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Shi D, Kang Y, Wang W, Liu R, Tang Q, Li Z, Jiang H, Ding J. Biodegradable polymeric occluder with controllable locking structure for closure of atrial septal defect via interventional treatment. Regen Biomater 2025; 12:rbaf016. [PMID: 40248504 PMCID: PMC12005900 DOI: 10.1093/rb/rbaf016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2025] [Revised: 02/24/2025] [Accepted: 03/17/2025] [Indexed: 04/19/2025] Open
Abstract
Atrial septal defect (ASD) is one of the major congenital heart diseases, and transcatheter closure with a cardiac occluder is a modern method to treat ASD with the advantage of mini-invasiveness over traditional surgical closure. While current occlusion devices are mainly made of non-degradable nitinol with superelasticity, the permanent existence of a metal in vivo may trigger potential complications and especially has an adverse effect on the heart development for children. However, it is challenging to invent a superelasticity-free occluder that can be delivered through a catheter but firmly locked after being opened at the target site; it is also much desired for research and development to quickly assess the feasibility of a superelasticity-free occluder in vitro. Herein, a biodegradable poly(L-lactide) (PLLA) occluder composed of a braided PLLA frame as the skeleton and a nonwoven PLLA fabric as the flow-blocking membrane is developed, and a controllable locking structure is designed to enable firm closure for a device even without superelasticity. We also suggest and justify a series of in vitro methods to assess the efficacy of the biodegradable occluder, and the results confirm the reliability of locking, water-blocking, mechanical strength and degradability. It is found that the PLLA fabric with moderate fiber density is optimal for surface endothelialization. We also carry out biological assessments; significant endothelialization and alleviated inflammation response are observed after 6 months of subcutaneous implantation into rabbits. The porcine model illustrates that the biodegradable polymeric occluder can be successfully implanted into the atrial septum via transcatheter intervention; the follow-ups have confirmed the safety and efficacy of this biodegradable polymeric occluder with the controllable locking structure.
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Affiliation(s)
- Daokun Shi
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Fudan University, Shanghai 200438, China
| | - Yahong Kang
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Fudan University, Shanghai 200438, China
- Shanghai Key Laboratory of Interventional Medical Devices and Equipment, Shanghai MicroPort Medical Group Co, Ltd, Shanghai 201203, China
- AccuPath Group Co., Ltd, Jiaxing 314000, China
| | - Weijie Wang
- Shanghai Key Laboratory of Interventional Medical Devices and Equipment, Shanghai MicroPort Medical Group Co, Ltd, Shanghai 201203, China
- AccuPath Group Co., Ltd, Jiaxing 314000, China
| | - Ruili Liu
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Fudan University, Shanghai 200438, China
| | - Quansheng Tang
- Shanghai Key Laboratory of Interventional Medical Devices and Equipment, Shanghai MicroPort Medical Group Co, Ltd, Shanghai 201203, China
- AccuPath Group Co., Ltd, Jiaxing 314000, China
| | - Zhaomin Li
- Shanghai Key Laboratory of Interventional Medical Devices and Equipment, Shanghai MicroPort Medical Group Co, Ltd, Shanghai 201203, China
- AccuPath Group Co., Ltd, Jiaxing 314000, China
| | - Hongyan Jiang
- Shanghai Key Laboratory of Interventional Medical Devices and Equipment, Shanghai MicroPort Medical Group Co, Ltd, Shanghai 201203, China
| | - Jiandong Ding
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Fudan University, Shanghai 200438, China
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Giordano M, Scognamiglio G, Gaio G, Marzullo R, Palma M, Barracano R, Fusco F, Borrelli N, Sperlongano S, Cimmino G, Russo MG, Sarubbi B. The Role of Trans-Oesophageal Echocardiography in the Interventional Cardiology of Adult Congenital Heart Diseases. J Clin Med 2025; 14:1049. [PMID: 40004580 PMCID: PMC11857008 DOI: 10.3390/jcm14041049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2024] [Revised: 01/11/2025] [Accepted: 02/01/2025] [Indexed: 02/27/2025] Open
Abstract
Advances in interventional cardiology have significantly broadened the range of congenital heart diseases (CHDs) amenable to trans-catheter interventions. Trans-oesophageal echocardiography (TOE) plays a pivotal role as a procedural guide in several percutaneous treatments. Enhanced imaging modalities and technological innovations in echocardiography have refined the precision and applicability of these approaches. This review explores the role, impact, and advancements of TOE in trans-catheter treatments for adult CHDs, including both common procedures (e.g., atrial septal defect closure, ventricular septal defect closure) and less frequent interventions (e.g., Mustard/Senning baffle leak closure, Fontan conduit fenestration, ruptured sinus of Valsalva embolization).
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Affiliation(s)
- Mario Giordano
- Paediatric Cardiology Division, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, AORN Ospedali dei Colli, 80131 Naples, Italy; (G.G.); (R.M.); (M.G.R.)
| | - Giancarlo Scognamiglio
- Adult Congenital Heart Disease Division, Monaldi Hospital, AORN Ospedali dei Colli, 80131 Naples, Italy; (G.S.); (M.P.); (R.B.); (F.F.); (N.B.); (B.S.)
| | - Gianpiero Gaio
- Paediatric Cardiology Division, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, AORN Ospedali dei Colli, 80131 Naples, Italy; (G.G.); (R.M.); (M.G.R.)
| | - Raffaella Marzullo
- Paediatric Cardiology Division, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, AORN Ospedali dei Colli, 80131 Naples, Italy; (G.G.); (R.M.); (M.G.R.)
| | - Michela Palma
- Adult Congenital Heart Disease Division, Monaldi Hospital, AORN Ospedali dei Colli, 80131 Naples, Italy; (G.S.); (M.P.); (R.B.); (F.F.); (N.B.); (B.S.)
| | - Rosaria Barracano
- Adult Congenital Heart Disease Division, Monaldi Hospital, AORN Ospedali dei Colli, 80131 Naples, Italy; (G.S.); (M.P.); (R.B.); (F.F.); (N.B.); (B.S.)
| | - Flavia Fusco
- Adult Congenital Heart Disease Division, Monaldi Hospital, AORN Ospedali dei Colli, 80131 Naples, Italy; (G.S.); (M.P.); (R.B.); (F.F.); (N.B.); (B.S.)
| | - Nunzia Borrelli
- Adult Congenital Heart Disease Division, Monaldi Hospital, AORN Ospedali dei Colli, 80131 Naples, Italy; (G.S.); (M.P.); (R.B.); (F.F.); (N.B.); (B.S.)
| | - Simona Sperlongano
- Cardiology Division, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (S.S.); (G.C.)
| | - Giovanni Cimmino
- Cardiology Division, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (S.S.); (G.C.)
| | - Maria Giovanna Russo
- Paediatric Cardiology Division, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, AORN Ospedali dei Colli, 80131 Naples, Italy; (G.G.); (R.M.); (M.G.R.)
| | - Berardo Sarubbi
- Adult Congenital Heart Disease Division, Monaldi Hospital, AORN Ospedali dei Colli, 80131 Naples, Italy; (G.S.); (M.P.); (R.B.); (F.F.); (N.B.); (B.S.)
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Cepas-Guillén P, Flores-Umanzor E, Horlick E, Aboulhosn J, Benson L, Freixa X, Houde C, Rodés-Cabau J. Interventions for adult congenital heart disease. Nat Rev Cardiol 2025:10.1038/s41569-025-01118-1. [PMID: 39833478 DOI: 10.1038/s41569-025-01118-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/06/2025] [Indexed: 01/22/2025]
Abstract
Advances in imaging diagnostics, surgical techniques and transcatheter interventions for paediatric patients with severe congenital heart disease (CHD) have substantially reduced mortality, thereby extending the lifespan of these individuals and increasing the number of adults with complex CHD. Transcatheter interventions have emerged as an alternative to traditional open-heart surgery to mitigate congenital defects. The evolution of techniques, the introduction of new devices and the growing experience of operators have enabled the treatment of patients with progressively more complex conditions. The general cardiology community might be less aware of contemporary interventions for adult CHD, their clinical indications and associated outcomes than interventional cardiologists and congenital heart specialists. In this Review, we provide a comprehensive evaluation of the available transcatheter interventions for adult patients with CHD.
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Affiliation(s)
- Pedro Cepas-Guillén
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Eduardo Flores-Umanzor
- Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Eric Horlick
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Jamil Aboulhosn
- UCLA Adult Congenital Heart Disease Center, University of California Los Angeles, Los Angeles, CA, USA
| | - Lee Benson
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
- Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Xavier Freixa
- Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Christine Houde
- Centre Hospitalier Universitaire de Quebec, Centre Mère-Enfant Soleil, Quebec, Quebec, Canada
| | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
- Centre Hospitalier Universitaire de Quebec, Centre Mère-Enfant Soleil, Quebec, Quebec, Canada.
- Department of Research and Innovation, Clínic Barcelona, Barcelona, Spain.
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Liu A, Duan X, Wang K, Fan H, Li L, Yan C. Evaluation of endothelialization of an occluder device with cardiac computed tomography and assessment of the pathological validation. PLoS One 2025; 20:e0316638. [PMID: 39792933 PMCID: PMC11723591 DOI: 10.1371/journal.pone.0316638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2024] [Accepted: 12/14/2024] [Indexed: 01/12/2025] Open
Abstract
BACKGROUND Assessing the endothelialization of occlusive devices noninvasively remains a challenge. Cardiac computed tomography angiography (CTA) can be employed to evaluate device endothelialization based on contrast uptake within the occluder. OBJECTIVE This study examined device endothelialization using cardiac CTA and investigated the pathological associations. METHODS From January 2010 to May 2022, we retrospectively analyzed 25 patients (age: 50.00 [17.00, 52.00] years; 12 Female) who underwent surgical device removal within 1 month after cardiac CTA examination (implantation period: 29.00[0.50, 108.00] months). The contrast uptake within the occluder was determined using cardiac CTA. The relationship between contrast uptake within the occluder and the endothelialization status with pathology was analyzed. RESULTS Contrast uptake within the occluder was identified in 76.00% of patients. Pathological examination confirmed incomplete coverage of fibrotic tissue and superposed neoendothelium on the surface of all devices exhibiting contrast uptake. This included no coverage in 47.37% of patients and partial coverage in the remaining cases. On the surface of all devices without contrast uptake, a complete range of fibrotic tissue was observed, with an incomplete range of superposed neoendothelium in 66.67% of patients. On the surface of devices with an implantation period > 6 months, 71.43% of patients had incomplete coverage of fibrotic tissue and superposed neoendothelium on the left disc, 42.86% of patients occurred the same on the right disc. CONCLUSIONS Contrast uptake within the occluder indicated incomplete endothelialization, as confirmed by pathological validation. Late endothelialization of the device occurs frequently, and further research is required to investigate related mechanisms.
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Affiliation(s)
- Ang Liu
- Department of Structural Heart Disease, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xuejing Duan
- Department of Pathology, Cardiovascular Institute and Fuwai Hospital, Beijing, China
| | - Ke Wang
- Department of Structural Heart Disease, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongguang Fan
- Department of Surgery, Cardiovascular Institute and Fuwai Hospital, Beijing, China
| | - Li Li
- Department of Pathology, Cardiovascular Institute and Fuwai Hospital, Beijing, China
| | - Chaowu Yan
- Department of Structural Heart Disease, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Kang JH, Wu HY, Long WJ. Effects of atrial septal defects on the cardiac conduction system. World J Clin Cases 2024; 12:6770-6774. [PMID: 39687649 PMCID: PMC11525910 DOI: 10.12998/wjcc.v12.i35.6770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Revised: 08/29/2024] [Accepted: 09/12/2024] [Indexed: 10/24/2024] Open
Abstract
The case report presented in this edition by Mu et al. The report presents a case of atrial septal defect (ASD) associated with electrocardiographic changes, noting that the crochetage sign resolved after Selective His Bundle Pacing (S-HBP) without requiring surgical closure. The mechanisms behind the appearance and resolution of the crochetage sign remain unclear. The authors observed the disappearance of the crochetage sign post-S-HBP, suggesting a possible correlation between these specific R waves and the cardiac conduction system. This editorial aims to explore various types of ASD and their relationship with the cardiac conduction system, highlighting the diagnostic significance of the crochetage sign in ASD.
