Underwent Transcatheter Device Closure Research Articles

The importance of recognizing the prominent Eustachian valve in the evaluation of atrial septal defects before percutaneous or surgical closure

Atrial septal defect closure is now routinely performed using a percutaneous approach under echocardiographic guidance. Since some echocardiographic features play an important role in the assessment of the defect and safety of the procedure, the salient features of the anatomical variations seen in adults undergoing transcatheter device closure should be well known to prevent inadvertent adverse effect or complications. It has been reported that the valve of the inferior vena cava, Eustachian valve, could be mistaken as the atrial septum thus ending in a wrong diagnosis and causing inadvertent surgical or percutaneous closure of an Eustachian valve to interatrial septum. We present a concise article that brings out a practical issue encountered during device closure of atrial septal defects.

Comparative study of the transcatheter and transthoracic device closure treatments for atrial septal defect: A Chinese single-institution experience.

The purpose of this study was to compare patient populations, safety, feasibility, complications, and total costs of the transcatheter and transthoracic device closure treatments for secundum atrial septal defect.From January 2014 to December 2014, we enrolled 155 patients with secundum atrial septal defects in our hospital. The patients were divided into 2 groups: the 70 patients in group A underwent transcatheter device closure, and the 85 patients in group B underwent transthoracic intraoperative device closure with a right lateral mini-thoracotomy.In group A, the total occlusion rate was 94.3% immediately after the operation, 100% at 3 months, and 100% at 12 months of follow-up; the group A results were not statistically different from the group B results (94.1%, 98.8%, 98.8%, respectively). There was a statistically significant difference in the minor complication rate (P < 0.05), and there were no reported deaths. There was a greater indicated scope using the transthoracic closure device to treat atrial septal defects. In our comparative study, the patients in group B had longer intensive care unit stays and hospital stays than group A (P < 0.05).Both of the device closure treatment options for secundum atrial septal defect are safe and feasible. The transcatheter device closure approach has the advantages of more cosmetic results, less trauma, and a shorter hospital stay than the transthoracic approach. On the contrary, the transthoracic closure device is an economical alternative choice, particularly for patients who are not eligible for the transcatheter closure device.

Longitudinal evaluation of P-wave dispersion and P-wave maximum in children after transcatheter device closure of secundum atrial septal defect.

Transcatheter device closure of the secundum atrial septal defect (ASD) in children prevents atrial arrhythmias in older age. However, the benefits of favourable atrial electrocardiographic markers in these children remain elusive. We aimed to review the electrocardiographic markers of atrial activity in a longitudinal fashion. We retrospectively reviewed longitudinal data of all children who underwent transcatheter device closure at the National University Hospital between 2004 and 2013. The inclusion criteria included the presence of a secundum-type ASD with left to right shunt and evidence of increased right ventricular volume load (Q p/Q s ratio >1.5 and/or right ventricular dilatation). A total of 25 patients with a mean follow-up of 44.7 ± 33.47 (7.3-117.4) months were included. P maximum and P dispersion decreased at 2 months, P amplitude at 1 week and remained so until last follow-up. A positive trend was seen with a correlation coefficient of +0.12 for P maximum, +0.08 for P dispersion and 0.34 for P amplitude. There was a higher baseline P amplitude and P dispersion in patients who were older than 10 years and a non-significant trend to support an increase in both P maximum (71.0 ± 8.8 vs. 73.2 ± 12.7), P dispersion (17.0 ± 6.5 vs. 22.0 ± 11.3) and P amplitude (0.88 ± 0.25 vs. 1.02 ± 0.23) in patients with an ASD more than 15 mm compared with an ASD <15 mm. There is reduction in both P maximum and P dispersion as early as 2 months, which persisted on follow-up. Earlier closure may result in more favourable electrocardiographic results.

