Device closure of asd is suitable for secondum asd with a good rim all around for holding the two discs together. Case 10 years old boy underwent successful transcather device closure of secundum asd in august 2011 with a 22 mm amplatzer septal occluder device. Echocardiography guidance of atrial septal defect closure. Dec 12, 2014 asd device closure usually is a procedure of choice for asd secondom when the patient has good rims and files full the criteria for that 810 rhythm disturbance is very rare complication of this procedure 7, and usual common in small children who has large defects need large device for suitable closure. The technique used by the authors is to be commended for its simplicity. A novel threedimensional echocardiographic method for device. Double disk umbrella helex coils asd vsd amplatzer figulla ceraflex.
Transesophageal echocardiography for device closure of. Atrial septal defect asd american heart association. Consensually agreed indications and imaging guidance for closure. Device closure of secundum atrial septal defects and the risk of.
Atrial septal defect closure device radiology case. An atrial septal defect asd is, due to its frequency, the fourth most common congenital heart disease, appearing in 3. Analysis of the therapeutic effect of transesophageal. Atrial septal defect transcatheter closure discharge care. The following is the supplementary data related to this article. A guide wire is introduced through the femoral vein into the inferior vena cava and further through the right atrium across the asd. Transcatheter and intraoperative device closure of atrial. Transesophageal echocardiography for device closure of atrial. Complications related to the procedure were minimal 16 patients. To close the hole, the doctor will place a special device in your childs heart by catheterization. Transcatheter closure of atrial septal defect with. This type of asd is technically challenging for device closure and requires specialized imaging and deployment techniques 5. Jul 25, 2017 nonsurgical closure postdevice closure followup. Aga medicalthe amplatzer septal occluder and delivery system instructions for use pdf.
Complications in atrial septal defect device closure pdf. Minimally invasive surgery vs device closure for atrial. Our knowledge of the complication rates of asd and pfo. Minimally invasive atrial septal defect asd closure. The patients are administered aspirin 5 mgkgday for 6 months. A guide wire is introduced through the femoral vein into the inferior vena cava and further through the right atrium. The secret to a successful procedure includes meticulous planning and execution. From january 2018 to april 2018, 87 patients with an isolated asd who had. Complications of transcatheter atrial septal defect closure. An atrial septal defect is a hole between the two upper chambers of the heart.
Patent foramen ovale closure for stroke prevention and other. You may need to take antibiotics before dental or other procedures for up to 6 months after your asd closure. Minimally invasive cardiac surgery mics has been found safe and effective for asd closure with comparable mortalitymorbidity and superior cosmetic results compared to conventional median sternotomy. Rhythm disturbance is one of these uncommon complications 57. We examined the efficacy and safety of the amplatzer, a new selfcentering. Though closure of osasd with device is now a standard fda approved mode of treatment, there are few wellknown immediate, intermediate, and longterm complications. Ucsf offers a minimally invasive approaches for atrial septal defect asd closure. Percutaneous catheter closure of atrial septal defect. Atrial septal defect asd device transcatheter closure.
Closure of atrial septal defects with the amplatzer occlusion. The operation is performed using a small 46 cm incision through the small space between the ribs. Anaesthesia for percutaneous closure of atrial septal defects. Device closure of atrial septal defect request pdf. Though closure of os asd with device is now a standard fda approved mode of treatment, there are few wellknown immediate, intermediate, and longterm complications. Proper device size selection is a crucial step for successful asd device closure. The current gold standard for device size selection is balloon sizing. Transcatheter closure of atrial septal defects asds has become an alternative to open surgical procedures.
Selection of device size for atrial septal defect closure. We read with interest the article by liang and colleagues 1 regarding surgical closure of the secundum atrial septal defect asd with a device. Percutaneous closure of atrial defects asd has evolved as the treatment of choice for the majority of defects and patent oval foramens. Descriptions of percutaneous device closure of a secundum asd have been extensively reported in other articles and will therefore not be detailed in. The biostar biodegradable implant avoids many issues associated with devices containing substantial amounts of metal. Accurate imaging of the anatomic features of the asd is critical for case selection. Transcatheter device closure of atrial septal defects. Transcatheter closure of atrial septal defect with amplatzer. Surgical treatment is safe and efficient, but entails the complications associated with thoracotomy, as well as the. Transcatheter closure of secundum atrial septal defect asd with amplatzer device is an alternative procedure to surgical repair, with some limitations. The benefits are significant including less post operative pain at the incision site, a shorter hospital stay, a faster return to normal activities, and an. Device embolization is a potential complication of every attempted asd closure, and the causative factors can be undersized device, inadequate or floppy rim, operatorrelated technical issues such as malposition during the pushpull maneuver, or excessive tension on delivery cable during device deployment. All of these tested to date are considered to be acceptable for patients referred for mr examinations based on findings for deflection angles, torque, mrirelated heating and the intended in vivo uses of these specific devices.
