Transcatheter Closure Of Atrial Septal Defect Research Articles

Functional tricuspid regurgitation after transcatheter closure of atrial septal defect

Abstract Funding Acknowledgements Type of funding sources: None. Main funding source(s): none Background Significant functional tricuspid regurgitation (FTR) often improves during the long-term follow-up after transcatheter atrial septal defect (ASD) closure. However, the timing of TR improvement and its relationship with right ventricle (RV) reverse remodeling are unknown. Methods A total of 50 patients (age: mean age 58 +/- 16 years old, range:18–88; male: 66%) who underwent transcatheter ASD closure were enrolled. Echocardiography was performed at baseline, 1month and 1year after transcatheter ASD closure. Results TR improved significantly 1month after treatment compared to baseline, but no further significant improvement in TR severity was observed up to 1 year after treatment. Tricuspid annulus diameter decreased gradually over 1 year, while RV diameter decreased significantly at 1 month and throughout 1 year after treatment. (Figure). Conclusion Reverse remodeling of the RV was achieved immediately after ASD closure and continued thereafter, whereas significant improvement in TR severity was demonstrated only immediately after ASD closure. Meticulous follow-up with more intensive therapies should be considered for patients with residual significant TR after ASD closure.

Comparison of functional tricuspid regurgitation after transcatheter closure of atrial septal defect in patients with sinus rhythm and atrial fibrillation

Abstract Funding Acknowledgements Type of funding sources: None. Background Significant tricuspid regurgitation (TR) often improves during the long-term follow-up period after transcatheter atrial septal defect (ASD) closure. However, It is unknown whether ASD closure improves TR in patients with atrial fibrillation (AF). Methods Between 2016 and 2021, 66 consecutive patients (66% males, mean age 58 +/- 16 years, 30% with AF, 68% with severe/moderate TR) underwent transcatheter ASD closure and were evaluated with transthoracic echocardiography at baseline, 1day, 1 month and 1 year. Results Sinus rhythm(SR) group showed an improvement in TR one month after ASD closure, which persisted at 12 months, whereas AF group demonstrated no improvement in TR after one month and 1 year.(figure1) Right atrial volume index improved in both groups, but tricuspid annular diameter showed no improvement in AF group.(figure2)(figure3) Conclusion Decrease in tricuspid annular diameter was significantly associated with TR improvement after ASD closure. Our findings suggest that TR is less likely to improve in patients with AF since ASD closure had less impact in tricuspid annular diameter.

Novel technique to reduce prolapsed device in atrial septal defect closure.

Transcatheter closure of atrial septal defect (ASD) has become an alternative treatment to surgical repair. One of the challenges is the prolapse of the left atrial disc during the procedure. Many techniques have been developed to prevent the prolapse but not reduce it. In this study, we present a novel technique, termed push back technique, that help reduce the prolapsed device. We enrolled 24 patients (8 males, 16 females) between May 2008 and January 2023 who underwent the push back technique during transcatheter closure of ASD in Taichung Veterans General Hospital. We recorded the hemodynamic data, success rate and complications including device embolization/migration, valvular regurgitation, pericardial effusion, and residual shunt. The median age was 6.3 years (1.2-70.5 years) and the median weight was 19.1 kg (7.8-90 kg). Fifteen (62.5%) patients had mild pulmonary hypertension. The median Qp/Qs was 2.54 (1.5-8.8). The median ASD stretched size was 21.2 mm (7.7-35.3 mm). The median device size was 22 mm (8-40 mm). The median fluoroscopy time was 14 min (5-23 min) and median procedure time was 47 min (25-78 min). The push back technique successfully reduced the prolapsed device in 21 (87.5%) patients. There was no complication in all patients. We present a novel push back technique that can successfully reduce the prolapsed device in 87.5% (21/24) patients without complications. It is feasible, safe and effective.

Intracardiac vs. transesophageal echocardiography for guiding transcatheter closure of interatrial communications: a systematic review and meta-analysis.

