Underwent Transcatheter Device Closure Research Articles

Transcatheter closure of a right pulmonary artery to left atrium fistula using multi-modality image fusion guidance.

We present the case of 53-year-old woman with a late diagnosis of an right pulmonary artery-left atrium fistula who underwent transcatheter device closure using multi-modality imaging for pre-procedural planning and procedural guidance.

Percutaneous Device Closure of Perimembranous Ventricular Septal Defects Associated with Aortic Valve Prolapse and Aortic Regurgitation.

The progression of aortic regurgitation (AR) in perimembranous ventricular septal defects (pVSD) remains uncertain; research indicates that the accompanying AR tends to worsen over time. There is controversy surrounding the percutaneous closure of defects in patients with pVSD associated with aortic valve prolapse (AVP) and AR. Our research focused on transcatheter closure for pVSD accompanied by AVP, AR, and septal aneurysm, with the aim of addressing challenges through device placement in aneurysmal tissue to eliminate the Venturi effect. We studied 44 patients with AVP, AR, and septal aneurysm who underwent transcatheter device closure. The mean age and weight were 10.5 ± 4.0years and 36.0 ± 15.1kg, respectively. Transcatheter closure was attempted in 44 patients. One case (2.3%) was referred to surgery, while the procedure was successfully completed in 43 out of 44 patients (97.7%). Early complications were minimal. Embolization of the device to the pulmonary artery was observed in one patient; upon re-evaluation, significant aneurysm tissue damage was detected, leading to a referral for surgery. Additionally, three patients (6.9%) developed permanent incomplete right bundle branch block (iRBBB). The median follow-up time was 43months. During the follow-up period, AR progressed in only 1(2.3%) patient, while AR in 7(16.3%) patients regressed markedly. Follow-up assessments demonstrated high rates of complete occlusion; the rates at immediate, 24h, 6months, and 1year were assessed as 72, 83.7, 93, and 95.3%, respectively. Transcatheter device closure of pVSD offers a minimally invasive, safe, effective, and alternative treatment option for patients with pVSD associated with AVP and AR.

A rare complication of intra-aortic balloon pump

Intra-aortic balloon pump (IABP) is commonly used for circulatory support in patients with cardiogenic shock. IABP is associated with several complications; however, IABP rupture was rarely reported. We present a female patient with acute myocardial infarction and ventricular septal rupture. The patient underwent transcatheter device closure of the ventricular septum and IABP insertion. After 4 days of insertion, we encountered a failure to cycle alarm. The IABP was removed with difficulty, and a leak coming from the shaft near the bifurcation was found. This case highlighted the importance of early detection of IABP rupture to avoid entrapment and further complications.

Follow up and outcome of transcatheter device closure in pediatric patients in a tertiary cardiac centre of Nepal

BackgroundCongenital heart diseases have significant effect on the growth and development of a child. Timely intervention helps a child to grow and develop to full potential. Cardiac interventionists have not long ago developed methods to cure conditions via transcatheter methods like device closures for shunt lesions. These interventions have been hugely accepted and applied all over the world. ObjectivesThe aim of this study was to determine the outcome of Transcatheter device closure in Atrial Septal Defect (ASD), Ventricular Septal Defect (VSD) and Patent Ductus Arteriosus (PDA) in terms of improvement in echocardiographic parameters and nutritional well-being. It also outlined the immediate and long term complications of Transcatheter device closure of the shunt lesions. MethodologyA prospective study was carried out among 129 pediatric patients who underwent Transcatheter device closure of shunt lesions at Shahid Gangalal National Heart Centre from March 2019 to March 2021. Simple convenient, consecutive non-probability sampling method was used for the study.Independent sample t-test was applied to see the correlation and significance of continuous variables and Linear regression was used to find out relation between weight gain and device closure. ResultsAmong 129 pediatric patients having either ASD, PDA or VSD without other comorbidities who underwent transcatheter device closure at Shahid Gangalal National Heart Centre, there was 1 mortality (0.7 %), 3 device embolization (2.3 %), 11 (8.5 %) tiny residual leaks, 6 (4.6 %) femoral artery thrombosis, 19 (14.7 %) Left ventricular systolic dysfunction, 4 (3.1 %) new onset arrhythmia, 13(10.0 %) new onset trivial AR and 2 (1.5 %) mild obstruction to surrounding structures. There were no long term complications observed during the study period. Pulmonary artery pressures improved in most along with normalization of chamber dilatation. There was significant improvement in weight of children at the end of one year follow up (P < 0.001), however among individual shunt lesion, only patients undergoing PDA device closure demonstrated significant weight gain. ConclusionTranscatheter device closure is a promising, safe and effective means of treatment for ASD, PDA and VSD. It has significant bearing in weight gain as well as general well-being of children. Judicious selection of cases, proficient expertise and availability of suitable infrastructures are paramount for successful outcome.

