Cardiac Erosion Research Articles

Long-Term Outcomes After Percutaneous Closure of Ostium Secundum Atrial Septal Defect in the Young: A Nationwide Cohort Study

ObjectivesThis study sought to assess procedural characteristics, early clinical outcome, and long-term complications after transcatheter closure of atrial septal defect (ASD) in children. BackgroundTranscatheter closure has become the preferred strategy in most cases of isolated secundum ASD. However, reported experience in the pediatric population is limited. MethodsA 1998 to 2016 retrospective multicenter study was performed in 9 French tertiary institutions. All children who had an attempt of percutaneous ASD closure with an Amplatzer Septal Occluder were included. ResultsIn 1,326 children (39% males; median age, 9 years [0.7 to 18]; weight, 29 kg [3.6 to 92]), transcatheter ASD closure was performed. Median ASD size was 15 mm (3 to 41); 254 (19.1%) patients had a large ASD (≥20 mm/m2). Procedural success rate was 95.3% (95% confidence interval: 93.9% to 96.3%). No death was observed but periprocedural complications occurred in 24 patients (1.8%). After a median follow-up of 3.5 years (range 6 months to 18 years; 173 patients [13%] followed >10 years), delayed major complications were minimal (n = 12; 1.04%) including no death and/or cardiac erosion. Periprocedural and delayed complications rates were significantly higher in children ≤15 kg (5.2% vs. 1.5%; p = 0.007 and 3.1% vs. 0.7%; p < 0.007, respectively) and those with large ASD (3.5% vs. 1.4%; p = 0.008 and 1.7% vs. 0.7%; p = 0.052, respectively). ConclusionsTranscatheter ASD closure using Amplatzer Septal Occluder is safe in children with a minimal rate of periprocedural complications and a favorable long-term outcome, especially with no death or cardiac erosion despite a substantial proportion of large defects. Children ≤15 kg and those with large ASDs had a greater risk of complications.

Long-term outcomes after percutaneous closure of isolated secundum atrial septal defect in the young: A nationwide cohort study

Transcatheter closure has become the preferred treatment strategy in most cases of secundum atrial septal defect (ASD). However, reported experience in the pediatric population is limited. To assess procedural characteristics, early clinical outcome and long-term device-related complications after transcatheter closure of ASD in children. A 1998–2014 retrospective multicenter study was performed in 9 French tertiary institutions. All children in whom a percutaneous ASD closure was attempted during the study period were included. In total, 1326 children (39% males, age: 9 years (0.7–18.0), weight: 29 kg [3.6–92]) were included. Median ASD size was 15 mm (3–41). Large ASDs ≥ 20 mm/m 2 were present in 254 (19%) patients. The procedure was performed under fluoroscopic guidance in all cases, assisted with TEE imaging in 856 cases (65%) and TTE in 470 cases (35%). Procedural success rate was 95.3%. Periprocedural complications occurred in 30 (2.2%) patients (including 15 device embolization but no death). After a median follow-up of 4 years (6 months–18 years), no death was observed. The rate of delayed complications 1.04% (95% confidence interval [0.5%–1.6%] including cardiac arrhythmias (n = 8), pulmonary hypertension ( n = 2) and transient ischemic attack (n = 2). No cardiac erosion nor endocarditis were reported. Periprocedural and delayed complications rates were significantly higher in children < 15 kg (6.2% vs 1.9%, P = 0.007; 3.1% vs 0.6%, P < 0.007, respectively) and those with large ASD (3.9% vs 1.8%, P = 0.008 and 1.9% vs 0.4%, P = 0.052, respectively). Our large-scale pediatric cohort confirms that transcatheter closure of isolated secundum ASDs is a safe procedure in children, with a favorable long-term outcome and no life-threatening delayed complication. Children ≤ 15 kg and those with large ASDs had an increased risk of both periprocedural and delayed complications.

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

Initial clinical experience with the GORE® CARDIOFORM ASD occluder for transcatheter atrial septal defect closure.

