Transcatheter closure of atrial septal defects without fluoroscopy: a well-established procedure for alternative use in children

Yang, Yifeng; Zhang, Weizhi; Wu, Qin; Gao, Lei; Jin, Wancun; Zhao, Tianli

doi:10.4244/eijv12i5a106

Cited by 20 publications

(28 citation statements)

References 18 publications

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“…This procedure has some disadvantages, including the following: the inevitable radiation damage to patients and operators; the adverse effects of contrast agents on kidneys; and high cost. Moreover, when serious complications occur, e.g., occlude falling off or iatrogenic injury leading to cardiac tamponade, thoracotomy or extracorporeal circulation cannot be immediately performed [6][7][8]. To avoid the abovementioned disadvantages, transesophageal echocardiography (TEE) with clear sound window is used for patients.…”

Section: Introductionmentioning

confidence: 99%

Patent foramen ovale closure by using transesophageal echocardiography for cryptogenic stroke: single center experience in 132 consecutive patients

Han

Zhang

2020

J Cardiothorac Surg

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Background: Percutaneous closure of patent foramen ovale (PFO) is routinely performed using plain fluoroscopy in the catheter room. This method results in inevitable radiation damage, adverse effects of contrast agents on kidneys, and high cost. We performed PFO closure with a simplified and economical transesophageal echocardiography (TEE)-only guided approach in the operating room. This study aimed to investigate the feasibility, safety, and effectiveness of the percutaneous closure of PFO by only using TEE. Methods: We reviewed the medical records of patients who underwent percutaneous PFO closure at our center from December 2013 to December 2017. A total of 132 patients with PFO and cryptogenic strokes underwent PFO closure by using cardi-O-fix PFO device under TEE guidance. The participants comprised 64 and 68 male and female patients, respectively. The mean age and body weight of the patients were 39.40 ± 13.22 years old (12-68 years old) and 65.42 ± 9.70 kg (40-95 kg), respectively. All patients only received aspirin (3-5 mg/kg body weight, oral administration) for 6 months. Contrast-enhanced transthoracic echocardiography (c-TTE) with Valsalva maneuver was performed during follow-up, and questionnaire surveys were obtained at 3, 6, and 12 months after the procedure. Results: All (100%) patients were successfully closed. Follow-ups were conducted for 13 months to 48 months, with an average of 27 months. No severe complications were found during the follow-up period. Paroxysmal atrial fibrillation occurred in 4 patients within 3 months after the procedure. No recurrent stroke or death occurred in all patients during the follow-up period. Transient ischemic attack occurred in one patient 6 months after the procedure. Ten (7.6%) patients had a right-to-left shunt, as demonstrated by c-TTE at 12 months of follow-up. Among the 57 patients suffering from migraine, significant relief or resolution was reported by 42 (73.7%) patients. Conclusion: TEE-only guided PFO closure was a safe, feasible, and effective method that did not require the use of X-rays and contrast agents.

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Section: Introductionmentioning

confidence: 99%

Patent foramen ovale closure by using transesophageal echocardiography for cryptogenic stroke: single center experience in 132 consecutive patients

Han

Zhang

2020

J Cardiothorac Surg

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“…Percutaneous device closure under TEE guidance just needs to establish a shorter transfer track that involves the right femoral vein, IVC, RA, TVs, RV, VSD, and LV. Third, the inclusion of TEE imaging is easier and safer [23,24]. And compared with TTE, the advantages of TEE are no obstruction of the chest wall and lung, clearer image, stronger color Doppler signal, more cardiac anatomy information, and no interference in the monitoring operation.…”

Section: Discussionmentioning

confidence: 99%

Echocardiography-guided percutaneous closure of perimembranous ventricular septal defects without arterial access and fluoroscopy

