A registry group was also studied to evaluate the device in patients with other conditions. The results showed noninferiority of device closure with a clinical success rate of 91. Complications in atrial septal defect device closure. Device closure of atrial septal defect with severe. Atrial septal defect asd is a form of a congenital heart defect that enables blood flow between two compartments of the heart called the left and right atria. Patients with anatomically large asd measuring 25 mm and a high probability of reversible pulmonary vascular disease were subjected to fenestrated device closure, despite severe pht and elevated pvr.
Intraoperative device closure of atrial septal defect in. Descriptions of percutaneous device closure of a secundum asd have been extensively reported in other articles and will. Pediatric cardiac interventions atrial septal defect. Pediatric cardiac interventions atrial septal defect asd.
Designed to perform with the natural anatomy of the heart, the gore cardioform septal occluder is a soft and conformable device for transcatheter closure of asds and pfos up to 17 mm, including challenging defects. Factors that decide suitability for transcatheter closure include size of the defect and presence of adequate tissue rims around the defect. Device closure of secundum atrial septal defects is sometimes needed in young children. Ostium secundum atrial septal defect asd is a common congenital heart defect. Even though surgery is the gold standard, percutaneous device closure is gaining popularity because of the short learning curve, cosmetic advantage and relative safety. Device closure of atrial septal defects with the amplatzer septal occluder. Transesophageal echocardiography for device closure of. Device closure of asd in children using the amplatzer devices. Transcatheter asd closure without fluoroscopy peter ewert, felix berger. Having a transcatheter closure of your atrial septal defect this leaflet aims to answer your questions about having the hole in your heart known as an atrial septal defect or asd closed. As a result of gores longstanding effort to solve complex challenges through physician collaboration, this innovative. On the day of the procedure, our expert pediatric cardiac anesthesiologist will place your child under sedation. Atrial septal defect asd american heart association.
Closure of atrial septal defects with the amplatzer. Transcatheter device closure of secundum asd is a maturing technology, now more than a decade old. For such patients, the amplatzer pfo occluder can prevent recurrent strokes. Successful nonsurgical closure of atrial septal defects asd was first described in 1974 by king and mills. Intraoperative device closure of asd intraoperative device closure of atrial septal defects with minimal transthoracic invasion. Device closure of atrial septal defects with the amplatzer. Patients frequently present with symptoms for the first time at adult age. The amplatzer septal occluder system summary of safety and. Complications of device closure of asds and pfos zahid amin. As a result of gores longstanding effort to solve complex challenges through physician. Thus, only secundum asd sasd may be suitable for percutaneous device closure and differ considerably in size, shape, location and number, see figure 3 images c, d, g, i.
Device closure of secundum atrial septal defects in children. Techniques and devices for transcatheter treatment have been evolved and refined. Having a transcatheter closure of your atrial septal defect. Birth prevalence of congenital heart disease worldwide. Device closure of atrial septal defect asd and patent foramen ovale pfo are both associated with short. Percutaneous closure of atrial septal defect 3 rasheed ibdah. To close the hole, the doctor will place a special device in your childs heart by catheterization. An atrial septal defect is a hole between the two upper chambers of the heart. This study reports our clinical experience with transcatheter closure of secundum atrial septal defects asds in children, using the amplatzer, a new occlusion device. Descriptions of percutaneous device closure of a secundum asd have been extensively reported in other articles and will therefore not be detailed in this paper. The short and mediumterm followup results were satisfactory, but longterm followup is required to assess the safety and feasibility of this method in infants more accurately.
Individual patient exposure to the device averaged 25. Advances in percutaneous transcatheter device closure of secundum atrial septal defect asd have resulted in high success rates. Jeffrey saver, md, discusses the data supporting the. In rashkinds original human study, successful closure of the asd was ac complished in patients, but in six closure was not adequate. If the asd is large, it can be closed with openheart surgery, or by cardiac catheterization using a device inserted into the opening to plug it. Device closure transcatheter asd closure was performed through right femoral vein approach as described. The contraindications to asd closure sidebar summarizes what we believe to be the major contraindications to device placement in secundum asd. A guide wire is introduced through the femoral vein into the inferior vena cava and further through the right atrium across the asd.
