Transcatheter ASD Closure Research Articles

Procedural success and complications of transthoracic echocardiography guided atrial septal defect device closure in children at a tertiary cardiac centre in Nepal

BackgroundAlthough transthoracic echocardiography (TTE) is easy and more widely available with excellent acquisitions in children, there are limited evidence regarding its use in guiding transcatheter closure of ASD. ObjectivesWe aimed to evaluate the safety, feasibility, and outcome of transcatheter closure of ASD in children guided by TTE in combination with fluoroscopy. MethodsAll children aged 4–15 years who were considered for and underwent transcatheter ASD closure of ASD Secundum type under TTE and fluoroscopy guidance at the National Heart Centre in Kathmandu, Nepal from August 2018 through May 2021, were retrospectively reviewed. ResultsOf the 94 children, transcatheter closure was attempted in only 89 patients, and implantation of device was successful in all of them (100 %). The procedure was done under total intravenous anesthesia in 79.8 % of children, and local anesthesia in the rest. The ASD size varied between 7 and 32 (15.2 ± 5.8) mm. ASDs were closed using the device size ranged between 10 and 38(19.2 ± 1) mm. The mean of device/patient weight and device/ASD size ratio were 82 ± 0.33 and 1.28 ± 0.25 respectively. Similarly mean duration of procedure and fluoroscopy was being 31.2 ± 8.6 and 6.5 ± 2.8 min respectively. Five children (5.6 %) had tiny residual shunt which closed spontaneously as documented by TTE within 6 months after the procedure. A new onset atrial tachycardia was detected in one child during follow up. Otherwise, we observed no major early postprocedural or late complications during follow up period of 18.4 ± 8.5 months. ConclusionTTE is a safe and feasible guiding tool in children with adequate acoustic windows for the deployment of the ASD device under fluoroscopy.

Impact of 3D TEE guided ASD transcatheter closure on procedure outcome and radiation exposure

Abstract Background Transcatheter ASD device closure of secondum ASD is widely accepted in closure of ASD. Radiation exposure increases the risk of cancer for both patients and staff members, fusion of 3- D TEE and fluoroscopy has helped us decrease radiation exposure during whole procedure. Aim to assess feasibility of 3 D TEE guidance in transcatheter ASD closure and assess its value in reducing radiation exposure as compared to control patients. Methods This study was conducted on 30 patients with secundum ASD referred to cardiology department - Ain Shams University for percutaneous ASD device closure under 3D TEE guidance and 54 control patients who performed percutaneous ASD device closure using conventional method. we calculated total procedure time (min), total DAP (mGy/cm2), (FT) fluoroscopy time (min), total air kerma (mGy), maximum ASD diameter (mm) and we recorded implanted device size and device type for all the patients. Results There was no significant difference between both groups regarding FT, total air kerma, dose area product. Operative time of study group was significantly longer than control group although FT reduced significantly in last case of the study. In the last 10 cases of the study radiation exposure decreases and was significantly lower than control group. Conclusion The Use of 3 D-TEE by well-trained imaging cardiologist on tracking catheter during percutaneous ASD device closure decrease significantly radiation exposure of patients as well as medical personnel.

Long-Term Outcomes of Percutaneous Trans-catheter Device Closure of Atrial Septal Defects During Teenage Life versus Adulthood