Clinical Study of Trans-catheter Closure of Patent Ductus Arteriosus with Occluder Devices among Children Aged 9 Months to 18 Years

Background and Objectives: This study was aimed at determining our experience with occluder devices over last 5 years. The objective of this study is to compare the complication rates and efficacy of different devices used for the closure of PDA. Methods: A cross-sectional retrospective study in which a review of the records of all children who had PDA surgery in a paediatric cardiac center, Innova Childrens’ Heart Hospital, Hyderabad, India over a five year period (June 2007 and July 2011) was undertaken. The hospital records showed that from June 2007 to July 2011, a total of 456 children aged 9 months to 18 years had trans-catheter closure over the study period, of Research Article International Journal of TROPICAL DISEASE & Health, 4(1): 31-44, 2014 32 these, 159 underwent trans-catheter device closure of PDA. A team of experienced paediatric cardiologist performed all the procedures. Results: Out of the 159 cases, 134 (84.2%) were successful while 25 (15.7%) were complicated. Five (5) {20.0%} cases had temporary residual leak, 3 (12.0%) had failure of the procedure that required surgical intervention, 9 (36.0%) had protrusion of the device into the aorta without significant Doppler pressure gradient. There exist a relation between success, complication and device used for the procedure.The type of occluder device used for the procedure significantly affect the outcome (χ = 16.37; p = 0.02) Chinese occlude devise had the highest success rate. Twenty five (25.0) {15.7%} patients had complications in all. The commonest complication (protrusion of the device into the aorta) was seen in 3 (1.8%) cases with Chinese duct occluder, 3(1.8%) with Sear Heart R and 3 (1.8%) cases with ADOs. Non died from the procedure. Conclusion: The commonest complication is (protrusion of the device into the aorta) with Chinese occludes devise showing the highest success rate. The learning curve and accumulating experience play an indispensable role in choosing the proper device and its size.

119 DEFINING PATENT FORAMEN OVALE MORPHOLOGY USING THREE-DIMENSIONAL TRANSOESOPHAGEAL ECHOCARDIOGRAPHY AND RELATIONSHIP TO SHUNT SIZE

Background Three dimensional transoesophageal echocardiography (3D TOE) has allowed better understanding of atrial septal anatomy and patent foramen ovale (PFO) morphology. Anatomical variations seen in patients undergoing transcatheter device closure may influence device choice and procedural success. Currently there is no standardised approach to 3D TOE imaging of a PFO. The aim of this study was to utilise a 3D imaging protocol to describe/quantify PFO morphological features of clinically important PFO9s and relate our findings to shunt size. Methods We examined 3D TOE images of the atrial septum in consecutive patients with otherwise structurally normal hearts undergoing TOE assessment prior to PFO closure. Datasets were obtained using Philips iE33 and then analysed offline (QLab 3DQ, Philips Healthcare). Linear measurements recorded included: tunnel dimensions, fossa ovalis dimensions, and septal sway. Other characteristics assessed included left atrial opening morphology, right atrial anatomy and presence of an atrial septal aneurysm (>10 mm septal excursion from the midline). Morphological features were categorised as either simple or complex. Complex defects were those with one or more of the following: long tunnel length (>8 mm), multiple openings into the left atrium, atrial septal aneurysm, hybrid defect (additional small defect(s) in fossa ovalis), thick secundum septum (>8 mm), Eustachian ridge (ER), Eustachian valve or Chiari network. The size of right-to-left shunt either at rest or with Valslava manoeuvre was assessed by transthoracic contrast echocardiography and graded according to the number of bubbles seen in a single still frame in the left atrium as: small-to-moderate ( 50 bubbles). Results 3D datasets were available for analysis in 73 patients. Mean age of the population was 47±12.7 years. and 62% were male. The most frequent indication for PFO closure was stroke (48%). Linear dimensions recorded from 3D datasets are presented (table). Left atrial opening was categorised as high, opening onto the left atrial roof, in 18% of patients and presence of multiple left atrial openings was observed in 8%. Atrial septal aneurysm was present in 12%. A prominent Eustachean ridge was seen in 78% patients and was positioned high on fossa ovalis in 32% cases. The majority of patients (88%) had one or more complex morphological features. There was no clear association observed between shunt size and size of PFO. Conclusions 3D transoesophageal echocardiography allows a practical, qualitative, and quantitative assessment of PFO morphology. In our cohort of patients a variety of complex anatomical features are demonstrated. Shunt size did not correlate with PFO dimensions.

