Atrial Septal Defect Diameter Research Articles

Echocardiography-guided percutaneous closure of oval-shaped secundum atrial septal defects

BackgroundAn atrial septal defect (ASD) is considered oval-shaped when its shortest diameter is less than 75% of the longest diameter. Research on percutaneous closure of oval-shaped ASDs is limited, with no known reports of non-fluoroscopic closure for this population.ObjectiveTo assess the effectiveness of non-fluoroscopic percutaneous closure for oval-shaped ASDs.MethodsThis single-center retrospective study evaluates patients undergoing non-fluoroscopic percutaneous closure of oval-shaped ASDs, defined by the shortest to longest diameter ratio < 0.75, a circular index of 1.33, or ultrasound visualization of an oval shape. Device size was chosen to be 0–4 mm larger than the defect’s longest diameter, based on transthoracic and transesophageal ultrasound measurements.ResultsWe identified 78 patients (33.3% children, 20.5% males) with a mean age of 27.4 ± 16.3 years and a mean weight of 46.8 ± 19.8 kg. The mean longest diameter and mean shortest diameter of ASDs were 23.3 ± 6.8 mm and 15.8 ± 5 mm, respectively. The mean ratio of the shortest to longest diameter was 0.7 ± 0.1. Percutaneous closure was not attempted in 7/78 (9%) patients. Three out of 71 (4.2%) procedures were fluoroscopy-guided upfront due to technical difficulties, and 5/71 (7%) were converted to fluoroscopy-guided closure. Overall procedural success rate was 98.6% (70/71) including 63/71 (88.7%) performed with zero fluoroscopy. Mean device size was 26.5 ± 7.1 mm. Mean procedural time was 45.3 ± 22.6 min. Eleven intraprocedural complications occurred including 6 arrhythmias, 3 pericardial effusions, and 2 device dislodgements.ConclusionTranscatheter closure of oval-shaped ASD is safe and feasible. Echocardiography is adequate for adequate operative guidance.

Long-Term Results of the Atrial Septal Defect Occluder ASSURED Trial for Combined Pivotal/Continued Access Cohorts

BackgroundThe GORE CARDIOFORM ASD Occluder (GCA, W. L. Gore & Associates) was approved in 2019 for ostium secundum atrial septal defect (ASD) closure. ObjectivesThis study sought to report the combined pivotal and continued access cohorts of the ASSURED (Safety and Efficacy Study of Transcatheter Closure of Ostium Secundum ASDs) trial results through 36 months. MethodsThis prospective, multicenter, single-arm trial evaluated procedural and clinical outcomes of ASD closure with the GCA. The primary endpoints were 6-month closure success following device implantation and composite clinical success (deployment/retention of device, safety, and closure). Technical and procedure success, safety, clinically significant new arrhythmia (CSNA) secondary endpoints, and wire frame fracture (WFF, with fluoroscopy) at 6 and 36 months were evaluated. ResultsOf 569 patients (median age of 10.4 years and median weight of 35.0 kg) who underwent attempted secundum ASD closure, 526 were technical successes. The mean stop-flow ASD diameter was 17.6 ± 5.3 mm. All 478 patients with 6-month imaging achieved closure success. Composite clinical success at 6 and 36 months was achieved in 87.6% (468/534) and 84.0% (351/418) of patients, respectively. Technical failure occurred in 8.1% (43/548), 30-day device- or procedure-related serious adverse event in 3.9% (21/534), and 6-month device events in 2.8% (15/534) of patients. At 30 days, 21 of 569 patients (3.7%) had CSNA. At 6 months, 138 of 436 (31.7%) patients had WFFs and 105 of 185 (56.8%) at 36 months (without sequelae). ConclusionsIn this large congenital ASD device trial, the GCA had acceptable results. WFFs, although common, did not result in any clinical sequelae. The unique features, size range, and safety profile expand the options for secundum ASD closure. (Safety and Efficacy Study of Transcatheter Closure of Ostium Secundum ASDs [ASSURED]; NCT02985684)