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Affiliation(s)
- Jin-Hua Kang
- Department of Geriatric, Shenzhen Hospital of Shanghai University of Chinese Medicine, Shenzhen 518000, Guangdong Province, China
| | - Hong-Yan Wu
- Department of Geriatric, Shenzhen Hospital of Shanghai University of Chinese Medicine, Shenzhen 518000, Guangdong Province, China
| | - Wen-Jie Long
- Department of Geriatrics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China
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Bellofatto Piazza N, Ben Yedder M, Delmas M, El Nakadi B. An Amplatzer Septal Occluder Trapped in the Left Ventricular Outflow Tract: A Case Report. Cureus 2024; 16:e73244. [PMID: 39650882 PMCID: PMC11625022 DOI: 10.7759/cureus.73244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2024] [Indexed: 12/11/2024] Open
Abstract
We present the case of a 32-year-old female patient who presented at the cardiology consultation with shortness of breath and palpitations. A large inter-atrial defect was identified through echocardiography, prompting the cardiology team to perform a percutaneous closure procedure using the Amplatzer Atrial Septal Occluder (Abbott Laboratories, Abbott Park, IL, USA). Seven weeks later, a migration of the prosthetic device into the left ventricular outflow tract was diagnosed. A surgical procedure was immediately performed to explant the device and repair the defect. This case highlights the importance of vigilant monitoring in patients undergoing percutaneous closure procedures to detect severe complications such as device migration at an earlier stage.
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Affiliation(s)
| | | | - Marie Delmas
- Anesthesiology, HUmani - CHU Charleroi-Chimay, Lodelinsart, BEL
| | - Badih El Nakadi
- Cardiothoracic Surgery, HUmani - CHU Charleroi-Chimay, Lodelinsart, BEL
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Zhang Z, Ding J. Successful occluder removal and reocclusion of an atrial septal defect after occluder immigration to aortic arch: a case report. J Cardiothorac Surg 2024; 19:575. [PMID: 39354534 PMCID: PMC11443626 DOI: 10.1186/s13019-024-03107-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 09/15/2024] [Indexed: 10/03/2024] Open
Abstract
BACKGROUND Atrial septal defect (ASD) is a common congenital heart disease, and currently, transcatheter intervention is the most common clinical treatment method. However, certain complications still occur during the percutaneous process, among which occluder loss and displacement are rare but serious complication. Although the probability of occluder loss and displacement is low, severe cases can endanger life. CASE PRESENTATION Here, we report the case of a patient who underwent ASD closure in which the occluder fell off into the aortic arch, the detached occluder was recovered through catheter intervention, and the patient underwent ASD closure again. CONCLUSIONS In this case report, we highlight that although percutaneous closure of an ASD is regarded as a routine procedure, clinicians should remember the possibility of complications, especially occluder loss and displacement. Therefore, interventionist should carefully evaluate the situation before intervention closure, establish standardized interventional treatment procedures, and provide timely treatment follow-up.
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Affiliation(s)
- Zaiqiang Zhang
- Department of Cardiology, The First College of Clinical Medical Sciences, China Three Gorges University, Yichang, 443000, Hubei Province, P. R. China
- Institute of Cardiovascular Diseases, Three Gorges University, Yichang, 443000, Hubei Province, China
- Hubei Key Laboratory of Ischemic Cardiovascular Disease, Yichang, China
- Hubei Provincial Clinical Research Center for Ischemic Cardiovascular Disease, Yichang, China
| | - Jiawang Ding
- Department of Cardiology, The First College of Clinical Medical Sciences, China Three Gorges University, Yichang, 443000, Hubei Province, P. R. China.
- Institute of Cardiovascular Diseases, Three Gorges University, Yichang, 443000, Hubei Province, China.
- Hubei Key Laboratory of Ischemic Cardiovascular Disease, Yichang, China.
- Hubei Provincial Clinical Research Center for Ischemic Cardiovascular Disease, Yichang, China.
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Flores-Umanzor E, Osten M, DeKoven J, Benson L, Abrahamyan L, Horlick E. Gore atrial septal occluder devices as an option in patients with nickel allergy. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:697-699. [PMID: 38428581 DOI: 10.1016/j.rec.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 02/13/2024] [Indexed: 03/03/2024]
Affiliation(s)
- Eduardo Flores-Umanzor
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Canada; Servicio de Cardiología, Instituto Cardiovascular, Hospital Clínic, Universidad de Barcelona, Barcelona, Spain
| | - Mark Osten
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Canada
| | - Joel DeKoven
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada; Division of Occupational Medicine, Department of Medicine, St Michael's site, Unity Health, University of Toronto, Toronto, Canada
| | - Lee Benson
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Canada; The Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Lusine Abrahamyan
- Toronto General Hospital Research Institute, University Health Network, Toronto, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Eric Horlick
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Canada.
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Song Q, He Y, Xia J, Gao J, Chen C. A case of cardiac tamponade occurred 1 day after transcatheter atrial septal defect closure. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024; 52:792-793. [PMID: 38629932 DOI: 10.1002/jcu.23697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 04/03/2024] [Accepted: 04/06/2024] [Indexed: 07/11/2024]
Abstract
Transesophageal echocardiography (TEE) shows pericardial effusion and a gap between the left atrium and the aortic sinus by atrial septal defect occluder.
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Affiliation(s)
- Qian Song
- Department of Ultrasound, Wuhan Asia Heart Hospital Affiliated to Wuhan University of Science and Technology, Wuhan Clinical Medical Research Center of Cardiovascular Imaging, Wuhan, China
- School of Medicine, Wuhan University of Science and Technology, Wuhan, China
| | - Yafeng He
- Department of Ultrasound, Wuhan Asia Heart Hospital Affiliated to Wuhan University of Science and Technology, Wuhan Clinical Medical Research Center of Cardiovascular Imaging, Wuhan, China
- School of Medicine, Wuhan University of Science and Technology, Wuhan, China
| | - Juan Xia
- Department of Ultrasound, Wuhan Asia Heart Hospital Affiliated to Wuhan University of Science and Technology, Wuhan Clinical Medical Research Center of Cardiovascular Imaging, Wuhan, China
- School of Medicine, Wuhan University of Science and Technology, Wuhan, China
| | - Junyi Gao
- Department of Ultrasound, Wuhan Asia Heart Hospital Affiliated to Wuhan University of Science and Technology, Wuhan Clinical Medical Research Center of Cardiovascular Imaging, Wuhan, China
- School of Medicine, Wuhan University of Science and Technology, Wuhan, China
| | - Chen Chen
- Department of Ultrasound, Wuhan Asia Heart Hospital Affiliated to Wuhan University of Science and Technology, Wuhan Clinical Medical Research Center of Cardiovascular Imaging, Wuhan, China
- School of Medicine, Wuhan University of Science and Technology, Wuhan, China
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Jiang H, Ran H, Xu P, Hu J, Xiahou Y, Zhou X, Liu M, Yuan X. Quantitative evaluation of right ventricular myocardial function changes in patients with atrial septal defect before and after occlusion by noninvasive right ventricular pressure-strain loop. Echocardiography 2024; 41:e15868. [PMID: 38924593 DOI: 10.1111/echo.15868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 05/28/2024] [Accepted: 06/09/2024] [Indexed: 06/28/2024] Open
Abstract
OBJECTIVE The noninvasive right ventricular pressure-strain loop (PSL) represents a novel method for the quantitative assessment of right ventricular myocardial function. Given that atrial septal defect (ASD) is a prevalent congenital heart anomaly associated with right ventricular volume overload, this study aimed to quantitatively assess the myocardial function of the right ventricle in ASD patients pre- and post-occlusion by noninvasive right ventricular PSL. METHODS This study included 36 patients diagnosed with secundum ASD group and 30 healthy adults (control group). We compared conventional right ventricular echocardiographic parameters, right ventricular strain, and myocardial work in the ASD group before occlusion, two days post-occlusion, and three months post-occlusion, with those in the control group. RESULTS Prior to and two days following occlusion, the ASD group exhibited higher right ventricular global work index (RVGWI), right ventricular global wasted work (RVGWW), and right ventricular global constructive work (RVGCW) compared to the control group (P < .05). Within the ASD group, post-occlusion, RVGWI, RVGCW, and RVGWW values were significantly reduced compared to pre-occlusion values (P < .001). Furthermore, RVGWI and RVGCW showed a significant decrease three months after occlusion compared to two days post-occlusion (P < .05). Multivariate regression analysis identified ASD diameter and pulmonary artery systolic pressure (PASP) as independent predictors of RVGWI (β = .405, P < .001; β = 2.307, P = .037) and RVGCW(β = .350, P<.001; β = 1.967, P = .023). CONCLUSIONS The noninvasive right ventricular PSL effectively demonstrates the alterations in right ventricular myocardial function in ASD patients, pre- and post-occlusion. The metrics of right ventricular myocardial work (RVMW) offer a novel indicator for evaluating right ventricular myocardial function in these patients. Moreover, ASD diameter and PASP emerge as independent determinants of RVGWI and RVGCW.
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Affiliation(s)
- Huanhuan Jiang
- Department of Ultrasound Medicine, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Hongling Ran
- Department of Ultrasound Medicine, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Pan Xu
- Department of Ultrasound Medicine, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Jia Hu
- Department of Ultrasound Medicine, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Yu Xiahou
- Department of Ultrasound Medicine, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Xiling Zhou
- Department of Ultrasound Medicine, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Ming Liu
- Jiangxi Medical Center for Critical Public Health Events, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Xinchun Yuan
- Department of Ultrasound Medicine, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
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11
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Hayama H, Makino K, Yazaki Y, Hara H. Upsizing of GORE® Cardioform ASD Occluder for Atrial Septal Defect With Atrial Septal Aneurysm. Cureus 2024; 16:e63281. [PMID: 39070307 PMCID: PMC11283311 DOI: 10.7759/cureus.63281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2024] [Indexed: 07/30/2024] Open
Abstract
Atrial septal defects (ASDs) often present with multiple foramina, including a patent foramen ovale (PFO) and atrial septal aneurysms (ASAs). Transcatheter device closure of an ASD may require additional supportive techniques in complex cases. Here, we report a case of a secundum ASD complicated by an ASA and a PFO in a man in his 50s. A GORE® Cardioform ASD Occluder (GCA) device of the optimal size for balloon sizing was implanted. However, edge leakage occurred from the front of the device because of a large, moving ASA. Implantation of a two-size-up GCA device successfully closed the ASD under controlled ASA movement.
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Affiliation(s)
- Hiromasa Hayama
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, JPN
| | - Kenji Makino
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, JPN
| | - Yoshiyuki Yazaki
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, JPN
| | - Hidehiko Hara
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, JPN
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Villasana-Gomez G, Toussie D, Kaufman B, Stojanovska J, Moore WH, Azour L, Traube L, Ko JP. Chest Intensive Care Unit Imaging: Pearls and Pitfalls. Clin Chest Med 2024; 45:213-235. [PMID: 38816084 DOI: 10.1016/j.ccm.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Imaging plays a major role in the care of the intensive care unit (ICU) patients. An understanding of the monitoring devices is essential for the interpretation of imaging studies. An awareness of their expected locations aids in identifying complications in a timely manner. This review describes the imaging of ICU monitoring and support catheters, tubes, and pulmonary and cardiac devices, some more commonly encountered and others that have been introduced into clinical patient care more recently. Special focus will be placed on chest radiography and potential pitfalls encountered.
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Affiliation(s)
- Geraldine Villasana-Gomez
- Department of Radiology at New York University Grossman School of Medicine, 660 1st Avenue, 3rd Floor, New York, NY 10016, USA.
| | - Danielle Toussie
- Department of Radiology at New York University Grossman School of Medicine, 660 1st Avenue, 3rd Floor, New York, NY 10016, USA
| | - Brian Kaufman
- Division of Pulmonary, Department of Medicine, Critical Care and Sleep Medicine at New York University Grossman School of Medicine, 6000 Royal Court, Unit 6007, North Hills, NY 11040, USA
| | - Jadranka Stojanovska
- Department of Radiology at New York University Grossman School of Medicine, 660 1st Avenue, 3rd Floor, New York, NY 10016, USA
| | - William H Moore
- Department of Radiology at New York University Grossman School of Medicine, 660 1st Avenue, 3rd Floor, New York, NY 10016, USA
| | - Lea Azour
- Department of Radiological Sciences at University of California Los Angeles David Geffen School of Medicine, 757 Westwood Plaza, Los Angeles, CA 90095, USA
| | - Leah Traube
- Department of Radiology and Biomedical Imaging at Yale School of Medicine, 330 Cedar Street, New Haven, CT 06520, USA
| | - Jane P Ko
- Department of Radiology at New York University Grossman School of Medicine, 660 1st Avenue, 3rd Floor, New York, NY 10016, USA
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13
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Condos GJ, McCabe JM, Joffe DC, Sheu RD. Novel Transcatheter Approach to Treat Primum Atrial Septal Defects. CASE (PHILADELPHIA, PA.) 2024; 8:180-185. [PMID: 38524970 PMCID: PMC10954577 DOI: 10.1016/j.case.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
•Degenerative common AVC defect can mimic rheumatic MV stenosis.•Closure of primum ASD can be achieved percutaneously.•Live 3D multiplanar TEE is crucial for procedural guidance.
