Transcatheter Device Closure of Atrial Septal Defects

Moore, John W.; Hegde, Sanjeet; El‐Said, Howaida; Beekman, Robert H.; Benson, Lee; Bergersen, Lisa; Holzer, Ralf; Jenkins, Kathy J.; Ringel, Richard; Rome, Jonathan J.; Vincent, Robert; Martin, Gerard R.

doi:10.1016/j.jcin.2013.02.005

Cited by 181 publications

(153 citation statements)

References 20 publications

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“…In addition to this first week of close follow-up, patients should, at minimum, be reevaluated one month, 6 months, and one year after implantation, because adverse events are more frequent in the first 12 months. 6,7 In suspect cases, the hospital stay should be prolonged and patients closely monitored. Of note, TTE and cardiac computed tomography are extremely helpful in the diagnosis of sequelae.…”

Section: Discussionmentioning

confidence: 99%

Late Cardiac Rupture after Amplatzer Septal Occluder Implantation

Arnaz¹,

Türkekul²,

Yalçınbaş³

et al. 2016

Texas Heart Institute Journal

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A trial septal defect (ASD), the most prevalent congenital heart disease in adults, accounts for 5% to 10% of all congenital heart diseases.1 Although most patients are asymptomatic until adulthood, early diagnosis and treatment are crucial to prevent such possible sequelae as right-sided heart failure, pulmonary hypertension, and arrhythmia. Surgery is the gold standard in the treatment of secundum ASD, because its morbidity and mortality rates are very low, while postoperative functional capacity and survival rates are excellent in the long term. Although surgery is a low-risk and recommended treatment method, its risks include post-pericardiotomy syndrome, arrhythmia, pleural and pericardial effusion, the need for blood products, and scar formation. Percutaneous closure of ASD was first performed in 1976. It has been widely adopted over the subsequent decades because it is a low-risk method, implies a short hospital stay, has no need for blood products, and produces no scars.2 However, it can lead to life-threatening early and late sequelae that require emergency intervention. Early sequelae can include residual shunts, systemic and pulmonary device embolization, thromboembolism, superior vena cava and right-upper pulmonary vein compression, tricuspid or mitral valve compression, and arrhythmia. Late and life-threatening sequelae include free ruptures of the right and left atrial walls that cause cardiac tamponade, erosion of the ascending aorta, and aorta-atrial fistula formation. 2 Case ReportIn February 2013, a 22-year-old woman was admitted to our emergency department with sudden-onset dyspnea and subsequent syncope. In the initial examination, she was unconscious and in respiratory arrest. After cardiopulmonary resuscitation, she was intubated. Transthoracic echocardiography (TTE) revealed dense pericardial effusion, fibrin, and cardiac tamponade. The patient, in shock, underwent urgent operation.Intraoperative examination revealed rupture of the left atrial roof and noncoronary aortic sinus, caused by an atrial septal occluder (ASO) (Fig. 1). We placed a temporary pledgeted suture on the ruptured noncoronary sinus of the ascending aorta, to stop the bleeding through a very small perforation. After a standard bicaval cannulation, we initiated cardiopulmonary bypass. The right atrium was opened after aortic cross-clamping and antegrade delivery of blood cardioplegia. The ASO was then removed, and a temporary autologous pericardial patch was constructed for the ostial

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Section: Discussionmentioning

confidence: 99%

Late Cardiac Rupture after Amplatzer Septal Occluder Implantation

Arnaz¹,

Türkekul²,

Yalçınbaş³

et al. 2016

Texas Heart Institute Journal

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“…However, because of concerns about erosion, we selected a just 1 mm larger device in this case. (6). Although we could achieve an acceptable position wherein more than 75% of the rim was trapped around the defect, the hypermobile atrial septum could not offer enough support for device stabilization, leading to migration.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Retrieval and Redeployment of an Atrial Septal Occluder under Three-Dimensional Transesophageal Echocardiographic Guidance: A Case Report

et al. 2014

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Percutaneous device closure for secundum atrial septal defects (ASDs) has been performed commonly and safely with high success rates. However, it is still challenging to close ASDs that are surrounded with deficient or hypermobile rims and could be compromised with an unexpected migration of device. We report a case of percutaneous Amplazter Septal Occluder (ASO; St. Jude Medical Inc., St. Paul, Minnesota, USA) device closure for an ASD with a thin and floppy interatrial septum, which immediately migrated into the right atrium and was not pulled back into the delivery sheath. To our knowledge, this is the first report on a successful percutaneous retrieval and redeployment of the device in such a situation, preventing any vascular injury or unplanned emergency open heart surgery.Graphical Abstract

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“…Cardiac perforations were increasingly reported with an estimated erosion rate of 0.28% and a consequent mortality in 0.05% of patients [44]. A deficient aortic rim is present in 90% of erosion cases [45]. Compared to occluders like CardioSEAL and StarFLEX, a lower risk of thrombus formation was found [46,47].…”

Section: Amplatzer Septal Occluder (Aso)mentioning

confidence: 99%

Historical developments of atrial septal defect closure devices: what we learn from the past

Nassif

Abdelghani

Bouma

et al. 2016

Expert Review of Medical Devices

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Introduction: Since King and Mills' pioneering work in percutaneous closure devices of secundum atrial septal defects (ASD) four decades ago, developments in device shape, material and implantation technique led to adoption of percutaneous ASD closure as current treatment of choice. Not only was the feasibility of such a percutaneous procedure tested altogether, but pursuing the ideal device in terms of safety and efficacy became priority. Areas covered: In this review we present the historical development of ASD devices in design, material and technique with clinical data, and provide the future perspectives in percutaneous ASD closures. Expert opinion: An 'ideal device' requires complete defect closure with negligible risk of complications using a safe, straightforward delivery technique with repositioning and retrieving properties. Some of the devices currently at hand come close to fulfilling these criteria, however none seem to provide those prerequisites completely. By understanding how challenges in device development were overcome in the past, new insights into future improvements are given. ARTICLE HISTORY

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Transcatheter Device Closure of Atrial Septal Defects

Abstract: This review discusses the current safety issues related to U.S. Food and Drug Administration approved atrial septal defect devices and proposes a potential avenue to gather additional safety data including factors, which may be involved in device erosion.

Cited by 181 publications

References 20 publications

Late Cardiac Rupture after Amplatzer Septal Occluder Implantation

Late Cardiac Rupture after Amplatzer Septal Occluder Implantation

Percutaneous Retrieval and Redeployment of an Atrial Septal Occluder under Three-Dimensional Transesophageal Echocardiographic Guidance: A Case Report

Historical developments of atrial septal defect closure devices: what we learn from the past

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