Transcatheter closure of atrial septal defect (ASD) and patent foramen ovale (PFO) is an established practice, and it requires monitoring and guidance. Both transoesophageal echocardiography (TEE) and intracardiac echocardiography (ICE) can be used as guidance tools. However, the use of ICE and TEE in structural heart disease is controversial and the advantages and disadvantages of both for ASD and PFO closure need to be investigated. We did a systematic review and meta-analysis to compare the efficacy and safety of TEE and ICE for guiding transcatheter closure of ASD and PFO. A systematic search of Embase, PubMed, Cochrane library, Web of Science was conducted from inception to May 2022. The outcomes of this study included average time for both fluoroscopy and the procedure, complete closure, length of stay at hospital and adverse events. This study was performed using mean difference (MD), relative risk (RR) and 95% confidence interval (CI). The meta-analysis was conducted with a total of 11 studies, involving 4,748 patients were included in meta-analysis, including 2,386 patients in the ICE group and 2,362 patients in the TEE group. The results of the meta-analysis showed that compared with TEE, ICE was shorter in time both fluoroscopy [MD: -3.72 (95%CI: -4.09 to -3.34) minutes, P < 0.00001] and the procedure [MD: -6.43 (95%CI: -7.65 to -5.21) minutes, P < 0.00001], shorter length of stay at hospital [MD = -0.95 (95% CI = -1.21 to -0.69) days, P < 0.00001], lower incidence of adverse events (RR = 0.72, 95%CI: 0.62 to 0.84, P < 0.0001), and the arrhythmia (RR = 0.50, 95% CI = 0.27 to 0.94, P = 0.03) and vascular complications (RR = 0.52, 95%CI = 0.29 to 0.92, P = 0.02) in ICE group were lower than those in TEE group. No significant difference in complete closure was found between ICE and TEE (RR = 1.00, 95% CI = 0.98 to 1.03, P = 0.74). Under the premise of ensuring successful rate of complete closure, ICE can shorten time between fluoroscopy and procedure and length of stay at hospital, and there was no increase in adverse events. However, more high-quality studies are needed to confirm the benefits of using ICE in ASD and PFO closure.

Effect of percutaneous closure on atrium and appendage functions in patients with secundum atrial septal defects.

The study aimed to assess the impact of percutaneous transcatheter atrial septal defect (ASD) closure on atrium and atrial appandage functions among patients with ostium secundum ASDs. A total of 101 patients (34,7% male, 65,3% female, 37,6 ± 12) with the diagnosis of ostium secundum type ASD underwent transthorasic (TTE) and transesophageal echocardiography (TEE) before and six months after percutaneous transcatheter ASD closure. Pulmonary venous flow and atrial appendage flow velocities were obtained from the TEE recordings. The offline evaluation of the global and segmental atrial appendage strains were evaluated with speckle tracking echocardiography (STE) via EchoPac 6,3 (GE Vingmed, Horten, Norway). Mean values of pulmonary artery pressure, right ventricular, left atrium, left ventricular end-diastolic and end-systolic diameters were significantly decreased 6 months after ASD closure. Statistically significant changes were documented in pulmonary venous and left atrial appendage flow velocities after ASD closure. Both left and right atrial appendage flow velocities and global strains of atrial appandages were improved after ASD closure. The mean left atrial appendage global strain value was - 11.45 ± 4.13% before the procedure, this value was - 16.82 ± 3.78% sixth months after the procedure (P < 0.001).The mean right atrial appendage global strain was - 13.31 ± 4.84% before the procedure and - 18.53 ± 4.69% sixth months after the procedure (P < 0.001). Left and right atrial appendage flow velocities and global strains of left and right atrial appandage can be improved after transcatheter ASD closure. Percutaneous transcatheter closure of ASDs not only improves atrial and left ventricular dimensions but also have a positive impact on left and right atrial appandage functions.

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

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

Intracardiac Echocardiography Guidance for Percutaneous Transcatheter Closure of Atrial Septal Defects - Nationwide Registry Data Analysis.