Early and Mid-Term Follow-up Results of Device Closure of Secundum Atrial Septal Defects Using Transesophageal Echocardiogram Guidance: A Comparison of Percutaneous Versus Peratrial Approaches

Background: Percutaneous closure of secundum atrial septal defects (ASDs) under only transesophageal echocardiogram (TEE) guidance is less invasive and avoids exposure to radiation, but the treatment of choice is controversial. Methods: One hundred and forty-four patients with a secundum ASD were included in this study. The patients received percutaneous device closure (PCDC/TEE) (n = 74) or peratrial device closure (PDC/TEE) (n = 70). A double-disk ASD occluder was used in both groups. The treatment was performed under only TEE guidance in both groups. Physical exams, electrocardiography, and echocardiography were performed immediately after device release, and at discharge, 3, 6, 12 months, and at yearly intervals after the procedure. Results: In ASD with a maximum diameter less than 20 mm, the successful closure rate was 100% for all PCDC/TEE and PDC/TEE. When the ASD diameter was between 20 mm and 25 mm, the success rate was 84% for PCDC/TEE and 100% for PDC/TEE. The average intracardiac manipulation time was 19.4 ± 6.4 minutes for PCDC/TEE and 5.7 ± 7.0 minutes for PDC/TEE (p &lt; 0.001). The average procedure time was 23.1 ± 6.8 minutes for PCDC/TEE and 51.1 ± 8.2 minutes for PDC/TEE (p &lt; 0.001). The postoperative hospital stay was 3 ± 1 days for PCDC/TEE and 5 ± 1 days for PDC/TEE (p &lt; 0.001). For the mean follow-up of 520 ± 256 days, there no cardiac deaths or significant residual shunts were documented in either group. Conclusions: In patients with an ASD less than 25 mm, PCDC/TEE is a safe and effective method of ASD closure. Additionally, PCDC/TEE is less traumatic, provides better cosmetic results, and decreases hospital stays. However, when the ASD diameter is greater than 20 mm and the aortic rim of ASD is less than 3 mm, the peratrial approach may be a better choice.

Quantitative evaluation of right ventricular myocardial function changes in patients with atrial septal defect before and after occlusion by noninvasive right ventricular pressure-strain loop.

The noninvasive right ventricular pressure-strain loop (PSL) represents a novel method for the quantitative assessment of right ventricular myocardial function. Given that atrial septal defect (ASD) is a prevalent congenital heart anomaly associated with right ventricular volume overload, this study aimed to quantitatively assess the myocardial function of the right ventricle in ASD patients pre- and post-occlusion by noninvasive right ventricular PSL. This study included 36 patients diagnosed with secundum ASD group and 30 healthy adults (control group). We compared conventional right ventricular echocardiographic parameters, right ventricular strain, and myocardial work in the ASD group before occlusion, two days post-occlusion, and three months post-occlusion, with those in the control group. Prior to and two days following occlusion, the ASD group exhibited higher right ventricular global work index (RVGWI), right ventricular global wasted work (RVGWW), and right ventricular global constructive work (RVGCW) compared to the control group (P<.05). Within the ASD group, post-occlusion, RVGWI, RVGCW, and RVGWW values were significantly reduced compared to pre-occlusion values (P<.001). Furthermore, RVGWI and RVGCW showed a significant decrease three months after occlusion compared to two days post-occlusion (P<.05). Multivariate regression analysis identified ASD diameter and pulmonary artery systolic pressure (PASP) as independent predictors of RVGWI (β=.405, P<.001; β=2.307, P=.037) and RVGCW(β=.350, P<.001; β=1.967, P=.023). The noninvasive right ventricular PSL effectively demonstrates the alterations in right ventricular myocardial function in ASD patients, pre- and post-occlusion. The metrics of right ventricular myocardial work (RVMW) offer a novel indicator for evaluating right ventricular myocardial function in these patients. Moreover, ASD diameter and PASP emerge as independent determinants of RVGWI and RVGCW.

Right disc thrombosis of the new Gore Cardioform ASD Occluder.

