Catheter closure of atrial septal defect: Successful use in a 3.6 kg infant

Abstract

The mechanical and ergonomic characteristics of a delivery cable can play a significant role in facilitating efficient occlusion of shunts in congenital heart disease. The aim of this study was to describe the initial experience using the new Amplatzer Trevisio delivery cable for percutaneous closure of atrial and ventricular septal defects. Additionally, bench testing was performed to compare the Trevisio and standard Amplatzer delivery cables.A retrospective chart review was performed on all procedures in which the Trevisio cable was used to facilitate device deployment at a single institution between September and November 2019. Bench testing of both cables was performed to compare straight-line pushability and device movement after release.Two atrial septal defects (ASD), one patent foramen ovale (PFO), and two ventricular septal defects (VSD) were successfully closed with Amplatzer occlusion devices using the Trevisio cable. Two of these successful procedures followed failed attempts to close the shunt using other devices due to anatomic complexity. Review of transesophageal (TEE) imaging in matched cases where a standard delivery cable had been used demonstrated a 15o shift in the angle of the device after release. On fluoroscopy, this shift was measured at 12.3o. Using the Trevisio cable, a shift of only 2.3o was noted fluoroscopically. Bench testing failed to demonstrate any difference in the objective or subjective pushability between both cables despite the flexible design of the Trevisio cable. Fluoroscopic testing with a 3D model demonstrated improved predictability of device position when using the Trevisio cable.The Amplatzer Trevisio delivery cable offers reduction in device tension prior to release and reorientation after release without sacrificing device pushability when compared to the traditional delivery cable for deployment of the Amplatzer series of devices.