Transesophageal echocardiography (TEE) has been used for percutaneous atrial septal defect (ASD) closure, with intracardiac echocardiography (ICE) guidance recently being introduced. The Japanese Structural Heart Disease Registry was established by the Japanese Association of Cardiovascular Intervention and Therapeutics. This study analyzed data from the Registry for 2,859 consecutive cases undergoing percutaneous ASD closure between January 2015 and December 2020. ASD closure was performed under ICE guidance (n=519; 18.2%), TEE guidance (n=1,428; 49.9%), or TEE plus ICE guidance ("Both"; n=900 cases; 31.5%). The success rates were similar in the TEE, ICE, and both groups (99.0%, 99.2%, vs. 98.0%, respectively; P=0.054), as were complication rates (1.2%, 0.5%, vs. 2.1%, respectively; P=0.24). In the TEE and Both groups, 92.4% and 79.6% of patients required general anesthesia, compared with only 2.9% of patients in the ICE group (P<0.001). Fluoroscopic time was longer in the ICE and Both groups than in the TEE group (median [interquartile range] 19 [14-28] and 21 [13-30] vs. 12 [8-19] min, respectively; P<0.001). Rim deficiency and larger defect diameter were inversely related, whereas hospital volume was positively related to ICE guidance. Percutaneous transcatheter ASD closure was as feasible under ICE as under TEE guidance. ICE guidance is used for less challenging cases in high-volume centers in Japan.

Transcatheter atrial septal defect closure late after completion of biventricular circulation in patients with pulmonary atresia intact ventricular septum or critical pulmonary stenosis.

This study aimed to explore anatomical and hemodynamic features of atrial septal defect, which was treated by transcatheter device closure late after completion of biventricular circulation in patients with pulmonary atresia and intact ventricular septum (PAIVS) or critical pulmonary stenosis (CPS). We studied echocardiographic and cardiac catheterization data, including defect size, retroaortic rim length, single or multiple defects, the presence of malalignment atrial septum, tricuspid and pulmonary valve diameters, and cardiac chamber sizes, in patients with PAIVS/CPS who underwent transcatheter closure of atrial septal defect (TCASD), and compared to control subjects. A total of 173 patients with atrial septal defect, including 8 patients with PAIVS/CPS, underwent TCASD. Age and weight at TCASD were 17.3 ± 18.3 years and 36.6 ± 13.9 kg, respectively. There was no significant difference in defect size (13.7 ± 4.0 vs. 15.6 ± 5.2 mm, p = 0.317) and the retro-aortic rim length (3.7 ± 4.3 vs. 3.6 ± 0.3.1 mm, p = 0.948) between the groups; however, multiple defects (50% vs. 5%, p < 0.001) and malalignment atrial septum (62% vs. 14%. p < 0.001) were significantly frequent in patients with PAIVS/CPS compared to control subjects. The ratio of pulmonary to systemic blood flow in patients with PAIVS/CPS was significantly lower than that in the control patients (1.2 ± 0.4 vs. 2.0 ± 0.7, p < 0.001); however, four out of eight patients with atrial septal defect associated with PAIVS/CPS had right-to-left shunt through a defect, who were evaluated by the balloon occlusion test before TCASD. The indexed right atrial and ventricular areas, the right ventricular systolic pressure, and mean pulmonary arterial pressure did not differ between the groups. After TCASD, the right ventricular end-diastolic area remained unchanged in patients with PAIVS/CPS, whereas it significantly decreased in control subjects. Atrial septal defect associated with PAIVS/CPS had more complex anatomy, which would be a risk for device closure. Hemodynamics should be individually evaluated to determine the indication for TCASD because PAIVS/CPS encompassed anatomical heterogeneity of the entire right heart.

Outcome of transcatheter atrial septal defect closure in a nationwide cohort

Background Transcatheter (TC) atrial septal defect (ASD) closure has been the mainstay of therapy for secundum-type ASDs for over 20 years. Aims This nationwide cohort evaluated the long-term outcome of transcatheter-closed ASDs. Methods The study enrolled every transcatheter ASD closure performed in Finland from 1999 to 2019. Five age, sex, and municipality-matched controls per ASD patient were gathered from the general population. The median follow-up period was 5.9 years (range 0–20.8). We used the hospital discharge register to gather all hospital visits and diagnoses. Closure complications and echocardiographic changes were collected from the electronic health records. Results Transcatheter ASD closure was performed in 1000 patients (68.5% females) during the study period. The median (range) age at the time of the procedure was 37.9 (1.8–87.5) years. ASD patients had an increased risk for new-onset atrial fibrillation (RR 2.45, 95% CI: 1.84–3.25), migraine (RR 3.61, 95% CI: 2.54–5.14), ischemic heart disease (RR 1.73, 95% CI: 1.23–2.45), ventricular fibrillation/tachycardia (RR 3.54 (95% CI: 1.48–8.43) and AV conduction disorder (RR 3.60, 95% CI: 1.94–6.70) compared to the control cohort. Stroke risk was not increased (RR 1.36, 95% CI: 0.91–2.03). Adverse events occurred in 6.3% (n = 63) of the patients, including four erosions and ten device embolizations. Conclusion After TC closure of ASD, patients had a higher risk of new-onset atrial fibrillation and migraine than controls without ASD. As novel findings, we found an increased risk for ischemic heart disease, AV conduction disorders, and ventricular fibrillation/tachycardia. Key messages Even though patients have an excellent overall prognosis after percutaneous ASD closure, the increased incidence of major comorbidities like atrial fibrillation and heart failure prompts more thorough lifelong follow-up. This study’s novel findings revealed the increased risk for ischemic heart disease, AV conduction disorders, or ventricular tachycardia/fibrillation during the follow-up. Major complications after the closure are rare; erosion is seen in 0.4% of the patients and embolization in 1.0% of the patients.