The GCA is a well performing device in terms of efficacy despite complex anatomies (aortic rim <5 mm and ASD diameter >17 mm) with a good safety profile. To evaluate atrial septal defect (ASD) features impacting on right disc device thrombosis in patients who underwent Gore Cardioform ASD Occluder (GCA) implantation. A total of 44 consecutive patients undergoing percutaneous ASD with GCA device from January 2020 to September 2022 at our tertiary care Center were evaluated. The minimum follow-up was 6 months. The patients were stratified in two groups according to a cut-off value of ASD diameter equal to 20 mm at sizing balloon, derived from ROC analysis (AUC = 0.894; p = 0.024). Baseline characteristics were comparable between groups in terms of age, sex, weight, height, and interatrial septum dimensions. Patients with ASD > 20 mm (n = 9) had a higher ASD/device dimension ratio, both at echocardiography (p = 0.009) and at sizing balloon (p = 0.001), longer fluoroscopic time (p = 0.022), and higher incidence of device thrombosis (0.006). Right disc thrombosis was observed in three patients of the ASD > 20 mm group, always in the inferior portion of the right disc. On univariate analysis, ASD diameter at sizing balloon (OR 1.360; p = 0.036) was the only positive predictor of device thrombosis. Right disc thrombosis of the GCA device may be under-recognized at follow-up, hence deserving clinical attention, especially in those patients with larger ASD diameters.

Cardiac troponin I release after transcatheter closure of atrial septal defects is associated with supraventricular arrhythmias on early follow-up.

Atrial septal defects (ASD) are prevalent congenital heart anomalies found in the adult population. Percutaneous ASD closure has become a routine clinical practice. Elevation of postprocedural transient cardiac biomarkers and exacerbation of supraventricular arrhythmias have been reported in the subject literature. To explore the relationship between cardiac troponin I (cTnI) elevation and supraventricular ectopy (SVE) following percutaneous closure of secundum atrial septal defect (ASD) in adult patients. 600 consecutive patients who underwent successful transcatheter ASD secundum closure were analyzed. Serum levels of cTnI were measured before and within 72 h of device implantation. 24-hour Holter monitoring was performed before the procedure, at 1 month, and at 6 months of follow-up. SVE burden increased 1 month after the procedure (median 1021.00; min.-max. 11.00-29 862.00) compared to baseline values (median 146.00; min.-max. 0-1865.00; p < 0.01). 61.7% of patients demonstrated a cTnI rise exceeding 50% of the upper reference limit within 24 h of the procedure. A statistically significant positive correlation between SVE burden 1 month after the procedure and periprocedural cTnI increase (p < 0.05, r = 0.41) was observed, while cTnI levels significantly correlated with procedure and fluoroscopy time (p < 0.001), device size (p < 0.001) and maximal ASD diameter (p < 0.001). A significant increase of cTnI is noted frequently after transcatheter ASD closure and seems to predict exacerbation in SVE burden on short-term follow up. The independent risk factors of cTnI rise are prolonged procedure duration and larger device sizes.

Sekundum Atriyal Septal Defektli Çocuklarda Galektin-3

Aim: There is a limited number of studies on the role of galectin-3 as a cardiac biomarker in the pediatric population. We aimed to investigate galectin-3 level and its relationship with N-terminal prohormone of brain natriuretic peptide (NT-proBNP) in children with secundum atrial septal defect (ASD).&#x0D; &#x0D; Material and Methods: Twenty-seven patients with secundum ASD formed the patient group. Thirty healthy children of similar age and gender formed the control group. The largest ASD diameter measured from any window with transthoracic echocardiography was recorded as the ASD size. Blood samples were collected for NT-ProBNP and galectin-3.&#x0D; &#x0D; Results: Children with secundum ASD had significantly higher NT-ProBNP levels compared with the healthy children (p=0.003). Galectin-3 levels of children with secundum ASD were similar to those of the healthy children (p=0.377). There was a statistically positive correlation between galectin-3 and NT-ProBNP levels in children with secundum ASD (rho=0.454, p=0.017). The area under the curve of galectin-3 was not statistically significant (AUC=0.537; p=0.643).&#x0D; &#x0D; Conclusion: Although there was an increase in NT-ProBNP level in patients with secundum ASD, galectin-3 level did not change. Although NT-ProBNP was a valuable biomarker for the prediction of secundum ASD, galectin-3 had no role in predicting this disease.

