Not just another large atrial septal defect: complex anatomy, challenging procedure, and an unusual complication

Haddad, Raymond N.; Massih, Tony Abdel; Saliba, Zakhia

doi:10.1017/s1047951120001468

Cited by 2 publications

(3 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Sometimes, it can be challenging to prevent the anterosuperior rim of the device from pulling from the LA into the right atrium before the core of the device can be developed. The ability of interventionists to tackle difficult anatomies from the femoral vein has improved over time with substantial modifications in the techniques of device delivery and deployment ( 5 – 12 ). Modified deployment maneuvers included changing the orientation of the left atrial disc within the LA or adjusting the deployment sequence by delivering the central core of the device slightly within the LA before bridging the device back to the septum and in case of failure delivering the left disc within the left or right upper PV.…”

Section: Discussionmentioning

confidence: 99%

“…More advanced deployment maneuvers included the use of modified or steerable delivery sheaths and guidewire-assisted, dilator-assisted, snare-assisted, and/or balloon-assisted closures ( 7 – 11 ). However, all these maneuvers are associated with longer procedural time, higher radiation exposure, and an increased risk of potential complications ( 12 , 13 ).…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, we believe that this new FAST technique has similar technical descriptions to the left upper PV deployment method. However, it might be safer and superior because it eliminates the risks of PV damage and bleeding ( 12 , 13 ).…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

FAST technique: fast atrial sheath traction technique for device closure of atrial septal defects

Haddad

Kaddoura

Kasem

et al. 2023

Front. Cardiovasc. Med.

Self Cite

View full text Add to dashboard Cite

BackgroundTranscatheter closure of atrial septal defects (ASDs) is well-established. However, this procedure can be challenging, requiring multiple attempts and advanced implantation maneuvers.Materials and methodsFrom July 2019 to July 2022, patients to whom the fast atrial sheath traction (FAST) technique was applied for ASD device closure were prospectively followed up. The device was rapidly unsheathed in the middle of the left atrium (LA) to let it clamp the ASD from both sides simultaneously. This novel technique was directly applied in patients with absent aortic rims and/or ASD size-to-body weight ratio higher than 0.9 or after failed attempts of standard implantation.ResultsSeventeen patients (64.7% males) were involved with a median age of 9.8 years [interquartile range (IQR), 7.6–15.1] and a median weight of 34 kg (IQR, 22–44). The median ASD size on ultrasound was 19 mm (IQR, 16–22). Five (29.4%) patients had absent aortic rims, and three (17.6%) patients had an ASD size-to-body weight ratio higher than 0.9. The median device size was 22 mm (IQR, 17–24). The median difference between device size and ASD two-dimensional static diameter was 3 mm (IQR, 1–3). All interventions were straightforward without any complications using three different occluder devices. One device was removed before release and upsized to the next size. The median fluoroscopy time was 4.1 min (IQR, 3.6–4.6). All patients were discharged the next postoperative day. On a median follow-up of 13 months (IQR, 8–13), no complications were detected. All patients achieved full clinical recovery with complete shunt closure.ConclusionWe present a new implantation technique to efficiently close simple and complex ASDs. The FAST technique can be of benefit in overcoming left disc malalignment to the septum in defects with absent aortic rims and in avoiding complex implantation maneuvers and the risks of injuring the pulmonary veins.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

FAST technique: fast atrial sheath traction technique for device closure of atrial septal defects

Haddad

Kaddoura

Kasem

et al. 2023

Front. Cardiovasc. Med.

Self Cite

View full text Add to dashboard Cite

show abstract

Preliminary Experience With the New Amplatzer™ Trevisio™ Delivery System in Transcatheter Atrial Septal Defect Closures in Children

et al. 2021

Self Cite

View full text Add to dashboard Cite

Objectives: To evaluate safety, efficacy, and technical advantages of Amplatzer™ Trevisio™ intravascular delivery system (ATIDS) in percutaneous atrial septal defect (ASD) closure in children.Background: The Trevisio™ is a novel delivery system designed for accurate and facilitated implantation of Amplatzer™ devices. There are no published clinical reports so far.Methods: During September 2020, 9 children with anatomically challenging ASDs underwent attempted transcatheter closure using ATIDS to deliver Amplatzer™ Septal occluders (ASO). All interventions were performed under general anesthesia, trans-esophageal echocardiography (TOE), and fluoroscopic guidance. Standard safety, immediate, and 60-days outcomes were prospectively assessed.Results: The median age was 8.1 (5.1–16.9) years and the median bodyweight was 30 (18–63) kg. Six patients had isolated secundum-type ASDs with absent anterosuperior rims including one with an aneurysmal septum. Three patients had unclassical defects associated with complex congenital heart anomalies. Eight devices were delivered from the femoral vein and the jugular vein was accessed in one patient with interrupted inferior caval vein and azygos continuation. All implantations were successful. The shape, position, and orientation of the ASO were identical before and after release on TOE and fluoroscopy. There was no device embolization or serious complication following closure. Complete shunt closure was confirmed on follow-up.Conclusions: We report the first clinical experience with ATIDS in transcatheter ASD pediatric closures. Safety and efficacy were witnessed in our case-series. The major advantage of reduced-tension deployment and reliable precision in device positioning is highly beneficial in challenging anatomies and unusual access.

show abstract

Not just another large atrial septal defect: complex anatomy, challenging procedure, and an unusual complication

Cited by 2 publications

References 11 publications

FAST technique: fast atrial sheath traction technique for device closure of atrial septal defects

FAST technique: fast atrial sheath traction technique for device closure of atrial septal defects

Preliminary Experience With the New Amplatzer™ Trevisio™ Delivery System in Transcatheter Atrial Septal Defect Closures in Children

Contact Info

Product

Resources

About