Consensually agreed indications and imaging guidance for closure. The adverse prognosis of untreated asd diagnosed in childhood is well studied and percutaneous device closure of these asds has evolved to become the standard of care in both pediatric and young adult populations. Alternative practices or procedures the only alternative to device closure of an asd is openheart surgery. Our knowledge of the complication rates of asd and pfo closure is limited. One of the most common late complications of an asd is the development of atrial tachyarrhythmias ats, especially atrial fibrillation af. We examined the efficacy and safety of the amplatzer, a new selfcentering. Complications of asd closure surgery versusdevices device n442 surgery n154 p arrhythmia needing rx 2 0 0. The presence of an asd or pfo can result in gas embolization to the arterial circulation and the development of neurological symptoms, known as decompression illness. Food and drug administration for patent foramen ovale closure and atrial septal defect closure are currently marketed. Transcatheter closure of atrial septal defects cardiac. Numerous studies have since described the safety and efficacy of the percutaneous approach and suggested it to be the preferred method of closure over surgery in certain patients 2, 3, 4. From january 2005 to september 2009, we enrolled 32 infants with secundumtype atrial septal defect in our institution.
Nightmare cases in the cardiac catheterization laboratory during percutaneous. The amplatzer pfo occluder set the standard, pioneering treatment with a device developed specifically for pfo closure. Figure 1 amplatzer septal occluder device and delivery system 6. The risk factors for cardiac erosion after device closure are not. Normally, the right and left atria are separated by a septum called the interatrial septum. Pdf device closure of secundum asds and the risk of. They were discharged on pulmonary vasodilators and were followed for 39. Certain metallic pda, asd, vsd occluders and pfo closure devices tested for magnetic qualities were made from either 304v stainless steel or mp35n. Accurate imaging of the anatomic features of the asd is critical for case selection. Over the years, routine closure of asd in childhood has been justi. Thus, only secundum asd sasd may be suitable for percutaneous device closure and differ considerably in size, shape. Selection of device size for atrial septal defect closure.
Intraoperative device closure of atrial septal defect in infants. Eventually, tissue growth covers the cardiac occluder or closure device and facilitates retention. Surgical closure of atrial septal defect asd has been the treatment of choice for decades, with excellent results, negligible mortality and limited morbidity. It explains the benefits, risks and alternatives to the procedure, as well as what you can expect when you come to hospital. Transcatheter closure of secundum atrial septal defects is considered. Several types of devices are used for percutane ous closure of asd andor pfo. Atrial septal defect closure device radiology case. Selecting the optimal closure device in patients with atrial septal.
Atrial septal defect asd is a common congenital cardiac anomaly. Transthoracic echo tte is done to assess the superior, aortic and mitral rims. Short and long term complications of device closure of atrial. Our team has extensive experience using the amplatzer duct occluder to repair pda in children. The implant arm also had a high rate of procedural complications 33. Asd asd occluder delivered recent studies found that transcatheter closure of isolated secundum atrial septal defects using the novel design of the occlutech asd occluder was safe, effective and had an excellent outcome during the 6 months followup period. Mar 02, 2018 asd closure is indicated in the presence of a significant lefttoright shunt, defined by a significant right heart enlargement due to volume overload, regardless of symptoms 3,4. Cardiac erosion related to transcatheter atrial septal defect closure devices is of.
Indications and catheter preparations, technique, and. Transcatheter device closure of atrial septal defects jacc. Device closure of secundum atrial septal defects in. As the percutaneous approach has evolved over the years, along with the advent of. If this septum is defective or absent, then oxygenrich blood can flow. Atrial fibrillation and stroke after atrial septal defect. Device closure of atrial septal defect in patients of age. Selecting the optimal closure device in patients with atrial. One type of device features two parallel disks made of a niti nol mesh, which. When compared to surgery, it provides a less invasive approach with quicker recovery and reduced physical and psychological impact. Pdf transcatheter device closure of atrial septal defect.
