Closure of Atrial Septal Defects With the Amplatzer Occlusion Device: Preliminary Results

Objectives. This study reports our clinical experience with transcatheter closure of secundum atrial septal defects (ASDs) in children, using the Amplatzer, a new occlusion device.Background. None of the devices previously used for transcatheter closure of interatrial communications has gained wide acceptance.Methods. We examined the efficacy and safety of the Amplatzer, a new self-centering septal occluder that consists of two round disks made of Nitinol wire mesh and linked together by a short connecting waist. Sixteen patients with secundum ASD met established two- and three-dimensional echocardiographic and cardiac catheterization criteria for transcatheter closure. The Amplatzer’s size was chosen to be equal to or 1 mm less than the stretched diameter. The device was advanced transvenously into a 7F long guiding sheath and deployed under fluoroscopic and ultrasound guidance. Once its position was optimal, it was released.Results. The mean ASD diameter by transesophageal echocardiography was 14.1 ± 2.3 mm and was significantly smaller (p < 0.001) than the stretched diameter of the ASD (16.8 ± 2.4 mm). The mean device diameter was 16.6 ± 2.3 mm. No complications were observed. After deployment of the prosthesis, there was no residual shunt in 13 (81.3%) of 16 patients. In three patients there was trivial residual shunt immediately after the procedure that had disappeared in two of them at the 3-month follow-up.Conclusions. The Amplatzer is an efficient prosthesis that can be safely applied in children with secundum ASD. However, a study including a large number of patients and a longer follow-up period are required before this technique can be widely used.     

Transcatheter closure of atrial septal defect without balloon sizing

Objective: To evaluate the safety and feasibility of transcatheter closure of atrial septal defect (ASD) without balloon sizing. Methods: A total of 243 patients (group I), aged 2.1–76 years (median 22 years), underwent transcatheter closure of ASD without balloon sizing. The maximal diameter of the defect was measured on transesophageal echocardiographic (TEE) images. The size of device selected was generally 4–6 mm and 5–8 mm larger than the maximal diameter, if the defect was <14 mm and ≥14 mm, respectively. The results of ASD closure in group I were compared with those of 271 patients (group II, median age 11 years) who underwent ASD closure with balloon sizing prior to the study period. Results: Of the 243 patients in group I, the maximal defect diameter ranged from 5.2 to 37 mm (mean 17.5 ± 6.6 mm, median 17 mm). A total of 247 Amplatzer septal occluders were deployed in 240 patients. Two patients were found to develop distal embolization of a device the next day. Therefore, failure occurred in five patients. Comparing the results between group I and group II, there was no significant difference in success rate (238/243 vs. 263/271), incidence of embolization (2/243 vs. 2/271) and complete closure rate at 3‐month follow‐up (94.1% vs. 95.8%). There is significant difference in mean age (26.6 ± 20.2 vs. 19.1 ± 17.6), maximal defect diameter (17.5 ± 6.6 vs. 14.1 ± 5.9 mm) and Q_p/Q_s ratio (2.77 ± 1.11 vs. 2.48 ± 0.97) between group I and II. The mean diameter of device used was significantly larger in group I than in group II (23.1 ± 8.1 vs. 19.6 ± 7 mm, P < 0.001). Conclusions: Balloon sizing may not be necessary in transcatheter closure of ASD. © 2008 Wiley‐Liss, Inc.     

A comparative study of Cardi‐O‐Fix septal occluder versus Amplatzer septal occluder in percutaneous closure of secundum atrial septal defects

Aim: We sought to investigate the safety and efficacy of Cardio‐O‐Fix septal occluder (CSO) in percutaneous closure of atrial septal defects (ASD) as compared to the Amplatzer septal occluder (ASO). Methods: A consecutive of 351 patients received transcatheter ASD closure with CSO or ASO from July 2004 to October 2010 were studied. The ASDs were divided into simple‐ (isolated defects <26 mm) or complex‐types (isolated defect ≥26 mm, double or multifenestrated defects). The procedures were guided by fluoroscopy and transthoracic or transesophageal echocardiography. Clinical and echocardiographic follow‐ups were arranged before discharge, at 1 month and then every 6‐month after implantation. Results: During the study period, 185 (125 males, aged 18.5 ± 15.6 years) and 166 (103 males, aged 21.0 ± 15.7 years) patients attempted CSO and ASO implants, respectively. The CSO group had similar ASD and device sizes, prevalence of complex lesions (17 vs. 16%, P = 0.796), procedural times and success rates (97% vs. 96%, P = 0.635) as compared to the ASO group. Acute residual shunts were less prevalent in CSO than ASO group and most shunts closed spontaneously at 6‐month follow‐ups. The average equipment cost per patient was lower in CSO group (US$ 4,100 vs. US$ 5,900, P < 0.001). The prevalence of device embolization and atrial arrhythmia (all <2%) were similar in both patient groups. Conclusion: Transcatheter ASD occlusion with CSO is safe and effective and it appeared to be an attractive alternative to ASO in closing simple‐type ASD because of its relatively low cost. © 2013 Wiley Periodicals, Inc.     

