Strategy of treating secundum atrial septal defect not referred to percutaneous closure

Zhang, Fei; Yang, Yifeng; Wu, Qin; Jin, Wancun; Bu, Haisong; Wu, Sijie; Zhao, Tianli; Hu, Shijun

doi:10.1111/chd.12753

Cited by 3 publications

(5 citation statements)

References 26 publications

(68 reference statements)

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“…In addition, considerably large defects are also unsuitable for percutaneous closure because the loading sheath is angulate to the defects in percutaneous closure but vertical to those in intraoperative device closure. "Unbutton effect" may occur in percutaneous closure with the same size of occluder [14]. Although auxiliary technology (pulmonary vein deployment technique or balloon-assisted technique) could be used to facilitate the transcatheter closure of large secundum ASDs, the procedure would inevitably increase the fluoroscopy time and dosage of contrast agent.…”

Section: Discussionmentioning

confidence: 99%

“…The intraoperative device closure technique used in group B has been described in previous studies [10][11][12][13][14][15]. In brief, the TEE probe was inserted after general anesthesia with endotracheal intubation was given to patients, and ASD closure was performed by only using TEE guidance.…”

Section: Methodsmentioning

confidence: 99%

“…In recent years, minimally invasive transesophageal echocardiography (TEE)-guided transthoracic occlusion has also been developed and applied in China. This technique can be used to directly puncture into the right atrium through a minimally invasive thoracic incision to avoid the possible damage of fluoroscopy and contrast agents to the body and the possibility of peripheral vascular injury [10][11][12][13][14][15]. For infants for whom percutaneous occlusion is unsuitable, transthoracic minimally invasive occlusion may be a good alternative.…”

Section: Introductionmentioning

confidence: 99%

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Transcatheter and intraoperative device closure of atrial septal defect in infants under three years of age

Han¹,

Zhang²,

Zhang³

2020

J Cardiothorac Surg

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Background: Transcatheter and intraoperative device closures have been widely used in the treatment of secundum atrial septal defect (ASD). However, for young infants with ASD, device closure remains controversial, and such treatment features limited data. We compared the clinical data and follow-up results of percutaneous and intraoperative device closure for ASD to evaluate the feasibility, safety, and efficacy of both treatments in infants under 3 years of age. Methods: From September 2010 to September 2018, 186 children under 3 years of age with significant secundum ASD were included in this study. A total of 88 and 98 patients were divided into groups A (transcatheter device closure) and B (intraoperative device closure), respectively. The clinical data and follow-up results of the two groups were analyzed retrospectively. Result: The mean age and weight of patients in group A were significantly higher than those in group B. The proportion of complex ASDs (multiples or rims deficiency) and the device/weight ratio in group B were significantly higher than those in group A. Successful closure was obtained in 86 (97.7%) and 96 (98.0%) infants in groups A and B, respectively, with two failed cases in each group (2.3% vs 2%). The rate of periprocedural complications reached 13.6 and 26.5% for groups A and B (P = 0.058), respectively. The durations of the procedure and postoperative hospital stay in group A were significantly shorter than those in group B (P < 0.05). Excellent follow-up results were observed in both groups. At present, no death nor major complications have occurred. Symptoms either resolved completely or improved significantly for all symptomatic infants. No residual shunts at the 6th month of follow-up evaluation were observed. Patients with failure to thrive gained weight appropriately for age, and the structure and hemodynamic parameters significantly improved during follow-up. Conclusion: Transcatheter and intraoperative device closure are feasible, effective, and safe methods for the treatment of ASDs in infants under 3 years of age. Considering improved cosmetic effect and the short duration of the procedure and postoperative hospital stay, transcatheter is preferred for patients with appropriate conditions. Intraoperative device closure can be performed as an alternative to percutaneous closure, particularly for infants with large, complex ASDs, young age, or low-body weight.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Transcatheter and intraoperative device closure of atrial septal defect in infants under three years of age

Han¹,

Zhang²,

Zhang³

2020

J Cardiothorac Surg

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“…Transthoracic closure is simpler because it is easier to adjust the delivery sheath to a position perpendicular to the interatrial septum, such that even if the rim of the aortic valve is close to zero the operation could be successful. For large diameter ASD defects, transcutaneous closure may be successful when transcutaneous closure fails [22]. Four patients in the PASD groups were transferred into IODC when device deployment failed.…”

Section: Discussionmentioning

confidence: 99%

Clinical evaluation of percutaneous and intra-operative device closure of atrial septal defects under transesophageal echocardiographic guidance: one center experience and mid-term follow-up