Each new device claims advantages in terms of safety and efficacy over earlier. Review article percutaneous device closure of secundum atrial. Device embolization is a potential complication of every attempted asd closure, and the causative factors can be undersized device, inadequate or floppy rim, operatorrelated technical issues such as malposition during the pushpull maneuver, or excessive tension on delivery cable during device deployment. Device closure of a large atrial septal defect in a patient with lung pathology the incidence of atrial septal defect asd is approximately 3 per 10,000 live births. If the hole is too big to close with the device or in the wrong position, the hole will be closed with surgery. Longterm follow up of secundum atrial septal defect. Transthoracic device closure of an asd with a domestic occluder in infants is a safe and feasible technique.
Device closure of asd is suitable for secondum asd with a good rim all around for holding the two discs together. Device closure of atrial septal defect with severe pulmonary. Ostium secundum asd is most common type of asd accounting for 75% of all asd cases. Secundum atrial septal defect asd is a common congenital heart. And its the leading pfo closure device to date, with over 100,000 devices implanted worldwide.
Indications and evaluation for asd closure cardiac. Selecting the optimal closure device in patients with. Longterm follow up of secundum atrial septal defect closure. Shortterm and midterm followup of transthoracic device. Evaluation for asd closure the first asd closure via transcatheter approach was performed in 1976. The amplatzer septal occluder system summary of safety. Transcatheter device closure of atrial septal defect in dextrocardia with situs inversus totalis. Pdf objective realtime threedimensional echocardiography, using both reconstruction methods and rt3d, has been used as an extra helping tool in. Atrial septal defect asd device transcatheter closure. Pdf intraoperative device closure of asd intraoperative. Device closure of secundum atrial septal defects and the risk of. Sometimes, if the asd is an unusual position within the heart, or if there are other heart defects such as abnormal connections of the veins bringing blood from the lungs back to the heart pulmonary. Complications of transcatheter atrial septal defect closure.
Outcomes after device closure of atrial septal defect in children. Transcatheter closure of atrial septal defect journal of thoracic. New minimally invasive techniques for surgical closure of asds and pfos nikolay v. Short and long term complications of device closure of. Occluders made from 304v stainless steel were found to be weakly ferromagnetic, whereas those made from mp35n were nonferromagnetic in association with a 1. Surgery is relatively safe with a mortality of less. Transcatheter device closure of atrial septal defects.
A third device from the gore family, the gore cardioform asd. Various devices for transcatheter asd closure are undergoing clinical trials. Device closure of a large atrial septal defect in a. Echocardiography guidance of atrial septal defect closure. Cardiac surgery that is required for closure of such defects is a major procedure that requires cardiopulmonary bypass.
Dec 22, 2017 a prerequisite for transcatheter device closure is the presence of adequate rims of tissue bordering the defect. A prerequisite for transcatheter device closure is the presence of adequate rims of tissue bordering the defect. The amplatzer device is the most advanced device of its type available in the united states. Initial experience of atrial septal defect closure with occlutech. Asd is indicated for the closure of secundum asds with a sufficient rim of tissue around the septal defect so that the closure device does not impinge upon the svc, ivc, or the tricuspid or mitral valves.
Asd closure is indicated in the presence of a significant lefttoright shunt, defined by a significant right heart enlargement due to volume overload, regardless of symptoms 3,4. Closure of secundum atrial septal defects with the. The aso is the only available device in the united states to close large asds. Atrial septal defects asds are the most common congenital cardiac abnormalities in adults. Transcatheter device closure of asd has come a long way since the first experimental closure in dogs by. Anaesthesia for percutaneous closure of atrial septal defects. None of the devices previously used for transcatheter closure of interatrial communications has gained wide acceptance. Pediatric pda closure devices childrens national hospital. Review article percutaneous device closure of secundum.