Abstract Aim and Objectives To evaluate the long-term follow up outcome of patients who underwent percutaneous trans-catheter closure of atrial septal defects during teenage life versus adulthood. Patients and Methods The study included 100 patients with secundum type ASD were treated by transcatheter closure of their defects. Two year after the procedure patients included in the study were subjected to thorough history taking, physical examination,12 leads surface electrocardiogram and Holter. Full 2D and Doppler echocardiographic study was performed in addition to Tissue Doppler Assessment of left ventricular function. Results At the 2 years follow up of transcatheter ASD closure, the RVEDD had decreased from 22.93±5.889 mm to 18±4.06 mm(P = 0.000). By comparing 2D echocardiographic parameters between teenagers and adults there was a highly significant difference in RV basal diameter (P = 0.004), RV systolic function (P = 0.000), RA area (P = 0.030). Mean PAP decreased from 18.37±4.796 mmHg to 14.77±4.75 mmHg (P = 0.022). RVSP decreased from 28.9±4.425 mmHg to 15.83±4.17 mmHg (P = 0.000). There was statistically significant difference regarding defect size (P = 0.037), device size (P = 0.038) and Holter findings (P = 0.042) while there was no statistically significant difference between both groups regarding mPAP, device type and ECG. Defect size was larger in adult group ranged from 9 to 33 mm with mean ± SD 15.57 ± 6.57 mm than teenagers ranged from 6 to 22 mm with mean ± SD 13.06 ± 5.18 mm. Also, incidence of arrhythmia in adults was higher than teenagers as follows: PACs was in 7 patients (14 %) in adult group while 3 patients (6 %) had PACs in teenagers group and paroxsymal AF was found in 4 patients (8 %) in adult group while no patients in teenagers develop AF. All the patients had normal sinus rhythm before closure and no one developed arrhythmia until 1 year after closure. 50 % of the patients had normal RV size at the 2-year follow up. Regarding Doppler parameters, mitral E/A ratio (P = 0.000) and lateral E/e' ratio (P = 0.041) had significant difference between adults and teenagers as shown in table (8) mostly related to age. Mitral E/A ratio in adults ranged from 0.7 to 1.5 with mean ± SD 1.06 ± 0.20 while in teenagers ranged from 1.1 to 1.8 with mean ± SD 1.45 ± 0.17. Lateral E/e’ ratio in adults ranged from 3 to 7.9 with mean ± SD 5.43 ± 1.24 while in teenagers ranged from 3 to 7 with mean ± SD 4.94 ± 1.13. Conclusion Transcatheter ASD closure leads to a significant improvement in heart cavity dimensions and RV function and reversal of electrical and mechanical changes. Novel parameters for assessment of RV function are promising and appear to be helpful for the assessment of RV function and its response to correction of volume. Key words: Atrial septal defect, arrhythmia, transcatheter closure, adults, teenagers. Abbreviations and Acronyms 2D: Two-Dimensional 3D:Three-dimensional ASD(s): Atrial septal defect(s) BSA: Body surface area CHDs: Congenital heart defects ECG: Electrocardiogram EF: Ejection fraction FAC: Fractional Area Change LA: Left Atrium mPAP: mean Pulmonary Artery Pressure RA: Right Atrium RAA: Right atrial area RBBB: Right Bundle Branch Block RV : Right Ventricle TEE : TransEsophgyeal Echocardiography TTE : TransThoracic Echocardiography

Transcatheter Closure of Atrial Septal Defects with Absent Aortic Rim and the Predictors of Right Atrial Reverse Remodeling: 5 Years Experience in China

Plain Language SummaryAtrial septal defect (ASD) is a common congenital heart disease. The transcatheter approach is not recommended for absent aortic rim ASD. However, almost 30–40% of ASD patients in China are found to have an absent aortic rim with right atrial (RA) remodeling. We evaluated the safety and efficiency of transcatheter ASD closure in patients with an absent aortic rim and the predictors of RA reverse remodeling. No major operative complications occurred in all patients with the absence of an aortic rim and a normal edge. Without coronary heart disease, a lower plasma creatinine level, and less tricuspid regurgitation before the operation were the predictive factors for the reverse of RA remodeling after treatment.

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.

Temporary atrial septal defect balloon occlusion test as a must in the elderly

BackgroundAtrial septal defect (ASD) can often remain asymptomatic until adulthood. It still remains unclear whether large ASD closure in senior people should be performed or not. Temporary ASD balloon occlusion test has been suggested as a tool to assess the risk of acute left ventricular heart failure post-ASD closure, and it allows to better distinguish responders from non-responders.Case presentationAn 83-year-old man with a long-standing uncorrected secundum ASD was admitted for recently decompensated right-sided heart failure. During hospitalization, this patient was studied with trans-esophageal echocardiography, cardiac magnetic resonance imaging, and right heart catheterization, showing high Qp:Qs ratio and favorable anatomical conditions for percutaneous closure. Because of patient’s increasing need for intravenous diuretics and worsening renal function, it was considered that transcatheter ASD closure could improve symptoms, hence it was performed an attempt of percutaneous closure of the ASD with a fenestrated device. Unfortunately, irrespective of ASD being hemodynamically significant, it was found a very significant increase in pulmonary capillary wedge pressure during the temporary balloon occlusion test, supporting the existence of concealed left ventricular diastolic dysfunction. As a result, it was decided to abandon the procedure and not to close the ASD.ConclusionThis clinical case illustrates the value of temporary balloon occlusion test before permanent percutaneous closure of ASD in elderly patients, regardless of left ventricular (systolic or diastolic) dysfunction.