To report the initial clinical experience with a novel atrial septal defect (ASD) closure device, the GORE® CARDIOFORM ASD Occluder (GCO). Transcatheter closure has become the treatment of choice for secundum ASD. A wide range of occluder devices are available, but concern has been raised about the risk of cardiac erosion associated with rigid devices and future access to the left atrium METHODS: Retrospective chart review of patients treated with the GCO at three Canadian centers. Primary outcomes were procedural success and residual shunting at follow-up, as well as 30-day major adverse events. Secondary outcomes included new onset atrial arrhythmias, wire frame fractures (WFF), and all cause mortality. Clinical, echocardiographic, procedural data, and follow-up outcome variables were collected in each participating hospital. Between February and December 2015, 26 patients (5 children and 21 adults) underwent transcatheter ASD closure with the GCO and were included in the study cohort. Procedural success was achieved in 22 of 26 patients (85%) and no major procedural complications were observed. Two patients (8%) presented new onset atrial tachyarrhythmia during early follow-up (0-30 days). Follow-up echocardiography (median of 119 days [IQR: 92-146]) demonstrated no residual shunt in all implanted patients. After a median clinical follow-up of 174 days (IQR: 135-239), one patient died of an unrelated cause, there were no documented major adverse cardiovascular events. Fluoroscopic imaging of the device was performed in 20 patients (91%), and WFF was noted in five cases. No clinical consequence or device dysfunction was observed in these patients. In this first-in-man multicenter study, the GCO was safe and effective for ASD closure, with no major adverse events or residual shunt at follow-up. © 2017 Wiley Periodicals, Inc.

TCT-609 Cardiac Erosion after the Transcatheter Closure of Atrial Septal Defect Using Amplatzer Septal Occluder: Japanese Nationwide Experience

Catheter closure of atrial septal defect (ASD) is an accepted highly successful alternative to surgical repair. In catheter closure of ASD using Amplatzer Septal Occluder, a cardiac erosion followed by a pericardial tamponade is an infrequent but potentially lethal complication and is difficult to

Relative Risk Factors for Cardiac Erosion Following Transcatheter Closure of Atrial Septal Defects: A Case-Control Study.

Transcatheter closure of secundum atrial septal defects (ASD) using the Amplatzer septal occluder is generally safe and effective, but erosion into the pericardial space or aorta has been described. Although the absolute risk of this complication is low, there has been no assessment of relative risk factors. All erosions reported to St. Jude Medical after ASD closure with an Amplatzer septal occluder (cases) were compared with controls (matched 2:1) who underwent ASD closure but did not develop an erosion. A total of 125 erosions were reported between 2002 and 2014, including 95 with an available echocardiogram. The median duration from implant to erosion was 14 days, but was >1 year in 16 patients. Nine patients (all age ≥17 years) who died were more likely to have an oversized device, and to have erosion into the aorta, than survivors. Aortic or superior vena cava rim deficiencies were more common in cases than in controls. In addition, larger balloon-sized ASD diameter, Amplatzer septal occluder device size, and device size-ASD diameter difference, and smaller weight:device size ratio were associated with erosion. On multivariable analysis, deficiency of any rim, device >5 mm larger than ASD diameter, and weight:device size ratio were associated with erosion. In addition to aortic rim deficiency, which was almost universal among erosion cases, there were several relative risk factors for erosion after ASD closure with the Amplatzer septal occluder device. To understand the mechanisms of and absolute risk factors for this uncommon but serious complication, an adequately powered prospective study with thorough echocardiographic evaluation will be critical.

Mid-Term Outcomes after Percutaneous Closure of the Secundum Atrial Septal Defect with the Figulla-Occlutech Device.

