Transcatheter Closure of Right-to-Left Interatrial Shunts to Resolve Hypoxemia

Abstract

Transcatheter closure of right-to-left shunts is well-tolerated and a rewarding approach. It should be applied in selected patients following careful morphologic and hemodynamic evaluation. Tolerance of temporary occlusion of the defect is predictive of a favorable procedural outcome.

Atrial Right-to-left Shunt without Pulmonary Hypertension in a Patient with Biventricular Non-compaction Cardiomyopathy Accompanied by Ventricular and Atrial Septal Defects

“…Hemodynamically, the higher pressure in the RA than in the LA is closely related to RV dysfunction. Atrial right-to-left shunt due to RV dysfunction can develop in patients with an obstructed right ventricular outflow tract, RV infarction, or arrhythmogenic right ventricular cardiomyopathy (4,5), but as far as we can ascertain, never in patients with hypoplasia of the RV and TV in biventricular non-compaction cardiomyopathy. The standard treatment for an interatrial defect is surgical closure under extracorporeal circulation.…”

“…However, even without pulmonary hypertension, this condition rarely occurs in patients with platypnea-orthodeoxia syndrome (2,3) and with right ventricular dysfunction (4,5). In contrast, non-compaction cardiomyopathy is a rare congenital disease characterized by prominent ventricular trabeculations and deep intertrabecular recesses (6).…”

Long-term Complications Following Surgical Patch Closure of Multiple Muscular Ventricular Septal Defects

“…These techniques have been proven safe and effective even when used in small infants. 9,[19][20][21][22][23][24] The successful percutaneous closure of multiple VSDs is well described. 9,25,26 The percutaneous closure of multiple VSDs by transcatheter techniques is feasible, but the presence of multiple devices implanted in the small ventricle will compromise ventricular size and may have local compressive effect leading to cardiac conduction defects.…”

“…Percutaneous and hybrid closure techniques have become increasingly an alternative to open VSD repair. These techniques have been proven safe and effective even when used in small infants . The successful percutaneous closure of multiple VSDs is well described .…”

Challenges in Atrial Septal Defect Occlusion

“…A rise in RA pressure above LA pressure may precipitate ARLS [31]. Diastolic RV dysfunction may be caused by different mechanisms, including acute myocardial infarction, age-related undiagnosed severe pulmonary stenosis, and pulmonary atresia with intact interventricular septum years following resolution of RV outflow obstruction [32]. Treatment of ARLS involves treating the underlying cause and/or closure of the shunt to resolve hypoxemia.…”