Congenital Heart Defects In Adults Research Articles

Abstract 17616: Recurrent Copy Number Variants are Enriched in Bicuspid Aortic Valve and Affect Cardiac Developmental Genes

Introduction: Bicuspid Aortic Valve (BAV) is the most common adult congenital heart defect. The spectrum of BAV ranges from chromosomal disorders such as Turner syndrome to sporadic isolated disease of unknown cause. We hypothesized that genomic copy number variants (CNVs) contribute causally to BAV. Methods: We conducted genome-wide SNP array analyses of BAV cases in six European American cohorts (3533 total subjects, 31% BAV, 45% female, ages 1-94 years) with sporadic or familial thoracic aortic aneurysms (37%), congenital left ventricular outflow tract obstructive defects (47%) or Turner syndrome (10%). Genotyping was performed on Illumina Omni microarrays, using PennCNV, Nexus and CNVPartition for CNV detection. Thresholds were set at a minimum of six consecutive SNPs for CNVs that were identified by at least two algorithms and intersect with known genes. A total of 1380 BAV cases were compared to 1065 cases with tricuspid aortic valves and 7013 dbGAP controls without a history of cardiovascular disease using association tests for rare CNVs as implemented in PLINK. Pathway and functional analyses of rare CNVs were performed using the ToppGene analysis suite. Genes within rare CNVs were prioritized by their connectivity to genes in the Notch pathway or established roles in human or animal cardiac phenotypes. Results: We identified 12 rare CNV regions that were recurrent in at least three different BAV groups and were absent or extremely rare (frequency <0.1%) in controls. Four of these regions involved genes that cause aortic valve or outflow tract defects when mutated. The largest and most prevalent of the recurrent CNVs were at Xq28 (four duplications and two deletions), at 22q11.21, telomeric to the DiGeorge syndrome critical region (four deletions, three duplications), and at 7p15.2 (four deletions). The percentage of individuals harboring rare CNVs was significantly greater in BAV cases than in tricuspid or dbGAP controls. Conclusions: We identified multiple loci affected by rare CNVs in BAV subjects, demonstrating the genetic heterogeneity of BAV and implicating alterations of candidate genes at these loci in the pathogenesis of BAV.

First Comprehensive Analysis of Outcomes in Adult Patients after Percutaneous Closure of Isolated Secundum Atrial Septal Defects.

Secundum atrial septal defect (ASD) is a common congenital heart defect in adults. If untreated, ASD leads to right ventricular (RV) failure, atrial arrhythmias, and pulmonary hypertension. The aim of this study is to analyze published data on outcomes and complications of percutaneous ASD closure in adults. PubMed searches performed for published literature on percutaneous ASD closure using the terms ASD, ASD closure or repair, and percutaneous or transcatheter closure. A total of 23 studies, 1958 patients, were analyzed. Baseline characteristics showed mean age of 49.1 ± 1.7 years, Qp:Qs of 2.2 ± 0.05, defect size 19.4 ± 1 and device size 24.0 ± 0.7. The percentage of patients in NYHA class I, II and III was 42.4 ± 6.3, 40.0 ± 6.5, and 9.3 ± 3.0, respectively. Mean follow-up was 12.6 ± 4.9 months with a closure rate of 96.9% ± 1.4. Echocardiographic parameters of improvement included decrease in RV volume from 157.2 to 100.2 mL (p = 0.02), RV end-diastolic dimensions from 40.8 to 32.4 mm (p < 0.0001) and pulmonary artery systolic pressures from 42.2±2.2 to 34.4±2.4 (p < 0.0001). The percentage of patients in NYHA class II and III decreased from 55±7.5 to 15.9±4.4 (p = 0.0013). At the end of follow-up, complications included 1% mortality rate, 0.8% device embolization, 5.8% new onset arrhythmias and 1.2% need for surgical closure. Our study confirms that percutaneous ASD closure in adults with moderate pulmonary hypertension and RV dilation is safe and effective with reverse remodeling and better functional capacity. Prospective studies are needed to evaluate efficacy of percutaneous ASD closure in adults with large defects, higher shunt ratios, and severe pulmonary hypertension.