Characteristics of Patients with Surgical Closure of an Atrial Septal Defect during Infancy.

Surgical closure of an atrial septal defect (ASD) is infrequently indicated during infancy. We evaluated the clinical characteristics and outcomes of patients who underwent surgical ASD closure during infancy. A single-center retrospective review was performed for 39 patients (19 males) who underwent surgical ASD closure during infancy between 1993 and 2020. The median body weight percentile at the time of operation was 9.3. During a median follow-up of 60.9 months, 4 late deaths occurred due to chronic respiratory failure. A preoperative history of bronchopulmonary dysplasia (BPD) was the only risk factor for late mortality identified in Cox regression (hazard ratio, 3.54; 95% confidence interval [CI], 1.75-163.04; p=0.015). The 5-year survival rate was significantly lower in patients with preoperative history of BPD (97.0% vs. 50.0%, p<0.001) and preoperative ventilatory support (97.1% vs. 40.4%, p<0.001). There were significant postoperative increases in left ventricular end-diastolic (p=0.017), end-systolic (p=0.014), and stroke volume (p=0.013) indices. A generalized estimated equation model showed significantly better postoperative improvement in body weight percentiles in patients with lower weight percentiles at the time of operation (<10th percentile, p=0.01) and larger indexed ASD diameter (≥45 mm/m2, p=0.025). Patients with ASD necessitating surgical closure during infancy are extremely small preoperatively and remain small even after surgical closure. However, postoperative somatic growth was more prominent in smaller patients with larger defects, which may be attributable to an increase in postoperative cardiac output due to changes in ventricular septal configuration. The benefits of ASD closure in patients with BPD are undetermined.

Headache after transcatheter closure of atrial septal defect: An attempt to explain its origin in the pediatric population.

Transcatheter closure of atrial septal defect (ASD) has become the treatment of choice for most patients. About 5% of them suffer from transient headache episodes (THE) after the procedure, whose etiology is unclear. To evaluate risk factors for THE occurrence after transcatheter closure of ASD in the pediatric population. Eight hundred and forty patients, after transcatheter ASD closure with nitinol devices, from a single center, were included in retrospective analysis. THE was defined as occurring up to 24 hours after the procedure. A logistic regression model including age, weight, ASD diameter, device size, presence of nitinol coating on the device, fluoroscopy time, application of balloon calibration, device oversizing, and residual shunt after 24 hours was created to evaluate risk factors for THE occurrence. There were 40 patients with THE (4.8%), 70% female and 30% male. The median age was 13 (7.35-16) years. In patients with headache, balloon calibration (BC) was performed more frequently (82.5% vs. 43.3%; P <0.001). The balloon waist median (interquartile range [IQR]), 19 (16-22) mm vs. 15 mm (12-18) mm (P <0.001), and device size median (IQR), 18 (13.5-22) mm vs. 14 (11-17) mm (P <0.001) were larger, and residual shunt after 24 hours (12.5% vs. 4.9%; P = 0.03) and a year (7.5 vs. 1.0%; P <0.001) were more frequent. ASD size and the prevalence of double/multiple ASD were similar in both groups. Age, BC application, no nickel release protection, duration of fluoroscopy, and device oversizing were predictors of THE (P <0.001). BC during percutaneous ASD closure and the lack of a protective layer against nickel release on the device are risk factors for headache occurrence in the early postprocedural period.

Temporary balloon occlusion test can overestimate the risk of acute pulmonary edema after transcatheter atrial septal defect closure.

