Percutaneous Atrial Septal Defect Closure Research Articles

Echocardiographic detection of intraluminal catheter thrombosis during percutaneous atrial septal defect closure.

Echocardiographic detection of intraluminal catheter thrombosis during percutaneous atrial septal defect closure.

Improvement Functional Capacity In Adult After Percutaneous ASD Closure

This case report describes a 24-year-old woman with a secundum atrial septal defect (ASD) who underwent successful percutaneous ASD closure with significant improvement in symptoms and functional capacity. The patient presented with easy fatigue and shortness of breath on exertion for 10 years. Echocardiography revealed a large secundum ASD with moderate to severe tricuspid regurgitation, mild mitral regurgitation, mild pulmonary regurgitation, and dilatation of the right atrium and ventricle. Right heart catheterization confirmed a large left-to-right shunt and pulmonary hypertension. The patient underwent ASD closure with a Figulla Flex II device, resulting in immediate improvement of hemodynamics. Follow-up at 3 and 6 months demonstrated decreased right ventricular size, improved left ventricular function, and increased exercise caapacity. This case highlights the benefits of ASD closure in improving symptoms and cardiac function, even in patients with longstanding right ventricular dilation.

Shed Atrial Septal Occluder Removed by Gastric Biopsy Forceps: A Case Report

Atrial septal defect (ASD) is a common congenital heart disease, and can be treated with occluders. However, occluder detachment remains one of the most urgent complications to be resolved. This paper reported a case of ASD occluder detachment, which was successfully resolved with gastroscopic biopsy forceps. A 57-year-old woman complained chest distress for over one week, and was admitted to cardiovascular department of Sir Run Run Shaw Hospital. Based on echocardiography, the patient was diagnosed as ASD, mitral and tricuspid valve regurgitation. On the second day after percutaneous closure of residual ASD, routine chest radiographs showed the occluder detached into the abdominal aorta. After a thorough evaluation and examination, we decided to use gastric biopsy forceps to remove occluder. As a result, the patient recovered well and discharged from the hospital. For postoperative patients with ASD, when occlusion devices detached and conventional strategies could not extract the occluders, gastric biopsy forceps would be appliable. Compared to conventional strategies, gastric biopsy forceps have better grasping force, and provide secure fixing for disconnected or detached occlusion devices in cardiac interventional surgeries.

Percutaneous Secundum Atrial Septal Defect Closure: Failure Rate and Procedural Predictors

Background: Percutaneous atrial septal defect (ASD) closure is one of therapeutic options for patients with a suitable ASD anatomy, however in developing countries, the exact figure and procedural characteristics remain unknown. Therefore, this study was conducted to identify the failure rate and procedural predictors of the percutaneous ASD closure.Materials and methods: A retrospective study using a database of all patients undergoing percutaneous ASD closure was conducted between March 2010 to November 2023. Patients who developed a pulmonary hypertensive crisis during the procedure were excluded. Procedural and echocardiographic parameter were measured and analyzed.Results: A total of 112 samples were included in this study, 74.1% were female and 55.36% were pediatric patients. The failure rate was 12.5% (n=14) with diameter index was higher in the failed group. Unpaired T-test revealed that ASD size was one of the predictor failure in pediatric patients (mean diameter: 24.7±6.46 mm vs. 16.36±5.94 mm, p=0.001). There were no statistically significant variations in rim diameters, while compared with all patients with appropriate rims (rim ≥7mm), the failure rate was higher in patients with two rims measuring between 5.9 and 6.9 mm and rims less than 5 mm. Two patients presented with device embolization and required surgical device removal.Conclusion: The failure rate of percutaneous ASD closure was 12.5%. A larger ASD increases the risk of failure of percutaneous closure in pediatric patients. Furthermore, patient with 5-6.9 mm on two or more rims as well as those with rim less than 5 mm, have a higher failure rate.Keywords: secundum atrial septal defect, percutaneous closure, failure rate

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.

Effects of percutaneous closure of atrial septal defects via the right internal jugular vein.