Transcatheter device closure of atrial septal defects in patients above age 60

Background Closure of an atrial septal defect (ASD) mostly causes reverse remodelling of the right heart, a decrease in pulmonary artery pressures (PASP), and improves functional capacity. However, abolition of the left-to-right shunt may be unfavourable in older patients. This study aimed at evaluating patients older than 60 years who underwent ASD closure.Methods and results Forty-seven patients (mean age 69 ± 5 years, 19.1% male) with ASD type secundum who underwent transcatheter device closure were included. Echocardiographic data before and after closure were obtained. Follow-up data until the last follow-up visit were retrieved. Age-, gender- and BMI-matched controls were selected.Before closure, ASD patients had a higher right ventricular end-diastolic diameter (RVEDD), right (RA) and left atrial (LA) dimensions, and PASP when compared to controls. After closure, RVEDD and PASP decreased whereas LVEDD and E/A-ratio increased. RVEDD, PASP, LA dimensions, left ventricular ejection fraction (LVEF) and E/A-ratio were higher than controls. NYHA class improved signifi cantly after ASD-closure. During a median follow-up time of 3.3 years, 6 patients died and 16 were hospitalized because of cardiac events.Conclusion Device closure in the elderly improved functional capacity, with a decrease, but not a normalization of RV dimensions and PASP, and an increase in LV dimensions, EF and mitral E/A-ratio. Atrial arrhythmias and coronary ischaemic events are common in this population.

Occurrence and clinical significance of in-hospital acquired thrombocytopenia in patients undergoing transcatheter device closure for congenital heart defect

BackgroundAcquired thrombocytopenia in patients treated by percutaneous coronary intervention is associated with hemorrhagic complications and prolonged in-hospital stay. This study sought to study the prevalence of thrombocytopenia in patients who underwent transcatheter device closure for congenital heart defect (CHD) and its relationship with clinical consequences. Methods and results299 patients with CHD who underwent successful transcatheter closure were prospectively studied. Thrombocytopenia developed in 135 (45.2%) patients; n=100 (33.4%) mild (100-150×109/L), n=25 (8.4%) moderate (50-100×109/L), and n=10 (3.3%) severe (P<50×109/L), respectively. From baseline, platelet counts tended to decrease on the 1st day after the procedure and reached a nadir level on the 3rd day, then gradually recovered to baseline values on the 9th day. By multivariate analysis, severe thrombocytopenia developed more frequently in patients who had larger device size (OR 2.755, P=0.000), and residue shunt (OR 2.069, P=0.009). Patients who developed thrombocytopenia, compared with those who did not, had higher in-hospital rates of hemorrhagic complications (11.9% vs. 3.0%, P<0.003), greater requirement for elevating platelet medical treatment or platelet transfusion (4.4% vs. 0, P=0.021), longer hospital stay (median 14 vs. 9days, P<0.001). Severe thrombocytopenia was an independent predictor of hemorrhagic complications (hazard ratio 8.083, 95% CI 4.021–16.237, P=0.001). Compare with patients without thrombocytopenia, bleeding events were markedly increased (11.9% vs. 3.0%, P=0.003) in those with thrombocytopenia during hospitalization. ConclusionThe size of occluder and other risk factors are independently associated with thrombocytopenia. Thrombocytopenia provides prognostic information, related to increased bleeding events.