Atrial septal defect (ASD) closure can cause acute pulmonary edema. Before transcatheter closure is performed, temporary balloon occlusion test (BOT) is recommended in patients with left ventricular dysfunction to predict the risk of pulmonary edema. However, the accuracy of BOT has not been verified. This study aimed to compare hemodynamic differences between BOT and transcatheter closure. A total of 42 patients with a single ASD over age 18 years who underwent BOT before transcatheter ASD closure between October 2010 and May 2020 were analyzed. Pulmonary capillary wedge pressure (PCWP) was measured using a Swan-Ganz catheter placed in the pulmonary artery at baseline, after 10 min of BOT, and after transcatheter closure. Amplatzer septal occluder was used for all transcatheter closures. Mean patient age was 64 ± 18 years (range, 18-78). Mean ASD diameter and pulmonary to systemic flow ratio were 18 ± 5and 2.8 ± 1.0 mm, respectively. Mean PCWP at baseline, during BOT, and after transcatheter closure was 8.9 ± 2.9, 13.5 ± 4.2, and 9.5 ± 2.6 mmHg, respectively. The difference between BOT and after transcatheter closure values was significant (p < 0.001). During BOT, PCWP increased ≥18 mmHg in 7patients, whereas after ASD closure, PCWP was <18 mmHg in all 7and none developed acute pulmonary edema. Temporary balloon occlusion of an ASD and transcatheter ASD closure result in different hemodynamic change. BOT overestimates increase of PCWP after transcatheter ASD closure and requires careful interpretation. Well-designed, larger studies in higher-risk patients are warranted to verify the clinical implications of BOT in more detail.

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.

Effect of ASD closure on right ventricular function using 3D echocardiography

Atrial septal defect (ASD) is the most common adult congenital heart disease. The left-to-right shunt causes a right ventricular (RV) volume overload. Only little is known about RV remodeling after ASD closure. We aimed to assess RV function using 2D, 3D echocardiography and 3D RV strain before and 1 month after ASD closure. We prospectively included in this monocentric study 9 patients with secundum ASD who underwent percutaneous closure between September 2019 and January 2020. 2D and 3D Echocardiography were performed in all patients before and 1-month after closure. While we initially planned to collect echocardiographic data 3- and 6-months after ASD closure, the COVID-19 pandemic made this impossible. All patients gave their informed consent to the study. Clinical and ultrasound data were collected and anonymized. 3D RV echocardiographic sequences were analyzed by semi-automatic software (Tomtec 4D RV Function, Unterschleissheim, Germany) and output meshes were post-processed to extract regional deformation. Patients’ mean age was 31.0 ± 12.3 years, 44.4% were female. Mean ASD diameter was 16.6 ± 7.4 mm. RV end diastolic diameter and right atrial (RA) area were significantly larger than normal values and decreased significantly after ASD closure (45.8 ± 4.9 vs. 37.8 ± 5.7 mm; P = 0.0009 and 21.4 ± 4.2 vs. 16.3 ± 2.7 cm2; P = 0.01, respectively). 3D RV volumes were significantly lower after ASD closure; respectively 156.3 ± 61.7 vs. 82.9 ± 17.40 mL, P = 0.02 for end diastolic volume and 59.4 ± 19.3 vs. 32.6 ± 9.2 mL, P = 0.01 for end systolic volume. RV function decreases after ASD closure as illustrated by TAPSE (23.3 ± 6.0 vs. 29.1 ± 4.2 mm, P = 0.03) as well as 3D RV strain with a significantly decreased in area strain, longitudinal strain as well as circumferential strain (respectively P = 0.006, P = 0.009 and P = 0.02) (Fig. 1). After percutaneous ASD closure, we demonstrate a decrease in RV function in all strain components using 3D strain. This decrease in RV strain probably illustrates the decrease in RV parietal stretch related to the normalization of RV loading conditions. 3D strain can be useful to assess the RV function evolution in response to different loading conditions.

Utility of 3D Echocardiography for Device Sizing During Transcatheter ASD Closure: A Comparative Study.

