Multiple Septal Defects Research Articles

Clinical advantage of real-time three-dimensional transesophageal echocardiography for transcatheter closure of multiple atrial septal defects

This study sought to evaluate the usefulness of real-time three-dimensional (3D) transesophageal echocardiography (TEE) to guide the repair of multiple atrial septal defects (ASDs). Of 212 consecutive patients with secundum ASD who were scheduled for transcatheter closure of their ASDs, 27 had multiple ASDs. These patients underwent two-dimensional (2D) transthoracic echocardiography, 2D TEE, and 3D TEE. Overall, 18 patients had two defects, and 9 patients had three or more defects. The latter group included three patients with multi-fenestrated defects. Optimal 3D images were obtained in 93 % of the patients. In patients with two defects, information on the positional relation of the defects was obtained using 2D TEE and 3D TEE in 71 and 94 % of patients, respectively (P = 0.22). The positional relations of the defects could not be evaluated with 2D TEE in patients with three or more defects, whereas it could be evaluated with 3D TEE in all of these patients (0 vs. 100 %, P = 0.008). In all patients, 3D TEE proved superior to 2D TEE for providing sufficient information (96 vs. 48 %, P = 0.002). Procedural success was obtained in 26 patients (96.3 %), without complications. Transcatheter closure of multiple ASDs under 3D TEE guidance is effective and safe. Real-time 3D TEE can provide useful information regarding complex ASD morphology. It can thus contribute to developing a successful treatment strategy, especially in patients with three or more defects.

Transcatheter Device Closure of Multiple Atrial Septal Defects in Children Under Body Weight 15kg

Transcatheter device closure of secundum atrial septal defects (ASD) is popular even in young children. In this study, the feasibility, safety and efficacy for transcatheter device closure of multiple ASD was evaluated in children under body weight 15kg, retrospectively.

First experience with the new GORE® septal occluder for the closure of multiple atrial septal defects

Transcatheter closure of an atrial septal defect (ASD) is considered the standard of care for most of the patients with secundum ASD. The existence of multiple or fenestrated ASD may constitute a challenge to achieve a satisfactory result. Data on the usage of multiple devices for closing multiple defects are limited. The GORE Septal Occluder (GSO) represents a new generation of transcatheter ASD occluders with a design that provides superior conformability, apposition, and closure performance compared with the previous GORE HELEX device. The present case report describes the first clinical experience with the implantation of two GSO devices in a patient with multiple ASDs and fenestrated septum.

Percutaneous transcatheter atrial septal defect closure with Amplatzer septal occluder device using three different techniques in three adult patients with complex ostium secundum type atrial defects

Complex ostium secundum type atrial septal defect (ASD) is a definition used for large (stretched diameter over 26 mm with deficient rim) or multiple ASDs or multi-fenestrated septum or ASDs with redundant and aneurysmal septal rims. Compared to simple defects, transcatheter ASD closure with Amplatzer septal occluder (ASO) is relatively challenging in these cases, and different techniques have been defined to increase procedure success. We report three adult patients with complex ostium secundum type ASDs that were closed with ASO device using three different techniques. The first case was a 36-year-old female patient with complaints of dyspnea, palpitation and fatigue. A complex ostium secundum type ASD was diagnosed, and the defect was closed with a 36 mm ASO device using a left upper pulmonary vein technique. The second case was a 47-year-old female patient with complaints of dyspnea and palpitation. A large and complex ASD was detected, and the defect was closed with a 28 mm device using a left atrial roof technique supported by non-inflated balloon. The third case was a 40-year-old female patient who presented with complaints of dyspnea and palpitation. Complex ASD was diagnosed, and the defect was closed with a 32 mm device using a partially inflated balloon technique. In large and complex ASDs, the classical implantation technique of an ASO device may fail at any time. The knowledge and application of different techniques that orient the left atrial disc parallel to the septum may increase the procedure success and decrease complications.

