Device Closure Of Atrial Septal Defect Research Articles

Device Closure in Multiple Atrial Septal Defect Secundum Concomitant with Atrial Flutter

This study discusses the case of a 23-year-old male with multiple atrial septal defect (ASD) secundum and atrial flutter who underwent ASD closure using device closure with satisfactory results. The patient recovered successfully and was discharged in good condition. ASD is a congenital heart disease often encountered in adulthood, with various types based on the location of the defect. Device closure of ASDs is one method to address abnormal blood flow, which can also reduce the risk of atrial arrhythmias through a negative remodeling process in the atria and ventricles. ASD closure in cases with multiple ASDs requires special consideration regarding the size, morphology, and distance between defects. Atrial flutter in ASD patients can be resolved with transcatheter ablation. Other studies have shown that device closure of ASDs is associated with a reduced prevalence of atrial tachyarrhythmia in the short to medium term, although atrial flutter/fibrillation and other arrhythmias are common in patients undergoing transcatheter ASD closure. Arrhythmias and conduction disturbances are also associated with ASD.

Late Presentation of Pulmonary Hypertension Crisis Concurrent with Atrial Arrhythmia after Atrial Septal Defect Device Closure

Background: ASD occurs when there is a septal defect between the right and left atria, resulting in a left-to-right shunt that increases the volume of the right heart and pulmonary circulation. Increased pulmonary resistance can lead to pulmonary hypertension (PH), resulting in progressive deterioration of right ventricular function, leading to right heart failure and death. Prolonged elevation of atrial pressure induces progressive atrial dilatation and electrophysiological remodelling. Together with autonomic modulation, this leads to atrial arrhythmias (AAs). Patients with significant shunts leading to ventricular volume overload are considered for ASD closure. However, in some cases, PH occurs after ASD closure.  Case Presentation: We report a 21 yo man diagnosed with ASD Secundum Post Closure with Device (September 1th, 2023) and Pulmonary Hypertension Crisis. The left atria (LA), right atria (RA) and right ventricle (RV) were dilated. We also found moderate mitral regurgitation, severe tricuspid regurgitation, and mild to moderate pulmonary regurgitation. There was a decline in systolic function in the right ventricle, and grade III diastolic dysfunction in left ventricle. There was a well-seated device with no residual shunt on interatrial septal. The pulmonary arteries were confluence and dilated. From ECG we found atrial flutter with variable conduction. This patient was transferred to HCU. This patient treated with digoxin, furosemide, milrinon, ceftriaxone, miniaspi, sildenafil, electrophysiology, and 3D ablation.  Conclusion: Pulmonary hypertension can occur in cases of congenital heart defects, such as ASD. The operative management of ASD is closure of the ASD, but in some unique groups, this can lead to pulmonary hypertensive crisis after its closure.

Original Article--Clinical and Procedural Characteristics of Successful Transcatheter Device Closure of Ostium Secundum Atrial Septal Defect in Symptomatic Children Weighing

This retrospective study sought to determine the feasibility of transcatheter atrial septal defect device closure in patients less than 15 kg, as well as to assess complication rates and the reasons for unsuccessful device closure. In general, the risks associated with transcatheter atrial septal defect device closure are believed and reported to be relatively low, but the evidence stems from trials involving adults and older children. Current guidelines do not recommend atrial defect closure in device closure in children <15 kg, due to limited data available for feasibility and safety of device closure in this group of patients. Retrospective review of all patients who underwent elective transcatheter closure of ostium secundum atrial septal defect between September 2013 to February 2022. We excluded all children above 15 kg, as well as those with complex congenital heart defects. Major and minor complications were predefined and indications for referral were evaluated. We identified 81 patients meeting criteria with a median procedural age of 3 years (1 year-8 years), and median weight of 12 kg (4-15 kg). Successful device closure was achieved in 95.1% (77/81) and in 4.9% (4/81), the procedure was aborted. There was 1 major (1.2%) and 1 minor (1.2%) complication, total complication rate (2.4%). 100% of the referrals had right heart enlargement and exertional dyspnoea, 18.5% had recurrent lower respiratory tract infection and 9.9% had failure to thrive. Rate of resolution of residual shunt was 95.1%. at post-procedure day 1 and 98.8% at post-procedure 3 and 6 months respectively. Percutaneous atrial septal defect closure can be done effectively and safely in symptomatic children weighing less than 15 kg in experienced centres. However, deferral for closure until the historically established timeline of around 4-5 years of age should be strongly considered in asymptomatic children.