Two-dimensional (2D) transesophageal echocardiography (TEE) is commonly used for assessing patients undergoing transcatheter atrial septal defect (ASD) device closure. 3D TEE, albeit providing high resolution en-face images of ASD, is used in only a fraction of cases. We aimed to perform a comparative analysis between 3D and 2D TEE assessment for ASD device planning. This was a prospective, observational study conducted over a period of one year. Patients deemed suitable for device closure underwent 2D and 3D TEE at baseline. Defect characteristics, assessed separately in both modalities, were compared. Using regression analysis, we aimed to derive an equation for predicting device size using 3D TEE parameters. Thirty patients were included in the study, majority being females (83%). The mean age of the study population was 40.5 ± 12.05 years. Chest pain, dyspnea and palpitations were the common presenting complaints. All patients had suitable rims on 2D TEE. A good agreement was noted between 2D and 3D TEE for measured ASD diameters. 3D TEE showed that majority of defects were circular in shape (60%). The final device size used had high degree of correlation with 3D defect area and circumference. An equation was devised to predict device size using 3D defect area and circumference. The mean device size obtained from the equation was similar to the actual device size used in the study population (p = 0.31). Device sizing based on 3D TEE parameters alone is equally effective for transcatheter ASD closure as compared to 2D TEE.

Minimally invasive and endovascular closure of atrial septal defect in children of different ages

Highlights. The article presents the outcomes of endovascular and minimally invasive atrial septal defect closure in children under the age of 3 and aged 3 to 18 years with subsequent assessment of heart remodeling.Aim. To compare the outcome and features of cardiac remodeling (CR) in children under and over 3 years of age after minimally invasive (MI) and endovascular closure of atrial septal defect (ASD).Methods. The retrospective single-center study included 100 children with secondary ASD who underwent endovascular and MI ASD closure. The patients were divided into 2 groups. The first group (n = 42) included children under the age of 3 years after MI and EC, the median age was 2 years [1.5; 3], and the second group (n = 58) included children aged 4-18 years after MI and EC, the median age was 7 years [6; 12], respectively, p = 0.001. According to the design of the study, the groups statistically differed in height and body weight (p = 0.001). According to the ASD diameter, there were no differences between the groups (p&lt;0.05) in the number of patients with perforated atrial septal aneurysms and aortic rim deficiency. During inpatient care and 3–4 months after surgery, the outcome and indices of CR obtained by echo imaging were assessed.Results. Surgical outcomes and medium-term follow-up analysis revealed that all children in both groups successfully underwent ASD closure in the absence of residual shunts. There were no hospital-acquired and medium-term complications. The length of hospital stay of children under 3 years was 7.5 days. [3; 9], which was significantly longer in comparison with the children of the older age group (3 days. [3;7]), (p = 0,001). ICU length of stay in the younger group of children was 24 hours [0; 24], while in the older group it was 0 days. [0; 24], p = 0,001. In the postoperative period, hemoglobin levels significantly decreased in children under 3 years of age (from 124.5 [119; 130] g/L, to 105 [97; 122] g/L, (p = 0.001)), while in the older age group this indicator remained the same. The analysis of features of CR during 3-4-month follow-up in both groups revealed that the initial changes indicating pathological CR were more pronounced in children older than 3 years. Significant dynamics of echocardiographic indices were observed in both groups during follow-up period, it manifested in the form of an increased volume and size of the left heart, and decreased volume and size of the right heart.Conclusion. Endovascular and minimally invasive ASD closure is an effective and safe technique of ASD closure in children of various ages. In children over 3 years of age, pathological CR is initially more pronounced than in children under 3 years of age, indicating the expediency of an early ASD closure. At the same time, younger children more often require mechanical ventilation, cardiopulmonary bypass, and a longer hospital stay and ICU stay. Higher number of EC performed in the group of young children could offset these negative consequences. Changes in CR indices after ASD closure in groups of children of different ages demonstrates comparable positive trends.