Perspectives in the management of congenital heart defects in adult patients

Due to improving results in congenital heart surgery, the number of adult patients with congenital heart defect is increasing. The question is: what kind of problems can be managed in this patient-group? The authors review the different problems of management of congenital heart defects in adults based on national and international literature data. Simple defects recognised in adults, postoperative residual problems, changing of small grafts and valves, correction of primary or operated coarctation aortae can be usually managed without problems. A very close follow-up is necessary to establish the correct period for heart transplantation in patients with transposition of great arteries with Senning/Mustard operation, and univentricular heart corrected with "Fontan-circulation" type surgical procedure. The authors conclude that although the number of patients increases, only a few congenital heart diseases may cause problems. It seems important (1) to monitor asymptomatic patient who underwent operation (Fallot-IV, Ross procedure, etc.), (2) follow up regularly patients who underwent Senning/Mustard procedure (magnetic resonance imaging, echocardiography, brain natriuretic peptide measurement), (3) define the proper period of preparation for heart transplantation of patients with a univentricular heart, with special attention to the possibility of multiorgan (lung, liver, etc.) failure. Due to the improvement of foetal diagnosis of congenital heart defects, the number of patients with complex congenital heart defects is decreasing. The standard management of these patients could be primary heart transplantation in infancy.

Gastrointestinal Complications after Cardiac Surgery: Eight Years Experience in a Single Center

Background: The aim of this study was to evaluate the frequency of gastrointestinal complications (GICs) and associated risk factors in patients after cardiac surgery, and to stratify them according to the risk of developing GICs in order to improve our diagnostic protocols.Methods: A total of 5959 patients who underwent cardiac surgery within a period of 97 months were retrospectively evaluated. Surgical procedures included coronary artery bypass grafting, heart valve surgery, aortic surgery, surgical correction of adult congenital heart defects, or combined procedures.Results: The frequency of GICs was 1.3% (75 patients). Intestinal ischemia and upper or lower gastrointestinal bleeding were the most common GICs. From 27 patients affected by intestinal ischemia, 21 patients were previously treated with intra-aortic balloon pump (p < 0.001). Low cardiac output, renal failure or dysfunction, renal risk, peripheral arterial disease, history of myocardial infarction, male gender, intra-aortic balloon pump, cardiopulmonary bypass time, aortic cross-clamp time, duration of intubation, SIRS, and MODS were associated with significantly increased risk of GICs. Conclusions: To decrease the occurrence of intestinal ischemia, we suggest that placement of intra-aortic balloon pump should be preceded by examination of the descending aorta to rule out severe atherosclerotic changes, in which case alternative cardiac support should be attempted.

Unique Echocardiographic Markers of Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery (ALCAPA) in the Adult

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital heart defect in adults. We report a 38-year-old male presenting with exertional syncope. He was referred for the evaluation of multiple muscular ventricular septal defects diagnosed on an outpatient echocardiogram. Echocardiography revealed mild left ventricular enlargement, abnormal flow-pattern in the ventricular septum and dilatation of the right coronary artery. Pulsed-wave Doppler with sample volume placed in the coronary ostium showed systolic coronary flow predominancy. This unique finding is characteristic for ALCAPA and can differentiate it from other coronary anomalies. Coronary angiography confirmed ALCAPA syndrome. Surgical correction was planned.

Ventricular Performance After Surgery for a Congenital Heart Defect as Assessed Using Advanced Echocardiography: From Doppler Flow to 3D Echocardiography and Speckle-Tracking Strain Imaging