Huge interatrial septal aneurysm associated with a multiple atrial septal defect evaluated by transesophageal echocardiography

Huge interatrial septal aneurysm associated with a multiple atrial septal defect evaluated by transesophageal echocardiography

Concomitant tuberculous meningitis and Lutembacher syndrome with multiple atrial septal defects and infective endocarditis.

Lutembacher syndrome is a rare combination of atrial septal defect (ASD) and mitral stenosis. Symptoms depend on the size of ASD, extent of mitral stenosis and degree of changes in the pulmonary circulation. Presentation can be due to cardiac failure, atrial arrhythmias, dyspnoea, exercise intolerance, paradoxical emboli or other disease related complications like pulmonary hypertension and infective endocarditis. Tuberculous meningitis is a chronic infection due to haematogenous dissemination of tubercle bacilli from lungs. It can lead to complications like cranial nerve palsies, hydrocephalus, cerebral oedema or focal neurological deficits presenting as stroke. The treatment should include antituberculous therapy for one year and corticosteroids for initial 4-6 weeks depending on the symptoms of the patient. This report describes the concomitant occurrence of all these conditions at a time in a 45 years old lady.

INTERVENTIONAL THERAPY OF MULTIPLE ATRIAL SEPTAL DEFECTS

ObjectivesTo evaluate the safety and efficiency of transactheter closure of multiple atrial septal defects.MethodsA total of 10 patients (5 males and 5 females) with multiple atrial septal defects underwent transcatheter...

Two- and Three-Dimensional Transesophageal Echocardiography for Multiple Atrial Septal Defects

Two- and Three-Dimensional Transesophageal Echocardiography for Multiple Atrial Septal Defects

Percutaneous closure of multiple atrial septal defects and patent ductus arteriosus during the same session

An alternative to the surgical repair of secundum type atrial septal defects (ASD) and of patent ductus arteriosus (PDA) is transcatheter closure. However, there is limited information about the efficacy of using percutaneous devices to close multiple ASDs. An 8-year-old female patient was admitted to our hospital with a cardiac murmur. A large secundum multi-fenestrated ASD (17 mm, 4.5 mm, 3 mm) and PDA (3 mm) were diagnosed upon echocardiographic examination. During cardiac catheterization, the PDA was closed with an Amplatzer Duct Occluder (6x4 mm) followed by the closure of the ASD with an Amplatzer septal occluder (22 mm) with no residual shunting. The percutaneous closure of multi-fenestrated ASD with PDA in pediatric patients may be considered as a first-choice treatment with minimal complications.

Techniki kissing balloons i kissing devices – przezskórne zamknięcie wielu ubytków w hipermobilnej przegrodzie międzyprzedsionkowej za pomocą dwóch urządzeń

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Küçükdurmaz Z, Karapinar H, Oflaz M, Gül İ, Yilmaz A. Case reportKissing balloons and kissing devices: transcatheter closure of multiple atrial septal defects on hypermobile atrial septum with two devices. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej. 2012;8(4):357-359. doi:10.5114/pwki.2012.31920. APA Küçükdurmaz, Z., Karapinar, H., Oflaz, M., Gül, İ., & Yilmaz, A. (2012). Case reportKissing balloons and kissing devices: transcatheter closure of multiple atrial septal defects on hypermobile atrial septum with two devices. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej, 8(4), 357-359. https://doi.org/10.5114/pwki.2012.31920 Chicago Küçükdurmaz, Zekeriya, Hekim Karapinar, Mehmet Burhan Oflaz, İbrahim Gül, and Ahmet Yilmaz. 2012. "Case reportKissing balloons and kissing devices: transcatheter closure of multiple atrial septal defects on hypermobile atrial septum with two devices". Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej 8 (4): 357-359. doi:10.5114/pwki.2012.31920. Harvard Küçükdurmaz, Z., Karapinar, H., Oflaz, M., Gül, İ., and Yilmaz, A. (2012). Case reportKissing balloons and kissing devices: transcatheter closure of multiple atrial septal defects on hypermobile atrial septum with two devices. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej, 8(4), pp.357-359. https://doi.org/10.5114/pwki.2012.31920 MLA Küçükdurmaz, Zekeriya et al. "Case reportKissing balloons and kissing devices: transcatheter closure of multiple atrial septal defects on hypermobile atrial septum with two devices." Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej, vol. 8, no. 4, 2012, pp. 357-359. doi:10.5114/pwki.2012.31920. Vancouver Küçükdurmaz Z, Karapinar H, Oflaz M, Gül İ, Yilmaz A. Case reportKissing balloons and kissing devices: transcatheter closure of multiple atrial septal defects on hypermobile atrial septum with two devices. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej. 2012;8(4):357-359. doi:10.5114/pwki.2012.31920.