Transthoracic Echocardiography and Fluoroscopy Guided Transcatheter Atrial Septal Defect Closure with Device in Children, Adolescents, and Young Adults

Objective: The aim of this study was to evaluate the safety and efficacy of transcatheter atrial septal defect (ASD) closure guided by fluoroscopy and transthoracic echocardiography (TTE) and to present our experiences. Material and Methods: In this study, we evaluated 108 patients’ files taken to the catheter laboratory for transcatheter ASD closure retrospectively. The procedure was abandoned in ten patients because of septum device disproportion (6) and deficient rims (4), mainly inferior vena cava rim. Results: Transcatheter ASD closure guided by TTE was performed in 98 patients (59 female). The mean age of patients was 9.5±6 years (2.6-46), and the mean weight was 30.3±15.3kg (12-80). TTE-guided ASD closure was successfully performed in 92 of 98 (94%) patients. The median largest ASD diameter measured by TTE was 10.75 mm (interquartile range (IQR) 9.12-14. The median stretched balloon diameter measured by fluoroscopy was 14 mm (IQR 12.4-18). The median device waist diameter was 14 mm (IQR 13-18), the median device left atrial (LA) disk diameter was 28 mm (IQR 26-31), and the median ratio of LA disc diameter to total septal diameter was 75% (IQR 68-81). The median fluoroscopy and procedural times were 8 minutes (IQR 5.6-13.75) and 36.5 minutes (IQR 30-49) respectively. Conclusion: Transcatheter ASD closure guided by TTE and fluoroscopy is safe and effective in children, adolescents, and young adults.

Transcatheter versus surgical closure of atrial septal defect in adult patients with tricuspid regurgitation

ObjectivesTranscatheter closure using a device has been established as an effective atrial septal defect (ASD) treatment, but its value in treating patients with concomitant functional tricuspid regurgitation (TR) is relatively...

Cardiac remodeling and outcome after endovascular and minimally invasive closure of atrial septal defect in children

Highlights. The article analyzes the features of cardiac remodeling and the outcomes of endovascular and minimally invasive closure of atrial septal defects in children.Aim. To compare the features of cardiac remodeling (CR) and the outcomes of endovascular and minimally invasive closure of atrial septal defects (ASD) in children.Methods. The study included 60 children with secundum ASD who underwent minimally invasive (MIC) or endovascular closure (EC) of ASD from the beginning of 2017 to the beginning of 2020. Patients were divided into two groups. The first group (n = 30) consisted of patients undergoing MIC, median age 5 years [2;12], and the second group (n = 30) consisted of patients undergoing EC, median age 5.5 years [1.7;13], p&gt;0.05. The groups were comparable in gender, height, and body weight (p&gt;0.05). The groups differed in the diameter of ASD. ASD defect size was 14 mm [7;30] in the MIC group, and 11.5 mm [7;22] in the EC group. The following indicators were assessed during hospital stay: the outcome of the intervention, residual shunt, hospital-acquired complications, and indicators that characterize CR before the procedure and 3-4 months after surgery.Results. The analysis revealed that all children successfully underwent minimally invasive and endovascular closure of ASD (confirmed absence of residual shunt). Hospital-acquired and long-term complications were not detected. Data are presented as a median and percentile. In the MIC group all patients required blood transfusion, intraoperative blood loss was 445 mL [300;1290], while in the EC group the blood loss did not exceed 5 mL [5;15], p = 0.001. EC was much more advantageous in terms of length of hospital stay (LoS) compared to MIC; in the MIC group LoS was 8 [6;14] days, and in the EC group LoS was 3 [3;4] days, p = 0.001. LoS in the Department of Anesthesiology and Intensive Care after MIC was 24 [3;96] hours, while patients in the EC group did not need to be transferred to this Department, p = 0.001. In both groups, significant changes were observed during 3–4-month follow-up in the form of a decrease in the volumetric and dimensional parameters of the right chambers and simultaneous increase in the same parameters of the left chambers.Conclusion. Minimally invasive and endovascular surgeries are effective and safe treatment modalities for ASD in children (median age of 5–5.5 years), which positively affect CR according to 3–4-month follow-up. At the same time, the advantages of EC regarding the intraoperative blood loss / blood transfusion, the need for mechanical ventilation, cardiopulmonary bypass, and LoS in the ICU and hospital are highlighted.

