Atrial Septal Occluder Research Articles

Primary transcatheter closure of post-myocardial infarction ventricular septal rupture using amplatzer atrial septal occlusion device: A study from tertiary care in South India

ObjectiveThe study investigated effectiveness of transcatheter closure of post-myocardial infarction (MI) ventricular septal rupture (VSR) using atrial septal device (ASD) occluder in a cohort of patients admitted at our institute. MethodThis was a retrospective, observational and single center study, which included patients who were treated with transcatheter closure for post-MI VSR at our tertiary care center between May 2000 and August 2014 depending upon inclusion and exclusion criteria. Primary outcome was all-cause mortality at 30-days follow-up. The MELD-XI (Model for End Stage Liver Disease) score was used as a predictor for poor outcome in these patients. ResultsA total of 21 patients (mean age 66.4±5.9years) were included in the study. Study cohort predominantly included male patients (n=15; 71.4%) and patients with single vessel disease (n=15; 71.4%). Revascularization of the culprit lesion, before VSR closure, was attempted in 6 patients. Except one patient (treated with Cera® occluder), all patients were treated with Amplatzer® ASD occluders. Average diameter of VSR was 20.8±6.9mm. Diameter of the device used in the study ranged from 10mm to 30mm. Residual defect was detected in 13 patients (62%). All-cause mortality at 30-day follow-up was observed in 9 (42.9%) patients. Time to VSR closure, diameter of VSR, and serum creatinine levels were significantly related to the 30-day mortality. MELD-XI score was found to be strongly associated with increased risk of mortality. ConclusionPrimary transcatheter VSR closure using ASD occluders is a feasible approach which can provide reasonable survival outcomes along with equitable mortality rates.

Pulmonary inhalation-perfusion scintigraphy in the evaluation of bronchoscopic treatment of bronchopleural fistula

ObjectiveTo evaluate the use of pulmonary inhalation-perfusion scintigraphy as an alternative method of investigation and follow-up in patients with bronchopleural fistula (BPF).Materials and MethodsNine patients with BPFs were treated through the off-label use of a transcatheter atrial septal defect occluder, placed endoscopically, and were followed with pulmonary inhalation-perfusion scintigraphy, involving inhalation, via a nebulizer, of 900-1300 MBq (25-35 mCi) of technetium-99m-labeled diethylenetriaminepentaacetic acid and single-photon emission computed tomography with a dual-head gamma camera.ResultsIn two cases, there was a residual air leak that was not identified by bronchoscopy or the methylene blue test but was detected only by pulmonary inhalation-perfusion scintigraphy. Those results correlated with the evolution of the patients, both of whom showed late signs of air leak, which confirmed the scintigraphy findings. In the patients with complete resolution of symptoms and fistula closure seen on bronchoscopy, the scintigraphy was completely negative. In cases of failure to close the BPF, the scintigraphy confirmed the persistence of the air leak. In two patients, scintigraphy was the only method to show residual BPF, the fistula no longer being seen on bronchoscopy.ConclusionWe found pulmonary inhalation-perfusion scintigraphy to be a useful tool for identifying a residual BPF, as well as being an alternative method of investigating BPFs and of monitoring the affected patients.

Atrial septal defect occluder devices for closure of tracheoesophageal fistulas: are they safe?

Atrial septal defect occluder devices for closure of tracheoesophageal fistulas: are they safe?

Surgical Retrieval of Atrial Septal Occluder Device after Late Embolization in Right Ventricle

Atrial septal defect (ASD) is the fourth most common congenital heart disease in the world. It was treated with surgical closure with the help of CPB in the earlier days. Now there are two approaches available, open surgery under CPB and transcatheter closure. Here we are going to present late complication of transcatheter closure of ASD.

Conscious sedation for transcatheter implantation of atrial septal occluders with two- and three-dimensional transoesophageal echocardiography guidance - a feasibility and safety study.

