Percutaneous closure of an iatrogenic atrial septal defect

Sur, James P.; Pagani, Francis D.; Moscucci, Mauro

doi:10.1002/ccd.21768

Cited by 14 publications

(6 citation statements)

References 11 publications

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“…There are multiple case reports of the deleterious effects of iASD (hypoxemia, heart failure, and systemic embolization). [8][9][10][11][12][13][14][15] There is only one single-center prospective study that suggested a possible negative impact of persistent iASD on right ventricular function, dyspnea, and mortality after TMVR Other studies have evaluated the effect of iASD on clinical outcomes, but were underpowered due to the very low incidence of adverse events (Table 1).…”

Section: Discussionmentioning

confidence: 99%

Iatrogenic Atrial Septal Defect

Alkhouli

Sarraf

Holmes

2016

Circ: Cardiovascular Interventions

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Section: Discussionmentioning

confidence: 99%

Iatrogenic Atrial Septal Defect

Alkhouli

Sarraf

Holmes

2016

Circ: Cardiovascular Interventions

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“…There are a number of different procedures requiring TSP, including left‐sided cardiac ablations, percutaneous mitral valve repairs, mitral balloon valvulotomies, left atrial appendage closures, and certain ventricular assist device placements . In many cases, the tissue of the FO is punctured and manipulated with large size devices.…”

Section: Discussionmentioning

confidence: 99%

“…As mentioned above, there are various procedures that require a TSP including left‐sided cardiac ablation, percutaneous mitral valve repair, mitral balloon valvulotomy, left atrial appendage closure, and certain ventricular assist device placements . These procedures along with some newer and future procedures, including left ventricular endocardial pacing and percutaneous mitral and aortic valve implantation, could potentially bring about a greater prevalence of TSPs and thus higher incidences of potential complications .…”

Section: Introductionmentioning

confidence: 99%

Tissue Properties of the Fossa Ovalis as They Relate to Transseptal Punctures: A Translational Approach

Howard

Quallich

Benscoter

et al. 2015

J Interven Cardiology

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Results may provide physicians with important knowledge about what to expect when treating a possible iatrogenic atrial septal defect or help them understand the consequences of transseptal punctures. Comparative data between swine and human atrial septal tissue properties provide critical insights between the species and offer clinicians and device designers important information relative to differences in tissue behaviors.

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“…More recently, LV mechanical support systems have been shown to precipitate right-to-left shunting and arterial hypoxemia in patients with heart failure with previously unrecognized ASD, patent foramen ovale, and iatrogenic/acquired defects. [18][19][20][21] The…”

Section: Atrial Septal Defect With a Right-to-left Shuntmentioning

confidence: 99%

The Impact of an Atrial Septal Defect on Hemodynamics in Patients With Heart Failure

Shah¹,

Waxman²,

Gaasch³

2017

US Cardiology Review

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Access at: www.USCjournal.comPulmonary venous hypertension and congestion that occurs with left ventricular (LV) failure is generally not seen in the presence of a large atrial septal defect (ASD). As long as right ventricular (RV) function and distensibility are not impaired, the ASD provides an alternate pathway for atrial emptying, thus preventing or attenuating elevated LV filling pressures.When RV dysfunction develops and right atrial pressure increases, this 'protective' effect of the ASD is reduced, the left to right shunt flow declines, and the LV filling pressures increase. [1][2][3][4][5][6] These observations indicate that the hemodynamic consequences of ASD closure (or the creation of an ASD) are influenced by the functional state and the interaction of the two ventricles. In this brief review, we emphasize pulmonary venous, left atrial (LA), and LV diastolic pressures, and consider the impact of an ASD on the hemodynamics of heart failure. Closure of an Atrial Septal DefectSymptomatic patients with uncomplicated ASD generally show an improvement in functional capacity after closure of an ASD. However, some patients require special consideration. For example, in the presence of an abnormal left ventricle, closure of an ASD removes its protective effect, and contributes to the poor clinical outcome that is occasionally seen. 4,5 A modest increment in LA pressure is often seen after closure of an ASD, but large changes in pressure are uncommon and seen primarily in older patients with hypertension and/or LV dysfunction. 5,7-10 Before proceeding with ASD closure in such patients, consideration should be given to test occlusion of the ASD to evaluate the potential for a deleterious increase in LA pressure.An example of the effect of ASD closure in a patient with RV and LV dysfunction and mitral stenosis (valve area = 1.1 cm 2 ) is shown in Figure 1. Transient occlusion of the ASD resulted in an increase in pulmonary capillary wedge pressure (PCWP) from 18 to 23 mmHg.The increase developed gradually over several minutes, stabilizing after 3 minutes. The pressure returned to baseline after removal of the occluding balloon catheter. Some authorities suggest that an LA pressure increase exceeding 3 mmHg during test occlusion should prompt a consideration of the use of a fenestrated occluder that reduces, but does not abolish, the left-toright interatrial shunt. 7 This approach should decrease the shunt flow and reduce the volume load on the right heart, and would potentially provide a lower LA pressure than would be expected with a complete closure. 9Others use an LA pressure increment of 10 mmHg (during test occlusion) to identify high-risk patients. 8 Test occlusion of the ASD in patients at risk of a significant increment in LA pressure is relatively easy to recommend, but the exact partition pressure that would optimally identify patients who might benefit from a fenestrated occluder is not known. Creation of an Atrial Septal Defect as a Therapeutic MeasureIn 1948 Harkin and associates recognized the infr...

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Percutaneous closure of an iatrogenic atrial septal defect

Cited by 14 publications

References 11 publications

Iatrogenic Atrial Septal Defect

Iatrogenic Atrial Septal Defect

Tissue Properties of the Fossa Ovalis as They Relate to Transseptal Punctures: A Translational Approach

The Impact of an Atrial Septal Defect on Hemodynamics in Patients With Heart Failure

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