Long-Term Follow-up of Transcatheter Ventricular Septal Defect Closure in Children, and Comparison of Single-Hole Versus Multi-holes Ventricular Septal Defects

Background: Evaluation of complications after transcatheter ventricular septal defect (VSD) closure in long-term follow-up and large samples of children is limited. Objectives: We compared the residual shunt after transcatheter closure in VSDs with a single hole and multiple holes, a new task that has not been done so far. Methods: This retrospective study included all patients who underwent transcatheter device closure for VSD in a tertiary cardiovascular center from 2009 to 2020. Follow-up evaluation using transthoracic echocardiography (TTE) and electrocardiogram (ECG) was performed at 1, 6, 12 months, and annually after the procedure. Results: A total of 409 patients underwent transcatheter VSD closure. The mean age was 7 years (2 - 15 years), and the median follow-up duration was 48 months (1 - 10 years). The number of patients with a singular VSD was 259 (63.4%), and those with multiple exit holes were 150 (36.6%). The incidence of a residual shunt immediately after implantation was significantly higher in VSDs with multiple holes than those with a single hole (P = 0.008). During the follow-up, the residual shunts decreased in the group of VSDs with a single hole. Forty-five patients (11%) and 16 patients (4%) had a new-onset of mild and moderate tricuspid regurgitation (TR), respectively, and it decreased dramatically over time. Only 1 patient showed a new-onset mild aortic regurgitation (AR). The most crucial complication shown in 2 patients was a persistent complete heart block. Conclusions: Ventricular septal defects with multiple exit holes are a risk factor for a residual shunt. After transcatheter VSD closure, the residual shunt in patients with a multiple-hole VSD was significantly higher (P = 0.008). Although TR may increase during the procedure, it decreases dramatically over time. Interestingly, patients who had pre-procedure tricuspid or aortic regurgitation disappeared after 2 years of the procedure. The most important complication was a complete heart block in 2 patients.

Predictors and long-term outcomes of heart block after transcatheter device closure of perimembranous ventricular septal defect.

Heart block is the most common and concerning complication associated with transcatheter device closure of perimembranous ventricular septal defect (pmVSD) and its occurrence remains a great challenge for device closure. Between June 2002 and June 2020, 1076 pediatric patients with pmVSD, who successfully underwent transcatheter device closure in our center, were enrolled in this cohort study, with a median follow-up of 64 months (range: 1 to 19 years). Of 1076 patients, 234 (21.8%) developed postprocedural heart block, with right bundle branch block being the most common (74.8%), followed by left bundle branch block (16.2%), and atrioventricular block (5.6%). Complete atrioventricular block occurred in 5 cases, including 3 cases with permanent pacemaker implantation, 1 case with recovery to normal sinus rhythm, and 1 case with sudden cardiac death. Most patients (97.9%) developed heart block within 1 week of procedure. Finally, 138 cases returned to normal cardiac conduction. Multivariate logistic regression revealed that thin-waist occluders (odds ratio [OR]: 1.759; 95% confidence interval [CI]: 1.023 to 3.022; P = 0.041), and oversized devices (OR: 1.809; 95% CI: 1.322 to 2.476; P < 0.001) were independently associated with occurrence of postprocedural heart block. Moreover, heart block was less likely to occur when the left disk of occluder was placed within the aneurysmal tissue (OR: 0.568; 95% CI: 0.348 to 0.928; P = 0.024). The outcome of postprocedural heart block is favorable in most cases. Oversized devices and thin-waist occluders should be avoided. Placement of the left disk of the device should into the aneurysmal tissue is highly recommended.