General anaesthesia may have negative impact on patient mortality and morbidity, as well as overall procedure costs, in atrial septal occluder (ASO) implantation. We sought to evaluate the safety, efficacy, and feasibility of conscious sedation for transcatheter implantation of ASOs. A total of 122 patients referred for transcatheter implantation of ASO were included. Mean patient age was 51 ± 15 years, and 43 (35%) patients were male. The initial dose of midazolam was 2 mg and fentanyl dose was 25 μg. Additional doses of midazolam and fentanyl were administered, if necessary. Patient responsiveness was assessed every 10 min, and the sedatives doses were titrated in order not to exceed grade 3 sedation in the Ramsey scale. Atrial septal occluders were successfully implanted in the majority of patients (98.4%). In two (1.6%) cases the proce-dure failed because of too small patent foramen ovale (PFO) diameter (n = 1, 0.8%) or device instability (n = 1, 0.8%). The mean duration of procedure was 47.6 ± 28.4 min and was similar for ASD and PFO closure (p = 0.522). The overall mean dose of midazolam was 4.7 ± 2.2 mg (63.9 ± 32.5 μg/kg) and fentanyl was 30.0 ± 11.9 μg (0.43 ± 0.17 μg/kg). Median entrance dose of radiation at the patient plane was 25 (interquartile range: 16-57) mGy, and did not differ between ASD and PFO procedures (p = 0.614). The majority of patients were free of complications (91.0%). The following early complications were observed: transient ischaemic attack (n = 2, 1.6%), supraventricular arrhythmias (n = 4, 3.3%), left atrial thrombus formation (n = 1, 0.8%), symptomatic bradycardia (n = 1, 0.8%), and femoral venous bleeding (n = 5, 4.1%). After mean follow-up of 386 days residual shunt was observed in eight (6.6%) patients. Conscious sedation for transcatheter implantation of ASO is a feasible, safe, and efficient technique, allowing successful PFO and ASD closure in the majority of patients.

Transseptal puncture and catheter ablation of atrial fibrillation in patients with atrial septal occluder: initial experience of a single centre.

Catheter ablation is underutilized in atrial septal defect (ASD) patients who have undergone implantation of an atrial septal occluder (ASO). This study evaluates the feasibility and safety of catheter ablation of atrial fibrillation (AF) in this subset of patients. Sixteen patients (age 56 ± 12 years, 10 men) with drug-refractory AF (10 paroxysmal and 6 persistent) and previously implanted ASO were enrolled. Balloon dilatation of the closure device was performed if the native septum passage could not be achieved. For paroxysmal AF, the ablation strategy was circumferential pulmonary vein isolation (CPVI), and for persistent AF, additional linear ablation was performed. Transseptal access was achieved through the native septum in 11 patients (Group A) and through the ASO using balloon dilatation in 5 patients (Group B). Circumferential pulmonary vein isolation was achieved in all 16 patients, and linear block was achieved in all persistent patients except for 1 patient who did not achieve mitral isthmus block. The transseptal, total fluoroscopy, and procedural durations were 5 ± 3 vs. 38 ± 8 min, 31 ± 11 vs. 54 ± 15 min, and 165 ± 35 vs. 224 ± 36 min, respectively, in Group A vs. Group B, respectively (all P < 0.05). No shunt at atrial level was detected by transthoracic echocardiography at 3-month follow-up. During a follow-up of 16 ± 6 months, sinus rhythm was maintained in 12 of 16 patients. No severe complications were observed. In ASD patients with ASO, catheter ablation of AF is feasible, safe, and effective. The balloon dilatation technique can facilitate transseptal access through the ASO.

Long-term complications evidenced studying the explanted Gore® HELEX® atrial septal defect occluder seven years after implantation: a case report

We present the results of the first morphological study of a Gore® HELEX® Septal Occluder 30 mm that was explanted seven years after interventional implantation due to a significant left-to-right shunt (7 mm) which resulted from the stretching of the concomitant patent foramen ovale by the occluder after atrial septal defect closure. Complete endothelialization of the surface of the device, the formation of the connective tissue around the implant, minor chronic inflammation, the appearance of foreign body giant cells and weakened myocardial cells adjacent to the implant as well as enhanced expression of matrix metalloproteinases were demonstrated.

Feasibility of device closure for multiple atrial septal defects using 3D printing and ultrasound-guided intervention technique

Objective: To investigate the feasibility of trans-catheter closure of multiple atrial septal defects (ASD) monitored by trans-thoracic echocardiography (TTE) under the guidance of 3D printing heart model. Methods: Between April and August 2016, a total of 21 patients (8 male and 13 female) with multiple ASD in Fuwai Hospital of Chinese Academy of Medical Sciences underwent CT scan and 3-dimensional echocardiography for heart disease model produced by 3D printing technique. The best occlusion program was determined through the simulation test on the model. Percutaneous device closure of multiple ASD was performed follow the predetermined program guided by TTE. Clinical follow-up including electrocardiogram and TTE was arranged at 1 month after the procedure. Results: The trans-catheter procedure was successful in all 21 patients using a single atrial septal occluder. Mild residual shunt was found in 5 patient in the immediate postoperative period, 3 of them were disappeared during postoperative follow-up. There was no death, vascular damage, arrhythmia, device migration, thromboembolism, valvular dysfunction during the follow-up period. Conclusion: The use of 3D printing heart model provides a useful reference for transcatheter device closure of multiple ASD achieving through ultrasound-guided intervention technique, which appears to be safe and feasible with good outcomes of short-term follow-up.