Lung perfusion studies after transcatheter closure of persistent ductus arteriosus with the Amplatzer duct occluder

Background : Reduced left lung perfusion has been described after transcatheter closure of the patent ductus arteriosus (PDA) with several prostheses. Although the Amplatzer ductal occluder (ADO) device is currently the most widely used occluder for closure of large‐sized PDAs, the potential consequences of flow distribution to the lungs of this device have not been completely clarified. We evaluated lung perfusion following occlusion of PDA with the ADO device. Methods : Forty‐seven patients underwent successful transcatheter PDA occlusion using the ADO device were included in this study. Lung perfusion scans were performed 6 months after the procedure. Results : Decreased perfusion to the left lung (defined as < 40% of total lung flow) was observed in 17 patients (36%), 5 of whom were low‐weight symptomatic infants. Ductal ampulla length was significantly shorter and minimal ductal diameter to ampulla diameter ratio was significantly higher in patients with decreased left lung perfusion and correlated well with left lung perfusion values (r = 0.516 and r = ?0.501, respectively). A cut‐off value of ≤5.8 mm for the ductal ampulla length and ≥1.9 for ampulla diameter to ampulla length ratio showed high sensitivity and specificity for reduced lung perfusion. Conclusions : The incidence of abnormal left lung perfusion is high 6 months after transcatheter closure of PDA with the ADO, more likely in the low weight symptomatic infants and in patients with a short duct or a relatively shallow duct having abrupt narrowing of a large ampulla. © 2010 Wiley‐Liss, Inc.     

FOLLOW‐UP IN CLOSING OF ATRIAL SEPTAL DEFECT BY CATHETERISM WITH TRANSESOPHAGEAL ECHOCARDIOGRAPHY (TEE) GUIDANCE

Background: Follow‐up in closing atrial septal defects (ASD) by transcatheter device, with TEE guidance. Methodology: In 137 patients with ASD ostium secundum (os) the mean (X) age of the patients was 8.78 years (range from 2 to 50 years). 120 patients with isolated defects, 12 with other small ASDs, 2 with fenestrated ASDs (fASD),1 patients had patent ductus arteriosus, 2 had ventricular Septal Defects (VSD). Following a routine hemodynamic evaluation in the catheter laboratory a TEE was conducted to measure in millimeters the location and size of the defect, as well as the distance from the defect to the upper pulmonary vein (upv), the tricuspid (TV) and mitral (MV) valves, and the superior (SVC) and inferior (IVC) cava veins. The residual shunt as well as complications were evaluated. Statistical Analysis: Statistical significance p < 0.05. Results: The ASD measured by TEE in short axis: X: 14.4 ± 4.53 mm (range: 7.4 ± 32), in 4‐chamber view: X: 14.77 ± 5 mm (range: 6.5–33), in sagittal, at level of cava veins: X: 17.49 ± 10,29 mm (range: 6.5–38); balloon sizing: 18.3 ± 5.39 mm (range: 10–38); mean size of the device: 18.11 ± 5.57 mm (range 10–38). The distance from the upper edge to the upper pulmonary vein (upv): X: 9.11 ± 2.44 mm (range: 5.3–15); to tricuspid valve (T.V): X: 13.35 ± 3.17 mm (range: 6.5–19), mitral valve (M.V): X: 11.26 ± 2.36 (range: 7–14.4), left superior vena cava (SVC): X: 11.21 ± 2.83 mm (range: 6.2–16.9) and inferior vena cava (IVC): X: 10.21 ± 3.12 mm (range: 7–17.7). The Qp/Qs: 1.97 ± 0.45 (range: 1.25–3.5), pressure in RA: 5.79 ± 3 mmhg (range: 2–12), in LA: 7.42 ± 3.19 mmhg (range: 2–12); in RV: 33.82 ± 6.73 mmhg (24–50) and in pulmonary artery: 29.5 ± 5.92 mmhg (range 20–60), the wedge pressure X: 13.76 ± 3.92 mmhg (range: 9–25). The closure was effective in 137 of 134 cases (97.8 %); there were three embolizations: two defects with size in upper limit, and 1 accidental. These three were operated and the device was recovered, 1 died at 48 hours post‐surgery. Residual shunts were found in 16 patients: 12 trivial, 4 light. Four remained permeable to another small ASD (3mm); 1patient had progressive mitral regurgitation and required mitral replacement. Ten patients had arrhythmia (2 with complete branch block, 2 with second degree block, 3 with supraventricular arrythmia, and 1 with sinusal tachycardia). Conclusion: Closure with the Amplatzer device was an effective procedure in 97.8% of the cases (137/134). During the procedure dangerous complications could take place (3 embolizations). The arrhythmias were not frequently in later evolution (10/137). Mortality was 0.72%. We still require further experience to be able to determine which procedure is best in each case.     

