Closure Of Interatrial Communications Research Articles

What Factors Delay Interatrial Communications Closure in the Oval Fossa?

Purpose: In most neonatal intensive care units, echocardiography is performed at the bedside. The lack of closure of interatrial communications (IACs) in the oval fossa can affect mortality and morbidity. This study aimed to establish the rate of spontaneous closure of IACs diagnosed in the neonatal period and predict the need for subsequent evaluation according to various factors, including defect size and shape.Methods: The study group comprised 1,242 newborns admitted between March 2017 and December 2020. We judged the closure of the IACs and evaluated the risk factors of each. Patients were classified into the absence or presence of IACs. The morphology of the IACs was classified into atrial septal defects, patent foramen ovale, and multiple holes.Results: A total of 317 patients (131 female, 186 male) were enrolled in the study, and the average defect size was 3.0±1.0 mm. An overall spontaneous closure rate of 89.9% was observed during an average follow-up interval of 5.1±1.1 months. When multiple Cox regression analyses were performed to analyze the risk factors for spontaneous closure, initial defect size was a significant factor. The optimal cut-off value for predicting spontaneous closure of the IAC was 3.05 mm, and the area under the receiver operating characteristic curve was 0.625 (95% confidence interval, 0.520 to 0.729). Preterm infants had a larger defect size corrected for birth weight and a higher closure rate than term infants.Conclusion: Other than large defect size, no factors delayed spontaneous closure. When defects in the oval fossa measure ≤3 mm, most patients experience spontaneous closure by 7 months of age.

Intracardiac vs. transesophageal echocardiography for guiding transcatheter closure of interatrial communications: a systematic review and meta-analysis.

Transcatheter closure of atrial septal defect (ASD) and patent foramen ovale (PFO) is an established practice, and it requires monitoring and guidance. Both transoesophageal echocardiography (TEE) and intracardiac echocardiography (ICE) can be used as guidance tools. However, the use of ICE and TEE in structural heart disease is controversial and the advantages and disadvantages of both for ASD and PFO closure need to be investigated. We did a systematic review and meta-analysis to compare the efficacy and safety of TEE and ICE for guiding transcatheter closure of ASD and PFO. A systematic search of Embase, PubMed, Cochrane library, Web of Science was conducted from inception to May 2022. The outcomes of this study included average time for both fluoroscopy and the procedure, complete closure, length of stay at hospital and adverse events. This study was performed using mean difference (MD), relative risk (RR) and 95% confidence interval (CI). The meta-analysis was conducted with a total of 11 studies, involving 4,748 patients were included in meta-analysis, including 2,386 patients in the ICE group and 2,362 patients in the TEE group. The results of the meta-analysis showed that compared with TEE, ICE was shorter in time both fluoroscopy [MD: -3.72 (95%CI: -4.09 to -3.34) minutes, P < 0.00001] and the procedure [MD: -6.43 (95%CI: -7.65 to -5.21) minutes, P < 0.00001], shorter length of stay at hospital [MD = -0.95 (95% CI = -1.21 to -0.69) days, P < 0.00001], lower incidence of adverse events (RR = 0.72, 95%CI: 0.62 to 0.84, P < 0.0001), and the arrhythmia (RR = 0.50, 95% CI = 0.27 to 0.94, P = 0.03) and vascular complications (RR = 0.52, 95%CI = 0.29 to 0.92, P = 0.02) in ICE group were lower than those in TEE group. No significant difference in complete closure was found between ICE and TEE (RR = 1.00, 95% CI = 0.98 to 1.03, P = 0.74). Under the premise of ensuring successful rate of complete closure, ICE can shorten time between fluoroscopy and procedure and length of stay at hospital, and there was no increase in adverse events. However, more high-quality studies are needed to confirm the benefits of using ICE in ASD and PFO closure.