The secret to a successful procedure includes meticulous. Transcatheter device closure of secundum asd is a maturing technology, now more. After asd closure, both tee and transthoracic echocardiography showed optimal device position without residual shunt or mitral valve impingement. Transcatheter device closure for secundum asd is the treatment of choice when the patient has a good rims 1,2 and it has an excellent shore and long term results with minimal complications 3,4. Pdf transcatheter device closure of atrial septal defect.
Toe for percutaneous closure of septal defect asd, vsd. The adverse prognosis of untreated asd diagnosed in childhood is well studied and percutaneous device closure of these asds has evolved to become the standard of care in both pediatric and young adult populations. Contraindications to device closure asd closure procedures. Even though surgery is the gold standard, percutaneous device closure is gaining popularity because of the short learning curve, cosmetic advantage and relative safety. Get an operative photograph of the defect and re analyse whether device would have been possible in retrospect. Pediatric cardiac interventions atrial septal defect.
Most common congenital heart disease in both adults and children prevalence. Transcatheter device closure of atrial septal defects jacc. Only few cases of device closure of atrial septal defect in dextrocardia with situs inversus totalis has been reported previously. In this paper, we describe the stepbystep procedure for transcatheter closure of an atrial septal defect using the. The closure i evaluation of the starflex closure system in patients with a stroke andor transient ischemic attack due to presumed paradoxical embolism through a patent foramen ovale trial was the first multicenter, open. Atrial septal defect asd is a common congenital cardiac anomaly. Atrial septal defect sizing and transcatheter closure fulltext. Reviewed was a consecutive series of 10 asd occlusions in a. Transcatheter closure of multiple atrial septal defects with. Closure of atrial septal defect with amplatzer device. The aim of this study was to assess the initial and midterm results of the treatment of asd with amplatzer septal occluder in children and adolescents. By using the mesh device called the amplatzer, pediatric cardiologists are now able to close the hole in a hospital procedure room known as the catheterization laboratory. If the asd is large, it can be closed with openheart surgery, or by cardiac catheterization using a device inserted into the opening to plug it.
Factors that decide suitability for transcatheter closure include size of the defect and presence of adequate tissue rims around the defect 32. Device closure of atrial septal defect asd and patent foramen ovale pfo are both associated with short and longterm complications. Transcatheter closure of multiple atrial septal defects. Jul 19, 2019 transcatheter and intraoperative device closure for atrial septal defect asd are widely applied to reduce the incision size and the potential for injury during cardiopulmonary bypass cpb in conventional surgical repair. The presence of an asd or pfo can result in gas embolization to the arterial circulation and the development of neurological symptoms, known as decompression illness. Factors that decide suitability for transcatheter closure include size of the defect and presence of adequate tissue rims around the defect. When compared to surgery, it provides a less invasive approach with quicker recovery and reduced physical and psychological impact.
However, transcatheter closure without cardiopulmonary bypass can be performed even in such highrisk patients, and several clinical studies have demonstrated the efficacy and safety of asd closure 33, 34. Post procedure echo studies check for a residual atrial shunt and unobstructed flow of pulmonary veins, coronary sinus, and venae cavae and proper function of the mitral and tricuspid valves. The catheter will be introduced into a leg vein at the groin and xray pictures angiograms performed to show the defect. Transesophageal echocardiography tee guidance for the closure procedure not only broadens the indications of interventional therapy for asds but also avoids radiation exposure. The amplatzer septal occluder aso has been approved since 2005 in japan, but there. Transcatheter closure of a secundum asd has been used for years with good results. The surgical technique now consists of approximating the edges of the defect in small. Methods sixtyeight infants underwent transthoracic device closure of an asd at union hospital, fujian medical university, fuzhou, china from january 2010 to january 2015.
The search for less invasive alternatives to surgery for closing secundum atrial septal defects asd has occupied cardiologists for decades. Transcatheter device closure of asd has come a long way since the first experimental closure in dogs by kings and mills in 1972. We compared the clinical data and followup results of percutaneous and intraoperative device closure for asd to evaluate the feasibility. Both of these types of asds can be easily closed using the transcatheter technique 4. Ostium secundum atrial septal defect asd is a common congenital heart defect. Transcatheter device closure of asd has come a long way since. Echocardiography guidance of atrial septal defect closure transcatheter procedures offer less invasive approaches allowing rapid recovery and earlier hospital discharge. We have used this technique in 3 patients ourselves, and we were able to successful close the defect in 2 patients. Complications in atrial septal defect device closure. Pediatric cardiac interventions atrial septal defect asd. Surgicaldevice closure indicated see above discussion under management o chf present o defect not spontaneously closed by 24 years of age two treatment options surgical or device o choice depends on. No studies had been conducted to compare the safety and efficiency of these three treatments.
Current concept of transcatheter closure of atrial septal. Device oversizing may increase the risk of erosion. Transcatheter closure of atrial septal defect using amplatzer septal occluder. A biodegradable device biostar for atrial septal defect. Left atrial thrombus on atrial septal defect closure device as a source of cerebral emboli 3 years after implantation. Surgical closure of atrial septal defect asd has been the treatment of choice for decades, with excellent results, negligible mortality and limited morbidity. A novel threedimensional echocardiographic method for. Us8398658b2 device and procedure for minimally invasive. Transcatheter and intraoperative device closure and. Thus, closure of asd in patients with pulmonary hypertension was considered as a highrisk procedure, especially with surgical closure. Transcatheter closure of atrial septal defect journal of thoracic. Secundum atrial septal defect asd is a common congenital heart.