Assessment of left atrial remodeling using speckle tracking echocardiography after percutaneous atrial septal defect closure in adult patients

BackgroundAtrial fibrillation (AF) is a well-known, long-term complication of atrial septal defect (ASD) in adults, even after device closure. Left atrial (LA) strain rate applied to the analysis of chamber function has been demonstrated to be an important predictor of LA reverse remodeling. This study aimed to determine the changes in chamber function after device closure of ASD.MethodsThis prospective study enrolled adults with secundum ASD undergoing transcatheter device closure from December 2016 to August 2017. We analyzed the clinical characteristics and LA strain rate before and six months after ASD closure.ResultsA total of 11 patients were enrolled. The mean age was 42.6 ± 9.9 years, and six (54.5%) were females. There was no significant change of conventional echocardiographic parameters after ASD closure. The mean global LA reservoir strain rate before ASD closure was 1.17 ± 0.34 and 0.85 ± 0.30 after ASD closure (p = 0.030). The median global LA conduit strain rate was 0.68 (0.42–1.16) and 0.41 (0.16–0.79) before and after ASD closure (p = 0.213), respectively. The mean global LA contractile strain rate at the six-month follow-up showed significant improvement compared with pre-procedural strain rate (0.33 ± 0.65 vs. − 0.43 ± 0.38, p = 0.006).ConclusionsLA functional changes occurred during the six-month follow-up, while LA and right atrial (RA) geometric changes were not significant. LA reverse remodeling was proved by restoration of LA late diastolic contractile function.

Feasibility, Safety, and Short-Term Outcomes of Transcatheter Patent Ductus Arteriosus Closure in Premature Infants on High-Frequency Jet Ventilation.

BackgroundProlonged exposure to a hemodynamically significant patent ductus arteriosus (PDA) is associated with major morbidity, particularly in infants born at <27 weeks’ gestation. High‐frequency jet ventilation (HFJV) is a standard of care at our center. There are no data about transcatheter PDA closure while on HFJV. The aim of this study was to assess the feasibility, safety, and outcomes of HFJV during transcatheter PDA closure.Methods and ResultsThis is a retrospective cohort study of premature infants undergoing transcatheter device closure on HFJV. The primary outcome was successful device placement. Secondary outcomes included procedure time, fluoroscopy time and dose, time off unit, device complications, need for escalation in respiratory support, and 7‐day survival. Subgroup comparative evaluation of patients managed with HFJV versus a small cohort of patients managed with conventional mechanical ventilation was performed. Thirty‐eight patients were included in the study. Median age and median weight at PDA device closure for the HFJV cohort were 32 days (interquartile range, 25.25–42.0 days) and 1115 g (interquartile range, 885–1310 g), respectively. There was successful device placement in 100% of patients. There were no device complications noted. The time off unit and the procedure time were not significantly different between the HFJV group and the conventional ventilation group. Infants managed by HFJV had shorter median fluoroscopy times (4.5 versus 6.1 minutes; P<0.05) and no increased risk of adverse respiratory outcomes.ConclusionsTranscatheter PDA closure in premature infants on HFJV is a safe and effective approach that does not compromise device placement success rate and does not lead to secondary complications.

Midterm Prognosis of Sexagenary Patients after Transcatheter Device Closure of Atrial Septal Defects: a Single-Chinese Center Experience.