Intracardiac echocardiography as transesophageal echocardiography replacement in percutaneous intervention imaging: a systematic review and meta-analysis

Abstract Background Intracardiac echocardiography (ICE) has become more popular as an alternative to transesophageal echocardiography (TEE), the current gold standard modality of intraoperative imaging in percutaneous closure of interatrial communications, despite the limited three-dimensional capabilities and operational learning curve. ICE's primary strength is the lack of general anaesthesia, thus reducing the risk from airway intervention. Studies have shown that the successful device deployment rate assisted with ICE was similar to TEE. In addition, the optimal use of ICE has been suggested to lower procedural and fluoroscopy time, leading to better outcomes. However, there is currently limited evidence in this area to support ICE as the better option for imaging in percutaneous atrial septal intervention. Purpose To compare the total procedural time and fluoroscopy exposure between ICE versus TEE for the guidance of percutaneous atrial septal intervention. Methods We performed a comprehensive literature search using PUBMED and Google Scholar from inception to December 2020. Publications that compared ICE and TEE in the atrial septal intervention in adult patients were screened according to our eligibility criteria. The primary outcome of the study was procedural time. Analysis was performed using Revman 5.4. Results Five studies were included in this study, providing a total of 332 (ICE=169 VS TEE=163) patients. The mean procedural time was shorter in the ICE group compared to the TEE group (mean differences −8.67 minutes, 95% CI: −10.48 to −6.86, p&amp;lt;0.0001, I2=95%). The mean fluoroscopy exposure was also shorter in the ICE group (mean differences −3.22 minutes, 95% CI: −3.73 to −2.71, p&amp;lt;0.0001, I2=87%). There was no difference in term of success rate of the closure nor significant complications during peri-procedural reported in all studies. Conclusion ICE-assisted intervention was shown to be more efficient and associated with statistically significant shorter procedure time and fluoroscopy time than TEE, reducing the possible risk for side effects. Therefore, our analysis suggested that ICE could replace TEE as primary guidance of percutaneous atrial septal intervention. Funding Acknowledgement Type of funding sources: None.

Simultaneous Transcatheter Closure of the Left Atrial Appendage and Congenital Interatrial Communication Closure

Background: Left atrial appendage closure (LAAC) with simultaneous interventional occlusion therapy for congenital interatrial communication has become a new focus of patients with nonvalvular atrial fibrillation. Little is known about the results of mid-and long-term results. Objective: The aim of this study was to evaluate the midand long-term safety and effectiveness of simultaneous transcatheter closure of the left atrial appendage (LAA) and congenital interatrial communication closure in atrial fibrillation (AF) patients. Methods: From Jan 2016 to June 2017, 27 patients with AF were treated with simultaneous transcatheter closure of the LAA and atrial septal defect (ASD, n = 22), patent foramen ovale (PFO, n = 5). Results: The perioperative closure success rate was 96.3%, except for cardiac tamponade occurred in one ASD patient. During the median 37.6-month follow-up period, no cases of cerebrovascular or peripheral vascular embolism, bleeding, infective endocarditis or thrombosis along the occluders were observed. Of the 21 patients with NYHA Class III, nineteen had significant improvements to NYHA Classes I or II, and 81.5% of patients were free from major or minor adverse events during midand long-term follow-up. Conclusions: Simultaneous closure of the LAA and congenital interatrial communication closure is a viable option for patients with nonvalvular atrial fibrillation who are at risk of stroke or systemic embolism, and it is effective and yields excellent mid-and long-term results.

Closure of atrial septal defect by minimally invasive surgery: An alternative approach

Percutaneous closure of interatrial communications (ASD) has become the standard for therapeutic management. However, some patients are ineligible for this technique due to the morphology of the ASD, thus requiring conventional surgical closure by sternotomy or lateral thoracotomy. Minimally invasive surgery (MIS) has been introduced in several adult heart surgery centers especialy for mitral surgery. The purpose is to present the preliminary experience of ASD closure by MIS. We analyzed all of the patients ( n = 5) treated from March 2019 (start date of the MIS program) to December 2019. The MIC was performed by an anterior mini thoracotomy of approximately 5 cm with femoral cannulation ( Fig. 1 ). The pre, per, and postoperative data were prospectively collected. All patients underwent postoperative vascular Doppler ultrasound of the femoral cannulation site. Average age at intervention was 27.3 years (range: 14.5–41), weight was of 60 kg (43–80) (4 women for 1 man). The median duration of CPB was 108 min (101–139), the duration of aortic cross clamping 45 min (36–61). There were no hospital deaths or major complication. One patient had a pneumothorax on D3. The median duration of extubation was 3.5 hours (3–6), the median duration of hospitalization was 8 days (6–11). Postoperative echocardiography did not show any residual ASD or pericardial effusion. All patients were sinus rhythm. No venous or arterial stenosis was observed at the cannulation sites. The average systolic pulmonary arterial pressure, was measured 34 mmHg (15–74) preoperatively, and estimated 30 mmHg (20–55) postoperatively. This clinical study shows the preliminary experience of MIS program for the closure of ASDs. This approach appears to be safe and effective, without major vascular complications. longer term follow-up is required to determine the specific role of MIS approach in the management of this patient population.