C36 ATRIAL SEPTAL DEFECT CLOSURE WITH A NEW OCCLUDER DEVICE, EXPERIENCE ON 100 PATIENTS

Abstract Background This perspective, observational study evaluated safety and efficacy of the GORE® Cardioform ASD Occluder (WL Gore &amp; Associates, Flagstaff, AZ), compliant and potentially innovative prosthesis recently approved for closure of ostium secundum atrial septal defects (ASD). Methods 100 unselected patients with significant ASD were submitted to trans–catheter closure with GORE® Cardioform ASD Occluder at two high–volume Italian Pediatric Cardiology centers. Primary endpoints were procedural success and safety. Secondary endpoints were closure rate and clinical safety at 1–month and 6–month follow–up. Results Patients‘age and weight were 7.8 (6.0–13.6)and 26.1 (20.0–54.0), respectively. ASD diameter was 17.4 + 4.4, resulting in QP/QS of 1.7 ± 0.7 (median 1.6). 33 patients presented an asd larger than 18mm in diameter. 58% of defects were considered complex based on the following characteristics: deficient rim(s) (except aortic rim), aneurismal/multi–fenestrated and ASD size/pt weight ratio &amp;gt;1.2. Device placement was successfully achieved in all but two patients (98%), in whom it embolized early after deployment, resulting in rescue surgical repair. No cross–over with different devices was recorded. Median procedure and fluoroscopy times were 54 and 11 min, respectively. Major adverse events were recorded in 7 pts. Complete closure rate was 87.3% at discharge, rising to 95.5% (39/42 pts) at 1 month evaluation, and 100% at 6 months without cardiac or extra–cardiac adverse events. “Complex” procedures were more time–consuming but as effective and safe as the “simple” ones. Conclusions The GORE® Cardioform ASD Occluder device was highly effective and versatile in closure of ASDs with different anatomy and size, even in challenging settings.

Deformação em tulipa em oclusor septal de nitinol

A 47-year-old woman was referred for transcatheter closure of a secundum atrial septal defect (ASD). Vascular access was obtained via the right femoral vein and 16-mm ASD diameter was determined using balloon and the stop-flow sizing technique (). […] Tulip-like deformation of a nitinol septal occluder

Assessment of atria function after percutaneous closure of atrial septal defect using 2D speckle tracking echocardiography.

Percutaneous occlusion of atrial septal defect (ASD) has recently become a standard therapeutic strategy, but little is known about atria function thereafter. Strain analysis by two-dimensional speckle tracking echocardiography (2D-STE) is considered to be a new tool to assess myocardial function. This study aimed to evaluate atria function by quantifying longitudinal strain in patients with chronic RV volume overload due to ASD before and after percutaneous closure using 2D-STE. 28 consecutive patients underwent percutaneous closure of ASD (18 female, 10 male) were examined, clinical and echocardiographic evaluation one day before, 1day, and one month after percutaneous closure of ASD. Peak longitudinal systolic strain and strain rate of both atria were analyzed by 2D-STE. Mean age of the patients was 15.07 ± 8.39years; mean diameter of ASD was 16.01 ± 2.78mm; left atrium (LA) diameter significantly increased after ASD closure; and peak longitudinal strain of RA increased significantly one day and one month after ASD closure (48. 77 ± 4.40, vs.55.36 ± 3.70 and, vs. 62.13 ± 3.81%, p = 0.001). LA longitudinal strain significantly decreased after ASD closure (42.55 ± 4.57, vs. 34.79 ± 3.20%, p = 0.001). Furthermore, negative correlation was found between the size of the ASD and delta LA systolic strain and strain rate. 2D-STE can be considered a feasible and simple technique for assessment of atrial deformation in ASD patients, and it useful to assess the effect of percutaneous ASD closure on atrial reservoir function by measuring peak atrial longitudinal strain.