Percutaneous Transcatheter Therapy in a Case of Lutembacher’s Syndrome

Lutembacher’s syndrome is a rare condition and is most often treated surgically. Due to the advances in percutaneous procedures, this form of management is desired which has the advantage of decreased morbidity and is aesthetically superior. In this case report of percutaneous treatment for a Lutembacher’s patient the percutaneous transvenous mitral commissurotomy and atrial septal defect device closure was done with minimal technical difficulties and with excellent post-procedure results.

Infective Endocarditis After Percutaneous Device Closure of Atrial Septal Defects: Incidence, Diagnosis, and Treatment. Case Report and Literature Review.

Infective endocarditis (IE) on atrial septal defect (ASD) closure devices, while extremely rare, has been reported to be more frequent early after the procedure. We describe a case of late IE after percutaneous closure of patent foramen ovale (PFO). We also performed a literature review on this subject. We reviewed a total of 42,365 patients who were treated with percutaneous devices: 13,916 for ostium secundum (OS) (32%), 24,726 for PFO (58%) and 3,723 for OS+PFO (8%). Among these patients, we identified 50 cases of IE after atrial septal defect device closure (0.001%). In contrast to previous reports, nearly 66% of IE in this setting occurred late, after at least 6 months from the procedure (33/50 patients). A statistical analysis clearly showed that the mean time from the procedure to IE increased in the last five years, probably associated with a change in antiplatelet therapy after ASD closure. Management of IE on an ASD occluder should always be discussed in the setting of a multidisciplinary heart team that includes a cardiologist, cardiac surgeon, and anesthetist. While surgical strategies gave excellent results, conservative management might be considered in cases of small IE vegetations and for patients in good general condition. However, in these cases, the patient must be closely observed with repeated blood and instrumental tests.

Pattern of transcatheter interventional procedure have done in Cath lab and their immediate outcome: one year experience at Bangladesh Shishu hospital and institute

Background: Congenital heart disease (CHD) is defined by structural and functional malformations of the heart. If CHD not managed through appropriate interventions, it affects quality of life of the individual and potential premature death. Objectives were assessing the frequency and pattern of interventional procedure done in Cath lab of paediatric cardiology department, Bangladesh Shishu Hospital and Institute and their immediate outcome. Methods: It was a cross sectional retrospective study. Total 56 patients of ventricular septal defect (VSD), atrial septal defect (ASD), patent ductus arteriosus (PDA), pulmonary stenosis (PS), aortic stenosis (AS), coarctation of aorta, pulmonary atresia, TGA from January 2019 to December 2019 who underwent trans-catheter interventional procedure by author at Cath lab of paediatric cardiology department, Bangladesh Shishu Hospital and Institute were enrolled in this study. Results: Among 56 patients, PDA device closure done in 19, balloon pulmonary valvuloplasty (BPV) in 13 patients, device closure of ASD in 3 patients, device closure of VSD in 2 patients and balloon aortic valvuloplasty (BAV) in 1 patient. Two patients died; one is pulmonary atresia with PDA dependent pulmonary circulation following ductal stenting another is d-TGA intact IVS with PFO following BAS. One PDA device embolized and retrieved surgically from main and right pulmonary artery. Mean fluoroscopy time=17.29 and mean total procedure time=38.52 min. Conclusions: Trans-catheter interventional procedure for PS, coarctation of aorta, PDA, ASD, VSD, AS, d-TGA, Pulmonary atresia is a safe and some procedure such as BAS for d- TGA, BPV for critical PS, Ductal stenting for pulmonary atresia, Balloon angioplasty for severe coarctation of aorta with LV dysfunction is lifesaving with a low adverse event rate.

PULMOEAST: A Comprehensive Analysis of Pulmonary Hypertension in Eastern India.