IntroductionThe objective of this study is to evaluate the efficacy and midterm prognosis of transcatheter device closure of atrial septal defects (ASDs) in sexagenary patients in China.MethodsForty-six sexagenary patients who underwent transcatheter device closure of ASDs in our hospital were included in this study. The patients’ preoperative and postoperative clinical symptoms, echocardiographic results, and quality of life were investigated and analyzed.ResultsOf the 46 sexagenary patients who participated in the study, 40 completed the study. After ASD closure, the clinical symptoms of the patients significantly improved, and the number of patients with dyspnea and palpitations significantly decreased after the operation. According to the echocardiographic results, few patients had a tiny residual shunt after closure, but the shunt disappeared completely at the three-month follow-up. The size of the right ventricular cavity was significantly smaller postoperatively compared with preoperatively. Regarding the patients’ quality of life, their feedback in all dimensions of the 36-Item Short-Form Health Survey (or SF-36) was significantly improved at the three-month follow-up, and it remained improved at the one-year follow-up.ConclusionThe clinical outcomes and subjective quality of life of sexagenary patients with ASDs improved significantly after transcatheter device closure of ASDs. Therefore, we believe that for sexagenary patients with ASDs, transcatheter device closure is a favorable treatment.

Mapping the Conduction System in Patients Undergoing Transcatheter Device Closure of Perimembranous Ventricular Septal Defect: A Proof-of-Concept Study.

Earlier studies that investigated the relation of atrioventricular (AV) conduction system to perimembranous ventricular septal defect (pmVSD) were based on cardiopathological specimens. To study the relationship of conduction system to pmVSD using 3-dimensional electroanatomic mapping system (EAMS) in patients undergoing device closure. Fifteen consecutive cases of pmVSD from January 2014 to July 2017 (age > 2years and weight > 8kg) were included in the study. The course of conduction system and its relationship with the pmVSD was mapped before and after device closure, with the use of EAMS. Median age and weight of the cohort was 10years (range 4-21years) and 25kg (range 13-55) respectively. Device implantation was successful in all patients except 1. The course and relation of the conduction system were posteroinferior to the pmVSD in all cases (100%), and away from the defect in 67% (10/15). In patient with baseline RBBB, the right-sided conduction system was in close proximity to the pmVSD. Two patients had part of left-sided conduction system in close proximity to pmVSD or device edges. Two patients developed RBBB following device deployment, which reverted to normal on follow up. No patient developed high grade AV block during the median follow-up of 34months (range 24-62). This experimental study has shown the feasibility of 3D EAM of conduction system during device closure of pmVSD. This novel concept can be utilized to understand the anatomy of conduction system in other congenital heart diseases.

Midazolam for conscious sedation in transcatheter device closure of atrial septal defects guided solely by transthoracic echocardiography.

To investigate the safety and feasibility of midazolam for conscious sedation in transcatheter device closure of atrial septal defects guided solely by transthoracic echocardiography. A retrospective analysis was performed on 55 patients who underwent transcatheter device closure of atrial septal defects from October, 2019 to May, 2020. All patients received intravenous midazolam and local anesthesia with lidocaine to maintain sedation. A group of previous patients with unpublished data who underwent the same procedure with general anesthesia was set as the control group. The relevant clinical parameters, the Ramsay sedation scores, the numerical rating scale, and the post-operative satisfaction questionnaire were recorded and analyzed. In the midazolam group, the success rate of atrial septal defect closure was 98.2%. Hemodynamic stability was observed during the procedure. None of the patients needed additional endotracheal intubation for general anesthesia. Compared with the control group, the midazolam group had no statistically significant differences in the Ramsay sedation score and numerical rating scale scores. Patients in the midazolam group experienced more post-operative satisfaction than those in the control group. Conscious sedation using midazolam is a safe and effective anesthetic technique for transcatheter device closure of atrial septal defects guided solely by transthoracic echocardiography.

