Amplatzer Atrial Septal Defect Research Articles

Right atrial myxoma after Amplatzer atrial septal defect closure device deployment.

Right atrial (RA) myxoma is common; however, RA myxoma after the percutaneous atrial septal defect closure is very rare. To the best of our knowledge, this might be the first reported case of RA myxoma after Amplatzer closure of an atrial septal defect, leading to a pulmonary artery embolism. We removed all the RA mass, occluder and pulmonary embolus and reconstructed the atrial septum successfully. As a result of surgery, there were no other complications as following up.

Emergent Surgical Retrieval of an Embolized Atrial Septal Occluder Device from Right Ventricle – An Unusual Occurrence

Atrial septal defect (ASD) is one of the most common congenital heart defects (3.78/10,000 live births). For several decades, surgical closure has been considered the standard method of repairing an ostium secundum ASD. Surgical treatment is safe and effective, but the complications relate to bleeding, arrhythmia, and residual defects. However, over the years, percutaneous device closure using the Amplatzer ASD occluder (AGA Medical Corp., Golden Valley, Minnesota) has been widely used for the treatment of ASD and has proven to be effective and safe as traditional surgical repair. However, procedure- or device-related complications can occur; Complications commonly associated with ASD closure device includes residual shunt, device malposition or embolization, thrombosis in the vena cava or atrium and erosion of the surrounding tissue which may lead to perforation of the heart, which could be fatal. We report an unusual case of a 16-year-old female with embolization of the ASD occluder device into the right ventricle immediately after device deployment. We removed the device surgically and closed the ASD in a standard manner, with an autologous pericardial patch. The patient was discharged from the hospital without any complications.

Application of Transesophageal Echocardiography in Amplatzer Atrial Septal Defect Occluder for Percutaneous Closure of Large Patent Foramen Ovale.

Objective The Amplatzer patent foramen ovale (PFO) occluder is the most commonly used device for percutaneous closure of a large PFO. However, its use may predispose the patient to postoperative residual shunting. To reduce the incidence of residual shunting, we investigated the safety and effectiveness of the Amplatzer atrial septal defect (ASD) occluder for percutaneous closure of a large PFO measured by transesophageal echocardiography (TEE) and evaluated the value of TEE in this procedure. Methods Overall, 118 patients who were diagnosed with a large PFO (all with a ≥ 2 mm left atrial side height after the Valsalva maneuver (VM) excluding those with a small ASD) using contrast transthoracic echocardiography (c-TTE) and TEE underwent closure under TEE guidance at The First Affiliated Hospital of Xi'an Jiaotong University. An ASD device was used in 48 patients (group I) and a PFO device in 70 (group II). After the procedure, we verified the safety and efficacy of different devices using c-TTE, TTE, and TEE. Results In both groups, the preoperative TEE results showed a significantly increased left height of the PFO after VM compared with that at rest (all P < 0.01). Compared with the left height of the PFO measured using TEE after VM, the PFO-stretch diameter (SD) measured by TEE after the delivery sheath passed the PFO was higher (all P < 0.01). We selected the ASD occluder size according to this PFO-SD. In group II, most patients underwent the implantation of the larger PFO devices. Interventional treatment was successfully performed on all patients. The effective occlusion rate in group I at 12 months after the procedure was significantly higher than that in group II (93.7% vs. 78.6%, P < 0.05). The TEE results showed that 18 patients with a medium and large residual shunt at 12 months after the procedure exhibited an intradisc tunnel-like shunt. Conclusion The Amplatzer ASD device and Amplatzer PFO device are safe for large PFO closure, but the Amplatzer ASD device has a higher effective occlusion rate. TEE plays a crucial role in the use of the Amplatzer ASD occluder for percutaneous closure of a large PFO.

Use of an Amplatzer ASD Occlusion Device for the Closure of an Ascending Aortic Pseudoaneurysm Presenting as Hemoptysis.