Background Pulmonary hypertension (PH) is a debilitating cardiovascular disorder characterized by abnormally elevated blood pressure within the lungs. The diverse range of causes and varied clinical presentations contribute to the complexity of its diagnosis and management. In eastern India and surrounding areas, awareness of PH remains limited, and resources for its management are scarce. This study aims to address this knowledge gap by investigatingclinical characteristics and treatment approaches adopted for PH patients in eastern India. Methods This retrospective-prospective cohort study included patients diagnosed with PH, defined by a pulmonary artery systolic pressure (PASP) > 50 mmHgor amean pulmonary artery pressure (mPAP)>20 mmHg, between July 2015 and October 2023. Data retrieved from hospital records formed the retrospective cohort, while the prospective cohort comprised patients directly recruited for the study. Results The PULMOEAST study enrolled 93 patients with confirmed PH, divided into prospective (59 patients) and retrospective (34 patients) cohorts. The most prevalent cause of PH was congenital heart disease (CHD), with shunt lesions (59.13%), followed by complex CHD (13.97%) and idiopathic PH (20.43%). Six additional patients presented with rare causes of PH, and three experienced transient PH following atrial septal defectdevice closure. Geographic distribution revealed that 72.04% of patients originated from eastern India, while 18.27% hail from other eastern states and 8.6% from neighboring countries. Patients exhibited varying functional classes (FC), with 57 classified as FC-II and 31 classified as FC-III. Treatment strategies primarily involve supportive medications and pulmonary vasodilators. Monotherapy was administered to 26 patients (27.95%), dual therapy to 50 patients (53.76%), and triple therapy to one patient. Notably, 16 patients did not receive any vasodilator therapy as they were waiting for further evaluation. Among the vasodilator regimen, two patients received Selexipag. Three patients underwent intervention for shunt lesion closure, including one patient who received a fenestrated atrial septal occluder implant. Additionally, one patient underwent clot removal for pulmonary thromboembolism. Despite the overall positive response to treatment, the study recorded eight fatalities (8.6%) during the observation period. However, most patients exhibited significant improvement, including a decrease in functional class, during a mean follow-up duration of 14.31 months. Conclusion The PULMOEAST study undertook a comprehensive exploration of PH in eastern India and surrounding regions, revealing a stark dominance of CHD as the primary culprit. The study confirmed the pivotal role of echocardiography as a readily available and effective tool for both initial and follow-up evaluations in resource-scarce settings. It painted a hopeful picture by showcasing significant clinical improvement in most treated patients, with supportive medications and pulmonary vasodilators playing a crucial role. However, the diverse etiologies, limited access to PH-specific resources, and lack of widespread awareness within the region continue to pose substantial challenges for patients. The study underscores the need for refined diagnostic approaches, cost-effective management strategies, collaborative care initiatives, and enhanced patient education to optimize PH care and improve outcomes in eastern India.

Atrial Septal Defect Device Closure in Patients with Metabolic or Genetic Diseases

Background: The coexistence of a metabolic or genetic disease can complicate the course of an atrial septal defect device closure. Methods: The database of our hospital was searched for patients who had undergone atrial septal defect (ASD) device closure and had concurrent metabolic and genetic diseases. Out of 188 such patients, 11 were identified. Results: This cohort study included 11 patients with type 1 diabetes mellitus, insulin resistance, mitochondrial diseases, rickets, Seckel syndrome, Alagille syndrome, cystic fibrosis, Down syndrome, and Crigler-Najjar syndrome type II. The patients were followed for a median of 4 years. Two patients experienced thromboembolic events. One procedure failed as the device was embolized. Large devices with a waist circumference greater than 1.5 times the body weight were used in 3 patients. One patient died 19 days after the procedure due to multi-organ failure, which was not related to device closure. Conclusions: In patients with metabolic or genetic diseases, this procedure may be complicated by factors such as small patient size, hypercoagulation, organ failure (cardiac, renal, or hepatic), vascular abnormalities, and issues with anesthesia or transesophageal echocardiography. It is recommended that careful attention be given to the specific challenges associated with each disease. The utilization of large devices can be considered safe, particularly in patients beyond 4 years of age.

Feasibility of transcatheter device closure of secundum atrial septal defect under transthoracic echocardiography guidance.

Objective: To determine the usefulness and safety of transthoracic echocardiography (TTE) imaging for real time guidance in transcatheter device closure of atrial septal defect (ASD) secundum. Study Design: Cross-sectional study. Setting: Department of Paediatric Cardiology, CPEIC, Multan, Pakistan. Period: January 2022 to December 2023. Material &amp; Methods: Patients of both genders aged above 3 years with clinical and echocardiographic evidence of ASD secundum with significant left to right shunt were analysed. All cases had morphologically suitable margins of defect confirmed on TTE. Usefulness and safety of intra-procedure and immediate post-procedure transcatheter device closure of secundum ASD were noted. Results: In a total of 34 patients, 20 (58.8%) were female and 14 (41.2%) male. The mean age was 21.32±17.21 years. The TTE findings revealed that the mean ASD side was 17.47±4.32 mm. Aortic margins were deficient among 28 (82.4%) cases. The mean fluoroscopy and procedure time were 9.29±6.98 minutes and 49.91±39.76. Residual leak was noted in one (2.9%) cases while none of the cases were observed to have superior vena cava, inferior vena cava or pulmonary vein obstructions. Post-procedure, transient supraventricular tachycardia (SVT) arrhythmia was the most common type of complication reported among 2 (5.9%) cases. None of the cases needed any kind of emergency surgical exploration. No cases of pericardial effusion were found. No mortality was reported. Conclusion: Transcatheter device closure of secundum atrial septal defect was found to be effective and safe using TTE.

