Closure Of Septal Defects In Patients Research Articles

Abstract 13708: Analyzing Outcomes of Atrial Septal Defect Closure in Patients With Ischemic Stroke and Thrombophilia

Introduction: Evidence on outcomes of ASD closure after a stroke in patients with thrombophilia is limited.: We illustrate differences in long-term outcomes amongst patients diagnosed with a stroke and thrombophilia, who underwent ASD closure up to 3 months after the stroke versus those who did not. Methods: We queried the TriNetX research database to identify adult patients with thrombophilia and ASD who had an ischemic stroke from 2016 to 2021. Patients were divided into two groups: those undergoing percutaneous transcatheter ASD closure within 3 months of the stroke and those who received medical therapy only. Subgroup analyses was performed comparing ASD closure with patients who received either anticoagulation or antiplatelets, and of those with a specific diagnosis of PFO. Propensity score matching (PSM) was used to control for age, sex, hypertensive diseases, CKD, diabetes, dyslipidemias, ischemic heart disease, and tobacco use. Outcomes were measured from 1 month to 3 years after the index event and included all-cause mortality, new onset Atrial fibrillation/flutter, arterial embolism, and services associated with stroke/arterial embolism namely thrombolysis, thrombectomy, and imaging (CT, CTA, MRI, MRA) of head and neck. Results: Patients with thrombophilia undergoing ASD closure after a stroke had lower all-cause mortality compared to medical therapy [HR 0.35, 95%CI 0.165 - 0.764]. This association persisted on subgroup analysis comparing ASD closure to antiplatelet use only [HR 0.392, 95% CI 0.163,0.947] (Table 1). Conclusions: ASD closure was associated with lower mortality in patients with thrombophilia and ischemic stroke. There was no statistical difference in incidence of A.fib/flutter, arterial embolism, or services associated to stroke/embolism. There were no differences in outcomes in patients with a specific diagnosis of PFO.

Transcatheter ASD closure in a patient with Dextroversion: A case report

Background: Cardiac dextroversion is location of the heart in the right chest with the left ventricle remaining in the normal position to the left but lying anterior to the right ventricle. To the best of our knowledge no specific technique has been described before for successful transcatheter secundum atrial septal defect closure in patients with dextroversion. Case presentation: We present a case of secundum atrial ASD in a patient with dextroversion, situssolitus, AV concordance and VA concordance. Patient was referred for transcatheter closure of ASD. Her transthoracic echocardiography showed a 7 mm secundum ASD, Upper normal RV size, small restrictive VSD 2 mm and a dilated main pulmonary artery. Transesophagealechocardiography showed an 11 mm defect with abnormal orientation of inter atrial septum due to cardiac dextroversion. Usual technique for positioning of ASD Amplatzer device (ASO 11) failed with prolapsing of the device into right atrium. Failed right upper pulmonary vein technique. With successful positioning of the device across the interatrial septum using left upper pulmonary vein technique. Conclusion: We recommend left upper pulmonary vein technique for safe and direct positioning of ASD device across interatrial septum in patients with dextroversion.

P1800The benefit of atrial septal defect closure in patients with borderline shunt

Abstract Objective Closure of atrial septal defect in patients with borderline shunt is controversial. The aim of the study was to evaluate the outcomes of transcatheter closure of secundum atrial septal defect (ASD) in the patients with the borderline shunt. Methods 215 pts (126 F,89 M) with a mean age of 31.9±18.2 (16–58) years with a small ASD who underwent transcatheter closure were analyzed. All patients had an isolated secundum ASD with pulmonary to systemic blood flow Qp:Qs ratio≤1.5, mean 1.2±0.6 (1.1–1.5). A symptom-limited treadmill exercise test with respiratory gas exchange analysis, transthoracic color Doppler echocardiographic study and Quality of life (QoL) (using the SF36 questionnaire (SF36q)) were repeated in all pts before and 36 months after the procedure. Results The device was successfully implanted in all pts (procedure time 19.1±5.2 (8–38) minutes, fluoroscopy time 8.1±4.4 (6–13) minutes). There were no major complications. The defect echo diameter was 7.7±3.9 (5 - 15) mm. The diameter of the implanted devices ranged from 6 to 18 mm. After 36 months of ASD closure, all the pts showed a significant improvement of exercise capacity. 7 QoL parameters (except mental health) improved at 36 months of follow-up compared with baseline. The mean SF36q scale increased in 168 (78.1%) pts of mean 40.2±20.1 (9–72). The right ventricular dimension decreased in 173 pts (80.4%) (Table 1). Table 1 Parameter Before ASD closure 36 months after ASD closure p value Time of exercise (min) 12.1±5.2 18.6±4.3 <0.001 VO2 peak (ml/kg/min) 10.2±4.7 14.8±4.2 <0.001 SF36q scale 0–100 37.3±22.3 79±29.5 <0.001 Right atrial area (cm2) 20.1±1.7 14.7±1.5 <0.001 Right ventricular area (cm2) 18.1±1.4 12.2±1.5 <0.001 Conclusions ASD closure in patients with borderline shunt resulted in a significant and long-term clinical and hemodynamic improvement after percutaneous treatment.