Aortic pseudoaneurysms can commonly be caused by previous thoracic surgery, trauma, and infection, quickly becoming life-threatening if ruptured. This pathology is typically asymptomatic and incidentally found on imaging; however, few cases have outlined hemoptysis as a presenting symptom for aortic pseudoaneurysms. Traditionally, management of these patients included surgical correction; however, percutaneous approaches have emerged as a safe alternative, helping to reduce the risk of morbidity and mortality associated with surgical correction. This report seeks to describe a case in which hemoptysis was the symptom unveiling the finding of a thoracic ascending aortic pseudoaneurysm and the use of an Amplatzer atrial septal defect (ASD) occlusion device as a viable option to safely resolve the disease process.

Cardiac solution for a vascular scenario!

BackgroundAscending aortic pseudoaneurysms (AAPs) constitute a rare, albeit potentially dangerous, condition that occurs in up to 13% of patients after cardiac or aortic surgeries. For patients with a history of cardiac surgery, repeat thoracotomy poses additive risks. The high morbidity and mortality rates associated with the surgical management of AAPs have led to the development of transcatheter approaches.Case reportWe report a case of AAP percutaneous closure at the site of aortic cannulation with an ASO device in a post-CABG 65-year-old man, who refused surgery.ConclusionThe use of the Amplatzer Atrial Septal Defect Occluder (ASO) device represents an acceptable alternative to surgery in treatment of Ascending aortic pseudoaneurysms.

A Round Peg for a Torn Hole – Percutaneous Closure of Anterior Mitral Valve Leaflet Perforation With Amplatzer Atrial Septal Defect Occluder

A 63-year-old male underwent planned percutaneous mitral valve repair for severe symptomatic mitral regurgitation (MR) due to a perforation of his anterior mitral valve leaflet (AMVL) following a past episode of infective endocarditis (Figure 1). He was deemed unsuitable for surgery following a heart team discussion due to comorbidities.

Modified Technique to Control the Eutachian Valve During Transcatheter Closure of Atrial Septal Defect/Patent Foramen Ovale

Abstract Objective to describe an approach to perform safe transcatheter closure of Atrial Septal Defect (ASD)/Patent Foramen Ovale (PFO) associated with large redundant Eustachian Valve. Background Transcatheter device closure of ASD/PFO is feasible in a great majority of patients. However, the presence of a huge mobile Eustachian Valve can compromise device placement. Patients and Methods Six patients (3 PFO and 3 ASD patients) with a huge redundant Eustachian valve were included. Two patients had PFO with long tunnel and were closed with Occlutech FigullaFlex II PFO occluders sized 23/25 and 27/30 respectively. The other PFO patient had an associated atrial septal aneurysm (ASA) and was closed with a 25 mm Amplatzer Multi-Fenestrated Septal Occluder “cribriform” device (St. Jude Medical – Abbott Vascular). The three ASDs were closed by regular ASD occluders (2 Flex II ASD Occluders sized 30 and 33 mm and 1 Amplatzer ASD Occluder sized 24 mm). Eustachian valve was successfully held with a steerable ablation catheter to deflect it against the lateral right atrial wall, keeping it away from the inter-atrial septum to prevent its entrapment or interference with the cable, the sheath or the device. Results All ASDs/PFOs have been successfully closed with no complications with free inferior vena cava (IVC) flow, with no residual inter-atrial shunt and the eustachian valve is not interfering with the device. Conclusions Safe percutaneous ASD/PFO closure can be achieved with proper control of a large redundant Eustachian valve.

Successful multiple Percutaneous Interventions and Biventricular Surgical Repair in a Child with Pulmonary Atresia with Intact Ventricular Septum— A Case Report

