Closure of Interatrial Septal Communications: Adverse Events and Lessons Learned

Abstract

BackgroundPercutaneous closure of interatrial septal communications (IASC) is generally being regarded as a safe and straightforward intervention. Reporting and classification of adverse events (AE) as is the case for percutaneous coronary intervention (PCI) is not standardized. Also, the focus of reported larger studies has not been primarily on AE and strategies to avoid them.MethodsThe data of all 112 consecutive patients undergoing IASC by a single operator were reviewed. In analogy to classification for PCI, an AE was considered to be major if any of the following occurred: death, major or minor stroke, myocardial infarction, the need for an originally unplanned additional surgery or intervention or blood transfusion. Every AE and how it may have been avoided is reviewed in detail.ResultsMajor AE according to the suggested classification occurred in 2.7% of patients, including tamponade in 1 patient necessitating thoracotomy 7 months after IASC, percutaneous retrieval of an embolized device in 1 patient, and ambulatory same day surgical treatment of an arteriovenous fistula in 1 patient.ConclusionsThe proposed new classification of AE provides a unified and comparable approach for IASC procedures. Retrospectively, two of the 3 major AE could have probably been avoided by more thoughtful patient and material selection.

A randomized, controlled, multi‐center trial of the efficacy and safety of the Occlutech Figulla Flex‐II Occluder compared to the Amplatzer Septal Occluder for transcatheter closure of secundum atrial septal defects

“…Although much uncertainty still remains as to the relative importance of the device, the defect and the implantation technique in the causation of this most worrying of complications, particularly considering the potential for late presentation , one has to assume that a stiffer device may lead to greater endocardial trauma. To date, there have been no published cases of cardiac erosion with the newer Occlutech ASD occluders, however there is one report with the original device . Although arguments can be made for the benefits of the design features of the OFFII supporting a more successful initial deployment rate and a more natural device deployment position, longer term follow‐up studies are required to determine if the less rigid device design will significantly reduce the last valid argument, cardiac erosion, leading to concerns with transcatheter ASD closure.…”

Can Computer Tomography Predict Compromise of Cardiac Structures After Percutaneous Closure of Interatrial Septal Defects?

“…As documented [1], the intrainterventional TEE had not detected impingement of cardiac structures in this patient, which is the reason why we decided to review our CT (and not TEE) data for the investigation of this question.…”

Surgical management of embolized Amplatzer septal occluder into the left ventricle tangled with the mitral valve

“…Management of ASO embolizations has been previously described in the literature as single case reports and very few multicenter experiences have been reported. 1,2,[4][5][6][7] Embolization sites can be the right atrium, right ventricle, pulmonary valve, tricuspid valve, and F I G U R E 1 A, Transthoracic echocardiography showing Amplatzer atrial septal occluder tangled with mitral anterior leaflet chordal apparatus. B, Cath-lab fluoroscopy of percutaneous retrieval attempt procedure, with the left atrial appendage occluder implanted and the dislodged atrial septal occluder snared through its waist by means of a loop F I G U R E 2 A, Left ventricular inferior dissecting hematoma.…”