A Patient Undergoing Laparoscopic Radical Prostatectomy and Atrial Defect Closure Simultaneously: A Case Report

Background: Prostatectomy offers the greatest potential for a definitive cure for localized prostate cancer. Closure devices for secundum atrial septal defects have a good safety and efficacy profile. Simultaneous operation of the two types of surgery has not been reported to date. Case Presentation: A 65-year-old man was admitted to receive laparoscopic radical prostatectomy for prostate cancer under general anesthesia. The chest CT imaging unexpectedly showed that the heart and the pulmonary artery were obviously enlarged. Subsequently, a secundum atrial septal defect (ASD) with left-to-right shunt measuring 27*23mm was observed on transthoracic echocardiography (TTE). After a multi-disciplinary team (MDT) consisting of departments of urology, cardiac surgery, and anesthesiology was assembled to discuss the surgical procedure, an atrial septal defect closure device was scheduled to be implanted, followed by laparoscopic radical prostatectomy. The patient underwent both surgeries and was successfully discharged from the hospital. Conclusions: Adequate perioperative assessment and management are crucial for patients. We should pay more attention to patients with cardiac disease undergoing both cardiac and non-cardiac surgery.

Abstract 15989: Gore Cardioform Device Complicated by Delayed Right Atrial Disk Expansion

This is a 31-year-old male with a recently discovered secundum atrial septal defect (ASD) with significant left-to-right shunt and associated right ventricular enlargement and dysfunction underwent an uncomplicated percutaneous ASD closure device placement earlier in 2023. Five weeks later, upon repeat transthoracic echocardiogram (TTE), the patient was found to have new onset atrial flutter and what was thought to be a large device-related thrombus abutting the right atrial disc. The patient was admitted to the hospital, started on systemic anticoagulation, and AV nodal blocker therapy. X-rays and a transesophageal echocardiogram (TEE) were performed and showed a Gore Cardioform ASD occluder device that was complicated with significant expansion of the right atrial disk and loosening of fabric likely in the setting of displacement of locking pin (Figure 1A-B). No clear thrombus was visualized. The patient underwent an uncomplicated ASD closure device removal, ASD repair with pericardial patch, right sided Maze, and left atrial appendage ligation in May of 2023 (Figure 1C). We report a case of extreme expansion of the right atrial disk of the Gore Cardioform septal occlusion device. Very few cases of right or left atrial disk expansion have been reported but only in the immediate post-implantation period. This is thought to be secondary to immediate post-operative increase in left atrial pressures. In our patient, intra-procedural TEE and immediate post-procedural TTE the day after showed a well-apposed device across the ASD with no residual shunt. Furthermore, the wedge pressure measured during the procedure was within normal limits. Extreme expansion of the right atrial disk five weeks after the implantation has not been reported. While we know that the pin unlocking caused the expansion of the atrial disk, it is currently unclear as to what initiated this series of events.

Transcatheter closure of large ostium secundum atrial septal defects in symptomatic small children: A single-center retrospective study

ABSTRACT Background: In general, the risks associated with transcatheter atrial septal defect (ASD) device closure are reported to be relatively low, but the evidence stems from trials involving adults and older children. Current guidelines do not recommend ASD device closure in children with defect sizes &gt;20 mm due to limited data available in this group of patients. This retrospective study sought to determine the clinical and procedural characteristics of successful transcatheter ASD device closure in small children with large defects and assess the complication rates and reasons for unsuccessful device closure. Methods: We retrospectively reviewed the data of all patients who underwent elective transcatheter closure of ostium secundum ASD in our department between September 2013 and February 2022. All children weighing &lt;20 kg, requiring a device of size 20 mm or greater, were included. Major and minor complications were predefined and indications for referral were evaluated. Echocardiogram reports were reviewed from the time of referral, postcatheterization day 1, and at 1-year follow-up. Results: We identified 40 patients meeting inclusion criteria with a median (interquartile range [IQR]) procedural age of 5 (4–7) years and median (IQR) weight of 14 (12–18) kg. Successful device closure was achieved in 39 patients with a success rate of 97.5%. The total complication rate was 2.5% (95% confidence interval: 0.44%– I2.8%) with only 1 major complication. All children had right heart enlargement and exertional dyspnea, 30% of patients had recurrent lower respiratory tract infections, and 10% had failure to thrive. At 1-year follow-up, a transthoracic echocardiogram showed a well-endothelialized device in a stable position in all the patients, and none of the patients had a residual shunt. Conclusion: In experienced centers, percutaneous ASD closure of large defects in symptomatic small children can be done effectively and safely with a great degree of predictability and a low complication rate.