Transcatheter closure of secundum atrial septal defect using Cocoon septal occluder: immediate and long-term results

BackgroundAtrial septal defect (ASD) is one of the common congenital heart defects. Its management has transformed dramatically in the last 4 decades with the transition from surgical to percutaneous transcatheter closure for most secundum-type ASDs. Various devices are available for transcatheter closure of ASD with Amplatzer atrial septal occluder being most commonly used worldwide. Cocoon septal occlude has a nanocoating of platinum using nano-fusion technology over nitinol framework that imparts better radiopacity and excellent biocompatibility and prevents leaching of nickel into circulation, and by smoothening nitinol wire makes this device very soft and smooth. The aim of this study was to evaluate feasibility, effectiveness, safety, and long-term outcome of transcatheter closure of ASD using Cocoon septal occluder (Vascular Innovation, Thailand).ResultsAll patients undergoing transcatheter closure of hemodynamically significant ASD between September 2012 and July 2019 in our institute were included into this single-center, prospective study. Exclusion criteria were defect > 40 mm, unsuitable anatomy, Eisenmenger syndrome, and anomalous pulmonary venous return. Three hundred and twenty patients underwent device closure, of which 238 (74%) were female. The mean age was 14.6 years (range 6–29), and the median weight was 30.2 kg (range 10–53 kg). Procedure was performed under fluoroscopy using transthoracic and transesophageal echocardiography in 298 (93.1%) and 22(6.9%) patients, respectively. Balloon-assisted technique was used, when septal defect was ≥ 34 mm, in 9 (2.8%) patients. The mean diameter of defect and device was 21.4 mm (range 12–36 mm) and 26.9 mm (range 14–40 mm), respectively. Aortic rim was absent in 11 (3.4%) patients. Primary success was achieved in 312 (97.5%) patients. Early embolization to right ventricle was noted in 2 (0.6%) patients. In both cases, 40-mm device was attempted for defect of 36 mm with inadequate aortic rim using balloon-assisted technique. One (0.3%) patient developed perforation of right atrium. All were surgically repaired. Three (0.9%) patients developed complete heart block following device deployment requiring device retrieval. Two patients had had moderate residual shunt at 6 months of follow-up. After mean follow-up of 50.92 months (range 12.5–89 months), no erosion, allergic reactions to nickel, or other major complications were reported.ConclusionsPercutaneous transcatheter closure of ASD by Cocoon septal occluder (up to 36 mm) is safe and feasible with high success rate and without any significant device-related major complications over long-term follow-up. With unique device design and excellent long-term safety, it could be preferred dual-disk occluder for transcatheter closure of atrial septal defect. In most of the patients, ASD device can be safely deployed under transthoracic echocardiographic guidance.

Pushing the boundaries: Are we approaching the limits for transcatheter ASD closure?

Pushing the boundaries: Are we approaching the limits for transcatheter ASD closure?

OUTCOME OF ASD CLOSURE WITH DEVICE SIZE BASED ON PRE PROCEDURE 3D TRANSTHORACIC ECHOCARDIOGRAPHY MEASUREMENTS AND ITS COMPARISON WITH 2D TRANSTHORACIC AND 2D TRANSESOPHAGEAL ECHOCARDIOGRAPHY: AN OBSERVATIONAL ANALYSIS AT A TERTIARY CARE HOSPITAL IN JAIPUR