Yang

et al. 2019

BMC Pediatr

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Background: Traditional percutaneous device closure of perimembranous ventricular septal defects (PmVSDs) is a minimally invasive technique, but can result in high radiation exposure and can result in potential arterial complications. Here, we aimed to assess the safety and feasibility of device closure of PmVSDs via the femoral vein approach under transesophageal echocardiography (TEE) guidance in children. Methods: From January 2014 to December 2017, a total of 46 PmVSD patients (mean age, 6.5 ± 2.3 years [range, 4.2-12.0 years]; mean body weight 22.1 ± 6.6 kg [range, 16.0-38.5 kg]; VSD diameter, 4.1 ± 0.6 mm [range, 3.2-5.0 mm]) underwent attempted transcatheter closure via the femoral vein approach under the guidance of TEE without fluoroscopy. Results: The transcatheter occlusion procedure under TEE guidance was successful in 44 (95.7%) patients. Surgery was necessary in 2 (4.3%) patients. The procedure duration was 28.2 ± 8.7 min (range, 12.0-42.0 min). One patient had immediate post-operative trivial residual shunt and three patients had immediate incomplete right bundle branch block (IRBBB) after operation; the new IRBBB in 1 case was noted in the first postoperative month. No residual shunt was noted at 3 months after the procedure, and no intervention related complications were detected at 1-24 months follow-up. Conclusions: Percutaneous device closure of PmVSDs under TEE guidance solely by femoral vein approach is effective and safe, avoids radiation exposure, potential arterial complications and a surgical incision.

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“…9 Percutaneous closure guided by digital subtraction angiography (DSA) was the first choice for secundum ASD. 11 Our center had established a whole strategy for treating ASD and the flow chart is showed in Figure 2. 11 Our center had established a whole strategy for treating ASD and the flow chart is showed in Figure 2.…”

Section: Discussionmentioning

confidence: 99%

“…In this study, small-edge occluder (right disc＞waist 3 mm different from normal occluder right disc > waist 5 mm) was employed and area rule was adopted for cases with deficient aortic or superior rim because of no "unbutton effect" in intraoperative device closure. In this study, all patients underwent intraoperative device closure got satisfactory results and avoided cardiopulmonary bypass.For secundum ASD, our center had established whole closure strategy including percutaneous closure,11 intraoperative device closure and surgical repair by TEE guiding merely. Zhu et al 23 had introduced a new atrial septum remodeling technique by breaking the rim between multiple ASDs for intraoperative device closure.…”

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confidence: 99%

Strategy of treating secundum atrial septal defect not referred to percutaneous closure

Zhang¹,

Yang

et al. 2019

Congenital Heart Disease

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Objective: To evaluate safety and effectiveness of intraoperative device closure for secundum atrial septal defect (ASD) not referred to percutaneous closure. Design and Patients:From April 2010 to December 2018, 231 secundum ASD children (≤14 years) directly recommended to surgical repair were enrolled in this study.These patients were divided into two groups according to the parents' choice based on surgeons' recommendation. Follow-up evaluations were adopted at 2 weeks, 3 months, 6 months, and 12 months after the procedure and yearly thereafter. In Group A, 127 patients underwent an initial attempt at device closure. In Group B, 104 patients underwent a repair procedure under cardiopulmonary bypass. Results: All patients survived. Group A had lower values of operation time, mechanical ventilation time, cardiac intensive care unit duration and amount of blood transfusion. Nevertheless, postoperative hospitalization time between two groups showed no statistical difference. In group A, 109 (85.83%) patients were successfully occluded, whereas 18 (14.17%) patients were converted to open-heart surgery. No severe complications occurred in the follow-up period.Conclusion: Intraoperative device closure is safe, effective procedure for selected cases with secundum ASDs which were not referred to percutaneous closure because of more suitable occluder selection, no "unbutton effect" and stitching enhancement. K E Y W O R D Schildren, intraoperative device closure, percutaneous closure, secundum ASD

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Transcatheter closure of atrial septal defects without fluoroscopy: a well-established procedure for alternative use in children

Abstract: Using a modified delivery system and a re-established procedure, we showed that transcatheter closure of ASD without fluoroscopy is a safe technique for alternative use in children.

Cited by 20 publications

References 18 publications

Patent foramen ovale closure by using transesophageal echocardiography for cryptogenic stroke: single center experience in 132 consecutive patients

Patent foramen ovale closure by using transesophageal echocardiography for cryptogenic stroke: single center experience in 132 consecutive patients

Echocardiography-guided percutaneous closure of perimembranous ventricular septal defects without arterial access and fluoroscopy

Strategy of treating secundum atrial septal defect not referred to percutaneous closure

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