A varying degree of impairment of ventricular performance is observed over the long-term after surgery for a congenital heart defect (CHD). Impaired ventricular performance has been shown to be of prognostic value for increased risk of cardiovascular events in adult CHD patients. This emphasizes the importance of delineating the timing and cause of this postoperative impairment. Impairment of ventricular performance could develop over time as a consequence of residua, sequelae and complications of the CHD or surgical procedure. Yet, impaired ventricular performance has also been observed immediately after surgery and can persist and/or worsen over time. This postoperative impairment of ventricular performance is the focus of this review. This article provides an overview of echocardiographic techniques currently used to assess ventricular performance. Furthermore, we review current literature describing ventricular performance, as assessed using echocardiography, after correction of a CHD. In general, a decrease in ventricular performance is observed directly after surgery for CHD’s. Subsequent follow-up of ventricular performance is characterized by a varying degree of postoperative recovery. A consistent observation is the persistent impairment of right-ventricular performance after repair in several different subgroups of CHD patients ranging from ventricular septal defect repair to surgery for Tetralogy of Fallot.

Indications for Percutaneous Closure in Adult Congenital Heart Defect

In recent years, advances in transcatheter percutaneous closures for adults with congenital heart defects have paralleled technological improvements, including imaging, arrhythmia management, and percutaneous interventions. Indications for percutaneous closure of congenital heart defects have expanded with the widening range of device shapes and sizes. This review gives a brief outline of accompanied by guidelines, indications for percutaneous closure in adult common congenital heart defects.

Congenital Heart Defects in Adults : A Field Guide for Cardiologists

Advances in cardiology and cardiac surgery allow a large proportion of patients with congenital heart defects to survive into adulthood. These patients frequently develop complications characteristic of the defect or its treatment. Consequently, adult cardiologists participating in the care of these patients need a working knowledge of the more common defects. Occasionally, patients with congenital heart defects such as atrial septal defect, Ebstein anomaly or physiologically corrected transposition of the great arteries present for the first time in adulthood. More often patients previously treated in pediatric cardiology centers have transitioned to adult congenital heart disease centers for ongoing care. Some of the more important defects in this category are tetralogy of Fallot, transposition of the great arteries, functionally single ventricle defects, and coarctation. Through this field guide, we provide an overview of the anatomy of selected defects commonly seen in an adult congenital practice using pathology specimens and clinical imaging studies. In addition, we describe the physiology, clinical presentation to the adult cardiologist, possible complications, treatment options, and outcomes.

The Perspective of Patients with Congenital Heart Disease: Does Health Care Meet Their Needs?

A first step in the delivery of tailored care is answering the following question: does health care meet the needs of patients? Therefore patients' perspective on health care use and their needs was examined. The design used was cross-sectional questionnaire study. A total of 1109 adult congenital heart defect (CHD) patients attending one of eight Dutch hospitals were randomly selected from a national database (10% of all registered patients). Patient reported questionnaires on in- and outpatient health care use during the past year and need for additional care. A total of 66% and 40% of patients had contact with their cardiologist and general practitioner, respectively. Six to 10 percent were hospitalized, operated upon, or visited the emergency room. For the majority, the amount of contact was sufficient. Most patients indicated that the communication skills and expertise of the cardiologist and general practitioner were sufficient, and health care improvements were not necessary. Frequent health care users had a poor functional status and frequent contact with their cardiologist and general practitioner. Patients who want more contact with their cardiologist rated the communication skills of the cardiologist as insufficient. For most patients, the amount and quality of care are both sufficient. Patients who rate the communication skills of the cardiologist as insufficient have need more contact. In addition to the recommended training program as described in the American College of Cardiology/American Heart Association (ACC/AHA) and European Society of Cardiology (ESC) guidelines, we recommend the incorporation of communication training. This is the first study to provide insight into health care use and needs of CHD patients in countries with a compulsory health insurance system from the patient perspective.