Pulmonary atresia (PA) with intact ventricular septum is a rare, heterogeneous congenital heart defect with varying degrees of right ventricular and tricuspid valve hypoplasia and wide spectrum clinical features. Initial treatment at presentation is to establish systemic to pulmonary shunt or ductus stenting. The treatment options i.e. biventricular, one and half ventricular or one ventricular repair are often dictated by the degree of development of the tricuspid valve and right ventricle. X, 11 years old teenage girl got admitted to Combined Military Hospital (CMH) Dhaka at 5 months of age with severe cyanosis, respiratory distress, acidosis and shock. After immediate stabilization and work up, she was diagnosed as pulmonary atresia with intact ventricular septum, flapped atrial septal defect (ASD) and a small patent ductus arteriosus (PDA). On urgent basis, stenting of PDA done with 3.5 X 11 mm coronary stent at cardiac catheterization laboratory. Her SPO2 stepped up to 90 % from base line SPO2 from 50% following procedure. At 15 months of age she underwent intracardiac repair with short trans annular patch and ASD left open as a vent for RV. On follow up her ASD was getting larger and became desaturated and symptomatic. She was followed up for the right ventricular (RV) and tricuspid valve growth and ASD shunt. As her RV was developing nicely during follow up and achieved TV z score –1, ASD device closure was done with 18 mm Amplatzer ASD device at 5 years of age. She is now asymptomatic and thriving well.&#x0D; Cardiovasc. j. 2020; 13(1): 81-85

Is This a Satellite Orbiting Unchartered Territory?

SummaryA 27-year old female i.v. drug user presented to our institution with chest pain. She had a history of bicuspid aortic valve endocarditis with aortic root abscess repaired with bioprosthetic aortic valve replacement and pericardial patch reconstruction of the left ventricular outflow tract and non-coronary sinus 6 weeks previously.Echocardiographic and cardiac CT imaging confirmed three foci of breakdown of the pericardial patch repair with active bleeding into a large posterior pseudoaneurysm (92 mm diameter) compressing the left atrium and pulmonary artery. Following multidisciplinary discussion, the consensus was to attempt urgent percutaneous closure of the defect, given the prohibitive surgical risks.The procedure was performed under fluoroscopic and 3D-transoesophageal guidance. TOE demonstrated the pericardial patch breaches and active bleeding into the large pseudoaneurysm (Figs 1 and 2). Initial deployment of an Amplatzer atrial septal defect occluder resulted in significant flow reduction, but there remained two small peri-device leaks (Fig. 3).During an attempt to implant an additional smaller Amplatzer vascular plug (AVP-2) to rectify this, the initial device dislodged and embolised into the pseudoaneurysm. This was felt irretrievable and unlikely to be clinically significant given its containment. The embolised device freely floated within the pseudoaneurysm, uniquely akin to a satellite orbiting in space (Video 1). The secondary device was removed and initial breach was satisfactorily closed with a 15-mm-sized Amplatzer atrial septal defect occluder (third device). This was confirmed to be well-seated on real-time 3D imaging (Video 2), with negligible residual leak on TOE (Fig. 4). This is the first published case of percutaneous cardiac device embolization into a pseudoaneurysm cavity that we are aware of.

Endoscopic closure of a bronchopleural fistula after pneumonectomy with the Amplatzer occluder: a step forward?

A bronchopleural fistula after pneumonectomy is a relatively rare but very serious complication. The development of endoscopic methods of treatment opens a new page in treating this condition. The goal of this paper was to confirm that the atrial septal defect Amplatzer device can be used for bronchopleural fistula closure in properly selected patients. A retrospective study of 13 patients with bronchopleural fistula after pneumonectomy was performed. There were 11 men and 2 women aged 26-70 years. Right-sided fistulas occurred in 10 patients and left-sided fistulas occurred in 3. The underlying disease was lung cancer in 7 patients and pulmonary tuberculosis in 6. Video-assisted thoracoscopic surgery (N = 7) and open-window thoracostomy (N = 6) were used to treat the empyema. To treat occlusion of the bronchial fistulas, we used Amplatzer atrial septal defect occluders originally intended for closure of ventricular and interatrial septal defects. The occluder was inserted from the bronchus by flexible bronchoscopy with the patient under local anaesthesia, with the help of video-assisted thoracoscopy or through a window thoracostomy from the pleural cavity. We noted 3 complications after the procedure. In 2 patients, displacement of the occluders required re-installation in 1 patient and latissimus dorsi muscle coverage in the other. In the third patient, the occluder became dislodged during severe exacerbation of tuberculosis that occurred after the patient violated the treatment regimen. She died of tuberculosis 6 months after the occluder was inserted. The course in the remaining 10 patients was uneventful. Our experience suggests that the use of an atrial septal defect occluder for the treatment of a bronchial fistula after pneumonectomy is a reliable option.