Always refer large defects and complex asds which are adjacent to aorta and av to a good surgeon. Surgical device closure indicated see above discussion under management o chf present o defect not spontaneously closed by 24 years of age two treatment options surgical or device o choice depends on. Pdf heart block after asd device closure researchgate. Transcatheter and intraoperative device closure and surgical. Jul 22, 2010 the inclusion criterion was a balloon stretched asd diameter of. Transcatheter and intraoperative device closure for atrial septal defect asd are widely applied to reduce the incision size and the potential for injury during cardiopulmonary bypass cpb in conventional surgical repair. Balloon sizing can be tedious, time consuming and increase fluoroscopy and procedure times as well as risk of complications. Pdf device closure of secundum asds and the risk of cardiac. A number of international guidelines have defined the role of echocardiography spanning diagnosis, detailed anatomical assessment, device sizing and selection, peri procedure guidance and post device surveillance. The patient described improvement of chest tightness and exercise intolerance one week after asd closure, and his condition remained stable during the 4month followup period. Asd device closure usually is a procedure of choice for asd. Erosion of amplatzer septal occluder device after closure of secundum atrial septal defects. Transthoracic echo tte is done to assess the superior, aortic and mitral rims.
Device closure is the firstline treatment for most atrial septal defects asds. None of the devices previously used for transcatheter closure of interatrial communications has gained wide acceptance. Review article percutaneous device closure of secundum. Your child is a possible candidate for this procedure, because there is considered to be a high likelihood of successful closure with this device. Sometimes, if the asd is an unusual position within the heart, or if there are other heart defects such as abnormal connections of the veins bringing blood from the lungs back to the heart pulmonary. Our goal was to compare percutaneous versus mics of asds. A number of international guidelines have defined the role of echocardiography spanning diagnosis, detailed anatomical assessment, device sizing and selection, peri procedure. Shortterm and midterm followup of transthoracic device.
The procedure of percutaneous asd closure required tee or intracardiac echocardiography ice. Atrial septal defect asd transcatheter closure is also called asd closure. In our patient the asd device was delivered using the standard technique from the right upper pulmonary vein without using any balloon or dilator assistance. Antibiotics help prevent a heart infection called bacterial endocarditis. Transcatheter and intraoperative device closures have been widely used in the treatment of secundum atrial septal defect asd. Background transcatheter device closure of secundum atrial septal defects asd using amplatzer septal occluder aso is usually well tolerated with favourable outcome with analgesics. However, for young infants with asd, device closure remains controversial, and such treatment features limited data. Complications of asd closure surgery versusdevices device n442 surgery n154 p arrhythmia needing rx 2 0 0. Transcatheter device closure of atrial septal defect in dextrocardia with situs inversus totalis. Review article percutaneous device closure of secundum atrial. King and mills demonstrated the feasibility of asd closure by using a device in 1974 2. Patent foramen ovale closure for stroke prevention and.
A surgical device for closure atrial septal defect asd with minimally invasive approach includes a head portion which is movable and includes a distal jaw that is distal relative to a person holding the surgical device, a guide rod which drives the distal jaw, and a plurality of first sutureguide channels attached to the distal jaw, and a body portion which is stationary and includes a. Paul, mn is a selfexpandable, doubledisc, occlusion device made of nitinol mesh, approved by the us food and drug administration in 2001 for percutaneous closure of secundum atrial septal defect asd. Pdf transcatheter device closure of atrial septal defect in. Closure of secundum atrial septal defects with the. Various pda, asd, vsd occluders and pfo closure devices have been evaluated at 3tesla see the list. Closure of atrial septal defects with the amplatzer. The most critical step in asd device closure lies before the procedure and. This study reports our clinical experience with transcatheter closure of secundum atrial septal defects asds in children, using the amplatzer, a new occlusion device. We reported a 4 years old boy that developed a first and second degree heart block few days after. We aimed to establish a simple and accurate method for device size selection using threedimensional. However, unlike earlier devices, the current generation is easier to deploy and retrieve.
We compared the clinical data and followup results of percutaneous and intraoperative device closure for asd to evaluate the feasibility, safety, and. If the hole is too big to close with the device or in the wrong position, the hole will be closed with surgery. The amplatzer, which is fda approved, is a twotiered, expanding device that closes the asd and are available in differentsizes. Problems in peroperative secundum atrial septal defect. Asd closure is indicated in the presence of a significant lefttoright shunt, defined by a significant right heart enlargement due to volume overload, regardless of symptoms 3,4. Heart block after asd device closure medcrave online. We aimed to establish a simple and accurate method for device size selection using threedimensional echocardiographic. Transcatheter device closure of asd has come a long way since the first experimental closure in. The purpose of this study was to outline the safety and feasibility of transthoracic device closure of an atrial septal defect asd with a domestic occluder in infants. The duration of the procedure will be about 12 hours.