Percutaneous atrial septal defect (ASD) closure is the preferred treatment for patients with suitable ASD anatomy. The safety and effectiveness of transcatheter closure have been established. However, reports on transesophageal echocardiography (TEE)-guided percutaneous closure of ASD via the right internal jugular vein (RIJV) are limited. The study aims to discuss the safety and effectiveness of percutaneous trans-jugular vein closure of ASD. We conducted a retrospective analysis of patients (n=103) with secondary ASD who underwent surgical treatment in the Department of Cardiovascular Surgery, the Second Hospital of Jilin University between July 2015 to July 2022. The article is a cross-sectional study. Clinical data, including age, gender, weight, defect diameter, tricuspid regurgitation, left atrial (LA) size, and the operation results, were collected and evaluated. Nonparametric rank sum tests were used to assess tricuspid regurgitation before and after surgery, while paired sample t-tests were used to compare LA size before and after surgery. TEE-guided percutaneous closure of ASD via the RIJV was successfully performed in 97 out of 103 (94.2%) cases. The average procedure time was 34.48±13.06 min, and the mean age at the time of the procedure and ASD size were 36±18 years and 15.45±5.82 mm, respectively. On analyzing medical records and echocardiographic images, postoperative complications were found to occur in four (3.9%) patients. Among these, three patients had residual shunt as indicated by echocardiography during the operation, which subsequently disappeared at the three-month follow-up. One patient developed atrial fibrillation after surgery but returned to normal sinus rhythm with medication. Percutaneous closure of ASD via the RIJV was unsuccessful in 6 patients (5.8%), with 5 of them undergoing transthoracic ASD closure and achieving satisfactory results. One patient refused further surgical treatment. No pericardial effusion, thrombosis, atrioventricular block, or other complications were observed during the 3-month to 1-year follow-up period. ASD closure via the RIJV is a safe and effective therapeutic approach. The initial results are satisfactory, but further studies with large sample sizes and long-term follow-up are warranted to assess the long-term outcomes.

An overview of treatment for atrial septal defect with pulmonary hypertension

Background: Atrial Septal Defect (ASD) is a congenital heart defect which can be the cause of comorbidities in the form of Pulmonary Arterial Hypertension (PAH) and therapy cannot be done simply by correcting the ASD but requires further study and evaluation.Purpose: Describe the treatment given to patients with ASD and PAH and the correlation between the administration of interventional therapy and the patient's probability of PH.Method: This study is a descriptive quantitative using a cross-sectional research design. The sampling technique was total sampling method. The samples were 41 ASD patients with PAH at Prof. Ngoerah General Hospital in Denpasar in 2022. Patients under 18 years of age and those with other congenital heart disease will be excluded. The demographic characteristics assessed were the patient's age and gender. The therapy data included information on medical therapy and intervention therapy.Results: Focus of medical therapy was supportive therapy rather than specific PAH therapy. Percutaneous ASD closure was the most widely-used intervention therapy compared to surgical ASD closure. Based on statistical analysis, the p value &gt; 0.05 is 0.284, so there is no significant correlation between the probability of the patient's pH and the provision of intervention therapy.Conclusion: At Prof Ngoerah General Hospital Denpasar, the majority of ASD patients with complications of pulmonary hypertension were females aged between 21 to 30 years. The medical therapy given is adjusted based on the severity of PH as assessed through echocardiography examination. Majority of patients received supportive therapy compared to specific therapy for PAH. Medical therapy is prioritized for patients who have contraindication criteria for interventional therapy. Percutaneous ASD Closure was found to be the largest percentage in interventional therapy regardless of the severity, except for patients who were indicated to undergo surgical ASD closure. There is no significant relationship between the patient's PH probability level and the choice of intervention therapy.

Differences and similarities in interatrial shunts management

Atrial septal defects (ASD) and Patent foramen ovale (PFO) represent the most common congenital heart diseases (CHD) adulthood. These two clinical entities, having different embryological origin, as well as clinical manifestations, clinical course and treatment must be carefully distinguished. Right heart failure and pulmonary hypertension are considered the major determinants of morbidity and mortality in ASD. Conversely, new pathophysiology concepts have been raised in the management of PFO as left atrium cardiopathy. New diagnostic tools, including cardiac magnetic resonance and intracardiac echocardiography have joint transthoracic and transesophageal echocardiography in the diagnostic definition of both ASD and PFO as well as in guiding their percutaneous closure. Moreover, several innovations have been developed in the field of percutaneous ASD and PFO closure devices including new evidence supporting the safety and efficacy of device-based closure. Aim of the present review is to present review we provided and update overview on ASD and PFO, focusing on the novel concepts regarding their pathophysiological and therapeutic aspects.