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

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

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

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

The effects of transcatheter atrial septal defect closure on appetite, nutritional hormones and growth in children

Objective: Children with congenital heart disease are at risk of malnutrition due to inadequate calorie intake, increased energy expenditure, pulmonary infections, and malabsorption. The aim of this study was to investigate the changes in appetite, nutritional hormones, and anthropometric measurements before and after the transcatheter closure of the atrial septal defect. Method: The study included 27 patients whose atrial septal defect closed percutaneously and 25 children as a healthy control group. The initial symptoms, anthropometric measurements, and laboratory tests were recorded initially, and 1 month and 6 months after the closure. Results: The mean age of patients and control group were 88.29 ± 58.25 months, 86.52 ± 55.81 months respectively. At the 1st month after the closure, all the symptoms in the patient group decreased compared to the initial visit except rapid breathing (p &lt;0.05). The percentage of patients who had a lack of appetite decreased from 45% to 5% at the 1st month visit. After the closure, the increase in weight for age, body mass index, and z-score were statistically significant at the 1st and 6th months (p &lt;0.05). Insulin-like growth factor-1 levels increased compared to the initial values at the 1st month (p =0.016). A linear decrease in ghrelin levels and a linear increase in leptin levels were observed in the atrial septal defect group during the 6-month follow-up after the closure. Conclusion: Children with atrial septal defect are at the risk of malnutrition. The primary prevention of malnutrition should be the goal of our treatment plan for these children; the timing of the interventional treatment is critical and has to be before the development of malnutrition.

Fungal Infective Endocarditis Post Device Occlusion in Perimembranous Ventricular Septal Defect

Recent increase in deployment of trans-catheter devices such as septal or ductal occluding coils and devices has been a possible risk factor for infective endocarditis, predominantly in the initial post deployment period before endothelialization has ensued. Though a long-term study of trans-catheter Atrial Septal Defect (ASD) closure revealed no cases of Infective Endocarditis, some case reports of endocarditis in trans-catheter device closure of ASD, VSD and Patent ductus arteriosus(PDA) advocate that residual defect after device occlusion may be a factor in the risk for Infective Endocarditis. We herein describe the case of a 9-month-old female patient who underwent device closure for peri-membranous ventricular septal defect (VSD) and developed fungal infective endocarditis in early post occlusion period which was confirmed on blood culture. Despite treatment with appropriate antifungal as per sensitivity, clinical condition of the patient deteriorated and it was decided to manage her with surgical explanation of device and closure of defect.

A case of infective endocarditis in an 8-year-old boy 3 months after transcatheter atrial septal defect closure using Figulla Flex II occluder.

Infective endocarditis is a rare complication of atrial septal defect closure using transcatheter procedure. We report about infective endocarditis in an 8-year-old boy 3 months after transcatheter closure using a Figulla Flex II atrial septal defect occluder. Transesophageal echocardiography showed vegetation attached to the left atrium side of the device. Device removal and atrial septal defect closure were performed. The device was less endothelialized on the left than on the right atrium side. Therefore, insufficient endothelialization may cause infective endocarditis.

