Transcatheter closure of atrial septal defect protects from pulmonary edema: septal occluder device gradually reduces LR shunt

Murakami, Tsutomu; Nakazawa, Gaku; Horinouchi, Hitomi; Torii, Sho; Ijichi, Takeshi; Ohno, Yohei; Amino, Mari; Shinozaki, Norihiko; Ogata, Nobuhiko; Yoshimachi, Fuminobu; Yoshioka, Koichiro; Ikari, Yuji

doi:10.1007/s00380-016-0863-5

Cited by 5 publications

(4 citation statements)

References 13 publications

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“…After closure, the residual shunt flow slowly disappears while cardiac reverse remodeling occurs, which allows adaptation to the hemodynamic change. [11][12][13] The fact that even patients with PCWP ≥18 mmHg during BOT did not develop acute pulmonary edema or heart failure supports this speculation.…”

Section: Procedural and Postprocedural Outcomesmentioning

confidence: 82%

“…We believe that the residual shunt flow functions as a relief valve; however, the degree of flow is less than that through a fenestrated occluder device. After closure, the residual shunt flow slowly disappears while cardiac reverse remodeling occurs, which allows adaptation to the hemodynamic change 11–13 . The fact that even patients with PCWP ≥18 mmHg during BOT did not develop acute pulmonary edema or heart failure supports this speculation.…”

Section: Discussionmentioning

confidence: 92%

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Temporary balloon occlusion test can overestimate the risk of acute pulmonary edema after transcatheter atrial septal defect closure

Nakagawa

Akagi

Takaya

et al. 2023

Cathet Cardio Intervent

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Background Atrial septal defect (ASD) closure can cause acute pulmonary edema. Before transcatheter closure is performed, temporary balloon occlusion test (BOT) is recommended in patients with left ventricular dysfunction to predict the risk of pulmonary edema. However, the accuracy of BOT has not been verified. This study aimed to compare hemodynamic differences between BOT and transcatheter closure. Methods A total of 42 patients with a single ASD over age 18 years who underwent BOT before transcatheter ASD closure between October 2010 and May 2020 were analyzed. Pulmonary capillary wedge pressure (PCWP) was measured using a Swan−Ganz catheter placed in the pulmonary artery at baseline, after 10 min of BOT, and after transcatheter closure. Amplatzer septal occluder was used for all transcatheter closures. Results Mean patient age was 64 ± 18 years (range, 18−78). Mean ASD diameter and pulmonary to systemic flow ratio were 18 ± 5 and 2.8 ± 1.0 mm, respectively. Mean PCWP at baseline, during BOT, and after transcatheter closure was 8.9 ± 2.9, 13.5 ± 4.2, and 9.5 ± 2.6 mmHg, respectively. The difference between BOT and after transcatheter closure values was significant (p < 0.001). During BOT, PCWP increased ≥18 mmHg in 7 patients, whereas after ASD closure, PCWP was <18 mmHg in all 7 and none developed acute pulmonary edema. Conclusion Temporary balloon occlusion of an ASD and transcatheter ASD closure result in different hemodynamic change. BOT overestimates increase of PCWP after transcatheter ASD closure and requires careful interpretation. Well‐designed, larger studies in higher‐risk patients are warranted to verify the clinical implications of BOT in more detail.

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Section: Procedural and Postprocedural Outcomesmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 92%

Temporary balloon occlusion test can overestimate the risk of acute pulmonary edema after transcatheter atrial septal defect closure

Nakagawa

Akagi

Takaya

et al. 2023

Cathet Cardio Intervent

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“…From May 2016 to December 2016, 23 patients with isolated secundum ASD and two patients with ASD combined with partial anomalous pulmonary venous connection (p-APVC) were selected and underwent totally endoscopic repair without the aid of the robotic system on beating heart. Study subjects included both adults and children with the following inclusion criteria: (1) isolated secundum ASD, ASD associated with p-APVC, sinus venosus ASD, ASD combined with tricuspid regurgitation (TR); (2) body weight of 13 kg or more; (3) no previous history of operation on right lung; and (4) no atherosclerotic stenosis of pelvic-femoral arteries. Patients who were unable to meet all of these criteria were excluded from this study.…”

