New technique for device closure of large atrial septal defects

Dalvi, Bharat; Pinto, Robin; Gupta, A. S.

doi:10.1002/ccd.20248

Cited by 75 publications

(61 citation statements)

References 29 publications

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“…The resulting sheath is straight and has an exit orifice essential in the side of the distal portion of the sheath-a straight, side-hole delivery sheath [30]. Use of a balloon catheter [31] or a long dilator [32] to support the left atrial disk and prevent its prolapse into the right atrium during deployment has been described. Although this technique requires additional venous access, the procedure, especially balloon assist technique, is relatively simple and less traumatic (Fig.…”

Section: Various Closure Techniques For Difficult Asdmentioning

confidence: 98%

Current concept of transcatheter closure of atrial septal defect in adults

Akagi

2015

Journal of Cardiology

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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.

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Section: Various Closure Techniques For Difficult Asdmentioning

confidence: 98%

Current concept of transcatheter closure of atrial septal defect in adults

Akagi

2015

Journal of Cardiology

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“…[1] Deployment from the left upper pulmonary vein (LUPV), left atrial appendage, balloon-assisted technique, using Hausdorf sheath and RUPV methods are described for large defects with deficient rims. [2–4] Difficulty of deployment of the atrial septal occluder in ASD associated with RAA is not described so far. However, Hill et al .…”

Section: Discussionmentioning

confidence: 99%

“…[1] Device closure of ASD is a well-established procedure; however, various methods of deployment are described in challenging cases. [2–4] Right aortic arch (RAA) is usually associated with certain congenital heart defects like Tetralogy of Fallot, pulmonary atresia with ventricular septal defect, truncus arteriosus and, rarely, with isolated ventricular septal defect. [5] Fossa Ovalis ASD associated with RAA is rare.…”

Section: Introductionmentioning

confidence: 99%

Unexpected difficulty during transcatheter device closure of atrial septal defect associated with right aortic arch

et al. 2012

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Right aortic arch (RAA) associated with isolated atrial septal defect (ASD) is very rare. We report successful closure of ASD associated with RAA using a 26-mm atrial septal occluder in a 30-year-old male patient. The impingement of right descending aorta in RAA caused malposition of the device in the left atrium. Deployment of the device through the right upper pulmonary vein successfully closed the defect. Follow-up evaluation by computerized tomography scan and echocardiogram showed no pulmonary venous obstruction.

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“…A balloon-assisted technique was used as described previously to facilitate device closure of large ASDs, and the choice was made by the operator. [19] Electrocardiogram (ECG) monitoring was performed during closure. Arrhythmic events occurring during the procedure were recorded by a certified technician in electrophysiology and double checked by a pediatric cardiologist.…”

Section: Methodsmentioning

confidence: 99%

Prediction of early-onset atrial tachyarrhythmia after successful trans-catheter device closure of atrial septal defect

Park¹,

Hwang²,

Chun³

et al. 2016

Medicine

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Atrial tachyarrhythmia is a well-known long-term complication of atrial septal defect (ASD) in adults, even after successful trans-catheter closure. However, the risk factors for early-onset atrial tachyarrhythmia after trans-catheter closure remain unclear. This retrospective study enrolled adults with secundum ASD undergoing trans-catheter closure from January 2000 to March 2014. We analyzed the clinical characteristics of patients and assessed risk factors for new-onset atrial tachyarrhythmia defined as a composite of atrial fibrillation or flutter (AF/AFL) after ASD closure. We enrolled a total of 427 patients; 123 were male (28.8%) and the median age was 37.0 (interquartile range [IQR]: 18.3–49.0). Nineteen (4.4%) patients had documented atrial tachyarrhythmia during the follow-up period (median: 11.4 months [IQR: 5.4–24]). Patients with transient AF/AFL during closure showed a greater incidence of new-onset atrial tachyarrhythmia during the follow-up period than patients with consistent sinus rhythm during closure (27.3% vs 3.8%; P = 0.01). Most new-onset atrial tachyarrhythmias were documented within 6 months (median: 2.6 [IQR: 1.2–4.1] months) of closure. In the multivariate analysis, the risk for new-onset atrial tachyarrhythmia was significant in patients with AF/AFL during closure (hazard ratio [HR]: 9.90, 95% confidence interval [CI]: 2.86–34.20; P < 0.001), deficient posteroinferior rim (HR: 5.48, 95% CI: 1.15–25.72; P = 0.04), and age of closure over 48 years (HR: 3.30, 95% CI: 1.30–8.38; P = 0.01). In conclusion, transient AF/AFL during trans-catheter closure of ASD as well as deficient posteroinferior rim and age of closure over 48 years may be useful for predicting early new-onset atrial tachyarrhythmia after device closure.

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New technique for device closure of large atrial septal defects

Cited by 75 publications

References 29 publications

Current concept of transcatheter closure of atrial septal defect in adults

Current concept of transcatheter closure of atrial septal defect in adults

Unexpected difficulty during transcatheter device closure of atrial septal defect associated with right aortic arch

Prediction of early-onset atrial tachyarrhythmia after successful trans-catheter device closure of atrial septal defect

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