Zhu

Qiang

Liu

et al. 2020

J Cardiothorac Surg

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Objective The percutaneous closure of a single secundum atrial septal defect (ASD) under transesophageal echocardiography guidance as an accepted alternative to the transcatheter closure with fluoroscopy has been proven. However, the technique has not been routinely used. This study was to present and share our experience in comparing the clinical outcomes of the percutaneous and intra-operative device closure (IODC) of atrial septal defects without fluoroscopy. Methods From January 2013 to December 2016, 103 patients with maximum diameters of ASD of less than 30 mm were allocated to groups taking either the percutaneous closure of atrial septal defects approach (PASD group, n = 53) or the intra-operative device closure approach (IODC Group, n = 50). They were operated on using the minimally invasive Amplatzer duct occluder under the guidance of transesophageal echocardiography without cardiopulmonary bypass. Echocardiography was performed to obtain an en face view of the ASD and important surrounding structures before the operation. Patient characteristics, perioperative data, and follow-up data were retrospectively documented and analyzed. Results Patient characteristics were comparable between the two groups. These were no differences in the maximum diameters of defects and the size of the occluders in each group (16.4 ± 5.3 mm vs16.4 ± 5.2 mm, P = 0.98; 22.4 ± 5.8 mm vs 21.3 ± 6.6 mm, P = 0.38). Intracardiac manipulation time was 20.72 ± 7.70 min in the PASD group and 6.01 ± 1.03 min in the IODC group (P < 0.001). The procedure time was 28.70 ± 10.41 min in the PASD group and 39.13 ± 6.03 min in the IODC group (P < 0.001). The successful closure defect was 100% in both groups when the maximum diameter of defect less than 25 mm. Four patients the PASD groups with maximum diameters between 25 mm and 30 mm were transferred to the IOCD group after unsuccessful device implantations. The total occlusion rate was 82% immediately after deployment, 98% at 3 months, and 100% at 6 months. No cardiac-related complications occurred during the follow-up period of between 3 to 65 months (mean 21.4 ± 9.8 months). Conclusions Percutaneous device closures of Secundum atrial septal defects showed safety and high efficiency in patients under guidance by transesophageal echocardiography when compared with intra-operative device closures and are especially suited for women and children.

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“…TEE is crucial for PFO and PFO closure for years [26]. With the great application of guiding of simple congenital heart disease for transthoracic intervention in China [27,28], TEE has been reconsidered changing its role from diagnosis to therapy guiding for structural heart disease. Even in the publication focusing on fluoroscopy for PFO closure [7,8] TEE has been confirmed as helpful in complex anatomy.…”

Section: Discussionmentioning

confidence: 99%

Transcatheter Patent Foramen Ovale Closure Guided Only by Transesophageal Echocardiography Without fluoroscopy

Zhao

Ruge

et al. 2020

Preprint

Self Cite

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Background Standby of transesophageal echocardiography (TEE) is necessary for any PFO closure in case of some cases with complicated anatomy of patent foramen ovale (PFO). The safety and effectiveness of Transcatheter PFO closure guided only by TEE navigation without fluoroscopy is unclear.Methods From 2017.06 to 2019.11, we included 38 patients who were recommended for PFO closure by the department of neurology at our hospital. The procedure was performed in a regular operating room by TEE navigation without fluoroscopy. Follow-up was given at 1st month, 3rd month, 6th month, 1st year and 2nd year after operation for each patient.Results All 38 patients were successfully performed PFO-closure guided by TEE. Procedural and intrahospital survival was 100%. Survival after a mean follow-up of 17.1±1.6months was 100%. "Catheter in sheath” technique was adopted in 16 cases. After the procedure, all 28 migraines with aura alleviated at different degree. All 10 patients suffering from pre-operational cryptogenic stroke survived and showed no evidence for recurrence of stroke (fatal or non-fatal), peripheral embolism or transient ischemic attack during follow-up. No serious adverse events in the PFO closure procedure and during the follow-up period.Conclusion First clinical experiences showed that percutaneous TEE guided PFO closure is safe and effective and might be promoted.

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Strategy of treating secundum atrial septal defect not referred to percutaneous closure

Cited by 3 publications

References 26 publications

Transcatheter and intraoperative device closure of atrial septal defect in infants under three years of age

Transcatheter and intraoperative device closure of atrial septal defect in infants under three years of age

Clinical evaluation of percutaneous and intra-operative device closure of atrial septal defects under transesophageal echocardiographic guidance: one center experience and mid-term follow-up

Transcatheter Patent Foramen Ovale Closure Guided Only by Transesophageal Echocardiography Without fluoroscopy

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