Intracardiac echocardiography imaging for device closure of atrial septal defects—A single-center experience

IntroductionDevice closure of interatrial communications has become a well-established technique to treat left-to-right shunt associated with atrial septal defect (ASD) and to prevent paradoxical embolism in patients with patent foramen ovale (PFO). Guidance by transesophageal echocardiography (TEE) is the standard practice but intracardiac echocardiography (ICE) is a feasible and safe alternative for monitoring these procedures. ObjectivesTo report our experience in the percutaneous closure of ASD and PFO guided by ICE. MethodsWe retrospectively reviewed all patients with ASD or PFO who underwent percutaneous closure guided exclusively by ICE between January 2008 and December 2010. All patients were followed clinically with regular echocardiographic evaluation (at discharge, one month, three, six and twelve months) to exclude residual shunt and device malposition. ResultsA total of 127 patients (mean age 46.6±12.2years; 71% female) underwent transcatheter device closure of ASD or PFO during the study period. Device deployment with ICE monitoring was 100% successful, with a low rate of complications and eliminating the need for additional imaging techniques. ConclusionsICE provides anatomical detail of ASD/PFO and cardiac structures, facilitating congenital cardiac interventional procedures. It eliminates the major drawbacks associated with TEE and enables the interventional cardiologist to control all aspects of the procedure without relying on additional echocardiographic support.

Encerramento percutâneo de defeitos do septo interauricular guiado por ecocardiograma intracardíaco − A experiência de um centro

IntroductionDevice closure of interatrial communications has become a well-established technique to treat left-to-right shunt associated with atrial septal defect (ASD) and to prevent paradoxical embolism in patients with patent foramen ovale (PFO). Guidance by transesophageal echocardiography (TEE) is the standard practice but intracardiac echocardiography (ICE) is a feasible and safe alternative for monitoring these procedures. ObjectivesTo report our experience in the percutaneous closure of ASD and PFO guided by ICE. MethodsWe retrospectively reviewed all patients with ASD or PFO who underwent percutaneous closure guided exclusively by ICE between January 2008 and December 2010. All patients were followed clinically with regular echocardiographic evaluation (at discharge, one month, three, six and twelve months) to exclude residual shunt and device malposition. ResultsA total of 127 patients (mean age 46.6±12.2 years; 71% female) underwent transcatheter device closure of ASD or PFO during the study period. Device deployment with ICE monitoring was 100% successful, with a low rate of complications and eliminating the need for additional imaging techniques. ConclusionsICE provides anatomical detail of ASD/PFO and cardiac structures, facilitating congenital cardiac interventional procedures. It eliminates the major drawbacks associated with TEE and enables the interventional cardiologist to control all aspects of the procedure without relying on additional echocardiographic support.

Skuteczne zamknięcie bardzo dużego ubytku w przegrodzie międzyprzedsionkowej typu II za pomocą urządzenia Occlutech Figulla®

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Tasal A, Bacaksiz A, Erdogan E, Sonmez O. Case reportSuccessful closure of a very large secundum atrial septal defect with the Occlutech Figulla® device. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej. 2012;8(4):347-350. doi:10.5114/pwki.2012.31918. APA Tasal, A., Bacaksiz, A., Erdogan, E., & Sonmez, O. (2012). Case reportSuccessful closure of a very large secundum atrial septal defect with the Occlutech Figulla® device. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej, 8(4), 347-350. https://doi.org/10.5114/pwki.2012.31918 Chicago Tasal, Abdurrahman, Ahmet Bacaksiz, Ercan Erdogan, and Osman Sonmez. 2012. "Case reportSuccessful closure of a very large secundum atrial septal defect with the Occlutech Figulla® device". Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej 8 (4): 347-350. doi:10.5114/pwki.2012.31918. Harvard Tasal, A., Bacaksiz, A., Erdogan, E., and Sonmez, O. (2012). Case reportSuccessful closure of a very large secundum atrial septal defect with the Occlutech Figulla® device. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej, 8(4), pp.347-350. https://doi.org/10.5114/pwki.2012.31918 MLA Tasal, Abdurrahman et al. "Case reportSuccessful closure of a very large secundum atrial septal defect with the Occlutech Figulla® device." Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej, vol. 8, no. 4, 2012, pp. 347-350. doi:10.5114/pwki.2012.31918. Vancouver Tasal A, Bacaksiz A, Erdogan E, Sonmez O. Case reportSuccessful closure of a very large secundum atrial septal defect with the Occlutech Figulla® device. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej. 2012;8(4):347-350. doi:10.5114/pwki.2012.31918.