Aorto-right Ventricular Fistula Closure after TAVR Guided by Intracardiac Echocardiography

Intracardiac echocardiography (ICE) has been historically used to guide device closure of interatrial communications and transeptal access for electrophysiological ablations.1 Recent advances in st...

P3596Aortic root changes after device closure of interatrial communications

P3596Aortic root changes after device closure of interatrial communications

Intracardiac echocardiography for percutaneous patent foramen ovale and atrial septal defect occlusion.

Transesophageal echocardiography (TEE) plays aunique role in transcatheter closure of atrial septal defects (ASD) and patent foramen ovale (PFO). However, problems such as the need for general anesthesia, possible trauma from endotracheal intubation, presence of "blind spots," and occasional inadequate imaging of some cardiac structures have necessitated better imaging techniques. Our study aimed to compare the findings of TEE during the initial diagnostic examination with those from intracardiac echocardiography (ICE) acquired during the interventional procedure. Atotal of 65patients in whom TEE was used for the diagnosis of ASD or PFO were included. Of these, 40 patients (61.5%) had ASD with significant left to right shunt and 25(38.5%) patients had PFO associated with transient ischemic attack or stroke. ICE imaging was performed under local anesthesia in all patients to guide interatrial communication closure. ICE provided adequate views of the defects and surrounding structures during the various stages of device deployment. In eight patients (12.3%) an additional anatomical variation was detected. All patients had successful device implantation and were discharged 1day after the procedure. ICE is asafe and high-quality imaging technique for guiding transcatheter ASD and PFO occlusion. Additionally, ICE can both facilitate device implantation and detect cardiac abnormalities that are not identified with TEE during the initial diagnostic investigation.

Feasibility of multiplane microtransoesophageal echocardiographic guidance in structural heart disease transcatheter interventions in adults.

IntroductionStructural heart interventions are guided by transoesophageal or intracardiac echocardiography (TEE/ICE). MicroTEE, developed for paediatric purposes, is smaller and therefore less invasive and traumatic, avoiding the need for general anaesthesia. We aimed to show feasibility of procedural guidance by comparing image quality of microTEE with standard TEE and ICE during adult transcatheter interventions, and assess the accuracy in obtaining left atrial appendage (LAA) measurements between the microTEE probe and standard TEE.Methods and resultsWe prospectively included 49 patients (20 women, 64 ± 18 years). Intraprocedural images were obtained by using the microTEE probe and standard (2D and 3D) TEE (LAA closure, MitraClip implantation) or ICE (interatrial communication closure, transseptal puncture for left atrial ablation). Two echocardiographers independently assessed image quality from 1 (excellent) to 4 (poor) and performed LAA measurements. Use of microTEE was not related to significant discomfort. Image quality obtained with the microTEE probe was lower than with standard TEE (2 [1–2] vs. 1 [1–2]; p = 0.04) and comparable with ICE images (2 [1–2] vs. 2 [1–2], p = 0.13). MicroTEE showed a wider field of view than ICE. LAA measurements on images obtained by microTEE were strongly associated with standard TEE.ConclusionsMicroTEE seems feasible for guidance during transcatheter heart interventions in adults. MicroTEE imaging offers a wider field of view than ICE, and its accuracy is comparable with TEE. In transcatheter interventions performed under conscious sedation, microTEE might be a viable and advantageous alternative to standard TEE or ICE.