FAST technique: fast atrial sheath traction technique for device closure of atrial septal defects.

Transcatheter closure of atrial septal defects (ASDs) is well-established. However, this procedure can be challenging, requiring multiple attempts and advanced implantation maneuvers. From July 2019 to July 2022, patients to whom the fast atrial sheath traction (FAST) technique was applied for ASD device closure were prospectively followed up. The device was rapidly unsheathed in the middle of the left atrium (LA) to let it clamp the ASD from both sides simultaneously. This novel technique was directly applied in patients with absent aortic rims and/or ASD size-to-body weight ratio higher than 0.9 or after failed attempts of standard implantation. Seventeen patients (64.7% males) were involved with a median age of 9.8 years [interquartile range (IQR), 7.6-15.1] and a median weight of 34 kg (IQR, 22-44). The median ASD size on ultrasound was 19 mm (IQR, 16-22). Five (29.4%) patients had absent aortic rims, and three (17.6%) patients had an ASD size-to-body weight ratio higher than 0.9. The median device size was 22 mm (IQR, 17-24). The median difference between device size and ASD two-dimensional static diameter was 3 mm (IQR, 1-3). All interventions were straightforward without any complications using three different occluder devices. One device was removed before release and upsized to the next size. The median fluoroscopy time was 4.1 min (IQR, 3.6-4.6). All patients were discharged the next postoperative day. On a median follow-up of 13 months (IQR, 8-13), no complications were detected. All patients achieved full clinical recovery with complete shunt closure. We present a new implantation technique to efficiently close simple and complex ASDs. The FAST technique can be of benefit in overcoming left disc malalignment to the septum in defects with absent aortic rims and in avoiding complex implantation maneuvers and the risks of injuring the pulmonary veins.

Percutaneous closure of an atrial septal defect in adult patients with congenitally corrected transposition of the great arteries.

Congenitally corrected transposition of great arteries is a rare anomaly which are responsible for 0.5% of all CHDs and can be associated with other congenital cardiac abnormalities. Association of congenitally corrected transposition of great arteries and isolated atrial septal defect is a very rare condition, and management of this association is challenging. In this paper, we describe three patients with congenitally corrected transposition of great arteries and isolated atrial septal defect who were admitted to our clinic and all of them underwent percutaneous closure of defect. From 2017 to 2020, we visited three patients with congenitally corrected transposition of great arteries and isolated atrial septal defect. Our patients' ages ranged from 28 to 38 years. All of them underwent percutaneous atrial septal defect device closure without any complications. Patients were discharged from hospital in good condition with a daily dose of Aspirin 80 mg and Plavix 75 mg. For all of them, follow-up echocardiography was performed the day after the procedure at 1, 3, and 6 months later and showed the function of the right-sided left ventricle improvement and the severity of the mitral regurgitation was reduced. Furthermore, clinical evaluation also indicated functional class improvement. Although the cases of percutaneous transcatheter closure are few and cannot be regarded as strong evidence to recommend this procedure, the outcomes are promising and can demonstrate that this approach is practical.

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

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

Assessment of atrial septal defects using 3-dimensional transthoracic echocardiography prior to percutaneous device closure: first report from Bangladesh.

