric cardiac interventions atrial septal defect. Transcatheter and intraoperative device closure and surgical. We aimed to establish a simple and accurate method for device size selection using threedimensional echocardiographic. Factors that decide suitability for transcatheter closure include size of the defect and presence of adequate tissue rims around the defect 32. Antibiotics help prevent a heart infection called bacterial endocarditis.
Balloon sizing can be tedious, time consuming and increase fluoroscopy and procedure times as well as risk of complications. Pdf heart block after asd device closure researchgate. Jul 25, 2017 nonsurgical closure postdevice closure followup. Transcatheter device closure of atrial septal defects jacc. Echocardiography guidance of atrial septal defect closure transcatheter procedures offer less invasive approaches allowing rapid recovery and earlier hospital discharge. Transcatheter device closure of asd has come a long way since the first experimental closure in. Paul, mn is a selfexpandable, doubledisc, occlusion device made of nitinol mesh, approved by the us food and drug administration in 2001 for percutaneous closure of secundum atrial septal defect asd. Surgical treatment is safe and efficient, but entails the complications associated with thoracotomy, as well as the. The amplatzer, which is fda approved, is a twotiered, expanding device that closes the asd and are available in differentsizes. To close the hole, the doctor will place a special device in your childs heart by catheterization. Complications in atrial septal defect device closure. Asd device closure usually is a procedure of choice for asd. Your child is a possible candidate for this procedure, because there is considered to be a high likelihood of successful closure with this device. The presence of an asd or pfo can result in gas embolization to the arterial circulation and the development of neurological symptoms, known as decompression illness.
Thus, closure of asd in patients with pulmonary hypertension was considered as a highrisk procedure, especially with surgical closure. The procedure of percutaneous asd closure required tee or intracardiac echocardiography ice. The surgical technique now consists of approximating the edges of the defect in small. Even though surgery is the gold standard, percutaneous device closure is gaining popularity because of the short learning curve, cosmetic advantage and relative safety. An atrial septal defect asd is, due to its frequency, the fourth most common congenital heart disease, appearing in 3. Asd closure is indicated in the presence of a significant lefttoright shunt, defined by a significant right heart enlargement due to volume overload, regardless of symptoms 3,4. Atrial septal defect asd is a common congenital cardiac anomaly. We examined the efficacy and safety of the amplatzer, a new selfcentering. Background transcatheter device closure of secundum atrial septal defects asd using amplatzer septal occluder aso is usually well tolerated with favourable outcome with analgesics. Most common congenital heart disease in both adults and children prevalence.
Us8398658b2 device and procedure for minimally invasive. Pdf device closure of secundum asds and the risk of cardiac. Both of these types of asds can be easily closed using the transcatheter technique 4. Transcatheter device closure of atrial septal defects. The catheter will be introduced into a leg vein at the groin and xray pictures angiograms performed to show the defect. Device embolization is a potential complication of every attempted asd closure, and the causative factors can be undersized device, inadequate or floppy rim, operatorrelated technical issues such as malposition during the pushpull maneuver, or excessive tension on delivery cable during device deployment. Transthoracic echo tte is done to assess the superior, aortic and mitral rims. We compared the clinical data and followup results of percutaneous and intraoperative device closure for asd to evaluate the feasibility.
Transcatheter closure of atrial septal defect using amplatzer septal occluder. A number of international guidelines have defined the role of echocardiography spanning diagnosis, detailed anatomical assessment, device sizing and selection, peri procedure. Only few cases of device closure of atrial septal defect in dextrocardia with situs inversus totalis has been reported previously. The technique used by the authors is to be commended for its simplicity. Device oversizing may increase the risk of erosion. We reported a 4 years old boy that developed a first and second degree heart block few days after. Atrial septal defect closure device radiology case. Methods sixtyeight infants underwent transthoracic device closure of an asd at union hospital, fujian medical university, fuzhou, china from january 2010 to january 2015. Our goal was to compare percutaneous versus mics of asds. Toe for percutaneous closure of septal defect asd, vsd. Shortterm and midterm followup of transthoracic device. All of these tested to date are considered to be acceptable for patients referred for mr examinations based on findings for deflection angles, torque, mrirelated heating and the intended in vivo uses of these specific devices.
The biostar biodegradable implant avoids many issues associated with devices containing substantial amounts of metal. The closure i evaluation of the starflex closure system in patients with a stroke andor transient ischemic attack due to presumed paradoxical embolism through a patent foramen ovale trial was the first multicenter, open. Contraindications to device closure asd closure procedures. The current gold standard for device size selection is balloon sizing. Reviewed was a consecutive series of 10 asd occlusions in a. The purpose of this study was to outline the safety and feasibility of transthoracic device closure of an atrial septal defect asd with a domestic occluder in infants. Closure of secundum atrial septal defects with the. Aga medicalthe amplatzer septal occluder and delivery system instructions for use pdf. Various pda, asd, vsd occluders and pfo closure devices have been evaluated at 3tesla see the list. Our knowledge of the complication rates of asd and pfo. A guide wire is introduced through the femoral vein into the inferior vena cava and further through the right atrium across the asd. We have used this technique in 3 patients ourselves, and we were able to successful close the defect in 2 patients. Get an operative photograph of the defect and re analyse whether device would have been possible in retrospect.