Complications of the Chest Wall and the Respiratory System After Surgery and Functional Performance

In a population of patients after successful heart surgery for congenital heart defects (CHD) might emerge noncardiac morbidities. Malfunction of the respiratory system (RS) including chest wall deformities (CWD) may represent risk for a long-term functional performance and QoL of these subjects. This review aims for the long-term (abnormal pulmonary hemodynamics prior to surgery) or short-term (e.g. thoracotomy) harmful impacts on the developing RS. CHD with redundant lung recoil may induce dramatic worsening of the mechanical properties of the RS. Despite successful repair of CHD harmful and successive adaptive processes may affect future development of the RS. Surgical treatment of CHD requires thoracic wall incision (median sternotomy or lateral thoracotomy), which currently with other perioperative impacts may represent unfavourable formation of CWD. Surprisingly, heart surgery itself does not lead either to an improvement or marked change in the severity or frequency of preoperative lung abnormalities (mostly lung volume restriction, hyperinflation, stiff lung or airway obstruction). Causes of RS dysfunction and CWD in patients after surgical repair of CHD are multifactorial. Therefore, a management of these abnormalities especially in adult and aged CHD is difficult. The early primary repair of CHD and recent interventional approaches (e.g., superior ministernotomy or usage of Amplatz occluder) may provide advantages regarding developing organ systems and prevent secondary changes of the heart and the RS. Further research should focus on individual factors in the development of CWD and postoperative respiratory changes. Long-term and/or probably permanent follow up of subjects after CHD repair is a must.

Management of Atrial Septal Defect-Related Pulmonary Hypertension Using Epoprostenol and Percutaneous Closure

INTRODUCTION: Atrial Septal Defect (ASD) is the commonest adult congenital heart defect (CHD). 15 % of these patients will eventually develop pulmonary hypertension (PHTN) if left untreated. ASD closure is not recommended when PHTN is irreversible. We present a patient with ASD and irreversible PHTN who was treated with Epoprostenol. She underwent percutaneous closure of her ASD with an altered closure device to allow right to left shunting with exercise.

Pulmonary Vascular Protective Mechanisms in Adult Patients with an Isolated Large Ventricular Septal Defect: A 21‐Year Experience

Ventricular septal defects (VSDs) are one of the most common congenital heart defects in adults. In adult patients with an anatomically large VSD and relatively preserved pulmonary vascular system, several pulmonary flow-limiting cardiac morphologic alterations (PFMA) are encountered. Ninety-eight male patients (mean age 22.5 +/- 2 years) operated for an anatomically large VSD in our institution were retrospectively reviewed. PFMA in patients with an anatomically large but functionally mild-to-moderate VSD (when ratio of pulmonary to systemic flow (Q(p)/Q(s)) < 2.2 and ratio of pulmonary to systemic vascular resistance (R(p)/R(s)) < 0.3) were recorded. Thirty patients (31.2%) revealed a mild-to-moderate VSD in functional severity. Five PFMA were encountered in these patients: (1) ostium (os) infundibulum (n = 10, 33.3%), (2) aneurysm of the membranous septum (AMS) (n = 10, 33.3%), (3) systolic bulging of the conal septum toward the right ventricular outflow tract (n = 6, 20%), (4) prolapse of the aortic cusps (n = 2, 6.7%), and (5) attachment of the tricuspid septal leaflet to the septal crest (n = 2, 6.7%). Double-chambered right ventricle was encountered in four patients with os infundibulum and classic tetralogy-type septal malalignment in one patient with aortic cusp prolapse. Concurrent to VSD repair, resection of the os infundibulum and the AMS and aortic valve repair were performed. Presence of a large VSD and relatively preserved pulmonary vascular system in adults is associated with several PFMA. Preoperative awareness and concurrent surgical treatment of these alterations seem to be crucial to improve the expected benefit of surgical repair of VSD in this subgroup of the patients.

Quantification of left-to-right shunting in adult congenital heart disease: phase-contrast cine MRI compared with invasive oximetry

