Cribriform Amplatzer Device Closure of Fenestrated Atrial Septal Defects: Feasibility and Technical Aspects

Abstract

Fenestrated atrial septal defects (F-ASDs) may pose a challenge to device closure; recently, a cribriform device with a minimal connecting intrawaist diameter and large, equal left- and right-sided discs has been designed to cover more than one adjacent defect. This study demonstrates the feasibility and technical aspects of closing F-ASDs using this new device. Sixteen patients between August 2003 and January 2006 were included in this study. The inclusion criterion was the presence of a F-ASD diagnosed by transesophageal echocardiography. One of the three available cribriform ASD device sizes (18, 25, or 35 mm) was implanted. Patients were followed for at least 1 year after the procedure. Thirteen patients had successful cribriform ASD device implantation (median age and weight, 12.5 years and 36 kg, respectively). Ten patients (62%) had an associated atrial septal aneurysm. The mean procedure time was 75.6 +/- 28.5 min and the mean fluoroscopy time 14.8 +/- 6.3 min. The RVEDD was significantly reduced, from a mean of 24.2 mm to 21.0 (p < 0.05). One patient developed atrial tachycardia requiring cardioversion during the procedure. There were no embolic events, heart block, or mortality. Complete closure was 10 of 13 (77 %) the next day and 12 of 13 (92%) at 6 and 12 months. We conclude that the cribriform Amplatzer device can be successfully and safely used in patients with F-ASDs. Complete closure may take up to 6 months.

Helex device closure of multiple atrial septal defects

“…However, the device must be deployed in a relatively small hole or fenestration due to its narrow waist. There are very few series evaluating the performance of ASD devices in the setting of multiple ASDs or fenestrated atrial septae, and none using the Helex device in pediatric patients . Szkutnik et al reported on closure of “double” ASDs with a single Amplatzer device, however if the two defects were further than 7 mm from each other and both were hemodynamically significant they recommended closure of the second defect with an additional Amplatzer device .…”

“…There were two complications that included a device embolization with successful percutaneous retrieval and one erosion that required urgent surgery 2 years post‐deployment. Numan et al reported on 16 patients who underwent closure of fenestrated ASDs with the Cribriform Occluder. Of those 16 patients, four weighed less than 20 kg.…”

Fenestrated Atrial Septal Defect Percutaneously Occluded by a Single Device: Procedural and Financial Considerations

“…Some cardiologists prefer to close these lesions using Cribriform devices [9, 12]. These are characterized by large discs and a narrow waist (or connecting pin).…”

“…Straightening the aneurysmal septum may also decrease the size of the defects. The size of the device is determined by the “steady rim,” which is the area that should include all defects [12]. Nevertheless, using a device which has an interconnecting pin rather than the regular waist means that after the release the device may cruise around the hole into which it was released, if the discs are not adherent to the IAS.…”

Transcatheter Closure of Complex Atrial Septal Defects

“…Although these authors were successful in occluding the defect, I do not favor using such a technique in view of potential problems with larger devices. Multiple defects may also be occluded with a large single device such as CardioSeal device or Cribriform Amplatzer device if such devices are available to the cardiologist. It is important to ensure that the all defects are completely covered by the device.…”