Introduction: For safe percutaneous ASD device closure, the rims surrounding the defect should be appropriate to allow the device to firmly hang onto the atrial septum. Two-dimensional transthoracic echocardiography (2D TTE) is adequate in detecting these defects, but the images obtained can lack the detail necessary to precisely measure their size, shape, and location. Three-dimensional transthoracic echocardiography (3D TTE) provides enhanced visualization of the defect in the majority of patients. The primary objective of the study is to estimate the proportion of cases where device was deployed safely as per the device size predetermined by pre procedure 3D TTE and to compare it with current gold standard imaging modality, ie, 2D TEE. Materials & methods: This single center observational study included 45 consecutive patients diagnosed as ostium secundum ASD by transthoracic echocardiography who were referred to SMS Hospital, Jaipur from March 2018 to September 2019. Patients included in the study, were examined by 2D and 3D TTE to determine the shape of the defect and visualize the surrounding structures before catheterization. Procedure performed under 2D TEE guidance, after measurement of defect size and surrounding tissue rims in the cath lab. Follow-up using 2D TTE and 3D TTE performed 24 hrs and 3 months after the trans-catheter ASD closure. Results: Trans-catheter ASD closure and echocardiographic examinations were successfully performed for all patients. No significant difference between the sizes of different rims by the three techniques (2DTTE vs 2DTEE vs 3DTTE). The ASD size by 3D TTE ranged from 14- 33 mm with a mean of 23.27 ± 4.91 mm and the ASD size by 2D TEE ranged from 11-32 mm with a mean of 21.73 ± 4.99 mm. While ASD size by 2D TTE ranged from 12–30 mm with a mean of 20.26 ± 4.55 mm. There was statistically significant difference between the maximum ASD diameter measured by 2D/ 3D TTE and that by 2D TEE (p = 0.013), with 3D TTE showing larger ASD diameter than 2D TTE/ 2D TEE resulting in larger predetermined size for ASD device closure. The assessment of the device relation to the aortic-mitral continuity, superior vena cava (SVC) and inferior vena cava (IVC) by 2D and 3D echocardiography was done at 24 hours and three months. Seven patients had mitral regurgitation none had more than mild mitral regurgitation. After the ASD closure, two devices were close to the SVC and one device was close to the IVC. Sixteen devices were close to the MV with mild regurgitation in three of them two were newly detected and one with previous mitral regurgitation. Twelve devices were close to the aortic rim without regurgitation. There is no major complication in any patient on follow up. Conclusion: Predetermination of ASD closure device size is possible and safe with 3D TTE. 3D TTE is a safe and non-invasive strategy as compared to 2D TEE for deciding about suitability of device closure with sufficient rims. This may be useful in patients in whom TEE could not be done, especially in pediatric population.

Appropriate device selection for transcatheter atrial septal defect closure using three-dimensional transesophageal echocardiography.

Detail morphological evaluation for ASD is essential to achieve successful transcatheter closure. Three-dimensional transesophageal echocardiography (3D-TEE) is emerging, but few studies have comprehensively verified the usefulness of 3D-TEE. We divided 329 patients who underwent transcatheter ASD closure at our university hospital into 157 in the Conventional group evaluated with 2-dimensional transesophageal echocardiography and balloon sizing (BS), and 172 in the 3D-TEE group evaluated with 3D-TEE additionally. We assessed usefulness of 3D-TEE and consider appropriate device selection procedure. Overall, the percentage with re-sizing of device tended to be lower in the 3D-TEE group than in the Conventional group (10.1% vs 6.0%, p = 0.187). Among preprocedural modalities, the device size was mainly decided based on the BS diameter. A logistic regression analysis demonstrated that large atrial septum aneurysms (ASA) were associated with a ≥ 2mm discrepancy of the BS diameter from the preprocedural 3D-TEE diameter (p < 0.05). Compared to the Amplatzer Septal Occluder, the differences in device size and the preprocedural ASD measurement were greater when using the Occlutech Figulla Flex II Occluder (FFII). Particularly, among the patients implanted with FFIIs, the discrepancies of the device size from the 3D-TEE measurement were greater in patients with large ASA than those with small ASA. Preprocedural 3D-TEE is useful to select the appropriate device size. Particularly, it is necessary to select a much larger device than that derived from the preprocedural 3D-TEE measurement when using FFII in patients with a septal aneurysm.

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.