Atrial septum defects (ASDs), ventricular septum defects (VSDs) and patent ductus arteriosus (PDA) are the most common adult congenital heart defects. The degree of left-to-right shunting as assessed by the ratio of flow in the pulmonary (Qp) and systemic circulation (Qs) is crucial in the management of these conditions. This study compared phase-contrast cine magnetic resonance imaging (PC-MRI), a non-invasive imaging technique, with invasive oximetry for the measurement of shunt volumes during cardiac catheterisation in adults with left-to-right shunting. Both invasive oximetry and shunt quantification by PC-MRI (1.5 T scanner; Sonata, Siemens Medical Solutions) were performed on 21 patients with left-to-right shunting (14 ASD, 5 VSD, 2 PDA) and data on Qp/Qs ratios and left-to-right shunt fraction compared. Mean Qp/Qs ratios assessed by PC-MRI and oximetry were 2.10+/-0.76 and 1.96+/-0.77, respectively (p = 0.37). Mean shunt fraction was 46.3+/-19.6% when calculated by PC-MRI and 42.3+/-20.1% when obtained by oximetry (p = 0.12). There was a strong correlation of Qp/Qs ratios and shunt fraction between both methods (r = 0.61, p < 0.01 and r = 0.84, p < 0.0001, respectively). The two methods had a good agreement according to Bland and Altman plots with a small but non-significant overestimation of Qp/Qs-ratios and shunt fraction by PC-MRI. On receiver operating characteristic analysis, the sensitivity and specificity of PC-MRI to detect an oximetry-derived Qp/Qs ratio of > or =1.5:1 were 93% and 100% at a PC-MRI threshold of a Qp/Qs ratio > or =1.75:1 (area under curve (AUC) = 0.99). Quantification of left-to-right shunting can be performed reliably and accurately by PC-MRI and the data obtained by this method correlate closely to those from invasive oximetry.

The estimated number of patients with adult congenital heart defects in Norway

An increasing survival rate for adult patients with congenital heart defects has been related to increased hospitalization and a greater risk of incidences during physical activity. The limited follow-up of these adult patients is partly due to a lack of knowledge about the number of adult patients in need of specialized care. Based on a classification into simple, moderate and severe forms of congenital heart defect, the population size was estimated for three age categories. Based on a conservative prevalence at birth of 7.0 per 1000 live births, approximately 14,000 adult patients with congenital heart defects between 16 and 64 years are alive in Norway today and in need of specialized cardiology attention. This is almost twice the number of children with a congenital heart defect. The assessment of the number of patients is important in order to reveal the risks of fatal incidence during physical activity in the adult congenital heart disease group. There is a need for knowledge and education about the potential risks during sports in coaches, teachers, health personnel, employers, parents, caretakers and in the patients themselves.

Adult Congenital Heart Disease

It has long been recognized that manifestations of congenital heart disease extend beyond the cardiovascular system. The extracardiac ramifications of congenital heart disease are multifaceted and bidirectional. The intricate interplay between congenital heart physiology, bi- or univentricular heart function, early and/or ongoing cyanosis, surgical and residual sequelae, and multisystemic effects are increasingly appreciated. Examples include the well-characterized neurological, hematologic, respiratory, skeletal, and hepatic consequences of cyanosis1; thromboembolic complications in surgically palliated univentricular hearts2; and dysregulation of the autonomic nervous system in various forms of congenital heart disease.3 Article p 2320 In the present issue of Circulation , Dimopoulos and associates4 provide original and important insights regarding the relationship between congenital heart disease and impaired renal function. They examine the prevalence of renal dysfunction across a wide-spectrum of adult congenital heart defects and explore implications on overall death rates. ### Heterogeneity of the Study Population A general and common challenge in congenital heart disease research that encompasses a broad spectrum of cardiac disorders is the complexity and marked heterogeneity of the study population. From a methodological perspective, there is often a trade-off between heterogeneity of the patient population and the precision of a given statistical inference. When the objective is to provide a global perspective on a novel association, such as renal dysfunction and death in adults with congenital heart disease, however, heterogeneity of the patient population may be advantageous. The nonrestrictive inclusion criteria enhance generalizability of the findings to a broad target population. Although the reported overall 9.3% prevalence of moderate to severe renal dysfunction must be interpreted within the context of a high-volume referral center, it reflects a wide spectrum of congenital heart disease subtypes. Heterogeneity of the study population also allows exploration of gradients …

Left and Right Atrial Myocardial Deformation Properties in Patients with an Atrial Septal Defect