Though closure of os asd with device is now a standard fda approved mode of treatment, there are few wellknown immediate, intermediate, and longterm complications. Review article percutaneous device closure of secundum. After asd closure, both tee and transthoracic echocardiography showed optimal device position without residual shunt or mitral valve impingement. Ucsf offers a minimally invasive approaches for atrial septal defect asd closure. Closure of atrial septal defect with amplatzer device.
Transcatheter closure of atrial septal defect with amplatzer. However, unlike earlier devices, the current generation is easier to deploy and retrieve. If the hole is too big to close with the device or in the wrong position, the hole will be closed with surgery. Atrial septal defect asd american heart association. Patent foramen ovale closure for stroke prevention and other. Consensually agreed indications and imaging guidance for closure. Transcatheter closure of atrial septal defect journal of thoracic. Device closure is the firstline treatment for most atrial septal defects asds. Transesophageal echocardiography for device closure of. Transcatheter device closure of asd has come a long way since. Left atrial thrombus on atrial septal defect closure device as a source of cerebral emboli 3 years after implantation. The secret to a successful procedure includes meticulous. By using the mesh device called the amplatzer, pediatric cardiologists are now able to close the hole in a hospital procedure room known as the catheterization laboratory.
Jul 19, 2019 transcatheter and intraoperative device closure for atrial septal defect asd are widely applied to reduce the incision size and the potential for injury during cardiopulmonary bypass cpb in conventional surgical repair. A surgical device for closure atrial septal defect asd with minimally invasive approach includes a head portion which is movable and includes a distal jaw that is distal relative to a person holding the surgical device, a guide rod which drives the distal jaw, and a plurality of first sutureguide channels attached to the distal jaw, and a body portion which is stationary and includes a. Erosion of amplatzer septal occluder device after closure of secundum atrial septal defects. Surgicaldevice closure indicated see above discussion under management o chf present o defect not spontaneously closed by 24 years of age two treatment options surgical or device o choice depends on. Rhythm disturbance is one of these uncommon complications 57. Analysis of the therapeutic effect of transesophageal. The patients are administered aspirin 5 mgkgday for 6 months. A biodegradable device biostar for atrial septal defect. Device closure of asd is suitable for secondum asd with a good rim all around for holding the two discs together. We aimed to establish a simple and accurate method for device size selection using threedimensional.
Atrial septal defect sizing and transcatheter closure fulltext. Problems in peroperative secundum atrial septal defect. Transcatheter and intraoperative device closure for atrial septal defect asd are widely applied to reduce the incision size and the potential for injury during cardiopulmonary bypass cpb in conventional surgical repair. Complications of transcatheter atrial septal defect closure. We read with interest the article by liang and colleagues 1 regarding surgical closure of the secundum atrial septal defect asd with a device. None of the devices previously used for transcatheter closure of interatrial communications has gained wide acceptance. Always refer large defects and complex asds which are adjacent to aorta and av to a good surgeon. Transcatheter device closure of asd has come a long way since the first experimental closure in dogs by kings and mills in 1972. Jul 22, 2010 the inclusion criterion was a balloon stretched asd diameter of. The most critical step in asd device closure lies before the procedure and. Though closure of osasd with device is now a standard fda approved mode of treatment, there are few wellknown immediate, intermediate, and longterm complications.
However, transcatheter closure without cardiopulmonary bypass can be performed even in such highrisk patients, and several clinical studies have demonstrated the efficacy and safety of asd closure 33, 34. Echocardiography guidance of atrial septal defect closure. No studies had been conducted to compare the safety and efficiency of these three treatments. Complications related to the procedure were minimal 16 patients. The secret to a successful procedure includes meticulous planning and execution. Current concept of transcatheter closure of atrial septal. A novel threedimensional echocardiographic method for. In this paper, we describe the stepbystep procedure for transcatheter closure of an atrial septal defect using the. Pdf transcatheter device closure of atrial septal defect in.
Transesophageal echocardiography tee guidance for the closure procedure not only broadens the indications of interventional therapy for asds but also avoids radiation exposure. Atrial septal defect asd transcatheter closure is also called asd closure. Secundum atrial septal defect asd is a common congenital heart. Atrial septal defect asd device transcatheter closure. The benefits are significant including less post operative pain at the incision site, a shorter hospital stay, a faster return to normal activities, and an. Post procedure echo studies check for a residual atrial shunt and unobstructed flow of pulmonary veins, coronary sinus, and venae cavae and proper function of the mitral and tricuspid valves. If the asd is large, it can be closed with openheart surgery, or by cardiac catheterization using a device inserted into the opening to plug it. Transcatheter device closure of secundum asd is a maturing technology, now more. Factors that decide suitability for transcatheter closure include size of the defect and presence of adequate tissue rims around the defect. Transcatheter and intraoperative device closures have been widely used in the treatment of secundum atrial septal defect asd. In our patient the asd device was delivered using the standard technique from the right upper pulmonary vein without using any balloon or dilator assistance. The following is the supplementary data related to this article.