Intracardiac echocardiography-guided device closure of atrial septal defects: our initial experience

Although intracardiac echocardiography (ICE) has long been used for various cardiologic interventions, its utilization has been quite limited in Turkey. We assessed our experience with the use of ICE during transcatheter closure of secundum atrial septal defects (ASD). Fourteen patients (8 females, 6 males; mean age 34 years; range 15 to 62 years) underwent transcatheter device closure of ASD with ICE guidance. Before the procedure, 13 patients were examined by transesophageal echocardiography (TEE). Intracardiac echocardiography was used to evaluate the interatrial septum, defect size, the relationship of the septal occluder with neighboring structures before its release, and residual shunts after device release. Using short- and long-axis ICE images, the anteroposterior and superoinferior rims of the ASD, coronary sinus, and pulmonary vein openings were successfully visualized in all the patients. Defect diameters measured by ICE were closely correlated with those measured by TEE (97%) and balloon sizing (95%). The defects were closed successfully in 13 patients; the procedure was terminated in one patient due to the prolapse of both discs into the left atrium. There was no procedural complication. One patient experienced gastrointestinal hemorrhage that required blood transfusion two days after the procedure. No residual shunts were observed on follow-up transthoracic echocardiographic examinations one and six months after the procedure. Having high image quality and color Doppler features, ICE is quite functional in determining defect size, position of the septal occluder and its relationship with neighboring structures; thus, it is a reliable alternative to TEE which is used routinely in transcatheter closure of ASDs.

Three-dimensional imaging of the atrial septum and patent foramen ovale anatomy: defining the morphological phenotypes of patent foramen ovale

Patent foramen ovale (PFO) is known to occur with greater prevalence in those with cryptogenic stroke. These observations support the role of a PFO as a channel for paradoxical embolism and a mechanism for cerebral ischaemic events. Transcatheter closure of PFO may be indicated in this setting. A prerequisite of procedural success is achieving complete closure of the shunt. Studies have shown a varying degree of successful shunt closure. Residual shunts are usually the result of a mismatch between the device shape and PFO anatomy. In this article, we review the features of PFO and their surrounding structures as seen by three-dimensional transoesophageal echocardiography in patients undergoing transcatheter closure and relate these to the variations in morphology on anatomical specimens for a better appreciation of their suitability for closure devices. The salient features of the anatomical variations seen in adults undergoing transcatheter device closure have been summarized and used to produce a practical pre-procedural checklist.

Not too old to be closed….

Not too old to be closed….

Transcatheter device closure of ruptured sinus of Valsalva: Immediate results and short term follow up

This is a retrospective, observational study comprising of eight patients with isolated rupture of the sinus of Valsalva (RSOV) who underwent transcatheter device closure. The mean age of presentation was 32.8 ± 10.0 years. New York Heart Association (NYHA) class at the time of presentation was II (six patients) and III (two patients). The RSOVs were all closed using a patent ductus arteriosus device. The mean procedural time was 42.3 ± 5.4 minutes, while the fluoroscopic time was 24.5 ± 6.9 minutes. All had complete closure of the shunt. The average hospital stay was 2.9 ± 1.1 days. There were no major complications. The patients were followed up for a mean of 11.3 ± 4.1 months. At the time of the last follow up all the patients were in NYHA class I. We conclude that in the short term, transcatheter closure of isolated RSOV is a viable alternative to surgical repair.

Characteristics of the Interatrial Communication in Patients Undergoing Transcatheter Device Closure of Atrial Septal Defects for Cryptogenic Stroke

Prior studies suggest that patent foramen ovale (PFO) diameter >4 mm is associated with a high probability of cryptogenic ischemic stroke (CIS). We evaluated all patients diagnosed with CIS who underwent closure of intra-atrial communication (IAC) using the Amplatzer atrial septal defect (ASD) occluder in our institution between August 1997 and March 2004. For each IAC, echocardiographic diameters and balloon-stretched diameters were recorded. Stretchability index was calculated as the ratio of stretched diameter to unstretched diameter. Fifty-six patients met the inclusion criteria for this study. There was an inverse logarithmic relationship between unstretched IAC diameter and stretchability index. For the 28 smaller defects, the median IAC diameter was 2 mm, and median stretchability index was 5.58 (range 2.6-15). For the 28 larger defects, median diameter was 6 mm, and median stretchability index was 2.38 (range 1.05-5). The difference in stretchability index between the two groups was significant (P < 0.0001). Our data bring into question the concept that the diameter of the defect would singularly predict the probability of stroke.