Feasibility of percutaneous closure of atrial septal defects in adults under transthoracic echocardiography guidance using the Figulla atrial septal defect occluder device

BackgroundClosure of atrial septal defect (ASD) among adults under transthoracic echocardiography (TTE) guidance using devices other than the Amplatzer Septal Occluder has not been extensively tested. Aim of workAssessment of the safety and efficiency of secundum ASD closure using the Occlutech Figulla ASD Occluder under TTE guidance in adult patients with hemodynamically significant secundum ASD. MethodsTwenty patients (mean age, 32.9±9.7, 75% of them females) were enrolled in the study. All patients underwent TTE and transoesophageal echocardiography (TEE) to assess the characteristics of the ASD prior to percutaneous closure. Procedures were performed using the Figulla Occluder device under both fluoroscopic and TTE guidance. Follow-up clinical and TTE examinations were done at 1, 3, and 6 months following the procedure. ResultsTTE estimated mean ASD size was 21.7±7.3 mm with adequate rims except for the aortic rim (deficient in one third of cases). Mean device size was 28.1±8.6 mm with mean procedure and fluoroscopic times of 46.2±16.4 and 15.7±5.4minutes respectively. ASD was successfully closed in all patients. Two patients showed a small residual shunt immediately after the device placement that disappeared by the end of the 2nd followup TTE examination. Transient complications were detected in 2 patients. All patients were asymptomatic during the follow-up period. ConclusionTranscatheter closure of secundum ASD in adults under TTE guidance using the Occlutech Figulla ASD occluder device is safe and effective when performed in a tertiary center and by expert echocardiographers and interventional cardiologists.

TCTAP C-055 Percutaneous Closure of Aortic Pseudo Aneurysm in a Young Female with Atrial Septal Occluder

TCTAP C-055 Percutaneous Closure of Aortic Pseudo Aneurysm in a Young Female with Atrial Septal Occluder

TCTAP C-166 Embolization of the Atrial Septal Occluder Device : Why Was This Device Dislodged

### Patient initials or identifier number YG ### Relevant clinical history and physical exam A 35 years old female patient was transferred from local hospital because of systolic murmur and facial edema. Her vital signs were stable and within normal limit. She had no cardiovascular risk factor

WCC 2017-C-103: Emergency Surgical Retrieval of Embolized Atrial Septal Defect Closure Device from Left Atrium

AbstractWith the introduction of technological improvements, invasive cardiologic interventions have become increasingly used alternatives to surgery. Despite its numerous benefits, serious and potentially life-threatening complications of invasive cardiology interventions may occur. Atrial septal defect is usually closed in the cardiac catheterisation laboratory using atrial septal occluder (ASO) device. One of the complications associated with the procedure is dislodgement of the device. We present a case of percutaneous trans catheter closure of an ostium secundum atrial septal defect in a 21 years old female, complicated by device dislodgement to the left atrium necessitating emergency surgical retrieval.

CRT-800.42 Transcatheter Atrial Septal Defect Occluder Devices: Trends in Adverse Events and Erosions in a Public Database

The risk of cardiac erosion with commercially available atrial septal defect occluders has led to changes in device labeling and implantation technique. Previous reports have described publicly-available data on erosion events but have not included recent experience. The FDA Manufacturer and User

Transcatheter closure of an atrial septal defect with high risk of erosion using a Figulla Flex II atrial septal defect occluder

An 85-year-old man with a high risk for open heart surgery underwent a percutaneous closure of an atrial septal defect that lacked adequate aortic and superior rims. To avoid the risk for erosion, a Figulla Flex II ASD occluder was selected for the procedure. Implantation was successful, and no complications were observed during the 6 months of follow-up.

Migration of an Atrial Septal Occluder Device to the Transverse Aortic Arch Detected With Echocardiography

Atrial septal defects (ASDs) are one of the most common heart defects diagnosed in the adult population. If left unrepaired, they may lead to significant complications including right heart volume overload, pulmonary complications, and heart failure. Percutaneous transcatheter closure by use of an occluder device is clinically indicated for most patients with a secundum ASD and who are symptomatic. Although this procedure is safe, in rare instances, complications may be encountered, including atrial wall perforation, arrhythmias, and, in very rare instances, device migration. Echocardiography has become a widely used and reliable form of patient imaging that relies on the skillset of the sonographer as well as the interpreting physician. This case study illustrates the specific role of the cardiac sonographer in taking a careful clinical history, imaging of an ASD occluder device, and its location as it migrated into the aortic arch. This case also demonstrates the importance of imaging beyond the standard echocardiographic protocol, given this clinical manifestation.