Abstract 17197: Closure of Multiple Atrial Septal Defects with the Helex Device

Background: The performance of the Helex Septal Occluder (HSO) for closure of fenestrated atrial septum/multiple ASDs (mASDs) has not been evaluated. We sought to review our experience with closure of mASDs with the HSO. Methods: We identified 48 patients with mASDs who underwent percutaneous closure between 6/2001 and 5/2011. Number and size of ASDs, number of implanted HSOs, residual shunt, and complications were recorded. Results: Of 48 patients, 27 had defect closure with ≥ 1 HSO. Indication for closure was RV enlargement (RVE) in 24 (89%) and cryptogenic neurologic event in 3 (11%). Median age was 9.1 (1.9-66.2) years, median weight 30.7 (12.2-99.5) kg. Six patients (22%) weighed < 20 kg. Median number of ASDs was 2 (2-≥5). Median stop-flow diameter in 25/27 patients was 12 (6-24) mm. Two patients had multiple small defects that were not sized. One HSO was implanted in 21 patients (78%), and 2 HSOs in 6 patients (22%). Procedural complications included device embolization in 2 patients, and both were retrieved percutaneously with successful deployment of another HSO. Residual shunt immediately post-closure was absent in 5/27 (19%), trivial in 15/27 (55%), small in 6/27 (22%), and moderate in 1/27 (4%). The median length of follow-up was 2 (0-9) years. Residual shunt at last follow-up was absent in 13/27 (48%), trivial in 8/27 (30%), small in 5/27 (18%), and moderate in 1/27 (4%). No complication occurred during follow-up. Of the 24 patients with RVE before closure, 2 are recent without follow-up and 1 is lost to follow-up. RV size normalized in 20/21 (95%) patients. No patient with a prior neurological event had a recurrence. The patient with moderate residual shunt and RVE had 1 HSO, and placement of a second HSO is planned. Conclusions: We conclude that closure of mASDs with 1 or more HSOs is effective with a low complication rate. The complication observed, embolization, did not significantly affect outcome in this series, as percutaneous retrieval was successful. In addition, the low profile of the HSO may facilitate safe implantation of multiple devices in smaller patients.

Five-year Follow-up of Intracardiac Echocardiography-assisted Transcatheter Closure of Complex Ostium Secundum Atrial Septal Defect

We sought to prospectively evaluate long-term follow-up results of intracardiac echocardiography-aided transcatheter closure of complex atrial septal defects (ASD) in the adults. Prospective multicenter registry in tertiary care hospitals. Over a 5-year period, we prospectively enrolled 56 patients (mean age 49 ± 16.7 years, 24 females) who have been referred to our center for catheter-based closure of complex secundum ASD (> 25 mm diameter, deficiency of ≥ 1 rim, multiple secundum ASD, multiperforated ASD, associated incomplete floor of the fossa ovalis with or without aneurysm, embryonic remnants of incomplete atrial septation). All patients were screened by means of transesophageal echocardiography before the operation. Eligible patients underwent intracardiac echocardiography study and closure attempt. Forty patients underwent a transcatheter closure attempt: transesophageal echocardiography-planned device type and size were modified in 32 patients (64%). Rates of procedural success, predischarge occlusion, and major complications rate were 100%, 90%, and 2%, respectively. On mean follow-up of 5.4 ± 1.8 years, the follow-up occlusion rate was 98%. During follow-up, only one case of permanent atrial fibrillation was observed. There were no cases of aortic/atrial erosion, device thrombosis, or new atrioventricular valve dysfunction. Intracardiac echocardiography-guided complex secundum ASD transcatheter closure is safe and effective and appears to have excellent long-term results, thus minimizing potential complications resulting from the complex anatomy.