Abstract 15278: Transcatheter Closure of Atrial Septal Defect Over the Age of 60

Introduction: The long-term benefits of transcatheter device closure of a secundum atrial septal defect (ASD) over 60 remain controversial. The aim of the study was to assess the predictors of death late after device closure in these elderly patients. Methods: This retrospective study enrolled 87 patients with successful ASD transcatheter closure over 60 and at least 1 year follow-up after closure. The mean age was 73.3±5 years, and 74 of them were female (85%). All patients had an isolated secundum ASD with a mean defect size of 18±4 (9-30) mm. At the time of closure 10 patients were known with pulmonary hypertension (11%), 52 with atrial arrhythmia (61%), 56 with heart failure (64%), and 15 with coronary artery disease (17%). Demographic, clinical and echo data were compared between values at the time of closure, and at the last follow-up. Predictors of death were analyzed with multivariate Cox regression. Results: After the mean follow-up of 5±4 years 11 patients developed high LV filling pressure, 15 patients had new atrial arrhythmia and 10 patients right heart failure. At the last FU a significant decrease in right ventricular (45±5 vs 38±8 mm, p=0.032) and right atrium dimension (62±10 vs. 59 ±10mm, p=0.045) were seen, together with right ventricular systolic pressure improvement (51±18 vs. 40±19 mmHg, p=0.038). The left atrium showed significant further dilatation after closure (60±9 vs. 62±9.5, p=0.048). The presence of pulmonary hypertension, right ventricular dilatation and tricuspid regurgitation correlated with the right heart failure after closure, and the atrial dimension, tricuspid regurgitation, and high filling pressure with new atrial arrhythmia. Fourteen patients died during follow-up. On multivariate analysis the main predictor of death was right heart failure (HR: 10; 95% CI 2,15-41). Conclusions: In terms of right heart remodeling, elderly patients still benefit from late ASD catheter closure. However, those who develop right heart failure after closure are at a high risk of death (HR:10). Diastolic dysfunction after the defect closure was not a predictor of death.

Early and Mid-Term Follow-Up Results After Transcatheter Closure of Secundum Atrial Septal Defect.

Transcatheter secundum type atrial septal defect closure is an alternative to surgical closure in many cases when conditions are appropriate. In this study, the demographic data and follow-up results of patients with secundum atrial septal defect undergoing transcatheter closure were discussed. Data of patients who underwent transcatheter closure of secundum atrial septal defect between 2004 and 2017 were investigated retrospectively. Gender, age at intervention, defect size, procedure duration, fluoroscopy time, periprocedural complications, residual shunt existence, and early and mid-term follow-up results were collected. A total of 179 patients [41% males; 10% adults, median age: 8.1 years (1.3-58.6); weight: 28 kg (11-90)] were admitted to catheterization for atrial septal defect closure and their median atrial septal defect size was 13 mm (6-30); 74 (41%) patients had a large atrial septal defect (≥12 mm). Suitable defects for closure were observed in 165 of 179 patients. The procedural success rate was 95.7%. No death was observed; however, minor complications occurred in 3 patients during the procedure (1.6%). The rate of residual shunt after 1 year was 1.3%, and all shunts were mild. After a median follow-up of 2.8 years (range, 6 months to 13.6 years), delayed major complications such as death, cardiac erosion, and infective endocarditis were not experienced. The delayed minor complication was supraventricular extrasystole in 1 patient. Transcatheter atrial septal defect closure is safe in children and adults with a minimal rate of periprocedural and delayed complications. It has a favorable early and mid-term outcome in our study, especially with no death or major complications.

Outcome of device atrial septal defect closure in different age groups: a nationwide cohort study

Abstract Background Catheter based ASD closure has been a mainstay therapy for secundum type ASD for over 20 years and up to 80–90% of defects are deemed eligible for catheter closure. We are starting to get long term results for the outcome of the procedure. Numerous studies have reported excellent prognosis and low complication rates in patients with TC closed defects. However, little is known about the disease burden in the long run after the closure. Objectives This nationwide cohort aimed to evaluate long-term outcome of transcatheter closed atrial septal defects (ASD) by evaluating 1) hospitalisations and disease burden, 2) complications and 3) echocardiographic changes. Material and methods We gathered every transcatheter ASD closure done in Finland during 1999–2019. Mean follow-up time was 6.8 years (SD 5.1). We used hospital discharge register to study the incidence of new onset atrial fibrillation, stoke and migraine after the closure. Closure complications and echocardiographic changes were gathered from the electronic health records. Results Overall transcatheter ASD closure was performed for 1000 patients (68.5% females) during the study period. ASD patients had increased risk for new-onset atrial fibrillation (RR 2.55, 95% CI: 1.94–3.36), migraine (RR 3.41, 95% CI: 2.40–4.84) and heart failure. Stroke risk was not increased during the follow-up (p=0.19). Hospitalisations were more common in the ASD group in the following 12 months after the closure (RR 2.52, 95% CI: 2.14–2.98). Adverse events occurred in 6.9% (n=69) of the patients, including 4 erosions and 10 device embolisations. Right heart size was enlarged in 83.9% of the patients before the closure and in 24.4% after the closure. Rate of mild mitral regurgitation increased 21.2% vs. 27.6%, p=0.005) and rate of sever to moderate tricuspid regurgitation decreased (9.4% vs. 5.6%, p=0.009) during the follow-up. Conclusion Catheter based Atrial septal defect closure is a safe procedure with low complication rates. TC closed ASD patients had more new-onset atrial fibrillation, heart failure and migraine during the follow-up. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): The Emil Aaltonen Foundation, Tampere, Finland