Endoscopic Closure of Esophagopleural Fistula With AMPLATZER Atrial Septal Defect Closure Device

Endoscopic Closure of Esophagopleural Fistula With AMPLATZER Atrial Septal Defect Closure Device

Fenestrated ASD device “angioplasty”: How to adjust a “pop‐off” mechanism when needed

We report on three cases of atrial septal defect (ASD) closure where a handmade fenestration had to be modified after device implantation. Two patients suffered from left ventricular diastolic dysfunction and one had severe pulmonary arterial hypertension. Amplatzer ASD occluder fenestration was created in all patients. Devices were implanted using an "over-the-wire" implantation technique. Due to a sub-optimal hemodynamic result, fenestration was upsized by using a new technique.

Simultaneous Transcatheter Device Closure of ASD, VSD and PDA in an Infant with Down Syndrome

Incidence of congenital heart defects in Down syndrome varies from 40% to 60%. Atrioventricular septal defect is most common defect seen, followed by isolated Ventricular Septal Defect (VSD). Multiple defects can be found in 5% to 10% of Down syndrome babies. Such patient usually presents with Pulmonary Hypertension (PAH) early in life and can develop rapid progression. An infant with Down syndrome weighing 6.5 kg presented with recurrent lower respiratory tract infections. A Transthoracic echocardiogram showed 10 mm secundum Atrial Septal Defect (ASD), 5 mm peri membranous Ventricular Septal Defect (VSD) and 3.5 mm conical shaped Patent Ductus Arteriosus (PDA) with Pulmonary Arterial Hypertension (PAH). As all the defects were suitable for transcatheter closure, patient underwent successful device closure of VSD by 6/4 mm Amplatzer duct occluder II (ADO II) device, PDA closure by 6/4 mm Amplatzer duct occluder (ADO) device and ASD closure by 12 mm Amplatzer septal occluder device. PA pressures of patient reduced significantly after the procedure and possible post-operative morbidity was avoided by transcatheter intervention.

Nickel hypersensitivity reaction following Amplatzer atrial septal defect occluder device deployment successfully treated by explantation of the device

Nickel hypersensitivity reaction following Amplatzer atrial septal defect occluder device deployment successfully treated by explantation of the device

Goose-neck snare-assisted transcatheter ASD closure: A safety procedure for large and complex ASDs.

To report on a new technique that increases the safety of percutaneous atrial septal defect (ASD) closure using a goose-neck snare system. ASD transcatheter closure is a widespread procedure. However, in some cases, ASDs may be large and with soft rims. In these situation, a potential risk exists for device malposition or embolization. When transesophageal echocardiography (TEE) evaluation and balloon sizing showed large defects with floppy rims the chosen Amplatzer device was implanted in a standard way. In large defects with floppy rims, before release a 5-mm goose-neck snare with its 4 Fr catheter was placed across the delivery cable and fixed to catch the screwing mechanism of implanted Amplatzer device. The delivery cable was unscrewed and the device reached its final position without any tension. If the position was considered satisfactory the device was released from the goose-neck snare. Thirteen patients had a snare-assisted ASD transcatheter closure. Median device size was 24 mm (range 14-38 mm). Retrieval or repositioning of the device using the goose-neck snare was performed in four cases: in three patients, because of device malposition after delivery cable release and in one patient, because of unsuitability of closure of a second significant defect. Furthermore, in two subjects with multiple ASDs, a second fenestration looked quite significant with the device still attached to the delivery cable while it appeared smaller after release. Snare-assisted Amplatzer ASD device placement is a new method for ASD percutaneous closure and adds safety to the procedure.

