Clinical evaluation of percutaneous and intra-operative device closure of atrial septal defects under transesophageal echocardiographic guidance: one center experience and mid-term follow-up

Abstract

Objective The percutaneous closure of a single secundum atrial septal defect (ASD) under transesophageal echocardiography guidance as an accepted alternative to the transcatheter closure with fluoroscopy has been proven. However, the technique has not been routinely used. This study was to present and share our experience in comparing the clinical outcomes of the percutaneous and intra-operative device closure (IODC) of atrial septal defects without fluoroscopy. Methods From January 2013 to December 2016, 103 patients with maximum diameters of ASD of less than 30 mm were allocated to groups taking either the percutaneous closure of atrial septal defects approach (PASD group, n = 53) or the intra-operative device closure approach (IODC Group, n = 50). They were operated on using the minimally invasive Amplatzer duct occluder under the guidance of transesophageal echocardiography without cardiopulmonary bypass. Echocardiography was performed to obtain an en face view of the ASD and important surrounding structures before the operation. Patient characteristics, perioperative data, and follow-up data were retrospectively documented and analyzed. Results Patient characteristics were comparable between the two groups. These were no differences in the maximum diameters of defects and the size of the occluders in each group (16.4 ± 5.3 mm vs16.4 ± 5.2 mm, P = 0.98; 22.4 ± 5.8 mm vs 21.3 ± 6.6 mm, P = 0.38). Intracardiac manipulation time was 20.72 ± 7.70 min in the PASD group and 6.01 ± 1.03 min in the IODC group (P < 0.001). The procedure time was 28.70 ± 10.41 min in the PASD group and 39.13 ± 6.03 min in the IODC group (P < 0.001). The successful closure defect was 100% in both groups when the maximum diameter of defect less than 25 mm. Four patients the PASD groups with maximum diameters between 25 mm and 30 mm were transferred to the IOCD group after unsuccessful device implantations. The total occlusion rate was 82% immediately after deployment, 98% at 3 months, and 100% at 6 months. No cardiac-related complications occurred during the follow-up period of between 3 to 65 months (mean 21.4 ± 9.8 months). Conclusions Percutaneous device closures of Secundum atrial septal defects showed safety and high efficiency in patients under guidance by transesophageal echocardiography when compared with intra-operative device closures and are especially suited for women and children.

Effect of remifentanil-based fast-track anesthesia on postoperative analgesia and sedation in adult patients undergoing transthoracic device closure of ventricular septal defect

“…The puncture of a femoral vein performs percutaneous device closure without a significant surgical incision. However, the percutaneous approach can be challenging because the patient has to undergo multiple exposures to X-ray radiation, which is particularly inappropriate for pregnant women and children [13,14]. The location and the surrounding structure of the VSD are essential factors in the procedure success.…”

Embolization of an Atrial Septal Defect Occluder Device Into the Left Ventricle

“…Amplatzer Atrial Septal Occluder device has been routinely and successfully used as a percutaneous alternative to conventional cardiac surgery for closure of atrial septal defects. Transcatheter closure of secundum type of ASD has become a standard treatment that is less invasive and presents with fewer complications and shorter recovery time than surgery, which requires cardiopulmonary bypass [1][2][3][4][5][6]. The occlusion techniques using this device include classic percutaneous ASD occlusion under fluoroscopy, percutaneous procedure under ultrasound-guidance, and intra-operative device close under ultrasoundguidance [1].…”

“…The occlusion techniques using this device include classic percutaneous ASD occlusion under fluoroscopy, percutaneous procedure under ultrasound-guidance, and intra-operative device close under ultrasoundguidance [1]. While percutaneous occlusion is generally considered effective and safe for patients with secundum ASD, limitations with this technique using fluoroscopy include damaging radiation exposure and higher risk for complications for children under 10 years of age [1,2]. The size and rim of the ASD in addition to the size of the occluder are also important to consider when using the percutaneous approach.…”

“…Atrial septal defect (ASD) is one of the most common congenital cardiac malformations [1][2][3]. ASD transcatheter occlusion techniques can use various devices, including the Amplatzer Septal Occluder, and have become the alternative to the surgical treatment of ASD [1][2][3][4].…”

“…Atrial septal defect (ASD) is one of the most common congenital cardiac malformations [1][2][3]. ASD transcatheter occlusion techniques can use various devices, including the Amplatzer Septal Occluder, and have become the alternative to the surgical treatment of ASD [1][2][3][4]. However, complications using such devices have been reported, including embolization, malposition, erosion, arrhythmias, endocarditis, and thromboembolic events [1,[4][5][6].…”