Predictors of tricuspid regurgitation and right ventricular remodelling following percutaneous atrial septal defect closure

Abstract Background Atrial septal defects (ASD) are one of the most common congenital heart defects, and if left unrepaired, life expectancy is decreased due to pulmonary hypertension (pHTN), atrial arrhythmias, and heart failure. Residual right ventricular (RV) dilation or dysfunction despite ASD closure can lead to worse outcomes. Purpose There is insufficient data on predictors of poor RV remodelling following ASD closure in adults. In this study, we aimed to identify risk factors of persistent RV dilation or dysfunction despite percutaneous ASD closure. Methods Patients undergoing primary percutaneous ASD closure between 1/2010-6/2021 were followed for a year. Patients with hemodynamically insignificant or iatrogenic ASDs, pHTN and Eisenmenger syndrome were excluded. Non-linear multiphase mixed–effects cumulative logistics regression model was used to assess the trend of the individual’s degree of TR, RV dysfunction and size over time. This was further stratified by age group (≥40 and &amp;lt;40). Partial dependence plot was used to study the association between age, body surface area (BSA), degree of RV and left ventricle (LV) dysfunction pre-procedurally with the likelihood of lack of RV remodelling. The association between ASD size and the likelihood of sustained RV dysfunction following ASD closure was also studied. Results A total of 185 patients met the inclusion criteria. The median age was 41 and 63% were female. The mean follow-up time of 3.6 months (range 1 day to 4.5 years). 249 echocardiograms were retrieved. Results showed a transient worsening of TR in the first 3 months post-ASD closure, which was more pronounced in older patients (≥40) (Figure 1). A larger ASD size was associated with a higher likelihood of early moderate or greater RV dysfunction (Figure 2). All patients had some degree of RV remodelling following the procedure. Older patients (≥40) were more likely to have RV dysfunction at the time of closure. Older age, RV and LV dysfunction, and high BSA were associated with poor RV remodelling or persistent RV dilation a year after ASD closure (Figure 3). Conclusions Patients who underwent percutaneous ASD closure with at least one of the following risk factors: age greater than 40, larger ASD, ventricular dysfunction, and high BSA require closer long-term follow-up given the reduced RV remodelling. Future studies are needed to elucidate the effect of poor RV remodelling on functional capacity, arrhythmic burden, and progression of TR and long-term outcomes.

Abstract 13441: Outcomes of Percutaneous Atrial Septal Defect Closure Following Mitraclip and Transcatheter Mitral Valve Replacement

Introduction: Data on clinical outcomes of percutaneous closure of iatrogenic atrial septal defect (PC-ASD) in patients undergoing transcatheter edge-to-edge repair (TEER) or mitral valve replacement (TMVR) remains limited. We used a real-world USA database to evaluate the differences in the in-hospital outcomes between both groups. Hypothesis: Is there a clinical significance for PC-ASD in patients undergoing TEER or TMVR? Methods: We used the National Inpatient Sample (2015-2020) by utilizing ICD-10 codes to identify all patients who underwent TEER or TMVR with or without PC-ASD. Multivariate logistic regression was used for adjusted outcomes (adjusted odds ratio [aOR]). Results: A total of 44,065 eligible weighted hospitalizations were included: 39,625 (89.9%) of the patients underwent TEER and 4,440 (10.1%) underwent TMVR. Rates of PC-ASD were higher in TMVR group compared to TEER group (10.7% vs. 2.0%, p&lt;0.01). In patients who underwent TEER without PC-ASD, PC-ASD was more associated with acute heart failure (AHF) (aOR 1.42 [1.19-1.68], p&lt;0.01) and longer hospitalizations (aOR 1.64 [1.41-1.89], p&lt;0.01), without significant difference in inpatient mortality (aOR 0.97 [0.61-1.54], p&lt;0.01), cardiogenic shock (aOR 1.13 [0.85-1.51], p=0.21), need for mechanical circulatory support (MCS) (aOR 0.98 [0.61-1.54], p=0.18), and stroke. Compared to patients who underwent TMVR without PC-ASD, PC-ASD was associated with higher inpatient morality (aOR 1.65 [1.13-2.4], p&lt;0.01), need for MCS (aOR 1.91 [1.33-2.73], p&lt;0.01) without significant difference in AHF (aOR 1.19 [0.94-1.51], p=0.18] and cardiogenic shock (aOR 0.83 [0.56-1.22], p=0.43). Remarkably, PC-ASD was less associated with stroke (aOR 0.27 [0.10-0.72], p&lt;0.01). Conclusions: Rates of PC-ASD after TEER were lower than after TMVR and were associated with worse in-hospital mortality and need for MCS in TMVR but not in TEER. Also, PC-ASD was less associated with stroke after TMVR.