Intra-operative device closure of multiple atrial septal defects facilitated by a unique atrial septum remodeling technique: initial results and experience in 11 patients

We introduced a new atrial septum remodeling technique and further investigated the feasibility of this method in facilitating the intra-operative device closure (IODC) of multiple atrial septal defects (ASDs). Adult patients with multiple nearby ASDs, which were not eligible for transcatheter closure, were enrolled in this study. Transesophageal echocardiogram (TEE) was applied for intra-operative evaluation. The multiple ASDs were divided into three different types according to its morphology. Based on the concept of breaking the rim between multiple ASDs and making it feasible for single device closure, atrial septum remodeling procedure was carried out via pre-atrial approach using special clamp under the guidance of TEE. IODC was then attempted for reshaped ASD. Successful rate and perioperative complications were then noted. Eleven patients were enrolled in this study, with mean age being 23.4 ± 5.3 years and mean weight 51.6 ± 8.0 kg. Among them, seven patients have double ASDs and four have triple ASDs. Mean diameter of isolated ASD was 10.4 ± 3.8 mm with a mean distance of 3.2 ± 1.2 mm between each other. Atrial septum remodeling procedure was successfully done in all patients. One device was then used for each patient. Mean ASD diameter after remodeling procedure was 20.6 ± 3.9 mm with mean device size 23.5 ± 4.0 mm. Complete closure of multiple ASDs was achieved in nine patients immediately after the procedure; two patients had trivial grade shunt after device deployment that resolved within the 3-month follow-up. No severe complications were noticed during the perioperative period and the 3-month follow-up. Atrial septum remodeling technique seems to be a safe and effective method that could largely facilitate the successful IODC of multiple ASDs.

Transcatheter closure of secundum atrial septal defects using the amplatzer septal occluder: initial experience in taiwan

We assessed the safety and efficacy of closure of secundum-type atrial septal defects (ASDs) using the Amplatzer septal occluder (ASO) in a sample of Taiwanese patients. Between June 2000 and April 2002, 25 patients underwent transcatheter closure of their secundum-type atrial septal defect/s using the ASO device. The procedures were performed under general anesthesia with access through the femoral vein using guidance provided by transoesophageal echocardiography (TEE) and fluoroscopy. Twenty-two patients had larger defects with right cardiac dilatation and paradoxical interventricular septal motion, while family concerns were the primary indications for closure for the other three. Twenty-five ASO devices were successfully implanted in 24 patients, with a lone individual referred for surgery due to implantation failure. The mean age of the patients was 12.5 years. The male-female ratio was 12:13. The mean pulmonary-systemic blood flow ratio (Qp:Qs) was 2.5:1. The ASD size (mean 20.2 mm; range 8–28.5) was measured using transoesophageal echocardiography, with a balloon-stretched diameter of 8–29.5 mm (mean 20.5). The size of the implanted devices ranged from 9–36 mm (mean 23.1). Fluoroscopy duration ranged from 9.7–41.2 minutes (mean 23.5). A residual shunt, assessed not significant from transoesophageal echocardiography, was detected in one patient who had received two ASO devices for multiple ASDs. Follow-up intervals ranged from 0.1–2 years (median 1.0), with no late complications determined for any patient. Transcatheter closure of secundum ASDs using the Amplatzer septal occluder is a safe and effective alternative to the surgical analog. With careful selection of patients, secundum ASDs can be successfully closed, with minimal procedural morbidity and excellent early results. Long-term follow up is necessary for evaluation, however, if this procedure is to be as effective as surgery.