Outcomes of Transcatheter ASD Closure Guided by 3D-TEE

Outcomes of Transcatheter ASD Closure Guided by 3D-TEE

GW27-e0999 The effects of anticoagulant therapy on coagulant state and platelet function following transcatheter closure of atrial septal defect

Several studies have demonstrated coagulant system was activated after transcatheter closure of ASD, but changes of platelet function still remain controversial. Currently, it is not clear which anticoagulant regiment is more effective to prevent thrombosis and embolic events after device implantion

Computer-generated real-time digital holography: first time use in clinical medical imaging.

Assessment of the feasibility of creating real-time interactive 3D digital holograms in a standard catheterization laboratory. 3D medical images are typically displayed and interacted with on 2D screens limiting their usefulness. A digital computer-generated real-time holographic display of patient's 3D data could provide a spatially accurate image with all the depth cues and afford interaction within the image. We performed a feasibility study of creating real-time interactive 3D digital holograms with a purpose-built prototype using intraprocedural data from 3D rotational angiography and live 3D transesophageal echocardiography. The primary objective was to demonstrate that all the anatomical landmarks identified on standard imaging can be similarly identified using dynamic and static holographic images. The secondary objective was to demonstrate the usability of interactions with the image. Parameters were assessed by a rating scale. Eight patients were enrolled of whom five underwent transcatheter ASD closure using 3DTEE and three patients were evaluated by 3D rotational angiography. In all cases dynamic real-time and static 3D holograms were created in standard cath lab conditions. Four individual observers identified all anatomical landmarks on the holographic display independently from the 2D display. Interactions with the hologram including marking, cropping and rotation were performed. There were no adverse events. This study demonstrates, for the first time, the feasibility of generating high quality, clinically relevant, 3D real-time colour dynamic holograms in a standard clinical setting with real patient volumetric data. The impact of computer-generated holography needs to be evaluated in controlled clinical trials.

Atrial septal defect closure with left ventricular dysfunction.

Atrial septal defects are one of the most common congenital heart diseases in adults that may result in significant left to right shunt. Secundum atrial septal defects can remain unrecognised until adult age and cause haemodynamic changes with or without symptoms. Transcatheter ASD closure is the gold standard; however, in those patients with left ventricular dysfunction there may be increased risk of complications due to acute changes in left-sided pressures. In this review, we discuss the clinical aspects of ASD closure in the setting of LV dysfunction and discuss methods to evaluate risk and strategies to minimise complications.

INFLUENCE OF SURROUNDING RIM MORPHOLOGY ON PROCEDURE SUCCESS RATE OF TRANSCATHETER ATRIAL SEPTAL DEFECT CLOSURE

Influence of surrounding rim morphology on transcatheter ASD closure remains to be clarified. 474 consecutive patients with ASD irrespective of surrounding rim morphology, underwent transcatheter closure using Amplatzer Septal Occluder. Rim deficiencies (<5mm) were classified into aortic,

Very late cardiac tamponade following successful transcatheter closure of an atrial septal defect with the Amplatzer septal occluder