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.

Mid-Term Electrical Remodeling after Percutaneous Atrial Septal Defect Closure with GCO Device in a Pediatric Population.

The GORE® CARDIOFORM (GCO) septal occluder is an atrial septal defect/patent foramen ovale closure device with theoretical advantages over other commercialized devices thanks to its softness and anatomical compliance. Our aim was to evaluate the short- and medium-term electrocardiographic changes after percutaneous ASD closure with GCO in a pediatric population. We enrolled 39 patients with isolated ASD submitted to trans-catheter closure from January 2020 to June 2021. ECG was performed before, at 24 h and 6 months after the procedure. P wave dispersion, QTc and QTc dispersion were calculated. ECG Holter was recorded at 6 months after implantation. Patients' age and body surface area (BSA) were 8.2 ± 4.2 years and 1.0 ± 0.3 m2 respectively. At the baseline, mean P wave dispersion was 40 ± 15 msec and decreased at 24 h (p < 0.002), without any further change at 6 months. At 24 h, PR conduction and QTc dispersion significantly improved (p = 0.018 and p < 0.02 respectively), while the absolute QTc value considerably improved after 6 months. During mid-term follow-up, QTc dispersion remained stable without a significant change in PR conduction. The baseline cardiac frequency was 88.6 ± 12.6 bpm, followed by a slight reduction at 24 h, with a further amelioration at 6 months after the procedure (87.3 ± 14.2, p = 0.9 and 81.0 ± 12.7, p = 0.009, respectively). After device deployment, two patients developed transient, self-limited junctional rhythm. One of them needed a short course of Flecainide for atrial ectopic tachycardia. No tachy/brady-arrhythmias were recorded at the 6-month follow-up. ASD closure resulted in a marked decrease in right heart volumes and diameters at 6 months after percutaneous closure. Percutaneous ASD closure with the GCO device results in significant, sudden improvement of intra-atrial, atrio-ventricular and intraventricular electrical homogeneity. This benefit persists unaltered over a medium-term follow-up. These electrical changes are associated with a documented positive right heart volumetric remodeling at mid-term follow-up.

Atrial Septal Defect with Paroxysmal Atrial Tachyarrhythmia in Middle Age Soldier Patient: A Case Report

Highlights: 1. ASD closure is still recommendable in late middle-aged patients, especially one that is combined with arrhythmias management. 2. ASD closure after age 40 seems to not affect the frequency of arrhythmia development during follow up. - Background: Atrial septal defects (ASDs) are frequently asymptomatic and can remain undiagnosed until adulthood. Atrial tachyarrhythmias are not uncommon seen in patients with ASDs. Atrial fibrillation and atrial flutter are relatively rare in childhood, but become more prevalent with increasing age at time of repair or closure. Case Summary: The present case was an active duty 50-year-old male soldier, referred to the arrhythmia division of Gatot Soebroto Army Hospital with palpitations and physical intolerance. Holter examination and electrophysiology study revealed atrial tachyarrhythmias. Transesophageal echocardiography was performed before radiofrequency catheter ablation, and unexpectedly found left to right shunt ostium secundum ASD. Right heart catheterization confirmed left to right shunt ASD with high flow-low resistance. He then underwent paroxysmal atrial tachyarrhythmias catheter ablation, followed by percutaneous transcatheter ASD closure using occluder device without fluoroscopy within six months. Both the procedures went well without any complications. His symptoms had improved during follow up, although he had episode of rapid paroxysmal atrial fibrillation on holter evaluation six months later. Conclusion: We conclude that ASD closure is still recommendable even in late middle age patients combined with arrhythmias management.