Transcatheter closure of atrial septal defect with. Surgical device closure indicated see above discussion under management o chf present o defect not spontaneously closed by 24 years of age two treatment options surgical or device o choice depends on. Heart block after asd device closure medcrave online. Pdf transcatheter device closure of atrial septal defect. Transesophageal echocardiography for device closure of atrial. The adverse prognosis of untreated asd diagnosed in childhood is well studied and percutaneous device closure of these asds has evolved to become the standard of care in both pediatric and young adult populations.
When compared to surgery, it provides a less invasive approach with quicker recovery and reduced physical and psychological impact. Device closure of atrial septal defect asd and patent foramen ovale pfo are both associated with short and longterm complications. Patent foramen ovale closure for stroke prevention and. Ostium secundum atrial septal defect asd is a common congenital heart defect. Transcatheter device closure for secundum asd is the treatment of choice when the patient has a good rims 1,2 and it has an excellent shore and long term results with minimal complications 3,4. Device closure of atrial septal defect request pdf. A guide wire is introduced through the femoral vein into the inferior vena cava and further through the right atrium. You may need to take antibiotics before dental or other procedures for up to 6 months after your asd closure. Sometimes, if the asd is an unusual position within the heart, or if there are other heart defects such as abnormal connections of the veins bringing blood from the lungs back to the heart pulmonary. Transcatheter device closure of atrial septal defect in dextrocardia with situs inversus totalis. Proper device size selection is a crucial step for successful asd device closure. Anaesthesia for percutaneous closure of atrial septal defects. We compared the clinical data and followup results of percutaneous and intraoperative device closure for asd to evaluate the feasibility, safety, and.
The search for less invasive alternatives to surgery for closing secundum atrial septal defects asd has occupied cardiologists for decades. Descriptions of percutaneous device closure of a secundum asd have been extensively reported in other articles and will therefore not be detailed in. Double disk umbrella helex coils asd vsd amplatzer figulla ceraflex. The amplatzer septal occluder aso has been approved since 2005 in japan, but there. From january 2018 to april 2018, 87 patients with an isolated asd who had. The operation is performed using a small 46 cm incision through the small space between the ribs. However, for young infants with asd, device closure remains controversial, and such treatment features limited data. Complications in atrial septal defect device closure pdf. A number of international guidelines have defined the role of echocardiography spanning diagnosis, detailed anatomical assessment, device sizing and selection, peri procedure guidance and post device surveillance. Transcatheter closure of a secundum asd has been used for years with good results.
Transcatheter closure of multiple atrial septal defects. Minimally invasive surgery vs device closure for atrial. Transcatheter and intraoperative device closure of atrial. King and mills demonstrated the feasibility of asd closure by using a device in 1974 2. Minimally invasive cardiac surgery mics has been found safe and effective for asd closure with comparable mortalitymorbidity and superior cosmetic results compared to conventional median sternotomy. Minimally invasive atrial septal defect asd closure. Atrial septal defect transcatheter closure discharge care. Selection of device size for atrial septal defect closure.
A novel threedimensional echocardiographic method for device. Closure of atrial septal defects with the amplatzer occlusion. This study reports our clinical experience with transcatheter closure of secundum atrial septal defects asds in children, using the amplatzer, a new occlusion device. Device closure of secundum atrial septal defects and the risk of.
This type of asd is technically challenging for device closure and requires specialized imaging and deployment techniques 5. An atrial septal defect is a hole between the two upper chambers of the heart. The duration of the procedure will be about 12 hours. Dec 12, 2014 asd device closure usually is a procedure of choice for asd secondom when the patient has good rims and files full the criteria for that 810 rhythm disturbance is very rare complication of this procedure 7, and usual common in small children who has large defects need large device for suitable closure. Transcatheter closure of atrial septal defects asds has become an alternative to open surgical procedures. Percutaneous catheter closure of atrial septal defect. Review article percutaneous device closure of secundum atrial. Transcatheter closure of secundum atrial septal defect asd with amplatzer device is an alternative procedure to surgical repair, with some limitations. Complications of asd closure surgery versusdevices device n442 surgery n154 p arrhythmia needing rx 2 0 0. Surgical closure of atrial septal defect asd has been the treatment of choice for decades, with excellent results, negligible mortality and limited morbidity. Accurate imaging of the anatomic features of the asd is critical for case selection. The aim of this study was to assess the initial and midterm results of the treatment of asd with amplatzer septal occluder in children and adolescents.
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