Atrial and Ventricular Septal Defects Can Safely Be Closed by Percutaneous Intervention

Abstract

Various transcatheter devices and methods to close congenital heart defects are currently available. Devices have been designed specifically for atrial septal defect (ASD), patent foramen ovale (PFO), and ventricular septal defect (VSD) closure. The trend in interventional treatment of intracardiac shunts shows toward defect-specific systems. The PFO is a tunnel defect requiring occluders that adapt to its length while common ASD strongly vary in their diameter, making a large scale of device sizes indispensable. VSDs are predominantly sealed by coils or tissue-adapted devices like muscular or perimembranous occluders. Since VSDs may occur with an aneurysm (VSA), a multi-perforated septum, an instable myocardial situation (postinfarction) or a high interventricular pressure gradient, closure of these defects is regarded sometimes as complicated. But during the last 30 years (since King and Mills implanted the first double-umbrella occluding system) several studies have proven procedure efficacy and safety of both ASD and VSD closure. This article reviews a large scale of studies and includes our single center data on 1,609 PFO, ASD, and VSD patients.

Transcatheter Intracardiac Echocardiography‐Assisted Closure of Interatrial Shunts: Complications and Midterm Follow‐Up

“…Although a specific comparison between a surgical approach and ICE‐aided percutaneous closure is beyond the scope of this experience, our study tried to evaluate the impact of ICE on procedural safety and success on midterm follow‐up. Our data suggest that midterm outcomes of ICE‐assisted closure compared very well with the results of surgical series and seem even better in terms of late complications than percutaneous series assisted by TEE 13 . In particular, the absence of erosion and device thrombosis in ICE‐guided procedures seems very attractive compared with TEE‐assisted procedure in which erosion and thrombosis appeared to be 0.1 and 2.5%, respectively 14–15 …”

“…Our data suggest that midterm outcomes of ICE-assisted closure compared very well with the results of surgical series and seem even better in terms of late complications than percutaneous series assisted by TEE. 13 In particular, the absence of erosion and device thrombosis in ICE-guided procedures seems very attractive compared with TEE-assisted procedure in which erosion and thrombosis appeared to be 0.1 and 2.5%, respectively. [14][15] Transcatheter closure of ostium secundum ASD has been performed for years using deep sedation or orotracheal intubation, transesophageal echocardiography, and the sizing balloon technique for size measuring the "stopflow" diameter of the defects.…”

PFO and Right-to-Left Shunting in Patients with Obstructive Sleep Apnea

“…31 Finally, tigation of the following aspects should be among the priorities in studying this patient population: First, it would be very important to prospectively establish whether individuals with OSA and PFO are more likely to experience strokes and, perhaps, are more likely to suffer from pulmonary or systemic hypertension than those with OSA and absent interatrial communication. Second, given the demonstrated procedural safety, 40 the impact of percutaneous PFO closure on the incidence of strokes and other undesired associated conditions such as pulmonary hypertension and systemic hypertension in this patient population should be investigated. Though it would allow further elucidation of the physiology and association of OSA and PFO, a randomized comparison of patients with OSA and PFO treated with CPAP compared to no treatment is, of course, unethical.…”

Oclusão percutânea de uma comunicação interatrial tipo ostium primum: nova opção terapêutica ou apenas um golpe de sorte?

“…Em ambos os casos, a ausência total da borda inferior do defeito impede a fixação das próteses tradicionais, tornando impossí-vel a abordagem terapêutica com cateter 2,3 .…”