Percutaneous Ventricular Septal Defect Closure in Patients Under 1 Year of Age.

Untreated ventricular septal defect (VSD) is an important cause of congestive heart failure in early infancy. Growth is impaired in this population, and surgical closure is challenging because of congestion in the lungs, making infants prone to respiratory infection, and because of their poor nutritional status. The aim of this study is to share our experience with percutaneous VSD closure in patients under 1year of age. Patients with hemodynamically significant left-to-right shunt, less than 1year of age, and with VSD diameter ≤ 6mm were retrospectively included in the study between December 2014 and January 2017. The median length of follow-up was 8.5 (4-14.2) months. Twelve patients from 2 to 12months of age, with a median weight of 6.75 (5.4-8) kg, were included. The mean VSD diameter as measured by angiography from the left ventricle side was 4.7 ± 0.25mm, and from the right ventricle side was 3.4 ± 1.1mm. All were of a perimembranous type except three, which were muscular. All defects were closed with the Amplatzer Duct Occluder II (ADO II) or the ADO II-additional size. The mean fluoroscopy duration and total radiation dose were 22.6 ± 18.7min and 1674 ± 851cGy/min, respectively. No aortic regurgitation associated with device closure was seen in any of the patients. Complete atrioventricular block occurred in one patient 6months after the procedure, and was treated with a permanent pacemaker. VSD closure is challenging, regardless of whether a surgical or percutaneous procedure is used. The risks are higher for children younger than 1year with low body weight. Percutaneous closure, which carries similar risks but is less invasive than surgery, may be the preferred alternative in early infancy.

The benefit of atrial septal defect closure in patients with borderline shunt

The benefit of atrial septal defect closure in patients with borderline shunt

Percutaneous atrial septal defect closure in patients with left ventricle failure or pulmonary hypertension

Transcatheter approach for closure of an ostium secundum atrial septal defect (ASD) is a safe and effective treatment that is now the first-line therapy in many centers based on various series demonstrating lower complication rates, shorter hospitalizations, and lower costs compared to surgery. Following transcatheter ASD closure, exercise capacity improves within days to weeks, and right heart hemodynamics can improve dramatically. Regression of right heart enlargement typically occurs over weeks to months, and immediate improvements in pulmonary artery pressure (PAP) can be seen with further improvement in late follow-up. Over recent years, the number of elderly patients treated percutaneously for ASD closure has increased. Since this population often presents with diastolic dysfunction, these patients are more prone to acute pulmonary edema following the procedure. Strategies have been developed to identify patients at high risk for post procedural heart failure. Patients with ASD and left to right shunts are also at risk of developing pulmonary hypertension (PHT) and the probability of PHT also increases with age. In this review, we will discuss ASD closure in patients with left ventricle (LV) failure and/or PHT corresponding to specific clinical settings more and more common in clinical practice.

Pharmacologic Preconditioning Therapy Prior to Atrial Septal Defect Closure in Patients at High Risk for Acute Pulmonary Edema

The aim of this study was to assess whether transient atrial septal defect (ASD) occlusion and, if required, vasodilator therapy would improve the safety of percutaneous ASD closure in high-risk subsets. While percutaneous ASD closure is generally considered a low risk intervention, hypertensive and elderly patients may develop pulmonary edema following the procedure because of underlying left ventricular (LV) diastolic dysfunction. Fifty-two consecutive patients who underwent successful percutaneous ASD closures were enrolled into a single-center prospective registry. Patients with arterial hypertension and/or >60 years of age (n = 15) were considered at risk for periprocedural pulmonary edema. Those patients were tested for an increase of LV filling pressures during transient ASD occlusion and, if this was the case, treated according to a prespecified algorithm. Clinical and echocardiography data were collected in-hospital and at 6 months follow-up. Shunt size was comparable in high and standard-risk patients (Qp:Qs 2.1 ± 0.8 vs. 2.1 ± 0.7, P = 0.82). High-risk patients had more often pulmonary hypertension (58% vs. 14%, P < 0.05) and were more frequently symptomatic. Among them, 4/15 (27%) demonstrated a significant rise of left-sided filling pressures during transient ASD balloon occlusion and underwent pharmacologic preconditioning prior to ASD closure. None of them developed periprocedural pulmonary edema. At follow-up, patients were less symptomatic (Pre: NYHA II n = 15, NYHA III n = 9; Post: NYHA II n = 15, NYHA III n = 0; P = 0.02) and right ventricular size decreased from 23 ± 5 cm(2) to 17 ± 5 cm(2), P < 0.05. Transient ASD occlusion and, if required, pharmacologic preconditioning prior to percutaneous closure may prevent periprocedural pulmonary edema in high-risk patients.