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Affiliation(s)
- Gregory J. Condos
- Division of Cardiology, University of Washington, Seattle, Washington
| | - James M. McCabe
- Division of Cardiology, University of Washington, Seattle, Washington
| | - Denise C. Joffe
- Department of Anesthesiology and Pain Medicine, Seattle Children’s Hospital, Seattle, Washington
| | - Richard D. Sheu
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
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14
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Castaldi B, Santoro G, Di Candia A, Marchese P, Cantinotti M, Pizzuto A, Scalera S, Garibaldi S, Fumanelli J, Sirico D, Di Salvo G. Impact of Gore Cardioform Atrial Septal Defect Occluder on Atrial and Ventricular Electromechanics in a Pediatric Population. Am J Cardiol 2024; 211:259-267. [PMID: 37984644 DOI: 10.1016/j.amjcard.2023.11.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/17/2023] [Accepted: 11/11/2023] [Indexed: 11/22/2023]
Abstract
Transcatheter closure is the first-line treatment for ostium secundum atrial septal defect (ASD). The GORE Cardioform ASD Occluder (GCA) is potentially innovative compared with other self-centering devices. This study aimed to compare the mechanic changes in atrial and ventricular properties before and after GCA implantation. All consecutive patients aged <18 years who underwent isolated ASD closure with a single GCA device were enrolled from 2 centers. Echocardiography and electrocardiogram were performed the day before, 24 hours, and 6 months after ASD closure. Between January 2020 and February 2021, 70 pediatric patients with ASD were enrolled. The mean age was 7.9 ± 3.9 years, and the mean defect diameter was 17.1 ± 4.5 mm. Global longitudinal strain analysis showed no change in left ventricular longitudinal function (T0 -23.2 ± 2.8%, 24 hours -23.0 ± 2.8%, and 6 months -23.5 ± 2.7%). An early and transient reduction in longitudinal strain was detected in the basal septal segments (T0 -19.8 ± 3.3%, 24 hours -18.7 ± 3.6%, and 6 months -19.2 ± 3.4%), left atrium (T0 41.4 ± 15.3%, 29.2 ± 1.4%, and 39.0 ± 12.9%), and right ventricle (-27.6 ± 5.4%, -23.6 ± 5.0%, and -27.3 ± 4.6) 24 hours after closure, secondary to hemodynamic changes because of flow redirection after ASD closure. Six months after the procedure, only the left atrium showed a mild global longitudinal strain reduction because of the presence of the device within the septum. GCA device had no impact on global and regional ventricular function. Atrial mechanics were preserved, except for the segments covered by the device. This is the first device demonstrating no impact on the left and right ventricular mechanics, irrespective of the device size.
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Affiliation(s)
- Biagio Castaldi
- Pediatric Cardiology Unit, Department of Women's and Children's Health, Univesity of Padua, Italy.
| | - Giuseppe Santoro
- Pediatric Cardiology Unit, Fondazione Toscana Gabriele Monasterio, Massa, Italy
| | - Angela Di Candia
- Pediatric Cardiology Unit, Department of Women's and Children's Health, Univesity of Padua, Italy
| | - Pietro Marchese
- Pediatric Cardiology Unit, Fondazione Toscana Gabriele Monasterio, Massa, Italy
| | | | - Alessandra Pizzuto
- Pediatric Cardiology Unit, Fondazione Toscana Gabriele Monasterio, Massa, Italy
| | - Silvia Scalera
- Pediatric Cardiology Unit, Fondazione Toscana Gabriele Monasterio, Massa, Italy
| | - Silvia Garibaldi
- Pediatric Cardiology Unit, Fondazione Toscana Gabriele Monasterio, Massa, Italy
| | - Jennifer Fumanelli
- Pediatric Cardiology Unit, Department of Women's and Children's Health, Univesity of Padua, Italy
| | - Domenico Sirico
- Pediatric Cardiology Unit, Department of Women's and Children's Health, Univesity of Padua, Italy
| | - Giovanni Di Salvo
- Pediatric Cardiology Unit, Department of Women's and Children's Health, Univesity of Padua, Italy
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15
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Conde I, Salomé N, Sousa A, Quina C. Unveiling an Unusual Cause of Cardiac Tamponade. Cureus 2023; 15:e50984. [PMID: 38259365 PMCID: PMC10801674 DOI: 10.7759/cureus.50984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2023] [Indexed: 01/24/2024] Open
Abstract
This case presents a 48-year-old woman initially diagnosed with an ostium secundum atrial septal defect (ASD) at the age of 36. Twelve years post-intervention, she presented to the emergency department with cardiac tamponade. This case highlights the importance of maintaining prolonged follow-up for individuals undergoing percutaneous ASD closure, given the possibility of potentially fatal late complications of ASD occlusion devices.
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Affiliation(s)
- Inês Conde
- Cardiology, Hospital de Braga, Braga, PRT
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16
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Yucel E, Patel NK, Crousillat DR, Baliyan V, Jassar AS, Palacios I, Inglessis I, Smith RN. Case 32-2023: A 62-Year-Old Woman with Recurrent Hemorrhagic Pericardial Effusion. N Engl J Med 2023; 389:1511-1520. [PMID: 37851878 DOI: 10.1056/nejmcpc2115845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Affiliation(s)
- Evin Yucel
- From the Departments of Medicine (E.Y., N.K.P., D.R.C., I.P., I.I.), Radiology (V.B.), Surgery (A.S.J.), and Pathology (R.N.S.), Massachusetts General Hospital, and the Departments of Medicine (E.Y., N.K.P., D.R.C., I.P., I.I.), Radiology (V.B.), Surgery (A.S.J.), and Pathology (R.N.S.), Harvard Medical School - both in Boston
| | - Nilay K Patel
- From the Departments of Medicine (E.Y., N.K.P., D.R.C., I.P., I.I.), Radiology (V.B.), Surgery (A.S.J.), and Pathology (R.N.S.), Massachusetts General Hospital, and the Departments of Medicine (E.Y., N.K.P., D.R.C., I.P., I.I.), Radiology (V.B.), Surgery (A.S.J.), and Pathology (R.N.S.), Harvard Medical School - both in Boston
| | - Daniela R Crousillat
- From the Departments of Medicine (E.Y., N.K.P., D.R.C., I.P., I.I.), Radiology (V.B.), Surgery (A.S.J.), and Pathology (R.N.S.), Massachusetts General Hospital, and the Departments of Medicine (E.Y., N.K.P., D.R.C., I.P., I.I.), Radiology (V.B.), Surgery (A.S.J.), and Pathology (R.N.S.), Harvard Medical School - both in Boston
| | - Vinit Baliyan
- From the Departments of Medicine (E.Y., N.K.P., D.R.C., I.P., I.I.), Radiology (V.B.), Surgery (A.S.J.), and Pathology (R.N.S.), Massachusetts General Hospital, and the Departments of Medicine (E.Y., N.K.P., D.R.C., I.P., I.I.), Radiology (V.B.), Surgery (A.S.J.), and Pathology (R.N.S.), Harvard Medical School - both in Boston
| | - Arminder S Jassar
- From the Departments of Medicine (E.Y., N.K.P., D.R.C., I.P., I.I.), Radiology (V.B.), Surgery (A.S.J.), and Pathology (R.N.S.), Massachusetts General Hospital, and the Departments of Medicine (E.Y., N.K.P., D.R.C., I.P., I.I.), Radiology (V.B.), Surgery (A.S.J.), and Pathology (R.N.S.), Harvard Medical School - both in Boston
| | - Igor Palacios
- From the Departments of Medicine (E.Y., N.K.P., D.R.C., I.P., I.I.), Radiology (V.B.), Surgery (A.S.J.), and Pathology (R.N.S.), Massachusetts General Hospital, and the Departments of Medicine (E.Y., N.K.P., D.R.C., I.P., I.I.), Radiology (V.B.), Surgery (A.S.J.), and Pathology (R.N.S.), Harvard Medical School - both in Boston
| | - Ignacio Inglessis
- From the Departments of Medicine (E.Y., N.K.P., D.R.C., I.P., I.I.), Radiology (V.B.), Surgery (A.S.J.), and Pathology (R.N.S.), Massachusetts General Hospital, and the Departments of Medicine (E.Y., N.K.P., D.R.C., I.P., I.I.), Radiology (V.B.), Surgery (A.S.J.), and Pathology (R.N.S.), Harvard Medical School - both in Boston
| | - R Neal Smith
- From the Departments of Medicine (E.Y., N.K.P., D.R.C., I.P., I.I.), Radiology (V.B.), Surgery (A.S.J.), and Pathology (R.N.S.), Massachusetts General Hospital, and the Departments of Medicine (E.Y., N.K.P., D.R.C., I.P., I.I.), Radiology (V.B.), Surgery (A.S.J.), and Pathology (R.N.S.), Harvard Medical School - both in Boston
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17
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Jiang Y, Luo F, Bu H. Percutaneous closure of simple congenital heart diseases under echocardiographic guidance. Eur J Med Res 2023; 28:408. [PMID: 37805534 PMCID: PMC10559656 DOI: 10.1186/s40001-023-01398-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 09/26/2023] [Indexed: 10/09/2023] Open
Abstract
Congenital heart disease (CHD), birth defect with the highest incidence rates worldwide, and is mainly characterized by the abnormal internal structure of the heart or/and the anatomical structure of great vessels. In the past few decades, CHD repair surgery through standard median sternotomy incision combined with cardiopulmonary bypass (CPB) technology has been considered the gold standard for surgical correction of heart and great vessels. With the promotion and clinical application of interventional catheterization technology, transcatheter closure of CHD under radioactive radiation has gradually been recognized and applied. However, its radiation exposure and potential complications related to arteriovenous vessels still face challenges. In recent years, an increasing number of surgeons have explored new surgical procedures, for the safe and effective treatment of CHD, as far as possible to reduce surgical trauma, avoid radiation exposure, and improve the cosmetic effect. Therefore, on the premise of satisfactory exposure or guidance, how to integrate ultrasound and percutaneous interventional technology remained the focus of the exploration. This mini-review highlights and summarizes the signs of progress of ultrasound intervention in the last decade that have proven the effectiveness and operability of a well-established procedure for percutaneous closure of congenital heart diseases under echocardiographic guidance only. We discuss potential diseases that will benefit from this emerging procedure based on this progress. Owing to the crucial advantages played by this strategy in the treatment of CHD, better understanding and promotion of this less exploited field may contribute to the development of therapeutics targeting CHD, improve medical utilization rate, promote the optimization of medical resources, and ultimately achieve precise and efficient medical treatment.
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Affiliation(s)
- Ying Jiang
- The Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
| | - Fanyan Luo
- The Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
| | - Haisong Bu
- The Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, People's Republic of China.
