Percutaneous closure of secundum type atrial septal defects: More than 5-year follow-up

Snijder, Roel J.R.; Suttorp, Maarten J.; Berg, Jurriën Ten; Post, Martijn C.

doi:10.4330/wjc.v7.i3.150

Cited by 15 publications

(18 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, as in our case, TTE may not reveal displaced devices or even remaining defects in the PFO. Accordingly, a recent follow-up study concluded that devices evaluated > 5 years after closure with TTE were well placed ( 33 ), but two patients in this population had their devices surgically removed, and up to 45% had residual shunting when evaluated with contrast. While intracardiac ultrasound may be of help during the insertion of PFO devices ( 34 – 39 ), TEE remains the diagnostic “gold standard” for evaluating cardioembolic sources of stroke ( 40 – 44 ), and repeated prerequisite Valsalva maneuvers followed by contrast injections and careful evaluations are important to avoid misinterpretations and diagnostic failure ( 25 ).…”

Section: Discussionmentioning

confidence: 99%

“…By contrast, AF occurred at similar rates after PFO closure with Amplatzer® devices (St. Jude Medical, Plymouth, MN, USA) compared with medical therapy in the RESPECT (Randomized Evaluation of Recurrent Stroke Comparing PFO Closure to Established Current Standard of Care Treatment) trial (2.9% vs. 1.0%; P = 0.16) and in the PC trial (Clinical Trial Comparing Percutaneous Closure of Patent Foramen Ovale Using the Amplatzer PFO Occluder with Medical Treatment in Patients with Cryptogenic Embolism) (3% vs. 1.5%; P = 0.13) ( 50 , 73 ). However, uniformly comparable heart rhythm monitoring before device closure was not available in any of the studies, and recent follow-up studies of “atrial septum defects closed with devices” demonstrate a high risk (6.6–17.9%) of AF in the first year after the procedure, decreasing to negligible (0–3.9%), but with only 76–82% of the original population included in one study ( 33 , 74 , 75 ).…”

Section: Discussionmentioning

confidence: 99%

“…A recent retrospective longitudinal multicenter study of 199 patients, “DysrhythmiAs in patieNts with congenitAl heaRt diseAse” (DaNaRA), demonstrated that patients with congenital heart disease, particularly patients with complex defects, develop AF at a young age and progress frequently from paroxysmal AF to (long-standing) persistent/permanent AF ( 91 ). Sixteen patients (8%) experienced a cerebrovascular event 14 ( 2 – 33 ) years before the first documented AF. The total incidence of TIA/stroke in the population was 13%.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Patent foramen ovale and atrial fibrillation as causes of cryptogenic stroke: is treatment with surgery superior to device closure and anticoagulation? A review of the literature

Kjeld

Jørgensen

Fornitz

et al. 2018

Acta Radiologica Open

View full text Add to dashboard Cite

Closure of persistent foramen ovale (PFO) to avoid cryptogenic strokes is performed globally with enthusiasm but lacks prove of efficacy. We present a 79-year-old man who had had a PFO device introduced nine years previously because of cryptogenic strokes presenting as syncopes. The patient was referred from his general practitioner with two new syncopes. Transthoracic echocardiography revealed no cardiac causes of embolism. Transesophageal echocardiography (TEE) revealed a misplaced device like an umbrella in a storm, but no septum defects. Holter revealed seconds-long episodes of atrial fibrillation (AF). The patient was successfully treated with anticoagulation.A literature review showed that: (i) the efficacy of PFO closure devices has not been proven in any trial, but was demonstrated in a meta-analysis comparing three different devices; (ii) PFO devices are rarely controlled by TEE during or after insertion; (iii) residual shunts are detected in up to 45% of cases; (iv) there is an increased rate of post-arrhythmic complications; (v) the risk of AF in congenital heart disease increases with increasing age, with a 13% risk of transient ischemic attacks and stroke; and (vi) surgical treatment of PFO was found to have a 4.1% risk of complications including stroke.The question to be asked is whether device closure of PFO should be avoided, considering that PFO is a congenital heart defect with risks of AF and (cryptogenic) stroke? Heart surgery should be a treatment option for symptomatic PFO.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Patent foramen ovale and atrial fibrillation as causes of cryptogenic stroke: is treatment with surgery superior to device closure and anticoagulation? A review of the literature