Zakrzepowe zapalenie żył głębokich kończyny dolnej u młodego mężczyzny powikłane skrzepliną prawego przedsionka przechodzącą przez otwór owalny do lewego przedsionka i zatorowością płucną

Mobile biatrial thrombus entrapped in a patent foramen ovale is a very rare condition associated with an increased risk of fatal complications due to a high prevalence of paradoxical embolism. Given the limited number of cases reported so far, recommending the most favorable treatment modality is difficult, as it cannot be supported by relevant clinical data. In our paper, we present a case of 28-year-old male patient with deep vein thrombosis of the left lower limb complicated by pulmonary embolism, with mobile thrombus in transit from the right to the left atrium through the patent foramen ovale, successfully treated with surgical embolectomy and closure of interatrial communication.

Large single centre experience with the Cera™ and CeraFlex™ occluders for closure of interatrial communications: usefulness of the flexible rotation feature.

We present our experience with the Cera (CO) and the CeraFlex occluder (CFO) in transcatheter closure of interatrial communications (IAC). Between 2013 and 2016, 201 patients (75 males, 16 with patent foramen ovale), aged 27±19 (5-75) years, underwent percutaneous closure of IAC using CO or CFO in our institution. After transoesophageal imaging, the procedure was aborted in 7 young paediatric (6-13years old) patients (3 multiple holes, 3 too small septum, 1 leak with 38mm occlusion balloon). The occluder was removed prior to release in 11 patients (5.7%), while occlusion was successful in 183 patients (94.3%) with 44 CO, 136 CFO, and 3 Cera multifenestrated occluders. There were no deaths, embolizations, or major complications. Small residual shunts were demonstrated in 8 patients immediately after implantation, 4 (8.5%) with CO and 4 (2.9%) with CFO, all disappearing after 3months. Over 1.8±1.7year follow-up, all patients improved with 2 asymptomatic, transient pericardial effusions and 5 adults with transient supraventricular arrhythmias, treated medically for 6months. IAC closure with CO and CFO proved safe with favourable success rates and few, nonserious complications. The CFO flexible rotation feature helped in conforming to various septal anatomies, minimising manoeuvres and possibly post-occlusion leaks.

Three-dimensional printing for quality management in device closure of interatrial communications

We report the case of a 48-year-old male who was found to have an atrial septal defect (ASD) of the secundum type with evidence of moderate right heart load requiring elective device closure. Intraprocedural balloon-sizing showed an average stretched diameter of 16 mm. The decision was made to implant a …

Percutaneous closure of inter-atrial communications (atrial septal defect and patent foramen ovale): single-centre experience and mid-term follow-up

Background Percutaneous closure of atrial septal defect (ASD) and patent foramen ovale (PFO) are increasingly being performed. Eff ective closure rate depends on the anatomy of the interatrial septum and the device used, but its relationship with outcome is poorly described. This study aimed at evaluating: (1) eff ective ASD and PFO closure rate, (2) factors related with eff ective closure rate, and (3) factors related with mid-term outcome.Methods All patients who underwent percutaneous ASD or PFO closure at Jessa Hospital Hasselt between April 2002 and February 2014 were enrolled. Closure rate was evaluated using consecutive contrast echocardiography studies. Adverse events were defi ned as a composite of all-cause mortality, hospitalization for heart failure, atrial arrhythmias and thrombo-embolic event.Results One-hundred and two patients (52) 12 y, 42% male, 75 PFO and 27 ASD) were included in the study. Moderate residual shunt was present in 6% and 10% 6 years after ASD and PFO closure, respectively. The presence of an aneurysmatic interatrial septum was associated with residual shunt after PFO closure (HR 0.57 95% CI 0.33-0.96; P= 0.031). Pulmonary hypertension (HR 1.09 95% CI 1.01-1.17; P= 0.017) and a history of atrial arrhythmias in ASD (HR 4.28 95% CI 1.06-17.40; P= 0.046) and age at closure (HR 1.09 95% CI 1.02-1.16; P= 0.012) in PFO patients were related with adverse events. The highest rate of adverse events was observed after placement of a Helex Septal OccluderR. AmplatzerR and OcclutechR devices yielded higher eff ective closure rates.Conclusions Eff ective closure rates were acceptable 6 years after ASD and PFO closure. The presence of an aneurysmatic septum is associated with residual shunting after PFO closure. Pulmonary hypertension in ASD and older age at closure in PFO are associated with adverse outcome. Adverse events are more frequent with the Helex occluder and eff ective closure rate depends on the device used.