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18
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Fujii T, Sugiyama H, Kanazawa H, Hara H, Muneuchi J, Yazaki S. Transcatheter retrieval of atrial septal defect and patent ductus arteriosus occluder: a guidance for device retrieval based on comprehensive bench tests. Cardiol Young 2023; 33:1597-1605. [PMID: 36093848 DOI: 10.1017/s1047951122002864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The aim of this study is to establish a guidance for device retrieval based on comprehensive bench tests. BACKGROUND Device embolisation remains a major complication in transcatheter closure of atrial septal defect and patent ductus arteriosus. Although percutaneous retrieval is feasible in the majority of cases, surgical retrieval may be required in complicated circumstances. However, the methods of transcatheter device retrieval have not been completely established. METHODS Bench tests of device retrieval were performed to verify the appropriate retrieval method according to device type/size. The devices used for testing were Amplatzer Septal Occluder (Abbott, Chicago, IL, United States of America), Figulla Flex II (Occlutech GmbH, Jena, Germany), Amplatzer Duct Occluder-I (Abbott), Amplatzer Duct Occluder-II (Abbott), and Amplatzer Vascular Plug-II (Abbott). The retrieval equipment constituted diagnostic catheters (multipurpose catheter and right Judkins catheter, 4-Fr or 5-Fr, Gadelius Medical, Tokyo, Japan), delivery sheath and cables for each device, Amplatz goose neck snares (Medtronic, Minneapolis, MN, United States of America), OSYPKA CATCHER (Osypka ag, Rheinfelden-Herten, Germany), and OSYPKA LASSOS (Osypka). We investigated the retrieval equipment and sheath sizes required for a successful retrieval procedure for variously sized devices. RESULTS For patent ductus arteriosus devices, the type of snare and the snaring position are considered important. For atrial septal defect devices, simple snare capture or a double-snare technique with a sufficiently large sheath is effective. Special care should be taken when using the OSYPKA CATCHER for device retrieval. CONCLUSIONS The results of this study may assist in the selection of both capture devices and a retrieval sheath or a catheter for complete retrieval.
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Affiliation(s)
- Takanari Fujii
- Pediatric Heart Disease and Adult Congenital Heart Disease Center, Showa University Hospital, Tokyo, Japan
| | - Hisashi Sugiyama
- Pediatric Cardiology, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Hideaki Kanazawa
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Hidehiko Hara
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Jun Muneuchi
- Department of Pediatrics, Japan Community Healthcare Organization, Kyushu Hospital, Fukuoka, Japan
| | - Satoshi Yazaki
- Department of Pediatric Cardiology, Sakakibara Heart Institute, Fuchu, Tokyo, Japan
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19
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Abu-Tair T, Martin C, Wiethoff CM, Kampmann C. The Prevalence of and Predisposing Factors for Late Atrial Arrhythmias after Transcatheter Closure of Secundum Atrial Septal Defects in Children. J Clin Med 2023; 12:jcm12113717. [PMID: 37297912 DOI: 10.3390/jcm12113717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/22/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND A 24 h Holter study in children after transcatheter secundum ASD (ASD II) closure was conducted to detect the prevalence of defects and/or device-related late atrial arrhythmias (LAAs). ASD II closure with an Amplatzer septal occluder (ASO) is an established procedure. Little is known about LAAs after device implantation. METHODS The eligible participants were children who had undergone ASO implantation, with a follow-up of ≥5 years, as well as one pre- and at least one post-procedural Holter ECG. RESULTS In total, 161 patients (mean age: 6.2 ± 4.3 years), with a mean follow-up of 12.9 ± 3.1 years (range 5-19), were included. A median of four Holter ECGs per patient were available. LAAs occurred before intervention in four patients (2.5%), and it was peri-interventional in four patients (2.5%), sustained in three patients (1.9%), and developed in three patients (1.9%). In patients with pre- and peri-interventional LAAs, the Qp/Qs ratio was higher (6.4 ± 3.9 vs. non-AA: 2.0 ± 1.1 (p = 0.002)) and the IAS/ASO ratio was lower (1.18 ± 0.27 vs. non-AA: 1.7 ± 0.4 (p < 0.001)). The patients with LAAs differed from those without LAAs in their Qp/Qs (6.8 ± 3.5 vs. 2.0 ± 1.3; p < 0.0001) and IAS/ASO ratios (1.14 ± 0.19 vs. 1.73 ± 0.45; p < 0.001). The patients with LAAs had a Qp/Qs ratio ≥2.94:1, and those who developed LAAs had an IAS/ASO ratio <1.15. CONCLUSIONS LAAs occurred in 1.9% of patients and were sustained in another 1.9% of patients but persisted in those with large shunt defects and large occluders in relation to the atrial septal length. The predisposing factors for LAAs after ASD closure were a high Qp/Qs ratio, pre-existing atrial arrhythmias, and a low IAS/ASO ratio.
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Affiliation(s)
- Tariq Abu-Tair
- Department of Pediatric Cardiology, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Claudia Martin
- Department of Congenital Heart Disease, Centre for Diseases in Childhood and Adolescence, University Medicine Mainz, 55131 Mainz, Germany
| | - Christiane M Wiethoff
- Department of Congenital Heart Disease, Centre for Diseases in Childhood and Adolescence, University Medicine Mainz, 55131 Mainz, Germany
| | - Christoph Kampmann
- Department of Congenital Heart Disease, Centre for Diseases in Childhood and Adolescence, University Medicine Mainz, 55131 Mainz, Germany
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20
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Garre S, Gadhinglajkar S, Sreedhar R, Krishnamoorthy K, Pillai VV. Atrial septal defect occluder device embolization: Experience of a tertiary care cardiac center. Ann Card Anaesth 2023; 26:149-154. [PMID: 37706378 PMCID: PMC10284467 DOI: 10.4103/aca.aca_28_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 07/10/2022] [Accepted: 07/31/2022] [Indexed: 09/15/2023] Open
Abstract
Background Percutaneous device closure of atrial septal defect (ASD) has become an increasingly popular procedure as it offers several advantages. However, it is associated with infrequent, but life-threatening complications such as device embolization. Objective To analyze the risk factors, common sites of embolization, associated complications, timing of embolization, and the treatment executed. Settings and Design A retrospective study was performed at a tertiary referral center for cardiac services. Material and Methods Pre-procedure, intra-procedure, and post-procedure data of patients whose ASD device embolized was collected retrospectively and analyzed for risk factors, common sites of embolization, associated complications, timing of embolization, and the treatment executed. Results: Thirty devices were embolized, out of which 13 were retrieved percutaneously in the Catheter laboratory, whereas 17 patients underwent surgery. Fourteen patients had an unfavorable septal morphology for device closure. Ten devices were embolized in the catheter laboratory, five in the intensive care unit, and two in the ward. The devices were embolized to almost all chambers of the heart and great vessels. One patient had an inferior vena cava rim tear while attempting percutaneous retrieval. One patient required a short period of total circulatory arrest (TCA) for retrieval of the device from ascending aorta, while another required a lateral position for retrieval from descending aorta. One patient required re-exploration for bleeding, while another had an air embolism and succumbed. Conclusions Once embolization occurs, the risks associated increase manifold. Most of the surgical extractions are uneventful; however, there could be certain complications that may need repair of valvular apparatus, the institution of TCA, or the need for the lateral position. Air embolization though very rare can occur which could be fatal.
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Affiliation(s)
- Sandeep Garre
- Department of Anaesthesiology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
| | - Shrinivas Gadhinglajkar
- Department of Cardiothoracic and Vascular Anaesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Rupa Sreedhar
- Department of Cardiothoracic and Vascular Anaesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - K.M Krishnamoorthy
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Vivek V. Pillai
- Department of Cardiothoracic and Vascular Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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21
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Ramaraju H, Massarella D, Wong C, Verga AS, Kish EC, Bocks ML, Hollister SJ. Percutaneous delivery and degradation of a shape memory elastomer poly(glycerol dodecanedioate) in porcine pulmonary arteries. Biomaterials 2023; 293:121950. [PMID: 36580715 DOI: 10.1016/j.biomaterials.2022.121950] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 11/23/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022]
Abstract
Shape memory biodegradable elastomers are an emergent class of biomaterials well-suited for percutaneous cardiovascular repair requiring nonlinear elastic materials with facile handling. We have previously developed a chemically crosslinked shape memory elastomer, poly (glycerol dodecanedioate) (PGD), exhibiting tunable transition temperatures around body temperature (34-38 °C), exhibiting nonlinear elastic properties approximating cardiac tissues, and favorable degradation rates in vitro. Degree of tissue coverage, degradation and consequent changes in polymer thermomechanical properties, and inflammatory response in preclinical animal models are unknown material attributes required for translating this material into cardiovascular devices. This study investigates changes in the polymer structure, tissue coverage, endothelialization, and inflammation of percutaneously implanted PGD patches (20 mm × 9 mm x 0.5 mm) into the branch pulmonary arteries of Yorkshire pigs for three months. After three months in vivo, 5/8 samples exhibited (100%) tissue coverage, 2/8 samples exhibited 85-95% tissue coverage, and 1/8 samples exhibited limited (<20%) tissue coverage with mild-moderate inflammation. PGD explants showed a (60-70%) volume loss and (25-30%) mass loss, and a reduction in polymer crosslinks. Lumenal and mural surfaces and the cross-section of the explant demonstrated evidence of degradation. This study validates PGD as an appropriate cardiovascular engineering material due to its propensity for rapid tissue coverage and uneventful inflammatory response in a preclinical animal model, establishing a precedent for consideration in cardiovascular repair applications.
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Affiliation(s)
- Harsha Ramaraju
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology Atlanta, GA 30312, USA.
| | - Danielle Massarella
- UH Rainbow Babies & Children's Hospital, Department of Pediatrics, Division of Pediatric, Cardiology, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Courtney Wong
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology Atlanta, GA 30312, USA
| | - Adam S Verga
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology Atlanta, GA 30312, USA
| | - Emily C Kish
- UH Rainbow Babies & Children's Hospital, Department of Pediatrics, Division of Pediatric, Cardiology, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Martin L Bocks
- UH Rainbow Babies & Children's Hospital, Department of Pediatrics, Division of Pediatric, Cardiology, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Scott J Hollister
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology Atlanta, GA 30312, USA.
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22
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Contreras AE, Ledesma F, Peirone AR, Juaneda E, Defago V, Cuestas E. Sufficient versus deficient rims during percutaneous closure of ostium secundum type atrial septal defect: A systematic review and meta-analysis. Indian Heart J 2023; 75:145-152. [PMID: 36736460 PMCID: PMC10123416 DOI: 10.1016/j.ihj.2023.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 12/24/2022] [Accepted: 01/29/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The aim of this meta-analysis was to compare the efficacy and adverse events of percutaneous occlusion among patients with sufficient and deficient rims. METHODS A systematic review of all articles published in the Pubmed, MEDLINE and Google Scholar databases was performed. Odds ratio (OR) and 95% CI were used as a measure of effect of the combination of studies. I2 with 95% CI was estimated to assess study heterogeneity. For the meta-analysis, a random effects model was used. RESULTS The systematic search identified ten studies which included 4355 patients; 2661 of those had sufficient rim and the remaining 1694 patients showed some rim deficiency. Implant failure rate was 4.13% CI 95% 3.53-4.72%. Compared to frequency of failures in the group with a deficient rim (5.43% CI 95% 4.35-6.50%), implant failure in patients with a sufficient rim was significantly lower (3.30% CI 95% 2.62-3.97%), OR 2.27 CI 1.34-3.83 (p 0.002). The combined adverse events were 5.19% CI 95% 4.22-6.35% vs 2.7% CI 95% 2.08-3.31% in the deficient vs sufficient rim groups respectively (OR 2.21 CI 0.93-5.29; p 0.07). Implant failures and adverse events were more frequent in patients with posterior inferior rim deficiency. CONCLUSION Patients presenting a posteroinferior rim deficiency are associated to both, an increased incidence of closure failure and a combined adverse events occurrence. More studies on posterior rim deficiency are necessary to ensure the feasibility and safety of the percutaneous approach.
