Current concept of transcatheter closure of atrial septal defect in adults

Abstract

After the introduction of catheter intervention for atrial septal defect (ASD) in the pediatric population, therapeutic advantages of this less invasive procedure were focused on adult through geriatric populations. The most valuable clinical benefits of this procedure are the significant improvement of symptoms and daily activities, which result from the closure of left to right shunt without thoracotomy and cardiopulmonary bypass surgery. These benefits contribute to increase the number of adult patients of this condition who have hesitated over surgical closure. In terms of technical point of view for catheter closure of ASD, the difficulties still exist in some morphological features of defect, or hemodynamic features in the adult population. Morphological features of difficult ASD closure are (1) large (≥30 mm) ASD, (2) wide rim deficiency, and (3) multiple defects. Hemodynamic features of difficult ASD are (1) severe pulmonary hypertension, (2) ventricular dysfunction, and (3) restrictive left ventricular compliance (diastolic dysfunction) after ASD closure. To complete the catheter ASD closure under these difficult conditions, various procedural techniques have been introduced. These are new imaging modalities such as real-time three-dimensional imaging, new technical modifications, and new concepts for hemodynamic evaluation. Especially, real-time three-dimensional transesophageal echocardiography can provide the high quality imaging for anatomical evaluation including maximum defect size, surrounding rim morphology, and the relationship between device and septal rim. In adult patients, optimal management for their comorbidities is an important issue, which includes cardiac function, atrial arrhythmias, respiratory function, and renal function. Management of atrial arrhythmias is a key issue for the long-term outcome in adult patients. Because the interventional procedures are not complication-free techniques, the establishment of a surgical back-up system is essential for the safe achievement of the procedure. Finally, the establishment of a team approach including pediatric and adult cardiologists, cardiac surgeons, and anesthesiologists is the most important factor for a good therapeutic outcome.

Assessment of atrial septal defects rims on transesophageal echocardiogram at Shahid Gangalal National Heart Centre, Kathmandu, Nepal

“…It is well known that morphological variations of ASD are frequent and appropriate patient selection for transcatheter ASD closure is crucial for successful procedure. 1 In our study four percentage of patients had more than one ASD. The presence of multiple defects of the inter-atrial septum have been reported between 5.3% to 7.3% of patients with ostium secundum ASD.…”

“…1 Morphological variations of secundum-type ASD are common and their recognition is crucial for selection of patients suitability for percutaneous closure. 2 Transesophageal echocardiogram (TEE) remains the gold standard for ASD closure.…”

Successful Percutaneous Device Closure for Giant Atrial Septal Defect with Massive Pericardial Effusion and Pulmonary Hypertension in an Elderly Patient

“…This is because a possible increase in left-toright shunt due to a reduction in pulmonary artery resistance might increase left ventricular inflow, leading to left ventricular heart failure due to masked left ventricular restriction [7] at the time of ASD closure. In this case, ASD closure with an ASO was safely performed without sure was greater than 70% of systemic pressure [8]. The pulmonary hypertension-specific medications that we administered are reportedly effective even in high-risk patients during long-term follow-up [8].…”

Flexible pusher cable for percutaneous closure of an atrial septal defect

“…Transcatheter closure of an atrial septal defect (ASD) with different occluder systems yields excellent longterm results [1][2][3][4][5][6]. Embolisation of occluders occurs in about 2% [7].…”