Atrial septal defect (ASD) is a common form of congenital heart defect in adults, which affects all cardiac chambers. Atrial myocardial function in patients with ASD has not yet been clearly elucidated. The aim of this study was to investigate atrial myocardial deformation properties in patients with ASDs. The study involved 24 patients with a secundum type ASD, and 22 healthy subjects. Color Doppler myocardial imaging was used to measure left and right atrial myocardial systolic strain and strain rate values, together with peak systolic velocity, early velocity, and late diastolic velocity. There was no significant difference between the two groups with regard to age, gender, body mass index, heart rate, blood pressure, left atrial diameter, and ventricular function. The peak systolic atrial myocardial strain and strain rate values in each of the atrial walls studied were lower in the ASD group compared to those of the control group, but the difference reached statistical significance only in the case of the right atrial wall (right atrial strain: 48.0 +/- 32.7% vs 100.2 +/- 46.6%, P = 0.006; right atrial strain rate: 2.6 +/- 1.2/sec vs 3.8 +/- 1.2/sec, P = 0.024). The left to right cardiac shunt that results from ASD leads to a reduction in the right atrial myocardial longitudinal lengthening that occurs during ventricular ejection. These findings demonstrate that the reservoir function of the atrium is impaired and atrial stiffness increases in patients with ASDs.

Technical Aspects of Pacing in Adult and Pediatric Congenital Heart Disease

As intuitive as it might appear, it must be remembered that children are not little adults and congenital heart defects do not equate to normal cardiac anatomy. In addition, repaired congenital heart defects in adults (ACHD) might also not equate to normal anatomy. In each of these clinical situations, pacemaker device therapy may dramatically differ from most of the published information available in the field of internal medicine cardiology. Since there are now more patients with structural congenital heart defects over than under the age of 21 years, all present and future generations of pacemaker implanters need to recognize the plethora of anatomical and structural nuances potentially associated with the implantation of device therapy in this continually expanding patient population. Fortunately, advances in pacemaker and lead technology over the past 20 years, which now permit precise implantation at selective endocardial sites other than the right ventricular apex or atrial appendage and improved epicardial leads, have greatly facilitated optimization of pacing therapy. Whereas past interests have focused on lead performance issues such as dislodgement, fractures, and exit block, improvements in lead design technologies now permit more interest in maintaining or improving paced myocardial function by optimizing lead placement at alternate or more select sites. This article reviews recent applications and future directions of these pacing technologies and emphasizes differences among patients with congenital heart defects.

Resonancia magnética cardíaca de las cardiopatías congénitas en el adulto

The study of congenital cardiopathies (CC) is one of the most clearly established indications of cardiac magnetic resonance imaging (CMRI). Different sequences, including anatomic, functional, flow (phase contrast), and 3D angiographic sequences, enable the diagnosis, treatment planning, and follow-up of these conditions. CMRI allows the anatomy, function, and alterations of flow in these cardiopathies to be evaluated in a single examination. Three-dimensional MR angiography enables the study of the great vessels and the anomalies associated to congenital heart defects in adults. This article describes an examination protocol and provides examples of MR images of the most common CC in adults: atrial septal defect, interventricular communication, atrioventricular canal, tetralogy of Fallot, transposition of the great arteries, congenitally corrected transposition of the great arteries, bicuspid aortic valve, subaortic stenosis, aortic coarctation, and Ebstein's anomaly.

Caring for the Adult with Congenital Heart Disease: Management of Common Defects

Caring for the Adult with Congenital Heart Disease: Management of Common Defects

Acute Pericardial Tamponade as a Remote Complication of a CardioSEAL Atrial Septal Defect Closure Device