Transcatheter Closure of Multiple Atrial Septal Defects With the Amplatzer Device

Percutaneous device occlusion of secundum atrial septal defect (ASD) has become an accepted alternative to surgical repair. A variety of devices have been used successfully. However, all of them have limitations. We report our experience with two devices used to close multiple ASDs.

Percutaneous closure of multiple defects of the atrial septum: Procedural results and long‐term follow‐up

The percutaneous closure of single atrial septal defect (ASD) is a valid alternative to surgery. To assess the feasibility of percutaneous treatment of multiple ASDs. Between 1998 and 2007, 165 out of 1280 consecutive patients undergoing ASD percutaneous closure at our institution showed multiple defects that were classified in four categories: double atrial septal defects (d-ASD), multifenestrated atrial septal defects (f-ASD), multifenestrated defects with no signs of right heart overload (f-PFO), and complex cases (c-ASD). The following end points were taken into consideration: (1) immediate procedural success; (2) long term safety and efficacy. In this study, up to 81% of multiple ASDs were suitable for percutaneous closure. Multiple device implantations were required in 47% of cases, especially in patients with d-ASD and c-ASD. Complication rate, residual shunt, and long term outcome were comparable among the four different categories. In particular, at long term follow-up (6 +/- 2 years) no patient required further surgical or percutaneous treatment and complete closure was confirmed in 99% of cases. Percutaneous closure of multiple ASDs is feasible and associated with a good outcome. A thorough identification and analysis of morphological aspects are mandatory in order to select the appropriate device and the optimal strategy.

Transcatheter closure of multiple atrial septal defects in an adolescent

Pediatrics InternationalVolume 51, Issue 5 p. 756-758 Transcatheter closure of multiple atrial septal defects in an adolescent Metin Sungur, Corresponding Author Metin Sungur Department of Pediatrics, Section of Pediatric Cardiology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, andMetin Sungur, MD, Ondokuz Mayıs University, Faculty of Medicine, Section of Pediatric Cardiology, Department of Pediatrics, Kurupelit, Samsun 055380, Turkey. Email: [email protected]Search for more papers by this authorAlpay Çeliker, Alpay Çeliker Department of Pediatrics, Section of Pediatric Cardiology, Hacettepe University Faculty of Medicine, Ankara, TurkeySearch for more papers by this authorSüheyla Özkutlu, Süheyla Özkutlu Department of Pediatrics, Section of Pediatric Cardiology, Hacettepe University Faculty of Medicine, Ankara, TurkeySearch for more papers by this authorTevfik Karagöz, Tevfik Karagöz Department of Pediatrics, Section of Pediatric Cardiology, Hacettepe University Faculty of Medicine, Ankara, TurkeySearch for more papers by this authorKemal Baysal, Kemal Baysal Department of Pediatrics, Section of Pediatric Cardiology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, andSearch for more papers by this author Metin Sungur, Corresponding Author Metin Sungur Department of Pediatrics, Section of Pediatric Cardiology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, andMetin Sungur, MD, Ondokuz Mayıs University, Faculty of Medicine, Section of Pediatric Cardiology, Department of Pediatrics, Kurupelit, Samsun 055380, Turkey. Email: [email protected]Search for more papers by this authorAlpay Çeliker, Alpay Çeliker Department of Pediatrics, Section of Pediatric Cardiology, Hacettepe University Faculty of Medicine, Ankara, TurkeySearch for more papers by this authorSüheyla Özkutlu, Süheyla Özkutlu Department of Pediatrics, Section of Pediatric Cardiology, Hacettepe University Faculty of Medicine, Ankara, TurkeySearch for more papers by this authorTevfik Karagöz, Tevfik Karagöz Department of Pediatrics, Section of Pediatric Cardiology, Hacettepe University Faculty of Medicine, Ankara, TurkeySearch for more papers by this authorKemal Baysal, Kemal Baysal Department of Pediatrics, Section of Pediatric Cardiology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, andSearch for more papers by this author First published: 28 September 2009 https://doi.org/10.1111/j.1442-200X.2009.02894.xCitations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Citing Literature Volume51, Issue5October 2009Pages 756-758 RelatedInformation