A Novel Percutaneous Technique Using Lasso Catheters for Retrieval of an Embolized Amplatzer Atrial Septal Occluder Device

A 56-year-old woman with large ostium secundum atrial septal defect (ASD) and severe right ventricular dysfunction was referred for percutaneous ASD closure. The ASD measured 25 mm on fluoroscopy ([Figure 1A][1]). A 26-mm Amplatzer septal occluder (AGA Medical, Golden Valley, Minnesota) was

Anesthetic management of concurrent Amplatzer atrial septal occlusion and transcatheter aortic valve implantation with percutaneous cardiopulmonary support in a patient with severe left ventricular dysfunction

Anesthetic management of concurrent Amplatzer atrial septal occlusion and transcatheter aortic valve implantation with percutaneous cardiopulmonary support in a patient with severe left ventricular dysfunction

Intermediate Outcome of Transcatheter Closure of Secundum Atrial Septal Defect on Cardiac Remodeling in Egyptian Children and Adults

Background: Atrial septal defects (ASDs) are the second most common congenital lesion in adults. ASD closure is followed by symptomatic improvement and regression of pulmonary artery pressure (PAP), reduction in right heart volume overload and hence the prevalence of arrhythmias, thus quantification of the RV function is an important prognostic factor. Tissue Doppler and strain imaging are helpful tools for the assessment of RV systolic and diastolic function. Purpose: To evaluate the intermediate-term outcome of transcatheter closure of ASD by Atrial Septal Occluder (ASO) on the cardiac remodeling especially RV using 2D Echocardiography and Tissue Doppler Methods: From April 2011 to January 2012, 30 patients with secundum type ASD were treated by transcatheter closure of their defects. One year after the procedure Patients included in the study were subjected to thorough history taking, physical examination and 12 leads surface electrocardiogram. Full 2D and color Doppler echocardiographic study was performed in addition to Tissue Doppler Assessment of right ventricular function via measurement of Tricuspid annular Tissue Doppler velocities, strain and strain rate from the RV free-wall and the interventricular septum and RV Tei index. Results: At the 1 year follow up of transcatheter ASD closure, the RVEDD had decreased from 22.93±5.889 mm to 18±4.06 mm(P=0.000), and the LVEDD had increased from 33.23±5.393 mm to 36.27±6.75 mm(P=0.001). Mean PAP decreased from 18.37±4.796 mmHg to 14.77±4.75 mmHg (P=0.022). RVSP decreased from 28.9±4.425 mmHg to 15.83±4.17 mmHg (P=0.000). Regarding electrocardiography, the P wave duration decreased from 107.13±19.62 ms to 77±14.18 ms (P=0.000) and the PR interval decreased from 177.97±21.932 ms to 160.33±26.06 ms (P=0.000).The QRS duration decreased from 134.40± 4.97 ms to a mean of 119.87±4.12 ms (P=0.000). All the patients had normal sinus rhythm before closure and no one developed arrhythmia until 1 year after closure. 50 % of the patients had normal RV size at the 1-year follow up. Tricuspid annular velocities, longitudinal strain, and strain rate measurement showed no significant difference as compared to normal values, which suggest improvement of the RV systolic and diastolic function after transcatheter closure. Conclusion: Transcatheter ASD closure leads to a significant improvement in heart cavity dimensions and RV function and reversal of electrical and mechanical changes. Novel parameters for assessment of RV function are promising and appear to be helpful for the assessment of RV function and its response to correction of volume

Patient radiation dose during atrial septal defect occluder

Introduction Atrial septal defect (ASD) is an abnormal opening in the wall between the two atrias of the heart. A catheter-based treatment in a heamodynamic room is a well established procedure. International literature has extremely limited data on related radiation dose levels. Purpose To determine radiation dose (RD) fluoroscopy time (FT) and Number of images (I) in ASD treatment in both paediatric and adult patients in a major cardiosurgery center in Greece. Materials and methods A sample of 161 patients were included in the study, divided in the following age categories: (1) 5–10 y, (2) 10–15 y, (3) 15–18;y and (4) >18 y. The X-ray machine used was a Siemens Artis Zee digital flat panel system. Various clinical (weight, body mass index, (BMI), etc.) and radiation related data (Kerma Area Product (KAP), fluoroscopy time (T) and number of images (F)) were recorded. Results Median W (kg), BMI (kg/m 2 ), KAP (Gycm 2 ), T (min) and F for the 4 weight categories were: (1) 25, 15.5, 5.8, 6.6 and 639, (2) 50, 21.5, 9.3, 4.6 and 409 (3) 58.5, 21.2, 11.6, 5.7 and 575 and finally (4) 58.0, 19.5, 5.8, 3.2 and 639. The correlation of various factors with KAP was investigated. Apart from fluoroscopy time there was no other factor that significantly correlated with radiation dose. Conclusion This study presents age-stratified radiation data for ASD occluder heart catheterizations. Fluoroscopy time or number of images are not adequate measures for monitoring radiation exposure. These values will be used as baseline for our future research on the subject.

Closure of a persistent esophagopleural fistula by use of an atrialseptal occluder device.

Closure of a persistent esophagopleural fistula by use of an atrialseptal occluder device.