Intracardiac Echocardiographic Guidance During Transcatheter Device Closure of Atrial Septal Defect and Patent Foramen Ovale

To describe our experience with intracardiac echocardiographic (ICE) guidance during transcatheter device closure of atrial septal defect (ASD) and patent foramen ovale (PFO) and to describe a detailed stepwise approach for performing ICE examinations. We reviewed the ICE results of all patients who underwent transcatheter device closure of ASD/PFO at the Mayo Clinic in Rochester, Minn, between October 2000 and November 2002. Conscious sedation was used, and all ICE studies were performed using a diagnostic ultrasound catheter. Ninety-four patients (47 male; median age, 51 years [range, 17-81 years]) underwent ICE during transcatheter device closure of ASD/PFO. Total procedure time was 128 minutes (range, 27-320 minutes). ICE identified a previously unrecognized anatomical diagnosis in 32 of 94 patients. An additional ASD or PFO was found in 16 patients; a redundant atrial septum or an atrial septal aneurysm was found in 12 patients. There were few ICE complications (4%): 3 patients developed atrial fibrillation, and 1 developed supraventricular tachycardia; of these 4, 2 resolved spontaneously, and 2 required cardioversion with no recurrence. ICE provides anatomical detail of ASD/PFO and cardiac structures facilitating congenital cardiac interventional procedures. ICE eliminates major drawbacks related to the use of transesophageal echocardiographic guidance for transcatheter device closure of ASD/PFO, specifically problems related to airway management. Finally, ICE gives the interventional cardiologist the ability to control all aspects of imaging without relying on additional echocardiographic support. We believe that ICE should be considered the preferred imaging technique for guidance of transcatheter device closure of ASD/PFO in adults and larger pediatric patients.

Transcatheter Amplatzer Device Closure of Atrial Septal Defect and Patent Foramen Ovale in Patients With Presumed Paradoxical Embolism

To review our experience with, and profile the safety and efficacy of, the Amplatzer PFO (patent foramen ovale) occluder (APO) and Amplatzer septal occluder (ASO) used to close PFO and/or atrial septal defect (ASD) in patients with paradoxical embolism (PE). Between April 1998 and November 2002, 103 patients at the Mayo Clinic in Rochester, Minn, and Scottsdale, Ariz, mean age 52.4 years, with presumed PE (transient ischemic attack [n=22], stroke [n=77], or peripheral emboli [n=4]) underwent transcatheter device closure of PFO (n=81), ASD (n=12), and ASD/PFO (n=10) with 106 devices (APO [n=22] or ASO [n=84]). All devices deployed successfully, and no patients died. Procedural complications included atrial fibrillation (n=2), vessel injury (n=3), profound sinus node dysfunction (n=1), and device embolization with successful retrieval (n=1). At 3 months, 7 of 95 monitored patients had trivial residual shunt; at 12 months, 2 of 28 monitored patients had trivial residual shunt. Three patients had recurrent events--2 transient ischemic attacks and 1 retinal artery occlusion--at a mean +/- SD follow-up of 8.3 +/- 8.1 months (range, 1-34 months). None of these 3 patients had residual shunt or evidence of intracardiac thrombus. The average annual recurrence of all events was 3.6% at 23 months. The overall mean +/- SD freedom from recurrence of all events was 98.9% +/- 1.2% and 83.8% +/- 10.2% at 12 and 29 months of follow-up, respectively. Transcatheter device closure of PFO and/or ASD with use of APO/ASO in patients with presumed PE is effective and safe. Recurrent events may occur in the absence of a residual shunt.