Transcatheter Device Closure of Secundum Atrial Septal Defect in Adult Patient

Background:Atrial septal abnormalities are common congenital lesions remaining asymptomatic until adulthood in a great number of patients. The most frequent atrial septal defects in adults are ostium secundum atrial septal defect (ASD). Complications from untreated, hemodynamically significant ASD are atrial arrhythmia, paradoxical embolization, Eisenmenger’s syndrome, pulmonary hypertension, and right ventricular failure.Objective:We present a case report of secundum ASD in adult female patient who underwent transcatheter device closure with Amplatzer occluder.Methods and Results:The case of female Bosnian patient 50 years old who lives in Belgium for 20 years ago and during her visit to Bosnia she came to our polyclinic for cardiological exam. Echocardiographic exam showed enlargement of left atrium (LAD 51mm), right atrium and ventricle (RAD 46mm, RVd 33mm), atrial septal defect 9mm with left right shunt Qp:Qs 2,3:1. Several months later transcatheter device closure with Amplatzer occluder was performed and subsequent symptomatic improvement reported after closure.Conclusion:Echocardiography has superior role for precise evaluation of ASD type secundum who are suitable for transcatheter device closure as primary treatment option. Transcatheter techniques has now become preferable to surgical repair and provide valid option of treatment for this type of CHD.

Effect of Trans-catheter closure of the Ductus Arteriosus in Preterm Infants

Purpose: Patent ductus arteriosus (PDA) is a common clinical condition in preterm infants with hemodynamic consequences of systemic hypo-perfusion and later pulmonary hypertension. Management of pulmonary hypertension in the presence of a large PDA with left to right shunting is challenging. We sought to assess the effect of the PDA and its trans-catheter device closure on the pulmonary vascular bed in preterm infants. Methods: A review of 100 consecutive children who underwent trans-catheter device closure of PDA was performed. Preterm infants who had a diagnostic right heart catheterization …

Successful totally transthoracic echocardiography guided transcatheter device closure of atrial septal defect in pregnant women.

BACKGROUNDTranscatheter device closure of atrial septal defect (ASD) guided by fluoroscopy and/or transesophageal echocardiography is a mature technology. Little study has focused on whether the technology can be guided totally by transthoracic echocardiography (TTE), even in pregnant women with ASD.AIMTo evaluate the safety and efficacy of totally TTE guided transcatheter device closure of ASD in pregnant women.METHODSSix pregnant women (gestational age 20-26 wk) with ASD underwent transcatheter device closure totally guided by TTE at our cardiac center from January 2015 to August 2017. A routine transcatheter procedure without fluoroscopy or intubation and a domestic occluder were used in this study.RESULTSAll patients had successful closure with good clinical results, and the overall immediate complete closure rate was 100%. The size of the occluder deployed ranged from 20 to 32 mm (26.7 ± 4.3 mm), the procedure time ranged from 30 to 50 min (41.7 ± 7.5 min), and the length of hospital stay was 2-3 d (mean 2.2 ± 0.4 d). There were no serious cardiovascular related complications, and transient arrhythmias occurred in one patient during the procedure. During the follow-up period (3 mo to 2 years), no occluder dislodgement, residual fistulas, or thromboses occurred. All of the patients underwent vaginal delivery between 36 and 38 wk of gestation.CONCLUSIONTotally TTE guided transcatheter device closure of ASD in pregnant women may be safe and effective.

Left Ventricular Torsion Deformation in Atrial Septal Defect Patients Undergoing Transcatheter Device Closure

Introduction: Atrial septal defects (ASD) considered being one of the known congenital heart diseases. ASD causes increased volume overload of the right heart. The purpose of this study was to evaluate left ventricular (LV) torsion deformation in ASD patients undergoing transcatheter device closure.Methods: All adult patients who underwent transcatheter device closure with ostium secundum ASD were included in the study. We assessed LV torsion in ostium secundum ASD patient’s pre and post device closure by using speckle tracking echocardiography.Results: A total of 37 patients (22 females and 15 males) were included in this study. The average age was 28 ± 19 years. LV peak basal rotation improved significantly (P = 0.028) in post transcatheter closure. LV torsion (2.88 ± 0.99˚/cm before vs. 3.40 ± 1.41˚/cm after closure, P = 0.009) and twisting (15.12 ± 4.69˚ before vs. 17.95 ± 6.21˚ after closure, P = 0.005) were statistically significant in post transcatheter closure. Volumetric assessment of LV including end-diastolic volume and systolic volume showed significant improvement (P = 0.02, P < 0.01) post device closure.Conclusions: The increased peak LV twisting and torsion was mainly attributed to the improved peak systolic clockwise rotation after ASD device closure. The LV twisting at a younger age was improved after the closure of ASD.