To evaluate the mid-term outcomes after percutaneous closure of the secundum atrial septal defects (ASD) using the Figulla-Occlutech device (FOD). Transcatheter closure has become the method of choice for most patients with ASD. Although the FOD may have some advantageous characteristics there is a paucity of data on later outcomes after the use of this relatively new device. Observational, single arm study including 200 non-consecutive patients who underwent ASD closure between 04/09 and 07/15 in 2 centers. Device performance, deployment technique, and immediate and mid-term outcomes were assessed. Median age and weight were 24 years (4-72) and 58 kg (15-92), respectively. Single defects were observed in 171 patients (median size of 19 mm). The remainder had multiple or multifenestrated defects. Implantation of FOD (median size of 24 mm) was successful in all (99%), but 2 patients (1 with deficient postero-inferior rim; 1 with a large ASD for the size of the child). Embolization with device retrieval occurred in 2 (1%). Median follow-up of 36 months was obtained in 172 patients. Serial echocardiographic assessment showed complete closure in all but 2 patients, in whom an additional small non-significant posterior defect was purposely left untouched. There have been no episodes of late arrhythmias, device embolization, cardiac erosion, endocarditis, thromboembolism, wire fracture, or death. Transcatheter closure of ASDs in older children, adolescents, and adults using the FOD was highly successful in a wide range of anatomical scenarios with high closure rates and no complications in mid-term follow-up.

Imaging essentials before transcatheter closure of an atrial septal defect: Detection of an unusual contraindication

Currently there are few contraindications to transcatheter closure of secundum atrial septal defects (ASDs). Known device-related complications of percutaneous ASD closure are worsening of aortic regurgitation and cardiac erosion. Interference of a septal occluder with anatomic variant coronaries is a rare but important complication that can result in post-interventional fatalities. We report a woman with ASD and anomalous left circumflex artery arising from the right sinus of Valsalva with a retro-aortic course. Device closure was not attempted in her due to concerns about coronary compression by the device occluder and hence she underwent surgical closure.<Learning objective: Adequate imaging studies to detect coronary variants in patients scheduled to undergo transcatheter atrial septal defect (ASD) device closure are essential. Identifying anomalies that are at risk for compression from the occluder device prevents post-procedural complications. This case study highlights the importance of thorough imaging, including coronary angiogram and computed tomography angiogram to delineate coronary anomalies associated with ASD.>

Device closure of secundum atrial septal defect's and the risk of cardiac erosion.

Cardiac erosion related to transcatheter atrial septal defect closure devices is of increasing concern. Erosion is reported to have occurred with most of currently available occluder devices. Perhaps due to the very large number of implants worldwide, the Amplatzer (St Jude) occluder is associated with the majority of cardiac erosion events reported in the literature. Best current estimates of the incidence of erosion with the St Jude device are between one and three cases per 1000 implants. Most events occur early after implantation and it is rare, although not unheard of, for events to occur after a year following device insertion. It is important that those involved with closure programmes are vigilant for the problem, because device-related erosion is associated with a significant mortality risk. Despite considerable debate, the risk factors (either patient or device) for erosion remain unclear and require further investigation. Currently available data sets have focussed largely on erosion cohorts and are unable to place these cases in appropriate context with non-erosion closure cases. What is certain is that programmes implanting these devices must take care to implant appropriately sized devices and have in place plans to ensure that patients are both well informed and can access help and advice in the event of developing symptoms.

Abstract 10404: Incidence and Predictors of Asymptomatic Pericardial Effusion After Transcatheter Closure of Atrial Septal Defect

