Surgery for complications of trans-catheter closure of atrial septal defects: a multi-institutional study from the European Congenital Heart Surgeons Association

Sarris, George E.; Kirvassilis, George; Zavaropoulos, Prodromos; Belli, Emrè; Berggren, Håkan; Carrel, Thierry; Comas, Juan V.; Corno, Antonio F.; Daenen, Willem; Carlo, Duccio Di; Ebels, Tjark; Fragata, José; Hamilton, Leslie; Hraška, Viktor; Jacobs, Jeffrey; Lazarov, Stojan; Mavroudis, Constantine; Métras, D; Rubay, Jean; Schreiber, Christian; Stellin, Giovanni

doi:10.1016/j.ejcts.2009.12.021

Cited by 66 publications

(55 citation statements)

References 24 publications

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“…In addition, aortaatrial fistulae can develop in certain patients. [3][4][5] Baseline measurements are crucial to prevent such consequences. In particular, an Amplatzer Septal Occluder should not be implanted in patients who have an anterosuperior rim of <4 mm 3 .…”

Section: Discussionmentioning

confidence: 99%

Late Cardiac Rupture after Amplatzer Septal Occluder Implantation

Arnaz¹,

Türkekul²,

Yalçınbaş³

et al. 2016

Texas Heart Institute Journal

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A trial septal defect (ASD), the most prevalent congenital heart disease in adults, accounts for 5% to 10% of all congenital heart diseases.1 Although most patients are asymptomatic until adulthood, early diagnosis and treatment are crucial to prevent such possible sequelae as right-sided heart failure, pulmonary hypertension, and arrhythmia. Surgery is the gold standard in the treatment of secundum ASD, because its morbidity and mortality rates are very low, while postoperative functional capacity and survival rates are excellent in the long term. Although surgery is a low-risk and recommended treatment method, its risks include post-pericardiotomy syndrome, arrhythmia, pleural and pericardial effusion, the need for blood products, and scar formation. Percutaneous closure of ASD was first performed in 1976. It has been widely adopted over the subsequent decades because it is a low-risk method, implies a short hospital stay, has no need for blood products, and produces no scars.2 However, it can lead to life-threatening early and late sequelae that require emergency intervention. Early sequelae can include residual shunts, systemic and pulmonary device embolization, thromboembolism, superior vena cava and right-upper pulmonary vein compression, tricuspid or mitral valve compression, and arrhythmia. Late and life-threatening sequelae include free ruptures of the right and left atrial walls that cause cardiac tamponade, erosion of the ascending aorta, and aorta-atrial fistula formation. 2 Case ReportIn February 2013, a 22-year-old woman was admitted to our emergency department with sudden-onset dyspnea and subsequent syncope. In the initial examination, she was unconscious and in respiratory arrest. After cardiopulmonary resuscitation, she was intubated. Transthoracic echocardiography (TTE) revealed dense pericardial effusion, fibrin, and cardiac tamponade. The patient, in shock, underwent urgent operation.Intraoperative examination revealed rupture of the left atrial roof and noncoronary aortic sinus, caused by an atrial septal occluder (ASO) (Fig. 1). We placed a temporary pledgeted suture on the ruptured noncoronary sinus of the ascending aorta, to stop the bleeding through a very small perforation. After a standard bicaval cannulation, we initiated cardiopulmonary bypass. The right atrium was opened after aortic cross-clamping and antegrade delivery of blood cardioplegia. The ASO was then removed, and a temporary autologous pericardial patch was constructed for the ostial

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Section: Discussionmentioning

confidence: 99%

Late Cardiac Rupture after Amplatzer Septal Occluder Implantation

Arnaz¹,

Türkekul²,

Yalçınbaş³

et al. 2016

Texas Heart Institute Journal

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“…However, there may be anatomic, patient-related, and procedural variables that are associated with an increased risk of erosion relative to the general population of patients undergoing ASD closure (ie, relative risk). Although multiple case reports, reviews, and analyses of the Manufacturer And User Facility Device Experience (MAUDE) database have been published, [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] there are no studies that adequately speak to the question of relative or absolute erosion risk.…”