Long-Term Outcome of Transcatheter Device Closure of Perimembranous Ventricular Septal Defects.

Background: Ventricular septal defect is a common congenital heart defect. Transcatheter closure of perimembranous ventricular septal defect (pmVSD) is an effective method alternative to surgical closure. The aim of the study is to evaluate the procedural result, early and long-term follow-up outcome of transcatheter closure of pmVSD.Methods: From January 2005 to December 2016, we retrospectively identified the patients who underwent transcatheter device closure of pmVSD. All patients underwent transthoracic echocardiography (TTE) and electrocardiogram (ECG) before and after the procedure. Follow-up evaluation was done at 1, 3, 6, 12 months and yearly thereafter with TTE and ECG.Results: Total 186 patients (95 male, 91 female) had catheter-based intervention of pmVSD. The mean age at the time of procedure was 5.4 ± 2.8 years (range 2~14 years) and the mean weight was 18.1 ± 6.7 kg (range 10.5~43 kg). The mean size of the implanted device was 8.4 ± 2.1 mm (range 5~16 mm). The device was successfully implanted in 180 patients (96.8%). Immediate post-procedural echocardiography showed complete occlusion in all but one patient had trivial residual shunt. Total early adverse events occurred in 16 patients (8.9%). Only in two patients it was significant, complete AVB occurred in a 9 years old boy, managed with temporary pacemaker and one patient had complete left bundle branch block, recovered fully after steroid therapy. During a median follow-up period of 18.4 months (range 6~120 months), no serious adverse events and complete AVB were encountered.Conclusion: In our experience, The incidence of serious adverse event is low and no late onset of complete AVB with excellent success rate and follow-up results, confirming the transcatheter closure of pmVSD is a valuable alternative to surgical closure in selected patients.

PCV12 - Hospitalization Outcomes For Adults In The United States With Atrial Septal Defect: Analysis Of A Multicenter Database

Atrial Septal Defect (ASD) closure in the elderly has been a topic of debate. Some experts suggest closure of ASD in the elderly, others believe risks outweigh benefits. The objectives of this study is to assess trends of ASD closure in the US between 2000 and 2012, and patient characteristics and outcomes for ASD closure in adults (16 to 59 years) and elderly adults (>60 years). The Nationwide Inpatient Sample was used to identify patients above 16 years of age who underwent transcatheter device closure (closed technique) and surgical closure (open technique) for ASD repair. ICD-9 codes were used to identify the study sample between 2000 and 2012. Risk factors for mortality in the 16-59 years age group and ≥ 60 years age group were determined based on clinical characteristics and comorbidities. Predictors for hospitalization outcomes including death, prolonged length of stay, and discharge to a skilled nursing facility were calculated. There were 11,018 cases of ASD repair in the US between 2000 and 2012. In the ≥ 60 years age group, there is a declining trend in closed technique (p <0.01) between 2006 (n = 1667) and 2012 (n = 920) and open technique (p<0.01) between 2009 (n=342) and 2012 (n=240). Unadjusted analyses revealed significant difference in mortality (0.57% vs 1.42%; p<0.05), length of stay (2.78 days vs 8.18 days; p < 0.001), and discharge to a skilled nursing facility (4.08% vs 67.14%; p<0.001) between closed technique vs open technique. Significant risk factors for mortality in closed technique included vascular complications due to procedure, previous myocardial infarction and acute kidney injury. Procedure volume of both – open technique and closed technique have increased since 2000. Mortality in open technique is three times that of closed technique (p<0.01).

Dexmedetomidine-propofol vs ketamine-propofol anaesthesia in paediatric and young adult patients undergoing device closure procedures in cardiac catheterisation laboratory: An open label randomised trial.

