Transcatheter closure of atrial septal defects

Abstract

Transcatheter closure of atrial septal defects has evolved significantly over the last 20 years. Transcatheter closure has replaced surgical closure for the treatment of most secundum atrial septal defectsat the current time. A major reason for this is the lower morbidity of transcatheter closure procedures. Several closure devices have come into clinical use. The Amplatzer septal occluder (AGA Medical Co.) currently has the largest reported experience and subsequently the best-established safety and efficacy features. Clinically challenging situations, such as larger atrial septal defects, atrial septal defects with deficient rims and multiple atrial septal defects, are increasingly being addressed using the transcatheter approach, with improved results. The incidence of most complications has significantly reduced over time, and serious side effects are relatively uncommon. In this review, the literature is summarized regarding the current role of transcatheter closure, the evolution of the different available devices for clinical use and the complications that occur with their use. A comparison is also made with surgical closure techniques.

Elevated level of plasma endothelin-1 in patients with atrial septal defect

“…Correction of the defect may prevents the development of pulmonary hypertension, rhythm disturbances or failure of the heart. Amplatzer Septal Occluders have been commonly used for defect closure since the 90s [1,3,5,6]. …”

“…The indications for ASD closure in adults however are ambiguous. The most controversial issue is selection of candidates for ASD closure who have normal pulmonary artery pressure, absent or negligible clinical symptoms and are over 40 years of age [5-9]. …”

Pre-procedural planning for percutaneous atrial septal defect closure: Transesophageal echocardiography compared with cardiac computed tomographic angiography

“…Knowledge of the plane of the interatrial septum is critical to an efficient percutaneous ASD closure because specific delivery catheter shapes are needed to provide the correct left atrial disc alignment during deployment. 3 Indeed, special catheter shapes such as the Hausdorf-Lock catheter (Cook Inc, Bloomington, IN) are often required to overcome the poor device alignment, and CTA theoretically can provide the ability to select the correct catheter shape before the procedure, replacing the current trial-and-error method used intraoperatively. The use of CTA for patient selection and planning for transcatheter aortic valve implantation has parallels to the current study about patients with secundum ASDs.…”

Patent Foramen Ovale and Cryptogenic Stroke

“…A built-in spring-back mechanism allows the umbrella frame to resume its original shape after deformation during delivery. 42) Advocates of the CardioSEAL occluder device cite as its positive attributes its conformability and well-established use in large numbers of patients. By contrast, the device's propensity for surface thrombus formation and inability to redeploy following unsuccessful implantation remain major criticisms of the CardioSEAL device.…”