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

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

Impaired Left Atrial Function in Patients with Atrial Septal Defect and History of Atrial Fibrillation.

In patients with atrial septal defect (ASD), atrial left-to-right shunting causes left atrial (LA) remodeling and dysfunction, leading to atrial fibrillation (AF). In adults with ASD and concomitant AF, LA function should be evaluated after ASD closure plus AF radiofrequency catheter ablation (RFCA).This multicenter retrospective cohort study included patients who underwent transcatheter ASD closure at one of the four leading hospitals. Patients with a history of AF also underwent preceding RFCA. The association between AF history and LA ejection fraction (EF) (indicating LA global function) at 6-12 months following ASD closure was evaluated. To account for differences in baseline characteristics between patients with and without a history of AF, we conducted the following statistical methods: (1) multivariate regression analysis in the prepropensity score (PS)-matched cohort and (2) univariate comparisons in the PS-matched cohort.Overall, this study included 231 patients (30 with AF history, 201 without). Multiple regression analysis showed that AF history was independently associated with impaired LAEF (β = -10.425, P < 0.001, model created prior to propensity matching). A one-to-one PS matching (25 pairs) showed that the LAEF at 6-12 months following ASD closure was significantly impaired in patients with ASD and AF history compared to that in patients without history of AF (median LAEF, 37.5% (interquartile range [IQR] 29.4%-48.5%) versus 52.3 [IQR 50.0%-56.6%]; P < 0.001).LA function was impaired in patients with ASD and a history of AF at 6-12 months after successful transcatheter ASD closure and on maintenance of sinus rhythm by RFCA.

Transcatheter Atrial Septal Defect Closure Before Versus After Adulthood.

ObjectivesTo evaluate the long-term outcome of patients who underwent percutaneous transcatheter closure of secundum atrial septal defects during teenage life versus adulthood.MethodsThe study included 100 patients with secundum type ASD who were treated by transcatheter closure of their defects 2–5 years before enrollment. The study population was subdivided into 2 equal groups: group 1 who underwent transcatheter closure during teenage life (13–19 years) and group 2 who underwent transcatheter closure after the age of 30 years. The two groups were compared according to resting 12 lead ECG, 24-h Holter ECG and transthoracic echocardiographic findings (Right ventricular size and functions, right atrial size, etc.)ResultsThe study population showed female predominance. The average follow up period was similar in both groups. Adult patients had more frequent right bundle branch block morphology in their resting 12 lead ECG than teenagers (69% versus 45% respectively, p < 0.01). The incidence of arrhythmias encountered in Holter ECG was also significantly higher in the adult group. Premature atrial contractions (PAC) were present in 10 patients (20%) in adult group while 3 patients (6%) had PACs in teenagers’ group with p < 0.01. The mean PAC burden was also higher in the adult group (9% versus 1.3%, p < 0.001). Paroxysmal AF lasting more than 30 seconds was found in 6 patients (12%) in the adult group while 1 patient in teenagers developed AF, p < 0.01. Regarding transthoracic echocardiography, adult patients showed significantly larger RV diameter, indexed RA area, indexed LA volume and more LV diastolic dysfunction. RV systolic functions were better in the teenage group as measured by 2D echocardiography. Adult patients with higher age, bigger defect size and device size had more abnormal ECG and echocardiographic findings.ConclusionEarly trans-catheter closure of secundum ASD during teenage life yields better right ventricular systolic function, better right ventricular size and less incidence of atrial arrhythmia.