Secundum atrial septal defect (ASD) is treated following trans-catheter closure in alternative to surgical treatment. Per-intervention selection of device size with balloon occlusive diameter (BOD) often cause tearing or enlarging, causing arrhythmias and hypotension. We assessed the suitability of percutaneous device closure for ASD using 3-dimensional transthoracic echocardiography (3DTTE). This study was conducted to investigate if 3DTTE could be an alternative of balloon sizing for selection of device size in atrial septal defect device closure. It was a cross-sectional comparative study. This study was conducted at the department of Pediatric Cardiology, Bangabandhu Sheikh Mujib Medical University for a period of 2 years. Thirty-three purposively selected secundum ASD patients suitable for device closure were included in the study. Ethical permission was taken from the Institutional Review Board and written consent was taken from each patient's guardian. In this study, 3DTTE derived ASD diameter and BOD were compared with that of deployed device size using correlation analysis. Out of 33 patients, 63.6% were female and 36.4% were males had a mean age of 18.07 ± 14.58 years (range 2-55 years). Mean diameter of ASD measured by 2-dimensional (2D) and 3-dimensional (3D) echocardiography were 17.09 ± 6.08 mm and 21.30 ± 6.56 mm, respectively, yielding a significant difference (p < 0.001). 3D echocardiography derived ASDs diameter were highly correlated with device size than BOD and 2D echocardiography derived diameter (2D echocardiography: r = 0.796, p = <0.001, 3D echocardiography: r = 0.960, p = <0.001, BOD: r = 0.840, p = <0.001). 3DTTE can accurately measure ASD diameter and can be used as an alternate, effective, and safe method to select device size.

Does every ASD closure device stay in the atrial septum?

Atrial septal defect (ASD) is one of the most common congenital heart defects and the most common type is secundum type ASD. There are 2 approaches to its treatment: open surgical repair and percutaneous intervention. In this article, we describe the complication and intervention performed on a patient whose ASD was repaired percutaneously. In our opinion, what made this case interesting was that a complex case was handled by cardiology without a Cardiology-Cardiovascular Surgery council.

Transcatheter Closure of Atrial Septal Defect with Carag Bioresorbable Septal Occluder™: First-in-Child Experience with 12-MonthFollow-Up.

Nowadays, transcatheter device closure of an atrial septal defect (ASD) is a standard approach in children. Potential early and long-term side effects or complications related to the metal framework of the devices are a known issue. A bioresorbable device such as the Carag Bioresorbable Septal Occluder™ (CBSO) could resolve such complications. Material and Results. The Carag Bioresorbable Septal Occluder™ (CBSO; Carag AG, Baar, Switzerland) is a self-centering double disk, repositionable, and retractable device with a bioresorbable framework (polylactic-co-glycolic acid), which is almost completely resorbed by 18-24 months postimplantation. This manuscript reports the four first-in-child ASD device closures using a CBSO. The patients' age was median (IQ1-IQ3), 4.5 years (4-7.25). Weight was 21.3 kg (17.6-32.7). We demonstrated procedural feasibility and safety. Effective defect closure with the device was 100%. Echocardiographic measurements of the thickness of the interatrial septum did not show any relevant increase over a 12-monthfollow-up period. There were no residual defects found after the procedure or later during the resorption process. The patients showed no evidence of any local or systemic inflammatory reaction. The CBSO device system could offer a new treatment option for transcatheter ASD device closure in the pediatric and adult fields. In our first-in-child experience, it was effectively and safely implanted. During the first 12 months of follow-up, no complications occurred.

Transcatheter closure of secundum atrial septal defects in Egyptian centers: immediate and short-term outcomes

Considered is the Atrial Septal Defect (ASD), with secundum ASDs being the most frequent. As known, in comparison to surgical approach, device closure of secundum ASD is less invasive, has few post-procedural complications, reduced anaesthesia risks, and has early hospital discharge. The present observational study discusses the outcome of the transcatheter closure of secundum ASD in Egyptian cardiac centres. The outcome included immediate and short-term results (up to one-year of intervention date).

Fungal Infective Endocarditis Post Device Occlusion in Perimembranous Ventricular Septal Defect

Recent increase in deployment of trans-catheter devices such as septal or ductal occluding coils and devices has been a possible risk factor for infective endocarditis, predominantly in the initial post deployment period before endothelialization has ensued. Though a long-term study of trans-catheter Atrial Septal Defect (ASD) closure revealed no cases of Infective Endocarditis, some case reports of endocarditis in trans-catheter device closure of ASD, VSD and Patent ductus arteriosus(PDA) advocate that residual defect after device occlusion may be a factor in the risk for Infective Endocarditis. We herein describe the case of a 9-month-old female patient who underwent device closure for peri-membranous ventricular septal defect (VSD) and developed fungal infective endocarditis in early post occlusion period which was confirmed on blood culture. Despite treatment with appropriate antifungal as per sensitivity, clinical condition of the patient deteriorated and it was decided to manage her with surgical explanation of device and closure of defect.