To avoid late complications, ASDs should be closed even when detected in adults, an endeavor that may be performed surgically or via the transcatheter approach, as is done for secundum-type ASDs that possess suitable anatomy and no associated lesions. Surgical ASD closure carries a higher periprocedural risk compared with transcatheter closure, but has an excellent long-term prognosis. We report the occurrence of a rare but life-threatening long-term complication following transcatheter ASD closure, cardiac perforation with cardiac tamponade, and its successful surgical treatment. Secundum-type ASD was diagnosed in a 30-year-old woman by cardiac catheterization in 1982. Paroxysmal atrial fibrillation (AF) developed at an age of 56. Both transthoracic (TTE) and transesophageal echocardiography (TEE, see Online Resource ESM Fig. 1) demonstrated biatrial enlargement, the volume-overloaded right ventricle appeared dilated and had a reduced function. All pulmonary veins were connected to the LA. Coronary angiography was normal. Cardiac catheterization demonstrated mildly elevated pulmonary artery pressures. Oxymetric analysis confirmed the presence of a predominant left-to-right (67 %) shunt and a small right-to-left shunt (7 %). The balloon-stretched ASD diameter measured 25 mm by angiography, and 26 mm by intracardiac echocardiography (ICE). The ASD was closed with a 28 mm Amplatzer Septal Occluder (ASO, St. Jude Medical, Inc., St. Paul, MN) in 2008. Antiplatelet therapy was prescribed for 6 months, and then TEE documented correct positioning of the ASO with no residual shunts. The sizes of the atria decreased, and the RV function improved. Symptomatic paroxysmal atrial fibrillation necessitated treatment with flecainide and bisoprolol. The patient remained on aspirin. Acute chest pain and shortness of breath required urgent hospitalization three years after transcatheter ASD occlusion. On admission, the patient was in cardiogenic shock due to a large pericardial effusion with tamponade physiology (Fig. 1a). The removal of 350 ml of nonclotting blood (hematocrit = 42 %, identical to peripheral blood) via pericardiocentesis resulted in immediate hemodynamic improvement. The patient was transferred to a tertiary-care hospital. Correct positioning of the ASO, as well as a residual pericardial effusion was shown by TEE. An ECGtriggered cardiac CT scan indicated that the ASO impinged the left atrial dorsal wall (Fig. 1b), causing its erosion. The intact ASO (see Online Resource ESM Fig. 2) was removed, the ASD was closed with a patch, and the left atrial roof was surgically reconstructed 10 days later (Fig. 2). Additionally, a bipolar maze procedure was performed, and the left atrial appendage was ligated. Symptomatic bradycardia required the implantation of a DDDR pacemaker postoperatively. Follow-up exams confirmed excellent long-term operative results. Electronic supplementary material The online version of this article (doi:10.1007/s00392-015-0829-0) contains supplementary material, which is available to authorized users.

0355: Complications after transcatheter ASD closure with the amplatzer septal occluder

The aim of this study is to report complications of transcatheter ASD closure using the Amplatzer Septal Occluder (ASO) (St Jude Medical). From December 1999 to October 2013 (April 2014), 760 patients underwent ASD closure with the ASO. Closure was mostly performed under general anaesthesia and transoesophageal echocardiography control. Choice of the device diameter was established after balloon sizing and measurement of the stretched diameter. Mean age of the patients was 31.9±22 years (0.5 month - 84 years). The stretched diameter was 22.5±6.6 mm (5-40mm) and device dimension 22±6.7mm (4-40mm). Duration of the procedure was 41±15 minutes (10-120 minutes) and fluoroscopic time 7.63±6.65 minutes (1-92 minutes). Dose of radiation was 18.7±22 Gy.cm 2 (median 12 Gy.cm 2 ). Implantation succeeded in 96.3% of pts and failure was mainly related to deficient rim. No device related death was noticed. Embolization occurred in 4 pts (0.5%): 1 in the aorta, 1 in the left ventricle, and 2 in the pulmonary artery. All but one underwent surgical extraction and ASD closure. The patient with aortic embolization had percutaneous device extraction and underwent subsequently successful implantation with a larger device. No patient required blood transfusion for any groin hematoma. One patient without aortic rim had hemopericardium one month after implantation; this was corrected by drainage with no recurrence and ASD full occlusion was noticed on colour Doppler control. No late complication was observed. The rate of full occlusion on Doppler control is more than 90%, and the remainings have trivial shunt. Transcatheter ASD occlusion with the Amplatzer Septal Occluder is a safe and effective procedure. The rate of immediate complication is very low and need for immediate surgery following the implantation is rare (<1%). No device related late complications were reported up to 15 years after implantation. The risk of aortic perforation in absence of anterior rim (observed in about 20% of pts) is trivial and not a real limitation in clinical practice.

Interventional ASD-closure with the Occlutech devices in 1333 patients - first results of the IRFACODE - registry

Introduction: Today, transcatheter ASD closure is a worldwide accepted treatment standard for suitable ASDs. The Occlutech ASD device series (OSO, Flex I, Flex II) show an improved device design and gained CE mark in 2007; however larger follow-up series are missing.

Report from the 4(th) Vietnam Congress of Congenital and Structural Heart Disease (8-10 January 2014, Saigon, Vietnam) - "Fistulas from A to Z".

Report from the 4(th) Vietnam Congress of Congenital and Structural Heart Disease (8-10 January 2014, Saigon, Vietnam) - "Fistulas from A to Z".