Long-term follow-up of percutaneous secundum-type atrial septal defect closure using Amplatzer Septal Occluder since 1995: a single-centre study.

The goal of this single-centre study was to evaluate long-term results of percutaneous closure of secundum-type atrial septal defect using Amplatzer Septal Occluder with the follow-up to 25 years. A retrospective analysis of patients who underwent percutaneous closure of secundum-type atrial septal defect between September 1995 and October 2012 in our institution was performed. All procedures were performed after fulfilling strict indication criteria. More than 5 years follow-up was reached in 651/803 patients (81%) with median follow-up time of 12 (5-25) years. The mean stretched defect diameter was 14,0 ± 5,2 mm. Early reintervention due to moderate or severe residual atrial septal defect had to be performed in 3/803 patients (0,03%). The incidence of long-term moderate or severe residual atrial septal defect was 0,0%. The complete closure rate at 10-year follow-up was 98,5%, as trivial residual shunts persisted in 8/508 patients (1,5%). A significant rate of the echocardiographic right ventricular end-diastolic diameter post-procedural normalisation (p < 0,05) was encountered. The rate of major complications was 0,5%. One device embolisation, one thrombus formation at the occluder surface, and one cardiac erosion in periprocedural or short post-procedural course were experienced. Only one late complication of infective endocarditis at the region of implanted occluder and the aortic valve was detected. The survival rate of all followed patients was 100%. Percutaneous closure of secundum-type atrial septal defect using Amplatzer Septal Occluder is a safe and effective procedure accounting for a very low incidence of major complications in the long-term follow-up.

Outcomes of Percutaneous Atrial Septal Defect Closure With Mitral Transcatheter Edge-to-Edge Repair and Transseptal Mitral Valve Replacement (2015 to 2020)

Patients who underwent transcatheter edge-to-edge repair (TEER) or transcatheter mitral valve replacement (TMVR) have a transeptal access created by an iatrogenic atrial septal defect (ASD) which leads to significant complications requiring closure. Given limited data, we used the National Inpatient Sample between 2015 and 2020 to evaluate the clinical outcomes of percutaneous closure of ASD (PC-ASD) in TEER/TMVR hospitalizations. A total of 44,065 eligible weighted hospitalizations with either TEER (n=39,625, 89.9%) or TMVR (n=4,440, 10.1%) with a higher rate of PC-ASD in the TMVR group (10.7% vs 2.0%, p<0.01). The TEER with PC-ASD group were more likely to experience acute heart failure and right ventricular failure and had longer hospital stays but there was no difference in in-hospital mortality compared with the no PC-ASD group. In the TMVR group, there was no difference in the odds of acute heart failure, right ventricular failure, cardiogenic shock, or acute hypoxic respiratory failure, but the odds of mechanical circulatory support, in-hospital mortality, and length of stay were significantly higher in patients with PC-ASD in the TMVR group. In conclusion, rates of percutaneous closure of ASD after TEER were lower than after TMVR and associated with worse in-hospital mortality in TMVR but not in TEER. Further prospective clinical trials are needed to identify patients who would benefit from the closure of iatrogenic ASD.

Complete Transthoracic Echocardiography for the Assessment and Guidance of Percutaneous Atrial Septal Defect Closure in Adults without Balloon Sizing: An Observed Study with a 10-Year Follow-Up.

This study aims to determine if complete transthoracic echocardiography (TTE)-guided percutaneous atrial septal defect (ASD) closure without balloon sizing could be safe and efficacious in adult patients. A total of 551 patients with ASDs were enrolled in this study, of which 438 patients underwent percutaneous ASD closure. Patients who received TTE-guided percutaneous ASD closure were classified into group T, and those who underwent a procedure that was guided by transesophageal echocardiography (TEE) were classified into group E. The clinical characteristics and the outcomes of the patients were analyzed. The characteristics were comparable at baseline, except for the body mass index (BMI) (21.6 ± 5.3 vs. 23.8 ± 7.1, p < 0.001) between group T and group E. No significant difference was observed between the two groups regarding in-hospital outcomes, except for the duration of the procedure (29.8 ± 15.3 min vs. 41.5 ± 20.4 min), the length of stay in the hospital (2.1 ± 2.3 d vs. 2.9 ± 2.6 d), and hospital costs (USD 6233.3 ± 312.4 vs. USD 6673.7 ± 446.9). There were no significant differences in the incidences of long-term complications, cardiac chamber sizes, and tricuspid regurgitation severity between the patients in the two groups during the 10-year follow-up period. TTE may be as safe and efficacious as TEE for the assessment and guidance of percutaneous ASD closure without balloon sizing in adult patients with lower BMIs who are commonly found in East Asia.