mentioning

confidence: 99%

“…[1][2][3][4] However, erosion of the device through an atrial wall into the aorta or pericardial space (cardiac erosion) is a rare but serious adverse event that can occur early or late after ASD closure. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] The absolute risk of erosion after ASO implant has been estimated to range from 0.043% to 0.3%. 2,6,8,[17][18][19] The specific mechanisms and risk factors for device erosion remain unclear, and are likely to be multifactorial.…”

mentioning

confidence: 99%

Relative Risk Factors for Cardiac Erosion Following Transcatheter Closure of Atrial Septal Defects

et al. 2016

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Background-Transcatheter closure of secundum atrial septal defects (ASD) using the Amplatzer septal occluder is generally safe and effective, but erosion into the pericardial space or aorta has been described. Although the absolute risk of this complication is low, there has been no assessment of relative risk factors. Methods and Results-All erosions reported to St. Jude Medical after ASD closure with an Amplatzer septal occluder (cases) were compared with controls (matched 2:1) who underwent ASD closure but did not develop an erosion. A total of 125 erosions were reported between 2002 and 2014, including 95 with an available echocardiogram. The median duration from implant to erosion was 14 days, but was >1 year in 16 patients. Nine patients (all age ≥17 years) who died were more likely to have an oversized device, and to have erosion into the aorta, than survivors. Aortic or superior vena cava rim deficiencies were more common in cases than in controls. In addition, larger balloon-sized ASD diameter, Amplatzer septal occluder device size, and device size-ASD diameter difference, and smaller weight:device size ratio were associated with erosion. On multivariable analysis, deficiency of any rim, device >5 mm larger than ASD diameter, and weight:device size ratio were associated with erosion. Conclusions-In addition to aortic rim deficiency, which was almost universal among erosion cases, there were several relative risk factors for erosion after ASD closure with the Amplatzer septal occluder device. To understand the mechanisms of and absolute risk factors for this uncommon but serious complication, an adequately powered prospective study with thorough echocardiographic evaluation will be critical.

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“…These complications are associated with increased morbidity and mortality rates compared to surgical closure. A major complication of ASD device closure using percutaneous techniques is device embolization or malposition [3][4][5][6][7][8]. In complicated circumstances,…”

mentioning

confidence: 99%

“…In recent years, transcatheter closure of ASD by means of the percutaneous deployment of a variety of occluder devices has increasingly gained wide popularity as an alternative to surgery in many centers [3][4][5][6][7].…”

mentioning

confidence: 99%

Surgical removal of an embolized Amplatzer septal occluder device from the right ventricle

Toktaş¹,

Özsin²,

Kaymakci³

et al. 2015

Eur Res J

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A secundum atrial septal defect (ASD) is one of the most common congenital cardiac abnormalities encountered in adults, accounting for 10% to 17% of congenital heart disease [1][2][3]. In recent years, transcatheter closure of ASD by means of the percutaneous deployment of a variety of occluder devices has increasingly gained wide popularity as an alternative to surgery in many centers [3][4][5][6][7].As seen in all invasive procedures, complications are encountered from time to time with increasing interventional number. These complications are associated with increased morbidity and mortality rates compared to surgical closure. A major complication of ASD device closure using percutaneous techniques is device embolization or malposition [3][4][5][6][7][8]. In complicated circumstances, ABSTRACT 146Atrial septal defect is one of the most common congenital heart defects encountered in adults. Currently, transcatheter atrial septal defect closure techniques have increasingly gained wide popularity as an alternative to surgery in many centers. However, they are associated with severe procedural complications requiring immediate surgical intervention. Here, we report a 29-year-old male patient with device embolization due to the migration of Amplatzer septal occluder device to the right ventricle at an early stage following percutaneous intervention. He underwent an emergency operation because of hemodynamic deterioration. The device was successfully removed with surgery and atrial septal defect was closed with a pericardial patch. The postoperative course was uneventful, and he was discharged from hospital on postoperative day 5.

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Surgery for complications of trans-catheter closure of atrial septal defects: a multi-institutional study from the European Congenital Heart Surgeons Association

Cited by 66 publications

References 24 publications

Late Cardiac Rupture after Amplatzer Septal Occluder Implantation

Late Cardiac Rupture after Amplatzer Septal Occluder Implantation

Relative Risk Factors for Cardiac Erosion Following Transcatheter Closure of Atrial Septal Defects

Surgical removal of an embolized Amplatzer septal occluder device from the right ventricle

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