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Affiliation(s)
- Alejandro E Contreras
- Department of Cardiology, Hospital Privado Universitario de Córdoba/Instituto Universitario de Ciencias Biomédicas de Córdoba, Córdoba, Argentina.
| | - Facundo Ledesma
- Department of Pediatrics, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Alejandro R Peirone
- Department of Pediatric Cardiology, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Ernesto Juaneda
- Department of Pediatric Cardiology, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Victor Defago
- Department of Pediatrics, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Eduardo Cuestas
- Department of Pediatrics, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
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Testa L, Popolo Rubbio A, Squillace M, Albano F, Cesario V, Casenghi M, Tarantini G, Pagnotta P, Ielasi A, Popusoi G, Paloscia L, Durante A, Maffeo D, Meucci F, Valentini G, Ussia GP, Cioffi P, Cortese B, Sangiorgi G, Contegiacomo G, Bedogni F. Patent foramen ovale occlusion with the Cocoon PFO Occluder. The PROS-IT collaborative project. Front Cardiovasc Med 2023; 9:1064026. [PMID: 36712245 PMCID: PMC9875285 DOI: 10.3389/fcvm.2022.1064026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 12/20/2022] [Indexed: 01/12/2023] Open
Abstract
Background The Cocoon patent foramen ovale (PFO) Occluder is a new generation nitinol alloy double-disk device coated with nanoplatinum, likely useful in patients with nickel hypersensitivity. Early results and mid-term outcomes of this device in percutaneous PFO closure are missing. Aims To assess the preliminary efficacy and safety profile of PFO closure with Cocoon device in an Italian multi-center registry. Methods This is a prospective registry of 189 consecutive adult patients treated with the Cocoon PFO Occluder at 15 Italian centers from May 2017 till May 2020. Patients were followed up for 2 years. Results Closure of the PFO with Cocoon Occluder was carried out successfully in all patients, with complete closure without residual shunt in 94.7% of the patients and minimal shunt in 5.3%. Except from a case of paroxysmal supraventricular tachycardia and a major vascular bleeding, no procedural and in-hospital device-related complications occurred. No patient developed cardiac erosions, allergic reactions to nickel, or any other major complications during the follow-up. During the follow-up period, 2 cases of new-onset atrial fibrillation occurred within thirty-day. Conclusions Percutaneous closure of PFO with Cocoon Occluder provided satisfactory procedural and mid-term clinical follow-up results in a real-world registry.
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Affiliation(s)
- Luca Testa
- Department of Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | | | - Mattia Squillace
- Department of Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | - Flavio Albano
- Department of Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | - Vincenzo Cesario
- Department of Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | - Matteo Casenghi
- Department of Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Paolo Pagnotta
- Cardio Center, Humanitas Research Hospital, Milan, Italy
| | - Alfonso Ielasi
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Grigore Popusoi
- Interventional Cardiology Service, Montevergine Clinic, Mercogliano, Italy
| | | | | | | | - Francesco Meucci
- Structural Interventional Cardiology, Careggi University Hospital, Florence, Italy
| | - Giuliano Valentini
- Cardiology Intensive Care Unit and Cath Lab, Ospedale Civile SS. Filippo e Nicola, L'Aquila, Italy
| | - Gian Paolo Ussia
- Unit of Cardiovascular Science, Department of Medicine, Campus Bio-Medico University, Rome, Italy
| | - Paolo Cioffi
- Department of Cardiology, Cardiac Cath Lab, Città di Alessandria Institute, Alessandria, Italy
| | | | - Giuseppe Sangiorgi
- Department of Biomedicine and Prevention, Tor Vergata University of Rome, Rome, Italy
| | - Gaetano Contegiacomo
- Department of Interventional Cardiology, Anthea Hospital, GVM Care and Research, Bari, Italy
| | - Francesco Bedogni
- Department of Cardiology, IRCCS Policlinico San Donato, Milan, Italy
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Sivakumar K, Jain G. Experience with the largest custom-made 48 mm fenestrated atrial septal occluder device and its 4-year follow-up. Ann Pediatr Cardiol 2023; 16:52-55. [PMID: 37287835 PMCID: PMC10243662 DOI: 10.4103/apc.apc_126_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/13/2022] [Accepted: 01/10/2023] [Indexed: 06/09/2023] Open
Abstract
Atrial septal defects (ASDs) measuring <38 mm are referred for transcatheter closure. Availability of larger devices up to 46 mm extended the inclusion criteria. An elderly hypertensive male with a 44 mm secundum ASD and coexistent sick sinus syndrome and atrioventricular (AV) nodal block presented with syncope. Balloon interrogation unmasked restrictive left ventricular (LV) physiology. After AV synchronous pacing, balloon-assisted deployment of a custom fenestrated 48 mm Figulla septal occluder (Occlutech Inc., Schaffhausen, Switzerland) prevented a rise of LV end-diastolic pressures beyond 12 mmHg. Echocardiogram and computed tomography after 4 years confirmed a patent fenestration and favorable remodeling. This report of the clinical use of the largest ASD device demonstrated the feasibility of closure of extremely large defects despite a restrictive LV.
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Affiliation(s)
- Kothandam Sivakumar
- Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, Tamil Nadu, India
| | - Gaurav Jain
- Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, Tamil Nadu, India
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Paediatrician's guide to post-operative care for biventricular CHD: a review. Cardiol Young 2022; 32:1721-1727. [PMID: 36165406 DOI: 10.1017/s1047951122002955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
IMPORTANCE Paediatricians play an integral role in the lifelong care of children with CHD, many of whom will undergo cardiac surgery. There is a paucity of literature for the paediatrician regarding the post-operative care of such patients. OBSERVATIONS The aim of this manuscript is to summarise essential principles and pertinent lesion-specific context for the care of patients who have undergone surgery or intervention resulting in a biventricular circulation. CONCLUSIONS AND RELEVANCE Familiarity with common issues following cardiac surgery or intervention, as well as key details regarding specific lesions and surgeries, will aid the paediatrician in providing optimal care for these patients.
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Albalawi M, Ahmad S, Nasef MA, Alotay A, Rajaa NA, Alsahari A, Saleem I, Abudlhamed JM. Mid-Term Outcome of Left Ventricle Reverse Remodeling After Atrial Septal Defect Closure: A Comparison Between Surgical and Device Groups. Pediatr Cardiol 2022; 43:1530-1538. [PMID: 35325281 DOI: 10.1007/s00246-022-02879-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/15/2022] [Indexed: 10/18/2022]
Abstract
Right ventricular (RV) volume overload occurs in patients with significant atrial septal defect (ASD II) shunts, which can impair left ventricle (LV) filling, thus decreasing LV indices. However, after ASD II closure, the left ventricle regains near normal dimensions. The purpose of this study was to compare the long-term outcomes of LV reverse remodeling between device and surgical closure. We retrospectively reviewed the echocardiographic data of 222 patients with isolated ASD II who underwent surgical (95 patients) or device closure (127 patients) between January 2012 and December 2017. The ASD II was significantly larger in the surgical closure group (p < 0.001.) leading to a higher degree of paradoxical interventricular septal (IVS) movement. In contrast, the LV volume was larger in the device closure group (p < 0.001). After a median follow-up period of 19.5 months, the maximum LV systolic and diastolic volumes were reached at 1 year in the device closure group and 2 years in the surgical closure group. IVS motion normalized in 91% of the device closure group compared to 57% of the surgical closure group (p = < 0.001). There was significant improvement in left ventricular indices and IVS motion after ASD II closure in both groups but more favorable in patients after device closure.
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Affiliation(s)
- Muflih Albalawi
- Division of Pediatrics, Department of Cardiology, King Salman Armed Forces Hospital, Tabuk, Saudi Arabia.
| | - Salim Ahmad
- Department of Pediatric Cardiology, Prince Sultan Cardiac Center (PSCC), Riyadh, Saudi Arabia
| | - Mohamed Al Nasef
- Department of Pediatric Cardiology, Prince Sultan Cardiac Center (PSCC), Riyadh, Saudi Arabia
| | - Abdulmajeed Alotay
- Department of Pediatric Cardiology, Prince Sultan Cardiac Center (PSCC), Riyadh, Saudi Arabia
| | - Najlaa Al Rajaa
- Department of Pediatric Cardiology, Prince Sultan Cardiac Center (PSCC), Riyadh, Saudi Arabia
| | - Atif Alsahari
- Department of Pediatric Cardiology, Prince Sultan Cardiac Center (PSCC), Riyadh, Saudi Arabia
| | - Irfan Saleem
- Department of Pediatric Cardiology, Prince Sultan Cardiac Center (PSCC), Riyadh, Saudi Arabia
| | - Jassim Mohamed Abudlhamed
- The King Abdul-Aziz Cardiac Center (KACC), King Abdul-Aziz Medical City (KAMC), Riyadh, Saudi Arabia
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Sandström C, Roos H, Henrikson O, Fagman E, Johnsson ÅA, Jeppsson A, Falkenberg M. Endovascular plugs to occlude proximal entries in chronic aortic dissection. Interact Cardiovasc Thorac Surg 2022; 35:6649737. [PMID: 35877082 PMCID: PMC9346262 DOI: 10.1093/icvts/ivac201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/16/2022] [Accepted: 07/22/2022] [Indexed: 11/21/2022] Open
Affiliation(s)
- Charlotte Sandström
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg , Gothenburg, Sweden
- Department of Radiology, Sahlgrenska University Hospital , Gothenburg, Sweden
| | - Håkan Roos
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg , Gothenburg, Sweden
- Department of Surgery, Division of Vascular Surgery, Ryhov Hospital , Jönköping, Sweden
| | - Olof Henrikson
- Department of Radiology, Sahlgrenska University Hospital , Gothenburg, Sweden
| | - Erika Fagman
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg , Gothenburg, Sweden
- Department of Radiology, Sahlgrenska University Hospital , Gothenburg, Sweden
| | - Åse A Johnsson
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg , Gothenburg, Sweden
- Department of Radiology, Sahlgrenska University Hospital , Gothenburg, Sweden
| | - Anders Jeppsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg , Gothenburg, Sweden
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital , Gothenburg, Sweden
| | - Mårten Falkenberg
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg , Gothenburg, Sweden
- Department of Radiology, Sahlgrenska University Hospital , Gothenburg, Sweden
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28
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Santoro G, Pizzuto A, Cuman M, Haxhiademi D, Marchese P, Franchi E, Marrone C, Pak V, Assanta N, Cantinotti M. Transcatheter closure of "Surgical" ostium secundum atrial septal defects with GORE® Cardioform ASD Occluder. J Card Surg 2022; 37:3200-3206. [PMID: 35900295 DOI: 10.1111/jocs.16786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/12/2022] [Accepted: 06/22/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the GORE® Cardioform ASD Occluder (GCA)(WL Gore & Associates) device for closure of ostium secundum atrial septal defects (ASDs) with predicted indication for surgical correction. BACKGROUND Closure of large ASD in small children by transcatheter approach is still challenging. This study evaluated the results of GCA in this subset of patients in a tertiary referral center. METHODS Between January 2020 and March 2022, 97 children underwent transcatheter ASD closure at our Institution. Of them, 38 had a large defect (diameter/weight > 1.2 or diameter/body surface area > 20 mm/m2 ), predicted suitable for surgery and underwent closure with GCA. Procedure results and midterm outcome are reported. RESULTS Patients' age and weight were 5.5 ± 1.5 years and 19.7 ± 4.7 kg, respectively. Absolute and relative ASD size was 21.5 ± 3.6 mm, 1.1 ± 0.2 mm/kg, and 27.7 ± 4.6 mm/m2 , respectively, resulting in QP/QS of 2.0 ± 0.8. Three patients were sent to surgery after balloon sizing. Four of the remaining 35 patients who underwent device deployment, needed rescue or elective surgery due to device embolization (n = 1), device instability (n = 2) or new-onset tricuspid valve regurgitation (n = 1). Procedure feasibility was 88.6%. Major complications were recorded in two patients (5.7%). Minor complications were recorded in five patients (14.3%). Complete closure at discharge was 90.3% (28/31 pts) rising to 100% at the last follow-up evaluation. Wireframe fracture rate at the 6 months examination was 52%, without clinical and instrumental consequences. CONCLUSIONS Percutaneous treatment with GCA device is effective and safe in a high percentage of ASD children with predicted indications for surgical correction.