Background and Aims:Several drug combinations have been tried in patients with acyanotic congenital heart disease (ACHD) undergoing transcatheter device closure in the cardiac catheterisation laboratory (CCL). Adequate sedation, analgesia, akinesia, cardiorespiratory stability, and prompt recovery are key requirements. Ketamine with propofol is used for this purpose. Dexmedetomidine carries a shorter recovery time. This study compared dexmedetomidine–propofol (DP) with ketamine–propofol (KP) in patients in the CCL.Methods:This was an open label randomised trial at a CCL over a 2-year period from August 2012 to August 2014. Fifty-six paediatric and 44 young adults with ACHD underwent device closure and were randomised to receive DP or KP. The primary outcome studied was time to regain full consciousness, airway and motor recovery.Results:Baseline characteristics were similar in the study groups. In the DP arm as compared to the KP arm, the time to recovery of consciousness (mean ± SD) was significantly faster in both paediatric patients [30 ± 15 vs. 58 ± 13 min (P < 0.001)] and in young adult patients [22 ± 10 vs. 35 ± 12 min (P < 0.001)]. There was significantly faster motor recovery also (mean ± SD) [paediatric: 25 ± 05 vs. 40 ± 14 (P < 0.001); young adult: 10 ± 05 vs. 22 ± 10 min (P < 0.001)].Conclusion:Procedural anaesthesia with DP in paediatric and young adult patients with ACHD undergoing device closure in the CCL resulted in faster recovery of consciousness and motor recovery compared to KP.

Transcatheter closure of large atrial septal defects: A single-center experience

Background: Despite the favorable history of surgical approach to repair secundum type atrial septal defects (ASDs), the transcatheter closure has increasingly become the preferred strategy because of its relatively high efficacy and lower morbidity compared to surgery in selected cases. However, there is some controversy around the preferred strategy and long-term complications of device closure of large ASDs. Here, we evaluated the early and midterm outcomes of adults with large ASDs who underwent transcatheter device closure with devices larger than 28 mm. Methods: A prospective single-center study was conducted encompassing all the patients who were 18 years of age or older and underwent device closure for secundum type ASD from 2006 to 2014 with device size of >28 mm, and early and midterm follow-up data were assessed. Results: The procedure was successful in 93.6% of the scheduled patients. Two and a half percent had nonsignificant residual shunt. Immediate device migration occurred in one patient (1.2%) who underwent surgical retrieval and defect closure. One case of device thrombosis (1.2%) was seen 1 month after the procedure who had successful medical treatment. There was a case of device erosion 1 month after the procedure referred for the surgery. Mild postintervention pericardial effusion was seen in 16.5% and reduced to 7.6% in the first outpatient visit. Conclusions: The study demonstrated that the vast majority of anatomically suitable large ASDs could be closed by using the transcatheter technique with a low complication rate. Therefore, the transcatheter closure could be recommended as the first-line strategy in adults with large ASDs. However, meticulous preprocedural imaging and evaluation by experts are necessary before scheduling patients with large ASDs for the percutaneous alternative.

Improvement of physical capacity in patients undergoing transcatheter closure of atrial septal defects.

IntroductionAtrial septal defect (ASD) is the most common congenital cardiac anomaly diagnosed in adults. It often remains asymptomatic until the fourth or fifth decade of life. Significant left-to-right interatrial shunting is associated with the risk of heart failure, pulmonary hypertension and atrial fibrillation. Percutaneous ASD closure is a recognized method of treatment.AimTo evaluate the clinical outcomes and physical capacity in patients undergoing transcatheter closure of ostium secundum ASD.Material and methodsOne hundred and twenty adult patients (75 females and 45 males) with a mean age of 43.1 ±13.3 (17–78) years who underwent transcatheter device closure of ostium secundum ASD were analyzed. Clinical evaluation and transthoracic color Doppler echocardiographic study were repeated in all patients before as well as 1 and 24 months after the procedure. To assess the physical capacity symptom-limited treadmill exercise tests with respiratory gas-exchange analysis were performed in all patients before the procedure and after 24 months of follow-up.ResultsThe devices were successfully implanted in all patients. During 24 months of follow-up all patients showed significant clinical and spiroergometric improvement of exercise capacity, and a significant decrease of right heart chamber overload features on echocardiography.ConclusionsTranscatheter closure of ASD in patients with significant shunt resulted in significant clinical and hemodynamic improvement regardless of the baseline functional class.