Introduction: Pericardial effusion (PE) without obvious periprocedural complications (e.g., cardiac perforation, device erosion) may occur after transcatheter closure of secundum atrial septal defects (ASD).It has only been described in case reports, and has not been the subject of systematic study. Hypothesis: The aim of the study is to investigate the incidence and predictors of PE unrelated to procedural complications, thus providing interventional cardiologists with a novel way to approach new-onset PE after ASD closure. Methods: We included all patients who had undergone successful percutaneous ASD closure from June 2009 to April 2014 (n=2652) with no preexisting PE or cardiac perforation or erosion. Transthoracic echocardiography (TTE) was performed during the procedure and 1, 3, and 6 months postoperatively. Results: After device implantation, fifty patients (1.9 %) developed new-onset PE (37 immediately, 13 during follow-up). These patients were asymptomatic, stable hemodynamically, and had no new arrhythmias. PE appeared mild (5.1±1.9 mm) and homogeneously echo-lucent by TTE (Figure). PE diminished spontaneously. Compared with 2602 patients without PE, factors independently predicting asymptomatic PE were the device touching the atrial free wall, device size, patient age, and total defect size (Table). Areas under the receiver operating characteristic curves were 0.78 (p&lt;0.001), 0.66 (p&lt;0.001) and 0.77 (p&lt;0.001) for device size, patient age, and total defect size, respectively. Conclusion: A new type of PE is firstly reported systematically. Our data provide new insights into new-onset PE after percutaneous ASD closure.

留置鼻胃管引发贲门糜烂的个案报道

To report a case of the cardiac erosion caused by indwelling nasogastric tube. Analyzed the reasons of the cardiac erosion from the aspects of the lesion location, influential factors and so on, and put forward new measures to prevent the complication of nasogastric gavage.

Cardiac erosion after catheter closure of atrial septal defect: Septal malalignment may be a novel risk factor for erosion

Pericardial tamponade occurred 3 days after the catheter closure of an atrial septal defect (ASD) using Amplatzer Septal Occluder (St. Jude Medical, St. Paul, MN, USA). Before the closure, two-dimensional and real-time three-dimensional transesophageal echocardiography demonstrated a deficient aortic rim and atrial septal malalignment. Perforation of the right atrium toward the non-coronary sinus of the aortic root was confirmed at the emergent surgery. Cardiac erosion is one of the most catastrophic complications in ASD patients undergoing catheter closure with Amplatzer Septal Occluder. Hence, several risk factors for this complication are discussed and identified. Oversized device deployment and a deficient aortic rim are accepted factors potentially causing cardiac erosion. Besides, atrial septal malalignment, which is a morphological characteristic of ASD, may be a novel risk factor for cardiac erosion.<Learning objective: Cardiac erosion is a potentially lethal complication when catheter closure of atrial septal defects using Amplatzer Septal Occluder (St. Jude Medical, St. Paul, MN, USA) is provided to the patients. However, mechanisms of this complication remain to be completely elucidated. Atrial septal malalignment may be one of the novel risk factors for this catastrophic complication.>

Percutaneous atrial Septal Occluder devices and cardiac erosion: A review of the literature

To systematically review all cases in the literature of erosion associated with atrial septal defect (ASD) occluder devices. Delayed erosion of the aortic or atrial wall is an infrequent but potentially lethal complication of percutaneous septal defect closure using an ASD device. The epidemiology is poorly understood. The MEDLINE database was searched for cases of ASD occluder device-associated erosion. Twenty-five articles present erosion events associated with the AMPLATZER™ septal occluder (ASO) device (March 2002-June 2011), documenting 21 independent, surgically confirmed cases. Another 79 distinct events are reported in case series and review articles. Of all identified independent cases, 73 were reported in the United States. No articles associate the HELEX™ Septal occluder and erosions. Additional events are reported in association with FDA-unapproved percutaneous defect closure devices (n = 16). Estimation of ASO erosion incidence is unreliable because the numerator (number of erosion events) and denominator (number of patients with an implanted device) are unknown; estimates range from 0.1 to 0.3%. Cardiac erosion is a rare but serious complication of the ASO device. Erosion events are most often ascribed to device over-sizing or deficient retro-aortic rims; however, both consensus and evidence for a cogent risk factor(s) is lacking. Further assessment of the root cause of erosion and true incidence of this complication is required; analyses using control patients and/or device registry establishment represent logical next steps.

