Combination of F-ASO and Targeted Medical Therapy in Patients With Secundum ASD and Severe PAH

First in-human modified atrial septostomy combining radiofrequency ablation and balloon dilation

“…Under local anaesthesia, percutaneous punctures of the femoral vein were performed and two intravenous introducers were inserted (one 8F introducer and one 11F introducer; Cordis, Cashel, Ireland) (online supplemental figure 1). All patients underwent right heart catheterisation using a 6F multipurpose diagnostic catheter (Cordis, Miami, Florida, USA) 27. After percutaneous puncture of the right femoral artery or radial artery, a 5F pigtail catheter (Terumo Medical, Somerset, New Jersey, USA) was introduced to perform left heart catheterisation.…”

“…For each patient, TTE was performed before CURB (online supplemental figure 3) and during follow-up. The interatrial fenestration size was defined as the largest dimension observed from the parasternal short-axis view, parasternal four-chamber view or subcostal view 27. Additionally, the direction of shunting was determined using Doppler echocardiography.…”

Transcatheter Interventions in Patients With Adult Congenital Heart Disease

“…4 Patients with severe pulmonary hypertension are usually not candidates for ASD closure; however, the use of pulmonary vasodilator therapy may reduce the pulmonary arterial pressure and resistance enough to permit ASD closure, with or without the use of a fenestrated device. 14,15 Although the surgical outcomes of ASD closure are excellent Q12 , surgical closure of an ostium secundum ASD has a higher complication rate than transcatheter closure, 16 and, thus, transcatheter closure has become the standard of care for most ostium secundum ASDs in adults. Preprocedural evaluation using transesophageal echocardiography (TEE) or cross-sectional imaging (cardiac computed tomography angiography [CTA] or MRI) is used to screen for associated defects, rule out partial anomalous pulmonary venous connections, and assess the rim size of ASDs.…”

Interventions in Congenital Heart Disease:A Review of Recent Developments: Part I

“…31 The InterAtrial Shunt Device (IASD) system (Corvia Medical, Tewkesbury, MA, USA) features a single fenestration size of 8 mm, 32 and the MemoPart atrial septal occluder (Shanghai Shape Memory Alloy, Shanghai, China) can be manufactured with a single 10-mm fenestration. 33 Several studies have reported successful use of the AFR in patients with PAH with significant symptomatic improvement, 29,31 with fenestration diameters of 8 to 10 mm considered important to provide clinical improvement of left ventricular preload. Short-term follow-up demonstrated persistent fenestration patency with tolerated induced hypoxia.…”

“…The fenestration was patent in all patients at a median of 10 months following implantation, with negligible left to right shunting (Qp:Qs 1.1) and no device-related complications. 33 While initial results with fenestrated ASD device closure in selected patients with PAH-ASD are promising, caution is warranted in applying this strategy more broadly. The longterm outcomes and risk of progression of underlying pulmonary vascular disease after ASD closure are unknown.…”