Kjeld

Jørgensen

Fornitz

et al. 2018

Acta Radiologica Open

View full text Add to dashboard Cite

show abstract

“…Amplatzer Septal Occluder is a catheter-based ASD closure device that consists of a self-expanding double-disk nitinol mesh that apposes both sides of the septal wall (Fig 8a). The Amplatzer Septal Occluder has shown high closure rates, with low residual shunting at 5-year followup (27). The device comes in multiple sizes and may also be used for muscular ventricular septal defect (VSD) occlusion.…”

Section: Device and Radiographic Appearance-thementioning

confidence: 99%

Radiographic Review of Current Therapeutic and Monitoring Devices in the Chest

et al. 2018

View full text Add to dashboard Cite

Chest radiographs are obtained as a standard part of clinical care. Rapid advancements in medical technology have resulted in a myriad of new medical devices, and familiarity with their imaging appearance is a critical yet increasingly difficult endeavor. Many modern thoracic medical devices are new renditions of old designs and are often smaller than older versions. In addition, multiple device designs serving the same purpose may have varying morphologies and positions within the chest. The radiologist must be able to recognize and correctly identify the proper positioning of state-of-the-art medical devices and identify any potential complications that could impact patient care and management. To familiarize radiologists with the arsenal of newer thoracic medical devices, this review describes the indications, radiologic appearance, complications, and magnetic resonance imaging safety of each device. RSNA, 2018.

show abstract

“…Atrial septal defects (ASDs) are a common cardiac congenital finding with complications due to the left-to-right shunt (LRS). Percutaneous closure of an ASD is considered to be the first choice and has been proven safe and effective using different devices [1,2]. Worldwide, there is a lot of good experience with the Amplatzer septal occluder.…”

Section: Introductionmentioning

confidence: 99%

Percutaneous Atrial Septal Defect Closure Using the Occlutech Figulla Device in Adults: More than 800 Patient-Years of Follow-Up

Snijder

Renes

Bosshardt

et al. 2020

Journal of Interventional Cardiology

View full text Add to dashboard Cite

Purpose. The Occlutech Figulla occluder has been proven safe and effective at midterm follow-up after percutaneous atrial septal defect (ASD) closure. We describe the safety and efficacy at long-term follow-up in adults. Methods. All consecutive adult patients that underwent ASD closure between 2008 and 2015 were included. All complications were registered. Residual left-to-right shunt (LRS) was diagnosed using color-Doppler transthoracic echocardiography (TTE). Right-to-left shunting was diagnosed using contrast TTE. Successful closure was defined as no LRS at follow-up. Results. In total, 166 patients (mean age 56.7 ± 16.1 years; 62% female) underwent percutaneous ASD closure using the Occlutech Flex I (70%) or Flex II (30%) device (diameter 24 mm; range 10–40 mm) under general anaesthesia and transoesophageal echocardiographic guidance. Long-term follow-up data were available for 144 patients (87%) with a mean follow-up of 5.9 ± 2.6 years, a total of 814 patient-years. During hospitalization, device embolization occurred in three patients (1.8%) with successful extraction in all. During the long-term follow-up, 15 patients (9.8%) suffered new-onset atrial fibrillation and stroke occurred in 2.1%. There was no residual LRS at 12-month follow-up. No device embolization occurred during the long-term follow-up. Conclusion. Percutaneous ASD closure using the Occlutech device appears to be safe at long-term follow-up with a high successful closure rate at one year.

show abstract

Percutaneous closure of secundum type atrial septal defects: More than 5-year follow-up

Abstract: Percutaneous ASD closure has good long-term safety and efficacy profiles. The residual RLS rate seems to be high more than 5 years after closure, especially in the CS/SF. Residual LRS was not observed.

Cited by 15 publications

References 20 publications

Patent foramen ovale and atrial fibrillation as causes of cryptogenic stroke: is treatment with surgery superior to device closure and anticoagulation? A review of the literature

Patent foramen ovale and atrial fibrillation as causes of cryptogenic stroke: is treatment with surgery superior to device closure and anticoagulation? A review of the literature

Radiographic Review of Current Therapeutic and Monitoring Devices in the Chest

Percutaneous Atrial Septal Defect Closure Using the Occlutech Figulla Device in Adults: More than 800 Patient-Years of Follow-Up

Contact Info

Product

Resources

About