Clinical Efficiency and Safety Analysis of Transcatheter Closure of Multiple Atrial Septal Defects in Adults

Transcatheter closure of atrial septal defects (ASDs) is currently a reliable alternative to surgery, even though challenging in patients with multiple ASDs. The aim of this study was to evaluate the clinical efficiency and safety of transcatheter closure in multiple ASDs. Multiple ASDs were diagnosed by transthoracic echocardiography (TTE) or transesophageal echocardiography (TEE). The occlusive condition and distance between 2 adjacent ASDs were measured by TTE examination. Then, the number and size of the occluder(s) was determined. TTE examinations were performed after transcatheter closure as follow-up. The transcatheter procedure was successful in 15 patients with multiple ASDs, using a single occluder in 9 patients and 2 occluders in the remaining 6 patients. Overall, 21 ASD occluders were implanted. During a follow-up period of 6 mo to 5 y, a slight residual shunt was found in 1 patient without any symptoms; a moderate residual shunt was identified at the inferior vena cava and the occluder was removed by surgery 1 mo after procedure. Other complications, including endocarditis, arrhythmia, thromboembolism, and atrioventricular valve damage were not recorded in any of the 15 patients during the follow-up period. Transcatheter closure of multiple ASDs is safe and efficient. Two occluders are necessary for the distance of 2 ASDs more than 7 mm, and a single occluder is sufficient for those 7 mm or less.

Concomitant Intraoperative Radiofrequency and Microwave Ablation of Atrial Fibrillation and Repair of Atrial Septal Defect

A B S T R A C T Atrial fibrillation (AF) is the most frequent form of atrial arrhythmias in adults with congenital heart disease. Some serious complications are related with the presence of AF after surgery. Because of the complexity and the risk of bleeding, the Maze III procedure has been largely replaced by alternative energy sources. A patient with multiple atrial septal defects (ASD) and AF underwent surgical closure with autologous pericardial patch and radiofrequency and microwave ablation of AF.

A novel deletion in proximal 22q associated with cardiac septal defects and microcephaly: a case report

BackgroundProximal 22q is rich in low copy repeats (LCRs) which mediate non-allelic homologous recombination and give rise to deletions and duplications of varying size depending on which LCRs are involved.MethodsA child with multiple septal defects and other congenital anomalies was investigated for genome imbalance using multiplex ligation-dependent probe amplification (MLPA) for subtelomeres and microdeletion loci, followed by array comparative genomic hybridization (CGH) using oligonucleotide arrays with 44,000 probes across the genome.ResultsMLPA identified a single probe deletion in the SNAP29 gene within band 22q11.21. Follow-up array CGH testing revealed a ~1.4-Mb deletion from 19,405,375 bp to 20,797,502 bp, encompassing 28 genes.ConclusionThis deletion is likely to be causally associated with the proband's congenital anomalies. Previous publications describing deletions in proximal 22q have reported deletions between LCRs 1 to 4, associated with 22q11 deletion syndrome; in addition, deletions between LCRs 4 and 6 have been described associated with "distal 22q11 deletion syndrome". To our knowledge, this is the first deletion which spans LCR4 and is not apparently mediated by LCRs. Comparison of the phenotypes found in conjunction with previously reported deletions, together with the function and expression patterns of genes in the deleted region reported here, suggests that haploinsufficiency for the Crk-like (CRKL) gene may be responsible for the reported cardiac abnormalities.