Beneficial Effects of Transcatheter Closure of Atrial Septal Defects Not Only in Young Adults

To compare cardiac events and remodeling effects after transcatheter closure of atrial septal defects (ASD) in pediatric, adult, and older adult patients. A retrospective review was conducted of 353 patients who underwent transcatheter ASD closure between February 1999 and December 2007 at Siriraj Hospital. The patients were divided into 3 groups according to age: children (<18 years; n = 99); adults (18-50 years; n = 169); and older adults (>50 years; n = 85). Cardiac events at 1 year, and changes in left and right ventricular dimensions between preprocedure and 6 months and 1 year postprocedure were compared between groups. Of the 353 patients, the average size of ASD was 22.1 ± 6.6 mm. Device: ASD diameter was 1.25 ± 0.28 mm. At 1 year postprocedure, the prevalence of chest discomfort and atrial fibrillation (AF) was higher in older adult patients, compared to the other age groups. Device embolization, cardiac erosion, pericardial effusion, syncope, migraine, thrombus formation, and residual shunt did not differ between groups. Within the first 6 months, the right ventricular (RV) dimension tended to dramatically decrease, while the left ventricular (LV) dimension increased in all age groups. These changes leveled off in children and in older adults, but in the adult group (18-50 years), RV shrinkage and LV expansion continued for 1 year. A low rate of early and late complications was noted. Transcather closure of ASD can cause cardiac remodeling, regardless of the patient's age at the time of the procedure. For older adult patients, the long-term risk of AF continuation and chest discomfort is likely.

Complications of transcatheter atrial septal defect closure

Percutaneous closure of atrial septal defect has replaced surgical closure in most centers. Percutaneous closure of patent foramen ovale is proposed as an alternative to medical therapy in the prevention of recurrent thromboembolic events in stroke patients. The overall complication rate of the percutaneous procedure is lower than the surgical complication rate. However, some of the major complications of device closure are potentially lethal. The complications vary with device type, age, defect morphology and center volume load. The most significant complications are device embolization, vascular complications at the puncture site, thrombus on the device, recurrent thromboembolic events, atrial arrhythmias and cardiac erosion or perforation. Meticulous technique, careful peri- and post-procedural monitoring and adequate device choice could lower the incidence of complications. If they occur, early recognition and treatment are warranted.

Early and Late Cardiac Perforation by Amplatzer ASD and PFO Devices

Cardiac perforation and device erosion is an infrequent but potentially lethal complication of percutaneous occluder device insertion. Transthoracic and transesophageal echocardiography (TEE) and gated cardiac CT are useful in detecting this complication.Wepresent characteristic clinical and imaging findings of early and late cardiac perforation diagnosed at our institution, prior to surgical correction. Results: Echocardiograms from 230 device insertions were retrospectively reviewed. 2 cases of confirmeddevice erosion were identified, occurring from 2 weeks to 18 months after device insertion. Clinical and imaging features of device erosion were: (a) new cardiac symptoms of pericardial pain, dyspnoea or tamponade, (b) device size and geometry in relation to atrial size, particularly device extending >90% across the atrial septum, (c) relationship of device to aorta and posterior atrial wall, (d) deficient superior-anterior rim, (e) presence of pericardial fluid adjacent to device, (f) TEE or CT evidence of disc protrusion into or through the atrial/aortic wall. Discussion: Device erosion can be gradual and present with progressive symptoms of pericardial chest pain and/or dyspnoea in the early or late stages post percutaneous ASD or PFO closure. Cardiac perforation by the closure device can cause intermittent symptoms and pericardial fluid accumulation, due to intermittent occlusion of the puncture site by the device itself. Conclusion: Deficient superior-anterior rim and encroachment of the occluder device on the posterior atrial wall are important and under-recognised risk factors for device erosion. TEE should be performed prior to device insertion with heightened awareness of atrial geometry andmanufacturer’s guidelines for device sizing. This may reduce occurrence of this serious complication. TEE and cardiac CT are useful in confirming device erosion when present.

Safer central venous access

Safer central venous access