Section: Patients and Methods Patient Selectionmentioning

confidence: 99%

“…For the past 20 years, transcatheter closure has been the first choice in almost all countries all over the world with many advantages. [2][3][4] However, there are many types of ASD that cannot be closed percutaneously, and there are increasing numbers of reports on long-term complications of transcatheter closure of ASD leading to reoperation or life-threatening conditions. [5][6][7] Surgical treatment of ASD through median sternotomy or small thoracotomy with endoscopic support still shows some limitations.…”

mentioning

confidence: 99%

Totally Endoscopic Cardiac Surgery for Atrial Septal Defect Repair on Beating Heart without Robotic Assistance in 25 Patients

Dang

Nguyen

et al. 2017

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The aim of the study was to investigate the effectivity and safety of totally endoscopic cardiac surgery without robotic assistance for atrial septal defect (ASD) closure on beating hearts. Methods: Twenty-five patients (adults/children: 15/10) underwent ASD closure using nonrobotically assisted totally endoscopic approach on beating heart. Three 5-mm trocars and one 12-mm trocar were used, only the superior vena cava is snared, filling the pleural and pericardial cavities with CO 2 , and the heart was beating during the surgery. Twentythree patients had isolated secundum ASD (2 of which had severe tricuspid regurgitation) and two patients had ASD combined with partial anomalous pulmonary venous connection. All ASDs were closed using artificial patch, continuous suture; tricuspid regurgitations were repaired and the anomalous pulmonary veins were drained to the left atrium. Results: No postoperative complications or deaths occurred. Mean ± SD operation time and mean cardiopulmonary bypass time were 267.2 ± 44.6 and 156.1 ± 33.6 min, respectively. These patients were extubated within the first 5 hours, and the volume of blood drainage on the first day was less than 80 mL. Four days after surgery, patients did not need analgesics and were able to return to normal activities 1 week postoperatively. Conclusions: Totally endoscopic operation for ASD closure on beating heart is safe, with short recovery period, and surgical scars are of high cosmetic value, especially in a woman and girl.

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Persistence of an iatrogenic atrial septal defect after a second-generation cryoballoon ablation of atrial fibrillation

et al. 2018

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Persistent iatrogenic atrial septal defects (iASDs) can be observed after intervention requiring a left atria (LA) access, including pulmonary vein isolation (PVI) of atrial fibrillation (AF). We investigated the incidence of iASDs post-second-generation cryoballoon ablation and the pre-procedural predictors. Eighty-three paroxysmal AF patients underwent PVI using second-generation cryoballoons. The LA was accessed with single 15-Fr steerable sheaths following a radiofrequency transseptal puncture, and the iASD was evaluated with transthoracic echocardiography (TTE), a median of 9.3 (7.1-13.3) months post-procedure. All patients underwent pre-procedural contrast-enhanced multi-detector computed tomography (CT) to evaluate the LA and PV anatomy. iASDs were detected by TTE in 7 (8.4%) patients, a median of 15.5 (6.8-17.3) months post-procedure. Patients with iASDs had significantly larger LA volumes and smaller atrial septal angles, defined as the angle between the atrial septum and sagittal line on the horizontal section at the height of the fossa ovalis, which could be the transseptal puncture site measured on CT, and more likely hypertension than those without. Multivariate analyses revealed that the atrial septal angle was the sole predictor of iASDs [odds ratio 0.764, 95% confidence interval (CI) 0.624-0.935, p = 0.009], and the optimal cut-off value was 57.5° (sensitivity 85.7%, specificity 88.2%, 95% CI 0.873-0.995, p < 0.0001). Patients with iASDs were asymptomatic and had no adverse clinical events during a 17.7 (14.4-25.8) month median follow-up. iASDs were still detectable in 8.4% of patients a median of 15.5 months after the second-generation CB ablation, and the atrial septal angle might aid in predicting persistent iASDs.

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Transcatheter closure of atrial septal defect protects from pulmonary edema: septal occluder device gradually reduces LR shunt

Cited by 5 publications

References 13 publications

Temporary balloon occlusion test can overestimate the risk of acute pulmonary edema after transcatheter atrial septal defect closure

Temporary balloon occlusion test can overestimate the risk of acute pulmonary edema after transcatheter atrial septal defect closure

Totally Endoscopic Cardiac Surgery for Atrial Septal Defect Repair on Beating Heart without Robotic Assistance in 25 Patients

Persistence of an iatrogenic atrial septal defect after a second-generation cryoballoon ablation of atrial fibrillation

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