Surgical and catheter procedures in adult congenital heart disease: simple national statistics of the UK tell us something

Published national statistics for the last decade in the UK were utilized to figure out the reality of interventions in adolescents and adults with congenital heart disease. There was a clear indication of increase in the number of procedures of some specific types, such as pulmonary valve replacement and other heart valve surgery. Intervention for closure of inter-atrial communication was another entity that showed a marked rise in numbers during the last 10 years. Overall survival rates at 30 days and 1 year were encouraging, including those for relatively uncommon procedures. On the basis of growing understanding and meticulous investigation into every aspect of this field, clinical practice in adults with congenital heart disease is likely directed to a promising future.

Amplatzer Septal Occluder Migration into the Pulmonary Trunk

The Amplatzer Septal Occluder for transcatheter closure of interatrial communications is a standard procedure and a widely accepted alternative to surgery in most patients with atrial septal defect (ASD). Device dislocation or embolization has been reported as one of the commonest complications of ASD percutaneous closure. In this case, if a transcatheter removal is not possible, it requires a surgical therapy, usually through a median sternotomy. We report on a case of a 30-year-old woman, who underwent percutaneous closure of an ostium secundum ASD. After a late embolization of the Amplatzer Septal Occluder into the pulmonary trunk 10 months later, the implant was successfully obtained via a surgical removal through a video-guided minimally invasive port-access approach. This case shows that, in experienced hands, the port-access technique for surgical procedures on the pulmonary trunk is feasible, and therefore, it might be a good alternative option to the traditional surgery, mainly in young patients.

Device closure of interatrial communications: peri-interventional echocardiographic assessment

The interventional closure of interatrial communications requires peri-interventional echocardiographic assessment and guidance to make those treatments as safe as possible. Transoesophageal echocardiography (TEE) including real-time three-dimensional (RT-3D) imaging, later complemented and in part replaced by intracardiac echocardiography (ICE), has become established as the standard approach to prepare for and to guide the interventional treatment of interatrial communications. Accurate imaging of the anatomic features of the particular communication is critical for case selection, planning, and intraprocedural guidance. Especially in the atrial septal defect (ASD) closure, which tends to be more challenging than the patent foramen ovale (PFO) closure, a certain risk of severe complications remains and may result from suboptimal device performance. Other complications may be related to discontinuous use of echocardiographic monitoring. Image fusion and RT-3D ICE are currently under clinical testing and might be suitable to facilitate spatial orientation. Nowadays, two-dimensional ICE is the method of choice for guiding percutaneous device closure, especially of ASDs and 'complex' PFOs. Uninterrupted TEE under deep sedation is an alternative. In contrast, the closure of 'simple' PFOs will often require nothing but final confirmation of the result, and therefore, short echocardiographic viewing is sufficient in many cases.

Contemporary echocardiographic guiding tools for device closure of interatrial communications.

Periinterventional echocardiographic guidance is considered desirable in order to make interventional closure of interatrial communications safe and straight forward. Transesophageal echocardiography (TEE) including real-time three-dimensional (RT-3D) imaging, later complemented and in part replaced by intracardiac echocardiography (ICE), has become established as the standard approach to guide those procedures. Especially in atrial septal defect (ASD) closure, which tends to be more challenging than patent foramen ovale (PFO) closure, a certain risk of severe complications remains and may result from suboptimal device performance. Other complications may be related to discontinuous use of echocardiographic monitoring. Image fusion and RT-3D ICE are currently under clinical testing and might be suitable to facilitate spatial orientation. Nowadays, two-dimensional ICE is the method of choice for guiding percutaneous device closure, especially of ASDs and "complex" PFOs. Uninterrupted TEE under deep sedation is an alternative. In contrast, closure of "simple" PFOs will often require nothing but final confirmation of the result, and therefore, short echocardiographic viewing is sufficient in many cases.

