Transcatheter Closure Of Septal Defect Research Articles

Impact of atrial septal defect device size on biventricular global and regional function: a two-dimensional strain echocardiographic study.

In this study, we assessed the acute changes in biventricular longitudinal strain after atrial septal defect transcatheter closure and its relation to the device size. Hundred atrial septal defect patients and 40 age-matched controls were included. Echocardiography and strain study were performed at baseline and 24 hours and 1 month after the intervention. The study group was divided into two subgroups; group 1: smaller devices were used (mean device size = 1.61 ± 0.05 cm, n = 74) and group 2: larger devices were used (mean device size = 2.95 ± 0.07 cm, n = 26). At baseline, there was a significant difference between the study group and controls as regards right ventricular global longitudinal strain with significant hyperkinetic apex (p = 0.033, p = 0.020, respectively). There was a significant immediate reduction in right ventricular global longitudinal strain (from -24.43 ± 0.49% to -21.62 ± 0.47%, p < 0.001), which showed insignificant improvement after 1-month follow-up. While only left ventricular global longitudinal strain increased after 1 month. Within 24 hours of device closure, all the basal- and mid-lateral segments strains and apical right ventricular strains showed a significant reduction. There was a significant negative correlation between the indexed large device size and an immediate change in the right ventricular global longitudinal strain (r = -0.425, p = 0.034). Significant right ventricular global longitudinal strain reduction starts as early as 24 hours after transcatheter closure, irrespective of the device size used. The rapid impact of closure was mainly on the biventricular basal and lateral segments and right ventricular apical ones, especially with the large sized atrial septal defect.

Percutaneous Intervention to Treat Platypnea-Orthodeoxia Syndrome: TheToronto Experience.

This study reviewed a series of patients treated with transcatheter closure of septal defect to treat platypnea-orthodeoxia syndrome, with specific attention to septal characteristics and device choice. Platypnea-orthodeoxia syndrome is an uncommon condition characterized by positional dyspnea and hypoxemia due to intracardiac right-to-left shunting through a patent foramen ovale (PFO), an atrial septal defect, or pulmonary arteriovenous malformations. Percutaneous closure of such defects is the treatment of choice. In this single-center series, 52 patients were treated with percutaneous closure of an interatrial communication after presentation between January 1997 and July 2015. Septal morphology, clinical, procedural, and outcomesdata were analyzed. All patients had a PFO; however, nearly one-quarter required a non-PFO device (11 Amplatzer Septal Occluder and 1 post-infarct muscular VSD), as opposed to a dedicated PFO device to achieve shunt occlusion. These patients werecharacterized by an aneurysmal septum, shorter primum septum overlap with the secundum septum, and greaterseptal angulation from the midline. After closure, all demonstrated acute improvements in oxygen saturation (pre-procedure: 81 ± 8%; post-procedure: 95.1 ± 0.5% on room air). Each patient was treated with a single device and no one required re-intervention. Patients presenting with platypnea-orthodeoxia syndrome can be treated successfully with a percutaneous intervention often requiring a variety of devices. Those requiring a non-PFO-type device had a greater prevalence of an aneurysmal septum, shorter primum septal overlap with the secundum septum, and greater septal angulation with the midline.

The Role of Antiplatelet Agents in the Management of Patients Receiving Intracardiac Closure Devices

Transcatheter closure of septal defects has become a widely used alternative to surgery or life-long anticoagulant therapy especially in patients with atrial septal defects (ASD) and patent foramen ovale (PFO). Post-procedural complications include thrombus formation on the occluder in about 0-10% of all cases. Therefore antithrombotic prophylaxis after device implantation is believed to be necessary, but still is variable and remains controversial. To date no randomized studies have been published to assess the optimal anticoagulation strategy. Thus, therapy is based on empirical data, local experience and case reports from the literature. The present review tries to give an overview on most of these mainly retrospective single center studies and summarizes their results. Factors influencing the rate of thrombus formation may be device type, existence of thrombophilic disorders and prophylactic medication. Thrombus formation has been described for each of the existing occluder types without a significant difference between the devices. For antithrombotic prophylaxis, most centers at present use either acetyl salicylic acid alone (ASA; 81 to 325 mg) for 6 months or a combination of ASA and clopidogrel (75 mg) for 6 to 8 weeks followed by ASA for additional 4 to 8 months. Inherited thrombophilic disorders should be excluded before device implantation in order to adapt antithrombotic prophylaxis. Follow-up examinations after device implantation should be performed using TEE within the first 4 weeks after implantation. Thus, thrombi may be recognized early enough to extend the antithrombotic regimen in order to avoid surgical device explantation.

Septal repair implants: evaluation of magnetic resonance imaging safety at 3 T

Specialized implants are used for transcatheter closure of septal defects, including atrial and ventricular septal defects, and patent foramen ovale. These metallic devices may pose a risk to patients undergoing magnetic resonance imaging (MRI) procedures especially if performed at 3 T. Therefore, this investigation evaluated MRI safety at 3 T for septal repair implants (CardioSEAL Septal Repair Implant and STARFlex Septal Repair Implant, NMT Medical, Boston, MA, USA) by characterizing magnetic field interactions, heating and artifacts. These implants exhibited minor magnetic field interactions; heating was not excessive (+0.5 degrees C); and artifacts will only create a problem if the area of interest is in the same area as or near these devices. Thus, the findings indicated that it would be safe for a patient with these implants to undergo MRI at 3 T or lower. Importantly, because of the minor magnetic field interactions, MRI may be performed immediately after implantation.

Hemoptysis after CardioSEAL device embolization of a venous collateral after the Fontan operation

Transcatheter closure of septal defects and other vascular structures in children is a rapidly evolving field with a growing number of applications for the currently available devices. Despite the widely accepted use of these closure devices for lesions such as atrial septal defects and patent ductus arteriosus, their use in the treatment of other defects is limited. Consequently, little is known about the associated risks and complications. We present here a case of a delayed complication of airway erosion from a CardioSEAL device (NMT Medical, Boston, Mass) used to close a large anomalous systemic to pulmonary venous channel after the Fontan operation.

Radiologic findings of 2 commonly used cardiac septal occluders with clinical correlation.

Transcatheter closure of an atrial septal defect, patent foramen ovale, or post-myocardial infarction ventricular septal defect has become a safe and effective alternative to medical and surgical therapy. Although the use of transcatheter closure of septal defects is becoming increasingly more popular, there are few reports of the radiographic appearance of the closure devices. We report the chest radiographic findings in 36 patients after transcatheter closure of septal defects with Amplatzer or CardioSEAL occluders in an effort to aid radiologists in recognizing the appearances of these devices and enable them to confirm proper positioning.