Concomitant Percutaneous Atrial Septal Defect Closure With an Amplatzer Septal Occluder and HeartMate 3 Implantation for High-Risk Heart Failure Patients: A Novel Hybrid Strategy

Concomitant Percutaneous Atrial Septal Defect Closure With an Amplatzer Septal Occluder and HeartMate 3 Implantation for High-Risk Heart Failure Patients: A Novel Hybrid Strategy

Early embolization of atrial septal defect occluder device into the left atrium

Atrial septal defect (ASD) is one of the most common types of congenital heart defects. Percutaneous closure of ASD is relatively safe and accepted as an alternative to surgery. However, device-related complications can occur rarely. Embolization of the Amplatzer atrial septal occluder (ASO) is one major complication of percutaneous device closure. The author presents a case of early embolization of ASO device into the left atrium, which removed the device surgically, and the ASD was closed.

PO-04-144 IMPACT OF AGE ON ATRIAL ARRHYTHMIA OUTCOMES AFTER PERCUTANEOUS ASD CLOSURE

Atrial Septal Defects (ASD) are one of the most common congenital heart defects, and if unrepaired, increase the risk of atrial fibrillation (AF) and atrial flutter (AFL). AF/AFL are linked to an increased risk of stroke and heart failure yet, it is not clear from existing data whether percutaneous ASD closure reduces the overall burden of AF/AFL and whether AF/AFL prevalence is impacted by closure age. To determine the effect of age at ASD closure on the prevalence of late atrial arrhythmias. All patients who underwent percutaneous ASD closure at Cleveland Clinic from January 2010 to July 2021 were included. Patients without right-sided dilatation and Qp:Qs < 1.5, iatrogenic ASDs, and those with Eisenmenger syndrome were excluded. A non-linear logistic mixed model informed a temporal decomposition model used to analyze the association between age at ASD closure and prevalence of AF/AFL, adjusting for gender and presence of pre-closure AF/AFL. A total of 192 patients met inclusion criteria, 121 (63%) female with a median age of 41.5 years (IQR 19-61) at time of ASD closure. Median follow up time was 2.7 years (IQR 0.64-4.7). 170 (89%) patients had a total of 681 records including ECGs and ambulatory rhythm monitors. Pre-procedural AF/AFL was associated with higher likelihood of late (>6 months) AF/AFL. The prevalence of post-ASD closure AF/AFL was composed of two phases: an early peaking phase of 13% at week 1 with a gradual decrease to 3.2% by 6 months. There was a late rising prevalence from 6 months up to 6 years from 3.2% to 4.7% (Figure 1a). Age ≥ 40 years was associated with higher likelihood of early (≤ 6 months) and late (> 6 months) post procedural AF/AFL prevalence (Figure 1b). Post-device closure, only 7 (3.6%) patients required cardioversions at a median time of 2.6 months, and 5 (2.6%) required ablations at a median time of 7.4 months post ASD closure. There were only 10 arrhythmia related ER visits during the follow up period. There is an increased prevalence of AF/AFL immediately post ASD closure that declines by 6 months. Patients older than 40 years of age and those with pre-procedure AF/AFL have ongoing risk for late AF/AFL post ASD closure. Rhythm monitoring before ASD closure may be indicated in age ≥ 40 to identify those at higher risk of developing late AF/AFL. Parametric estimate of prevalence of AF or AFL after percutaneous ASD closureTime1 day1 week2 week1 month6 month1 year3 year5 year6 yearOverall (%)0.8813106.73.23.54.24.64.7Stratified by age (%)<4002.61.80.630.0130.002000≥401.34332154.656.26.97.1 Open table in a new tab