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Affiliation(s)
- Giuseppe Santoro
- Pediatric Cardiology and Cardiac Surgery, Heart Hospital "G. Pasquinucci," National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Alessandra Pizzuto
- Pediatric Cardiology and Cardiac Surgery, Heart Hospital "G. Pasquinucci," National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Magdalena Cuman
- Pediatric Cardiology and Cardiac Surgery, Heart Hospital "G. Pasquinucci," National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Dorela Haxhiademi
- Anesthesia and Intensive Care Unit, Heart Hospital "G. Pasquinucci," National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Pietro Marchese
- Pediatric Cardiology and Cardiac Surgery, Heart Hospital "G. Pasquinucci," National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Eliana Franchi
- Pediatric Cardiology and Cardiac Surgery, Heart Hospital "G. Pasquinucci," National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Chiara Marrone
- Pediatric Cardiology and Cardiac Surgery, Heart Hospital "G. Pasquinucci," National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Vitali Pak
- Pediatric Cardiac Surgery, Heart Hospital "G. Pasquinucci," National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Nadia Assanta
- Pediatric Cardiology and Cardiac Surgery, Heart Hospital "G. Pasquinucci," National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Massimiliano Cantinotti
- Pediatric Cardiology and Cardiac Surgery, Heart Hospital "G. Pasquinucci," National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
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Apostolos A, Drakopoulou M, Trantalis G, Synetos Α, Oikonomou G, Karapanayiotides T, Tsioufis C, Toutouzas K. The management of patent foramen ovale in divers: where do we stand? Ther Adv Neurol Disord 2022; 15:17562864221103459. [PMID: 35837370 PMCID: PMC9274415 DOI: 10.1177/17562864221103459] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/10/2022] [Indexed: 11/16/2022] Open
Abstract
Diving is a fascinating activity, but it does not come without any cost; decompression illness (DCI) is one of the most frequent diseases occurring in divers. Rapid surfacing after diving causes alveolar rupture and bubbles release, which enter in the systemic circulation and could embolize numerous organs and tissues. The presence of patent foramen ovale (PFO) contributes to the passage of venous gas bubbles into the arterial circulation, increasing the risk of complications related to DCI. The diagnosis is established with a detailed medical history, a comprehensive clinical evaluation, and a multimodal imaging approach. Although the percutaneous closure of PFO is ambiguous for divers, as a primary prevention strategy, transcatheter management is considered as beneficial for DCI recurrence prevention. The aim of this study is to introduce the basic principles of DCI, to review the pathophysiological connection between DCI and PFO, to highlight the risk factors and the optimal treatment, and, last but not least, to shed light on the role of closure as primary and secondary prevention.
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Affiliation(s)
- Anastasios Apostolos
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Maria Drakopoulou
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - George Trantalis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Αndreas Synetos
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - George Oikonomou
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Theodoros Karapanayiotides
- Second Department of Neurology, School of Medicine, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Costas Tsioufis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Konstantinos Toutouzas
- Professor of Cardiology, First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, 114 Vasilissis Sophias Avenue, Athens 115 27, Greece
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Kim AY, Woo W, Lim BJ, Jung JW, Young Choi J, Kim YJ. Assessment of Device Neoendothelialization With Cardiac Computed Tomography Angiography After Transcatheter Closure of Atrial Septal Defect. Circ Cardiovasc Imaging 2022; 15:e014138. [PMID: 35861980 PMCID: PMC9298151 DOI: 10.1161/circimaging.122.014138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although the transcatheter closure of atrial septal defect was established as the treatment of choice several decades ago, the process of device neoendothelialization (NE) in humans is not well understood. We aimed to measure the extent of device NE using cardiac computed tomography angiography and analyze its risk factors.
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Affiliation(s)
- Ah Young Kim
- Division of Pediatric Cardiology, Department of Pediatrics, Severance Hospital (A.Y.K., J.W.J., J.Y.C.), Yonsei University College of Medicine, Seoul, Korea
| | - Wongi Woo
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital (W.W.), Yonsei University College of Medicine, Seoul, Korea
| | - Beom Jin Lim
- Department of Pathology, Gangnam Severance Hospital (B.J.L.), Yonsei University College of Medicine, Seoul, Korea
| | - Jo Won Jung
- Division of Pediatric Cardiology, Department of Pediatrics, Severance Hospital (A.Y.K., J.W.J., J.Y.C.), Yonsei University College of Medicine, Seoul, Korea
| | - Jae Young Choi
- Division of Pediatric Cardiology, Department of Pediatrics, Severance Hospital (A.Y.K., J.W.J., J.Y.C.), Yonsei University College of Medicine, Seoul, Korea
| | - Young Jin Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital (Y.J.K)
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Pre-clinical Evolution of a Novel Transcatheter Bioabsorbable ASD/PFO Occluder Device. Pediatr Cardiol 2022; 43:986-994. [PMID: 34981140 DOI: 10.1007/s00246-021-02809-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 12/20/2021] [Indexed: 10/19/2022]
Abstract
To date, there has been limited investigation of bioabsorbable atrial septal defect (ASD) or patent foramen ovale (PFO) closure devices using clinically relevant large animal models. The purpose of this study is to explore the function and safety of a bioabsorbable ASD occluder (BAO) system for PFO and/or secundum ASD transcatheter closure. Using a sheep model, the intra-atrial septum was evaluated by intracardiac echo (ICE). If a PFO was not present, atrial communication was created via transseptal puncture. Device implantation across the intra-atrial communication was performed with fluoroscopic and ICE guidance. Our 1st generation device consisted of a main structure of thin Poly(L-lactide-co-epsilon-caprolactone) (PLCL) fibers, and an internal Poly glycolic acid (PGA) fabric. Four procedures validated procedure feasibility. Subsequently, device design was modified for improved transcatheter delivery. The 2nd generation device has a two-layered structure and was implanted in six sheep. Results showed procedural success in 9/10 (90%) animals. With deployment, the 1st generation device did not reform into its original disk shape and did not conform nicely along the atrial septum. The 2nd generation device was implanted in six animals, 3 out of 6 survived out to 1 year. At 1 year post implantation, ICE confirmed no residual shunting. By necropsy, biomaterials had partially degraded, and histology of explanted samples revealed significant device endothelialization and biomaterial replacement with a collagen layer. Our results demonstrate that our modified 2nd generation BAO can be deployed via minimally invasive percutaneous transcatheter techniques. The BAO partially degrades over 1 year and is replaced by host native tissues. Future studies are needed prior to clinical trials.
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Seol JH, Kim AY, Jung SY, Choi JY, Park YJ, Jung JW. Intracardiac Echocardiogram: Feasibility, Efficacy, and Safety for Guidance of Transcatheter Multiple Atrial Septal Defects Closure. J Clin Med 2022; 11:2394. [PMID: 35566520 PMCID: PMC9100238 DOI: 10.3390/jcm11092394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/15/2022] [Accepted: 04/21/2022] [Indexed: 02/04/2023] Open
Abstract
We aimed to determine the feasibility, efficacy, success, and safety of intracardiac echocardiography (ICE) in transcatheter multiple atrial septal defect (ASD) closure. Of 185 patients with multiple ASDs who underwent transcatheter closure, 140 (76%) patients who weighed <30kg with a narrow distance between defects or in whom single device closure was anticipated were guided by ICE and 45 patients were guided by three-dimensional (3D) transesophageal echocardiography (TEE) with or without ICE. Patients in the ICE group were relatively younger and weighed less than those in the 3D TEE group (p < 0.0001). The ratio of the distance between defects >7 mm was high, and more cases required ≥2 devices in the 3D TEE group than those in the ICE group (p < 0.0001). All patients in the 3D TEE group and seven patients (5%) in the ICE group were operated on under general anesthesia (p < 0.0001). The fluoroscopic time was shorter in the ICE group (13.98 ± 6.24 min vs. 24.86 ± 16.47 min, p = 0.0005). No difference in the complete closure rate and complications was observed. ICE-guided transcatheter and 3D TEE were feasible, safe, and effective in successful multiple ASD device closures, especially for young children and patients at high risk under general anesthesia.
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Affiliation(s)
- Jae-hee Seol
- Division of Pediatric Cardiology, Department of Pediatrics, Congenital Heart Disease Center, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul 03722, Korea; (J.-h.S.); (A.-y.K.); (S.-y.J.); (J.-y.C.)
- Department of Pediatrics, Yonsei University Wonju College of Medicine, Wonju 26493, Korea
| | - Ah-young Kim
- Division of Pediatric Cardiology, Department of Pediatrics, Congenital Heart Disease Center, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul 03722, Korea; (J.-h.S.); (A.-y.K.); (S.-y.J.); (J.-y.C.)
| | - Se-yong Jung
- Division of Pediatric Cardiology, Department of Pediatrics, Congenital Heart Disease Center, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul 03722, Korea; (J.-h.S.); (A.-y.K.); (S.-y.J.); (J.-y.C.)
| | - Jae-young Choi
- Division of Pediatric Cardiology, Department of Pediatrics, Congenital Heart Disease Center, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul 03722, Korea; (J.-h.S.); (A.-y.K.); (S.-y.J.); (J.-y.C.)
| | - Yeon-jae Park
- Department of Biostatistics, Yonsei University Wonju College of Medicine, Wonju 26493, Korea;
| | - Jo-won Jung
- Division of Pediatric Cardiology, Department of Pediatrics, Congenital Heart Disease Center, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul 03722, Korea; (J.-h.S.); (A.-y.K.); (S.-y.J.); (J.-y.C.)
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Midazolam for conscious sedation in transcatheter device closure of atrial septal defects guided solely by transthoracic echocardiography. Cardiol Young 2022; 32:282-286. [PMID: 34024301 DOI: 10.1017/s104795112100202x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To investigate the safety and feasibility of midazolam for conscious sedation in transcatheter device closure of atrial septal defects guided solely by transthoracic echocardiography. METHODS 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. RESULTS 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. CONCLUSIONS Conscious sedation using midazolam is a safe and effective anesthetic technique for transcatheter device closure of atrial septal defects guided solely by transthoracic echocardiography.
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Memic Sancar K, Isık A, Aydın U, Kalkan AK, Erturk M, Babur Guler G. A case of progressive dyspnea: Atrial septal device-related functional mitral regurgitation after myocardial infarction. J Cardiovasc Thorac Res 2022; 13:370-373. [PMID: 35047143 PMCID: PMC8749366 DOI: 10.34172/jcvtr.2021.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 09/30/2020] [Accepted: 11/07/2020] [Indexed: 11/09/2022] Open
Abstract
Transcatheter device closure is a common treatment option of atrial septal defect. Mitral regurgitation has been reported with comorbid mitral valve prolapse and atrial septal defect. However there is no consensus regarding the pathogenesis of mitral regurgitation after closure. We are reporting a patient with functional mitral regurgitation associated with both an oversize closure device and wall motion abnormality after inferior myocardial infarction.
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Affiliation(s)
- Kadriye Memic Sancar
- Mehmet Akif Ersoy Thoracic and Cardiovascular Research and Education Hospital, Cardiology, Istanbul, Turkey
| | - Ayan Isık
- Mehmet Akif Ersoy Thoracic and Cardiovascular Research and Education Hospital, Cardiology, Istanbul, Turkey
| | - Unal Aydın
- Mehmet Akif Ersoy Thoracic and Cardiovascular Research and Education Hospital, Cardiovascular Surgery, Istanbul, Turkey
| | - Ali Kemal Kalkan
- Mehmet Akif Ersoy Thoracic and Cardiovascular Research and Education Hospital, Cardiology, Istanbul, Turkey
| | - Mehmet Erturk
- Mehmet Akif Ersoy Thoracic and Cardiovascular Research and Education Hospital, Cardiology, Istanbul, Turkey
| | - Gamze Babur Guler
- Mehmet Akif Ersoy Thoracic and Cardiovascular Research and Education Hospital, Cardiology, Istanbul, Turkey
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Santoro G, Pizzuto A, Cuman M, Cantinotti M, Franchi E, Corana G, Viacava C, Assanta N. Rescue atrial septal defect closure with the new GORE ® cardioform atrial septal defect occluder. Ann Pediatr Cardiol 2022; 15:192-194. [PMID: 36246756 PMCID: PMC9564420 DOI: 10.4103/apc.apc_240_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 05/19/2021] [Indexed: 11/04/2022] Open
Abstract
Atrioventricular block (AVB) is an infrequent but life-threatening complication of transcatheter closure of atrial septal defect (ASD), accounting for 0.1%–6.2% of cases in large series. It has been related to unfavorable defect anatomy as well as size and intrinsic stiffness of the occluding device. In this setting, the new GORE® cardioform ASD occluder (GCA) device could be an appealing technical advance in ASD treatment. We report a case of complete AVB after ASD closure with an Amplatzer septal occluding (Abbott, Plymouth MN, USA) device successfully treated by its percutaneous retrieval and “rescue” deployment of GCA device few months later.