Percutaneous closure of traumatic ventricular septal defects: device selection and reasoning

Dear Editors, A ventricular septal defect (VSD) is one or more holes in the wall that separates the right and left ventricles of the heart. VSD is one of the most common congenital (present from birth) heart defects. Many types of VSDs have been reported, including congenital VSDs, post-infarction VSDs 1, and post-traumatic VSDs 2. Furthermore, there are four types of congenital VSDs; perimembranous VSD is the most common, while outlet, atrioventricular, and muscular VSDs are less common 3. VSDs vary in size, number, and location within the interventricular septum, and their clinical implications often depend on these factors. Childhood mortality has continuously decreased in recent decades, and mortality has shifted almost entirely to adulthood as a result of both conservative and surgical treatments 4. Small congenital VSDs often close on their own as the heart grows, and such patients may be treated conservatively 5. However, some patients may require surgical intervention. Percutaneous closure of VSDs has emerged as a good alternative to address important and difficult cardiac surgical problems and prevent issues related to cardiopulmonary bypass in selected patients 2. The most important issue prior to percutaneous closure is to decide whether the defect can be closed via a percutaneous approach and which device should be chosen. Various devices that have been used for VSD closure have been reported in previous articles. These devices include amplatzer® VSD Occluder, atrial septal defect (ASD) Occluder, and patent ductus arteriosus (PDA) Occluder 2,6,7. However, there is no clear consensus on device selection 8. The investigators present their experience with choosing devices for percutaneous VSD closure in this paper. The main factor in choosing a device is the length of the occluder's waist. The Amplatzer Muscular VSD Occluder and ASD Occluder are designed for congenital heart disease, and congenital VSDs are uniformly straight and short. Therefore, the length of occluder's waist is limited to approximately 4 mm. This device is also suitable for post-infarction VSDs and other straight and short VSDs 6,7. Post-traumatic VSDs, as described by Xi EP, Zhu J, Zhu SB and their colleagues, are angled 2. The length of this type of VSD is typically longer, frequently more than 9 mm. Therefore, the Amplatzer Muscular VSD Occluder and ASD Occluder are not appropriate. The use of the PDA Occluder for post-traumatic VSD closure suggested a new way of approaching treatment for the closure of different types of VSDs and provided a new standard for the design of occlusion devices. The use of the PDA Occluder for VSD closure has several advantages compared with the Amplatzer Muscular VSD Occluder and the ASD Occluder. First, if the right-sided opening of the VSD is near the right ventricular outflow tract, the right disc may obstruct the ventricular outflow tract when VSD or ASD Occluders are used. The PDA Occluder cannot cause ventricular outflow tract obstruction because it only has a left disc; furthermore, this single disc reduces the cost of the closure device. In addition, the metal waist of a PDA Occluder is both more flexible and softer than other occluder implants, so it is more easily released and molded. The implant also moves in synchrony with the heartbeat. Fatigue damage to an occluder's metal material 9 occurs under the action of the dynamic load, and an implant's main cause of failure is fatigue rupture. This type of rupture is more likely to occur in occluders that have two discs and a very narrow waist, which are more likely to experience fatigue rupture because of the loads on the two discs. Based on our limited experience and a lower observed morbidity rate, our view is detailed below. The use of PDA Occluder devices for percutaneous closure of post-traumatic VSDs is feasible, safe and effective. This method could allow all types of VSDs to be closed via a percutaneous approach. Furthermore, the use of a PDA Occluder provides a new standard for the design of occluder devices. However, in the absence of larger studies comparing surgical options, observational management and skillful clinical intervention, and most clinicians have more clinical experience using these devices, we suggest continuing to use a VSD Occluder or ASD Occluder in general VSD cases for routine repair for a longer experience on clinical application. But due to different types of VSD, different options of the device should be taken to solve them.

Transcatheter closure of left ventricular free wall rupture with Amplatzer atrial septal defect occluder