Intracardiac echocardiography imaging for device closure of atrial septal defects—A single-center experience

IntroductionDevice closure of interatrial communications has become a well-established technique to treat left-to-right shunt associated with atrial septal defect (ASD) and to prevent paradoxical embolism in patients with patent foramen ovale (PFO). Guidance by transesophageal echocardiography (TEE) is the standard practice but intracardiac echocardiography (ICE) is a feasible and safe alternative for monitoring these procedures. ObjectivesTo report our experience in the percutaneous closure of ASD and PFO guided by ICE. MethodsWe retrospectively reviewed all patients with ASD or PFO who underwent percutaneous closure guided exclusively by ICE between January 2008 and December 2010. All patients were followed clinically with regular echocardiographic evaluation (at discharge, one month, three, six and twelve months) to exclude residual shunt and device malposition. ResultsA total of 127 patients (mean age 46.6±12.2years; 71% female) underwent transcatheter device closure of ASD or PFO during the study period. Device deployment with ICE monitoring was 100% successful, with a low rate of complications and eliminating the need for additional imaging techniques. ConclusionsICE provides anatomical detail of ASD/PFO and cardiac structures, facilitating congenital cardiac interventional procedures. It eliminates the major drawbacks associated with TEE and enables the interventional cardiologist to control all aspects of the procedure without relying on additional echocardiographic support.

Encerramento percutâneo de defeitos do septo interauricular guiado por ecocardiograma intracardíaco − A experiência de um centro

IntroductionDevice closure of interatrial communications has become a well-established technique to treat left-to-right shunt associated with atrial septal defect (ASD) and to prevent paradoxical embolism in patients with patent foramen ovale (PFO). Guidance by transesophageal echocardiography (TEE) is the standard practice but intracardiac echocardiography (ICE) is a feasible and safe alternative for monitoring these procedures. ObjectivesTo report our experience in the percutaneous closure of ASD and PFO guided by ICE. MethodsWe retrospectively reviewed all patients with ASD or PFO who underwent percutaneous closure guided exclusively by ICE between January 2008 and December 2010. All patients were followed clinically with regular echocardiographic evaluation (at discharge, one month, three, six and twelve months) to exclude residual shunt and device malposition. ResultsA total of 127 patients (mean age 46.6±12.2 years; 71% female) underwent transcatheter device closure of ASD or PFO during the study period. Device deployment with ICE monitoring was 100% successful, with a low rate of complications and eliminating the need for additional imaging techniques. ConclusionsICE provides anatomical detail of ASD/PFO and cardiac structures, facilitating congenital cardiac interventional procedures. It eliminates the major drawbacks associated with TEE and enables the interventional cardiologist to control all aspects of the procedure without relying on additional echocardiographic support.

Catheter closure of atrial septal defect in patients with cryptogenic stroke: initial experience in Japan

A recent study has shown that cryptogenic stroke can occur even in patients with small or insignificant atrial septal defects (ASD). However, clinical experience in this field is still limited in Japan, also the efficacy and safety of catheter closure of such defects have not been identified. To evaluate the efficacy and safety of catheter closure of interatrial communication in patients with cryptogenic stroke, 13 patients who were diagnosed with cerebrovascular events due to cryptogenic embolism were included in this study. Mean age at procedure was 43 ± 15 (range 17-68) years. In all patients, the presence of spontaneous or provoked interatrial right-to-left shunts was demonstrated by transesophageal contrast echocardiography. Mean defect size evaluated by the balloon sizing technique was 9.2 ± 2.8 mm, and mean size of the Amplatzer Septal Occluder deployed was 9.5 ± 2.8 mm. Devices were successfully deployed in all patients, though one device migrated into the descending aorta was retrieved by a snare catheter. Complete closure was detected by transesophageal contrast echocardiography at 12 months after the procedure was in 11 (85%) of the 13 patients. During the follow-up period (30.1 ± 9.4 months), no recurrent thromboembolic event was observed. Catheter closure of interatrial right-to-left communications can be safely performed. This procedure may contribute to reduction or prevention of recurrent neurological events in this patient population.