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Santoro G, Cuman M, Pizzuto A, Haxhiademi D, Lunardini A, Franchi E, Marrone C, Pak V, Assanta N, Cantinotti M. GORE® Cardioform ASD Occluder experience in transcatheter closure of "complex" atrial septal defects. Catheter Cardiovasc Interv 2021; 99:E22-E30. [PMID: 34652048 DOI: 10.1002/ccd.29977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 09/25/2021] [Accepted: 10/03/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To evaluate the GORE® Cardioform ASD Occluder (GCO) (WL Gore & Associates, Flagstaff, AZ) device for "complex" atrial septal defects (ASD) closure. BACKGROUND Transcatheter ASD closure is still challenging in "complex" clinical/anatomic settings. This study evaluated the results of GCO in closure of "complex" ASD in a tertiary referral center. METHODS Between January 2020 and March 2021, 72 patients with significant ASD were submitted to transcatheter closure with GCO at our Institution. Based on clinical/anatomic characteristics, they were classified as "complex" (n = 36, Group I) or "simple" (n = 36, Group II). We considered as "complex", defects with rim deficiency (< 5 mm) other than antero-superior, relatively large (diameter/patient weight > 1.2 or diameter/patient BSA > 20 mm/m2 ) or within a multifenestrated septum. Procedure results and early outcome were compared between the groups. RESULTS Absolute and relative ASD size (20 ± 4 vs. 15 ± 3 mm, p < 0.0001; 0.9 ± 0.3 vs. 0.4 ± 0.2 mm/kg, p < 0.0001; 23 ± 7 vs. 12 ± 5 mm/m2 , p < 0.0001), QP/QS (2.0 ± 0.8 vs. 1.4 ± 0.3, p < 0.001), procedure and fluoroscopy times (73 ± 36 vs. 43 ± 21 min, p < 0.0001; 16 ± 9 vs. 9 ± 4 min, p < 0.0001, procedure feasibility (94.4 vs. 100%, p < 0.0001) and overall complication rate (13.9 vs. 0%, p < 0.0001) were significantly different between the groups. Successful closure of "surgical" ASDs was achieved in 92% of cases. Complete closure at last follow-up evaluation did not significantly differ between the groups (97.1 vs. 100%, p = NS), as was wireframe fractures rate (49.1% in the overall population), without clinical, EKG and echocardiographic consequences. CONCLUSIONS Percutaneous treatment with GCO device is effective and safe in high percentage of "complex" ASDs.
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Affiliation(s)
- Giuseppe Santoro
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Magdalena Cuman
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Alessandra Pizzuto
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Dorela Haxhiademi
- Anesthesia and Intensive Care Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Alessia Lunardini
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Eliana Franchi
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Chiara Marrone
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Vitali Pak
- Pediatric Cardiac Surgery, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Nadia Assanta
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
| | - Massimiliano Cantinotti
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Foundation "G. Monasterio", Massa, Italy
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Zhang WL, Liang F. An asymptomatic child of pre-perforation erosion after transcatheter closure of atrial septal defect. J Cardiothorac Surg 2021; 16:263. [PMID: 34537071 PMCID: PMC8449868 DOI: 10.1186/s13019-021-01646-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 05/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fatal pericardial tamponade caused by aortic or atrial perforation due to erosion of atrial septal occluders has been reported previously, but the timing of erosion is uncertain, and the process is also unclear. CASE PRESENTATION We present a case of a 5-year-old boy with erosion of the aorta and atrium by the occluder not leading to perforation or pericardial tamponade because of early detection and timely surgery. A small amount of pericardial effusion may be the only manifestation of early erosion. This case firstly revealed the early process of device erosion in children. CONCLUSIONS An absent aortic rim may be a higher risk factor for erosion than oversized device for a child, and it is wise to choose a relatively small occluder or change to surgery. This may be helpful for preventing and treating serious complications caused by erosion of the occluder.
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Affiliation(s)
- Wen-Long Zhang
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong Fist Medical University, No. 324, Jingwu Road, Jinan, 250021, China
| | - Fei Liang
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong Fist Medical University, No. 324, Jingwu Road, Jinan, 250021, China.
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Haider SW, Patel A, Argulian E, Kwan TW. Successful Transcatheter Closure of a Rare Malaligned Atrial Septal Defect With a Membranous Chord. JACC Case Rep 2021; 3:1327-1331. [PMID: 34471888 PMCID: PMC8387834 DOI: 10.1016/j.jaccas.2021.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 05/05/2021] [Accepted: 05/24/2021] [Indexed: 11/29/2022]
Abstract
Atrial septal defect (ASD) is a common congenital defect that leads to various hemodynamic complications if untreated. Transcatheter closure (TCC) of isolated secundum ASD is the preferred treatment. Herein we describe a unique malaligned ASD secondary to a membranous chord. With balloon sizing and intracardiac echocardiography (ICE), TCC was successfully pursued. (Level of Difficulty: Beginner.).
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Affiliation(s)
- Syed W. Haider
- Division of Cardiology, Icahn School of Medicine, Mount Sinai Morningside Hospital, New York, New York, USA
| | - Apurva Patel
- Division of Cardiology, Icahn School of Medicine, Mount Sinai Morningside Hospital, New York, New York, USA
| | - Edgar Argulian
- Division of Cardiology, Icahn School of Medicine, Mount Sinai Morningside Hospital, New York, New York, USA
| | - Tak W. Kwan
- Division of Cardiology, Icahn School of Medicine, Mount Sinai Morningside Hospital, New York, New York, USA
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Strategies for Recovering an Embolized Percutaneous Device. Curr Cardiol Rep 2021; 23:123. [PMID: 34269875 DOI: 10.1007/s11886-021-01554-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/17/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE OF REVIEW Device embolization is a rare but potentially life-threatening complication of transcatheter structural heart interventions and may require prompt intervention. The present work aims to provide an overview of strategies for device retrievals in order to better guide the evaluation and management of device embolization. RECENT FINDINGS Although the evolution of transcatheter device therapies has had a tremendous impact on the management in structural heart disease, availability of various retrieval devices, knowledge in how to use them, and multidisciplinary collaboration are key for successful device retrieval. Understanding the reasons for embolization, strategies to avoid embolization, and the techniques for retrieval of devices used in structural heart disease should be appreciated by the treating physician.
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Khajali Z, Firouzi A, Pouraliakbar H, Hosseini Z, Jorfi F. Case report of worsening of preexisting pericardial effusion after ASD device closure: is it calamitous? Egypt Heart J 2021; 73:50. [PMID: 34089387 PMCID: PMC8179864 DOI: 10.1186/s43044-021-00171-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 05/07/2021] [Indexed: 11/30/2022] Open
Abstract
Background Secundum-type atrial septal defects (ASD) constitute 8% to 10% of congenital heart defect. Secundum ASDs can be closed either percutaneously or surgically. However, ASD device closure has proven to be technically safe and feasible; it is not free of complications. These complications include device embolization/malposition which have been reported in 3.5% of cases, arrhythmia, and pericardial effusion in 2.6% and 0.5–1.5% respectively, device thrombus, residual shunting, and impingement of the device on the adjacent structures. Case presentation We introduce three patients with secundum ASD who had preexisting pericardial effusion, device closure was performed for them, and after the procedure, the effusion size progressed significantly. We used multimodality imaging to diagnose the cause of pericardial effusion (PE). Cardiac erosion was diagnosed in one of the patients that managed surgically. We did not found any specific procedure-related cause for worsening the pericardial effusion in the other two patients. Conclusion Several reasons include procedure-related complication and other systemic causes should be considered in patients who develop pericardial effusion after trans catheter closure of ASDs.
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Affiliation(s)
- Zahra Khajali
- Shaheed Rajaei Cardiovascular Medical and Research Center, Tehran, Iran
| | - Ata Firouzi
- Shaheed Rajaei Cardiovascular Medical and Research Center, Tehran, Iran
| | | | - Zahra Hosseini
- Shaheed Rajaei Cardiovascular Medical and Research Center, Tehran, Iran
| | - Fateme Jorfi
- Atherosclerosis Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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41
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Shin SH. Percutaneous Device Closure of Atrial Septal Defect: Neglected Long-Term Effects on the Left Atrium. J Cardiovasc Imaging 2021; 29:133-134. [PMID: 33605103 PMCID: PMC8099575 DOI: 10.4250/jcvi.2020.0232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 12/15/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Sung Hee Shin
- Division of Cardiology, Inha University College of Medicine, Incheon, Korea.
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Cardiac Tamponade Due to Very Late Perforation of Left Atrium by Atrial Septal Defect Occluder. JACC Cardiovasc Interv 2021; 14:e49-e51. [PMID: 33582082 DOI: 10.1016/j.jcin.2020.11.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/17/2020] [Accepted: 11/24/2020] [Indexed: 11/20/2022]
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Thanopoulos BVD, Soendergaard L, Ngugen HL, Marasini M, Giannopoulos A, Bompotis GC, Thonghong T, Krishnamoorthy KM, Placid S, Deleanou D, Toutouzas KP. International experience with the use of Cocoon septal occluder for closure of atrial septal defects. Hellenic J Cardiol 2021; 62:206-211. [PMID: 33484876 DOI: 10.1016/j.hjc.2020.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/14/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND The Cocoon septal occluder (CSO) is a new generation double disk occluder device for catheter closure of the secundum atrial septal defect (ASD). Initial clinical evaluations with the use of this device have shown quite satisfactory results but large follow-up studies are missing. In this international multicenter study, we present procedural and follow-up data from 4008 patients with secundum ASD who underwent catheter closure with the use of CSO. METHODS The study cohort consisted of 1853 pediatric and 2155 adult patients with secundum ASD treated with the CSO. Patients were enrolled retrospectively from 11 international centers and were followed for a mean period of 43 months (range 12-84 months), postprocedural. Clinical, electrocardiographic, echocardiographic, procedural, and follow-up data were collected from each collaborating hospital. RESULTS The CSO was permanently implanted in 3983 patients (99.4%). Echocardiographic evaluation at one month follow-up revealed complete closure in 99.6% of those patients who had a device implanted. Thrombus formation in one adult patient was the only major device related to procedural complication. During the follow-up period, no patient developed cardiac erosions, allergic reactions to nickel, or other major complications. CONCLUSIONS Implantation of CSO provided satisfactory procedural and follow-up results with high success and no device-related cardiac erosions and nickel allergy.
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Affiliation(s)
| | - Lars Soendergaard
- Department of Cardiology Copenhagen University Hospital, Rigshospitalet, Denmark
| | | | | | - Andreas Giannopoulos
- Department of Pediatric Cardiology AHEPA University General Hospital of Thessaloniki, Greece
| | - Georgios C Bompotis
- Department of Cardiology Papageorgiou General Hospital of Thessaloniki, Greece
| | - Tasalac Thonghong
- Department of Cardiology Chiang Mai University Hospital, Chiang Mai, Thailand
| | | | - Sebastian Placid
- Department of Cardiology Sakaharna Hrudayalaya Hospital, Kerala, India
| | - Dan Deleanou
- Institute for Cardiovascular Diseases C.C. Iliescu, Bucharest, Romania
| | - Konstantinos P Toutouzas
- First Department of Cardiology Hippokration General Hospital, National and Kapodistrian University of Athens, Greece
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Nakayama R, Takaya Y, Akagi T, Watanabe N, Miki T, Nakagawa K, Toh N, Ito H. Efficacy and safety of atrial septal defect closure using Occlutech Figulla Flex II compared with Amplatzer Septal Occluder. Heart Vessels 2021; 36:704-709. [PMID: 33386412 DOI: 10.1007/s00380-020-01739-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/20/2020] [Indexed: 11/25/2022]
Abstract
Few studies have reported the efficacy of Occlutech Figulla Flex II (FFII) device compared with Amplatzer Septal Occluder (ASO) device. The aim of this study was to examine the efficacy and safety of FFII compared with ASO for transcatheter atrial septal defect (ASD) closure. We retrospectively evaluated 190 patients using FFII and 190 patients using ASO who underwent transcatheter ASD closure. ASD characteristics were evaluated by transesophageal echocardiography. The prevalence of procedural complications, including erosion, device embolization, stroke, and new-onset atrial arrhythmia, and the presence of a residual shunt were evaluated between the two groups during 12-month follow-up. FFII was used more frequently than ASO in patients with a deficient aortic rim or septal malalignment (P = 0.02, P < 0.01, respectively). The procedural complications of erosion, device embolization, and stroke did not occur in any patients. New-onset atrial arrhythmia occurred in 3 patients of the FFII group and 4 patients of the ASO group, and the difference between the two groups was not significant (P = 0.70). A large residual shunt (≥ 3 mm) was observed in 6 patients of the FFII group and 5 patients of the ASO group, and the difference between the two groups was not significant (P = 0.76). FFII was used frequently in patients with high-risk ASD morphology; however, there was no difference in the prevalence of procedural complications or efficacy between patients using FFII and those using ASO.