Left ventricular free wall rupture is a dramatic complication of acute myocardial infarction and is presumably responsible for as much as 20–30 % of all infarct-related deaths [1]. Surgical management is essential [2]. Needle pericardiocentesis is the conventional treatment of cardiac perforation [3]. A 79-year-old man in evolving cardiogenic shock (BP 70/40) mmHg, sinus tachycardia (120 beats/ min) was transferred to our regional cardiac center. ECG showed ST-segment elevation in II, III, aVF and V4–6 leads. Emergency coronary angiography was performed, and totally occluded obtuse marginalis and nonsignificant stenosis in others coronary arteries were detected (Fig. 1a). Bedside transthoracic echocardiography (TTE) revealed LV regional wall motion abnormality and cardiac tamponade. Cardiac rupture was detected at the LV apex. TTEguided pericardiocentesis was performed immediately. However, there was no drainage from the catheter. Hemoglobin decrease was approximately 4 mg/dL during this time. We have decided to try percutaneous closure due to lack of 7/24 surgical backup. The procedure was applied in order to gain time; as a bridge for surgery. The procedure was an emergency and the defect size was only measured with transthoracic echo and a standard Amplatzer TorqVue delivery system was used through a 7F sheath. A 10, 5-mm Amplatzer occluder (Amplatzer occluder is from St. Jude Medical) was deployed (Fig. 1b). The operation was finished in 15 min. A subsequent TTE showed the defect was successfully occluded with only a trivial residual leak (Figs. 2a, 3). The patient slightly recovered after the procedure, blood pressure could be recorded but he was still in cardiogenic shock due to the impossibility of removing the agglutinant pericardial effusion. Therefore, the patient was transferred to the operation room (Fig. 2b). A large haemorrhagic pericardial effusion was seen and the entire heart was covered in a thick fibrinous peel. But he died 6 h after the initial chest pain. This case confirms that transcatheter closure of ventricular free wall rupture with an occluder device is a bailout strategy in very skilled centers for selected cardiogenic shock patients in the absence of on-site cardio-thoracic support.

Recent Changes in Instructions for Use for the Amplatzer Atrial Septal Defect Occluder: How to Incorporate These Changes While Using Transesophageal Echocardiography or Intracardiac Echocardiography?

The Amplatzer septal occluder is commonly used to close secundum atrial septal defects (ASDs). Recently, the manufacturer's recommendations have been modified with regard to contraindications for its use. These changes primarily focus on evaluation of the aortic rim (anterio-superior rim) with transesophageal echocardiography (TEE) and intracardiac echocardiography (ICE). In this editorial, we will review systematically all of the sequential views in TEE and ICE that are required for thorough assessment of the aortic rim and provide explanation of what constitutes deficiency of the aortic rim as seen on ICE.

A new “tool” for transcatheter atrial defect closure: The St. Jude SL2™ sheath

Orienting the left atrial disc of an atrial septal defect (ASD) closure device parallel to the septum is important, particularly in cases of ASD with deficient retroaortic rim. Standard vascular sheaths can make this challenging. We report the use of an electrophysiologic sheath, the SL2™ St. Jude Vascular sheath (St. Jude Medical, St. Paul, MN) for closure of ASD. All patients undergoing ASD closure between July 2010 and February 2011 at The Children's Hospital at Montefiore in which the SL2 sheath was used were reviewed. Nine patients underwent transcatheter ASD or PFO (1/9) closure with the SL2 sheath. Mean age was 22.7 years (range, 3-58); weight was 46.5 kg (range, 14.7-78.6). The Amplatzer ASD Occluder (AGA Medical Corp., Plymouth, MN) was used in all cases. The mean measurement of the ASDs via "stop-flow" technique was 13.3 mm (range, 4-19). The mean device size was 13.9 mm (range, 5-20) or 105% the size of the defect. The retroaortic rim was deficient (<2 mm) in 3 of 9. ASD closure was achieved in 9 of 9. In all, the left atrial disk was brought toward the atrial septum parallel to the atrial septum, and repositioning or recapturing of the device was unnecessary in any case. Mean fluoroscopy time was 9.3 min (range, 2.2-18). No significant complications. The SL2 sheath was useful to position the ASD device parallel to the atrial septum, eliminating the need for redeployment during the procedure. This sheath was useful in those cases of deficient retroaortic rim in this study.

Life-Threatening Isometric-Exertion Related Cardiac Perforation 5 Years After Amplatzer Atrial Septal Defect Closure: Should Isometric Activity Be Limited in Septal Occluder Holders?

Life-Threatening Isometric-Exertion Related Cardiac Perforation 5 Years After Amplatzer Atrial Septal Defect Closure: Should Isometric Activity Be Limited in Septal Occluder Holders?