CLOSURE OF A secundum atrial septal defect (ASD) or a patent foramen ovale (PFO) using a percutaneously deployed transcatheter occlusion device has emerged as a safe, less invasive, and widely accepted alterative to open surgical repair of these common congenital heart defects in adults 1 Chessa M. Carminati M. Butera G. et al. Early and late complications associated with transcatheter occlusion of secundum atrial septal defect. J Am Coll Cardiol. 2002; 39: 1061-1065 Abstract Full Text Full Text PDF PubMed Scopus (497) Google Scholar , 2 Krumsdorf U. Ostermayer S. Billinger K. et al. Incidence and clinical course of thrombus formation on atrial septal defect and patent foramen ovale closure devices in 1000 consecutive patients. J Am Coll Cardiol. 2004; 43: 302-309 Abstract Full Text Full Text PDF PubMed Scopus (485) Google Scholar and children. 3 Butera G. De Rosa G. Chessa M. et al. Transcatheter closure of atrial septal defect in young children Results and follow-up. J Am Coll Cardiol. 2003; 42: 241-245 Abstract Full Text Full Text PDF PubMed Scopus (114) Google Scholar Despite the demonstrated utility of transcatheter occlusion devices in the vast majority of patients, as many as 8% of patients undergoing percutaneous closure of an ASD or PFO require surgical intervention for device failure or the management of complications. 4 Berdat P.A. Chatterjee T. Pfammatter J.P. et al. Surgical management of complications after transcatheter closure of an atrial septal defect or patent foramen ovale. J Thorac Cardiovasc Surg. 2000; 120: 1034-1039 Abstract Full Text Full Text PDF PubMed Scopus (102) Google Scholar A wide variety of acute and chronic complications of transcatheter devices has been previously described in the literature, including the presence of a hemodynamically significant residual shunt after device deployment 5 Bohm J. Bittigau K. Kohler F. et al. Surgical removal of atrial septal defect occlusion system-devices. Eur J Cardiothorac Surg. 1997; 12: 869-872 Crossref PubMed Scopus (43) Google Scholar ; recurrent cerebral embolism 6 Z’Brun A. Dai-Do D. Meier B. et al. Recurrent systemic embolism after transcatheter closure of a patent foramen ovale. Eur J Cardiothorac Surg. 1997; 12: 813-814 Crossref PubMed Google Scholar ; device deformation, malposition or embolization 7 Gildein H.P. Daebritz S. Geidel A. et al. Transcatheter closure of atrial septal defects by the “buttoned” device: Complications and need for surgical revision. Pediatr Cardiol. 1997; 18: 328-331 Crossref PubMed Scopus (22) Google Scholar ; thrombus formation 2 Krumsdorf U. Ostermayer S. Billinger K. et al. Incidence and clinical course of thrombus formation on atrial septal defect and patent foramen ovale closure devices in 1000 consecutive patients. J Am Coll Cardiol. 2004; 43: 302-309 Abstract Full Text Full Text PDF PubMed Scopus (485) Google Scholar ; entanglement of the device in a Chiari network 8 Cooke J.C. Gelman J.S. Harper R.W. Chiari network entanglement and herniation into the left atrium by an atrial septal defect occluder device. J Am Soc Echocardiogr. 1999; 12: 601-603 Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar ; endocarditis 9 Goldstein J.A. Beardslee M.A. Xu H. et al. Infective endocarditis resulting from CardioSEAL closure of a patent foramen ovale. Catheter Cardiovasc Interv. 2002; 55: 217-220 Crossref PubMed Scopus (34) Google Scholar ; device-induced mitral regurgitation 7 Gildein H.P. Daebritz S. Geidel A. et al. Transcatheter closure of atrial septal defects by the “buttoned” device: Complications and need for surgical revision. Pediatr Cardiol. 1997; 18: 328-331 Crossref PubMed Scopus (22) Google Scholar ; and cardiac perforation. 4 Berdat P.A. Chatterjee T. Pfammatter J.P. et al. Surgical management of complications after transcatheter closure of an atrial septal defect or patent foramen ovale. J Thorac Cardiovasc Surg. 2000; 120: 1034-1039 Abstract Full Text Full Text PDF PubMed Scopus (102) Google Scholar In this report, the authors describe the occurrence of acute pericardial tamponade 5 years after implantation of a CardioSEAL septal occluder (Nitinol Medical Technology, Boston, MA) as a result of erosion of a device wire support through the dome of the left atrium (LA) and briefly discuss the perioperative management of the patient.