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Affiliation(s)
- Rie Nakayama
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Yoichi Takaya
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
| | - Teiji Akagi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Nobuhisa Watanabe
- Division of Medical Support, Okayama University Hospital, Okayama, Japan
| | - Takashi Miki
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Koji Nakagawa
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Norihisa Toh
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
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Ghosh S, Abozeed M, Bin Saeedan M, Raman SV. Chest radiography of contemporary trans-catheter cardiovascular devices: a pictorial essay. Cardiovasc Diagn Ther 2020; 10:1874-1894. [PMID: 33381431 DOI: 10.21037/cdt-20-617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
There is a plethora of cardiovascular devices used for therapy and monitoring, and newer devices are being introduced constantly. As a result of advancement of medical technology and rapid development of such technology to address unmet needs across cardiovascular care, multiple conditions which were previously treated surgically or with medications now benefit from trans-catheter device-based evaluation and management. Moreover, innovation to existing technology has transformed the structural design of many traditional cardiovascular devices, making them safer and enabling easier deployment within the chest (catheter-based versus surgical). A post-procedure chest radiography (CXR) is often the first routine imaging test ordered in these patients. A CXR is a relatively inexpensive and noninvasive imaging tool, which can be obtained at the patient's bedside if needed. Commonly implanted cardiovascular devices can be quite easily checked for appropriate positioning on routine CXRs. Potential complications associated with mal-positioning of such devices may be life-threatening. Such complications often manifest early on CXRs and may not be readily apparent on clinical examination. Prompt recognition of such abnormal radiographic appearances is critical for timely diagnosis and effective management. Clinicians need to be familiar with new devices in order to assess proper placement and identify complications related to mal-positioning. This pictorial essay aims to describe the radiologic appearances of contemporary cardiovascular devices, review indications for their usage and potential complications, and discuss magnetic resonance imaging (MRI) compatibility.
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Affiliation(s)
- Subha Ghosh
- Thoracic Imaging, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mostafa Abozeed
- Cardiopulmonary Imaging Division, University of Alabama at Birmingham, Birmingham, AL, USA.,Radiology Department, Al-Azhar University, Cairo, Egypt
| | - Mnahi Bin Saeedan
- Thoracic Imaging, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Subha V Raman
- Indiana University Health and IU Krannert Institute of Cardiology, Indianapolis, IN, USA
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He C, Zhou Y, Tang SS, Luo LH, Feng K. Completed atrioventricular block induced by atrial septal defect occluder unfolding: A case report. World J Clin Cases 2020; 8:5715-5721. [PMID: 33344565 PMCID: PMC7716307 DOI: 10.12998/wjcc.v8.i22.5715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/15/2020] [Accepted: 09/22/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND An atrial septal defect is a common condition and accounts for 25% of adult congenital heart diseases. Transcatheter occlusion is a widely used technique for the treatment of secondary aperture-type atrial septal defects (ASDs).
CASE SUMMARY A 30-year-old female patient was diagnosed with ASD by transthoracic echocardiography (TTE) 1 year ago. The electrocardiogram showed a heart rate of 88 beats per minute, normal sinus rhythm, and no change in the ST-T wave. After admission, TTE showed an atrial septal defect with a left-to-right shunt, aortic root short-axis section with an ASD diameter of 8 mm, a parasternal four-chamber section with an ASD diameter of 9 mm, and subxiphoid biatrial section with a diameter of 13 mm. Percutaneous occlusion was proposed. The intraoperative TTE scan showed that the atrial septal defect was oval in shape, was located near the root of the aorta, and had a maximum diameter of 13 mm. A 10-F sheath was placed in the right femoral vein, and a 0.035° hard guidewire was used to establish the transport track between the left pulmonary vein and the inferior vena cava. A shape-memory alloy atrial septal occluder with a waist diameter of 20 mm was placed successfully and located correctly. TTE showed that the double disk unfolded well and that the clamping of the atrial septum was smooth. Immediately after the disc was revealed, electrocardiograph monitoring showed that the ST interval of the inferior leads was prolonged, the P waves and QRS waves were separated, a junctional escape rhythm maintained the heart rate, and the blood pressure began to decrease. After removing the occluder, the elevation in the ST segment returned to normal immediately, and the sinus rhythm returned to average approximately 10 min later. After consulting the patient’s family, we finally decided to withdraw from the operation.
CONCLUSION Compression of the small coronary artery, which provides an alternative blood supply to the atrioventricular nodule during the operation, leads to the emergence of a complete atrioventricular block.
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Affiliation(s)
- Chuan He
- Department of Cardiology, Affiliated Hospital of Chengdu University, Chengdu 610081, Sichuan Province, China
| | - Yang Zhou
- Department of Cardiology, Affiliated Hospital of Chengdu University, Chengdu 610081, Sichuan Province, China
| | - Si-Si Tang
- Department of Cardiology, Affiliated Hospital of Chengdu University, Chengdu 610081, Sichuan Province, China
| | - Li-Hong Luo
- Department of Cardiology, Affiliated Hospital of Chengdu University, Chengdu 610081, Sichuan Province, China
| | - Kun Feng
- Department of Cardiology, Affiliated Hospital of Chengdu University, Chengdu 610081, Sichuan Province, China
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Santoro G, Castaldi B, Cuman M, Di Candia A, Pizzuto A, Sirico D, Cantinotti M, Garibaldi S, Pak V, Di Salvo G. Trans-catheter atrial septal defect closure with the new GORE® Cardioform ASD occluder: First European experience. Int J Cardiol 2020; 327:68-73. [PMID: 33220363 DOI: 10.1016/j.ijcard.2020.11.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/25/2020] [Accepted: 11/09/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND This perspective, observational study evaluated safety and efficacy of the GORE® Cardioform ASD Occluder (WL Gore & Associates, Flagstaff, AZ), compliant and potentially innovative prosthesis recently approved for closure of ostium secundum atrial septal defects (ASD). METHODS Between January and June 2020, 43 unselected patients with -significant ASD were submitted to trans-catheter closure with GORE® Cardioform ASD Occluder at two high-volume Italian Pediatric Cardiology centers. Primary endpoints were procedural success and safety. Secondary endpoints were closure rate and clinical safety at 1-month follow-up. RESULTS Patients' age and weight were 8.2 ± 3.9 years (range 3-21, median 9.9) and 29.6 ± 15.3 kg (range 16-57, median 33.3), respectively. ASD diameter was 16.6 ± 4.5 mm (median 10), resulting in QP/QS of 1.7 ± 0.7 (median 1.6). Seventeen pts. (39.5%) were considered "surgical" candidates due to challenging septum morphology, ASD rim deficiency or ASD diameter/patient weight ratio ≥ 1.2. Device placement was successfully achieved in all but one patient (97.7%), in whom it embolized early after deployment, resulting in rescue surgical repair. No cross-over with different devices was recorded. Median procedure and fluoroscopy times were 40 and 6.8 min, respectively. Major adverse events were recorded in 7.0% (3 pts). Complete closure rate was 78.5% at discharge, rising to 92.9% (39/42 pts) at 1 month evaluation, without cardiac or extra-cardiac adverse events. "Challenging" procedures were more time-consuming but as effective and safe as the "simple" ones. CONCLUSIONS The GORE® Cardioform ASD Occluder device was highly effective and versatile in closure of ASDs with different anatomy and size, even in challenging settings.
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Affiliation(s)
- Giuseppe Santoro
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Region Foundation "G. Monasterio", Massa, Italy.
| | - Biagio Castaldi
- Pediatric Cardiology, University of Padua, Padua, Italy; Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Region Foundation "G. Monasterio", Massa, Italy
| | - Magdalena Cuman
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Region Foundation "G. Monasterio", Massa, Italy
| | | | - Alessandra Pizzuto
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Region Foundation "G. Monasterio", Massa, Italy
| | | | - Massimiliano Cantinotti
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Region Foundation "G. Monasterio", Massa, Italy
| | - Silvia Garibaldi
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Region Foundation "G. Monasterio", Massa, Italy
| | - Vitali Pak
- Pediatric Cardiology and GUCH Unit, Heart Hospital "G. Pasquinucci", National Research Council-Tuscany Region Foundation "G. Monasterio", Massa, Italy
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Appropriate device selection for transcatheter atrial septal defect closure using three-dimensional transesophageal echocardiography. Int J Cardiovasc Imaging 2020; 37:1159-1168. [PMID: 33151513 DOI: 10.1007/s10554-020-02095-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 10/30/2020] [Indexed: 10/23/2022]
Abstract
Detail morphological evaluation for ASD is essential to achieve successful transcatheter closure. Three-dimensional transesophageal echocardiography (3D-TEE) is emerging, but few studies have comprehensively verified the usefulness of 3D-TEE. We divided 329 patients who underwent transcatheter ASD closure at our university hospital into 157 in the Conventional group evaluated with 2-dimensional transesophageal echocardiography and balloon sizing (BS), and 172 in the 3D-TEE group evaluated with 3D-TEE additionally. We assessed usefulness of 3D-TEE and consider appropriate device selection procedure. Overall, the percentage with re-sizing of device tended to be lower in the 3D-TEE group than in the Conventional group (10.1% vs 6.0%, p = 0.187). Among preprocedural modalities, the device size was mainly decided based on the BS diameter. A logistic regression analysis demonstrated that large atrial septum aneurysms (ASA) were associated with a ≥ 2 mm discrepancy of the BS diameter from the preprocedural 3D-TEE diameter (p < 0.05). Compared to the Amplatzer Septal Occluder, the differences in device size and the preprocedural ASD measurement were greater when using the Occlutech Figulla Flex II Occluder (FFII). Particularly, among the patients implanted with FFIIs, the discrepancies of the device size from the 3D-TEE measurement were greater in patients with large ASA than those with small ASA. Preprocedural 3D-TEE is useful to select the appropriate device size. Particularly, it is necessary to select a much larger device than that derived from the preprocedural 3D-TEE measurement when using FFII in patients with a septal aneurysm.
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Soliman M, Mowaphy K, Elsaadany NA, Soliman R. Hybrid retrieval of embolized device in abdominal aorta after transcatheter closure of large patent ductus arteriosus. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2020; 7:56-60. [PMID: 33665532 PMCID: PMC7903193 DOI: 10.1016/j.jvscit.2020.10.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/08/2020] [Indexed: 11/22/2022]
Abstract
Patients with a large patent ductus arteriosus (PDA) can have several presentations. Many will be asymptomatic, some could develop severe pulmonary hypertension, and others can develop Eisenmenger syndrome. We have presented a case in which a PDA correction device was embolized to the abdominal aorta, 2 months after transcatheter closure of a large PDA. The patient presented with an acute abdomen. In the management of the case, we implemented a hybrid technique in the process of device retrieval. Transbrachial access and a lower abdominal midline incision were accomplished to dislodge the device from the supraceliac aorta to the aortic bifurcation. The Amplatzer Ductal Occluder (St Jude Medical Inc, St Paul, Minn) was extracted through a small arteriotomy of the distal abdominal aorta. The procedure was followed by a dramatic improvement of the ischemic liver and bowel, evidenced by the vanishing of the cyanotic hue of the liver and normalization of the bluish discoloration of the intestine.
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Affiliation(s)
- Mosaad Soliman
- Department of Vascular Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Khaled Mowaphy
- Department of Vascular Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Nshaat A Elsaadany
- Department of Vascular Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Reem Soliman
- Department of Vascular Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Choudhury M, Bhardwaj V, Hote MP. Role of Transesophageal Echocardiography in Retrieval of Dislodged Atrial Septal Defect Device Occluder. JOURNAL OF CARDIAC CRITICAL CARE TSS 2020. [DOI: 10.1055/s-0040-1716945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
AbstractTranscatheter atrial septal defect (ASD) device closure has emerged as a safe and effective alternative procedure for surgical ASD repair. However, ASD device malposition and embolization has been reported with an incidence of 0.5 to 1.1%. We report here a case of a 32-year-old male, who presented to the hospital 5 months after ASD device closure for routine follow-up. This case reports highlights the significance of transesophageal echocardiography (TEE) evaluation in successful surgical retrieval of a dislodged ASD Amplatzer device.
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Affiliation(s)
- Minati Choudhury
- Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Vandana Bhardwaj
- Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Milind P. Hote
- Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
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