Sequential implantation of two helex septal occluder devices in a patient with complex atrial septal anatomy

Abstract

We report the first implantation of two Helex septal occluder devices in a 10-year-old boy with complex atrial septal anatomy. The unique characteristics of this new device are discussed in the following case report.

Initial experience in Brazil with the Helex septal occluder for percutaneous occlusion of atrial septal defects

“…I). One patient with 2 ASDs (3.6 and 5mm) with a 12-mm distance between the holes was selected for the possible implantation of 2 devices, according to previous reports 22,23 . The smaller hole was in a postero-inferior position in the septum, near the inferior vena cava, and the other was in the antero-superior position behind the aortic torus.…”

“…Because the device is made of polytetrafluoroethylene, the long-term biocompatibility was not questioned 19 . Its flexible nitinol frame and its round nonabrasive borders considerably minimize the risk of cardiac perforations 18,19,23 . The implantation system is controlled, and it may be recaptured and repositioned before its final deployment.…”

“…This feature is only found in this device. Because it is very flexible and has an atraumatic contour, its rescue, in case of embolism, is safer, and with low risk of damage to the cardiac or vascular structures 18,19,23 . However, some disadvantages make its use more limited: the implantation technique is not so simple, requiring special training of the operator.…”

“…Because its maximum diameter is 35mm, only small to moderate defects can be approached with such a device 19 . Although the device is not self-centered during implantation, this feature may be advantageous in cases of multiple close atrial septal defects or of a fenestrated septum that may be occluded with a single device 8,9,19,23 . Distant defects may need 2 devices as was seen in our study and in other experiences 23 .…”

“…Although the device is not self-centered during implantation, this feature may be advantageous in cases of multiple close atrial septal defects or of a fenestrated septum that may be occluded with a single device 8,9,19,23 . Distant defects may need 2 devices as was seen in our study and in other experiences 23 . In these cases, the Helex's low profile is an advantage because it results in less intracardiac material.…”