The Impacts of Transcatheter Occlusion for Congenital Atrial Septal Defect on Left Ventricular Systolic Synchronicity: A Three‐Dimensional Echocardiography Study

Objectives: To investigate the impacts of transcatheter occlusion for congenital atrial septal defect (ASD) on left ventricular (LV) systolic synchronicity using a real time three‐dimensional echocardiography (RT3DE). Methods: Thirty patients with ASD closure were recruited for the study. Realtime three‐dimensional echocardiographic data sets were acquired for the measurement of LV volumes LV ejection fractions and LV three‐dimensional systolic synchronicity before and at 6 months after transcatheter occlusion for ASD. M‐mode echocardiography and RT3DE were performed to characterize interventricular septal (IVS) motion. Results: There were no differences in LV systolic synchronicity between before and after transcatheter closure of ASD (Tmsv‐16SD%: 5.6%± 1.4% vs 5.8%± 1.8%, P > 0.05; Tmsv—12SD%: 5.2 ± 1.1% vs 5.4 ± 1.2%, P > 0.05). But the abnormal IVS motion was found before device closure and normalized after transcatheter occlusion for ASD using M‐mode echocardiography and the excursion‐time figure (bull's‐eye derived from RT3DE); At the same time, LV ejection fraction (59.8 ± 2.6 vs 66.7 ± 5.9, P < 0.05) stroke volume (49 ± 14 vs 63 ± 11, P < 0.05) was improved significantly as well as normalization of IVS motion after transcatheter occlusion for ASD. The correlation between ASD diameter and change of LVEF is significant (r = 0.85, P < 0.001). Conclusion: Although transcatheter occlusion did not significantly impact on intrinsic LV systolic synchronicity in patients with ASD, LV systolic function can be improved through normalization of IVS abnormal motion after transcatheter ASD occlusion. (Echocardiography 2010;27:324‐328)     

Safety and Long‐Term Outcome of Modified Intracardiac Echocardiography‐Assisted “No‐Balloon” Sizing Technique for Transcatheter Closure of Ostium Secundum Atrial Septal Defect

Background: The need for sizing the secundum atrial septal defect (ASD) with the balloon sizing technique is still debated at least in adult patients. We sought to prospectively evaluate the effectiveness of intracardiac echocardiography (ICE)‐aided sizing technique for transcatheter closure of secundum ASD, without using a balloon sizing. Methods: In a prospective 5‐year registry, we enrolled 81 patients (mean age 48 ± 13.7 years, 54 females) who had been referred to three different centers for catheter‐based closure of secundum ASD. Eligible patients underwent ICE study and closure attempt. In a preliminary group of 21 patients, sizing balloon was performed under ICE guidance to assess the value of rim thickness necessary for device anchorage. In the remaining 60 patients, the retrieved value of the rim thickness was measured on ICE and used as key points to measure the defect and select the device. Results: In the preliminary group of patients, the value of thickness at point of initial deflection by the balloon was 1.23 ± 0.1 mm. ASD diameter in the study group was measured at the point of rim with at least 1.2 mm and the mean ASD diameter was 26.2 ± 10.1 mm. Rates of procedural success, predischarge occlusion, and major complications rate were 100%, 93.3%, and 0%, respectively. On mean follow‐up of 5.4 ± 1.8 years, the occlusion rate was 98.7% with no long‐term complications. Conclusions: Our novel ICE‐sizing technique appears to be safe and effective in adult patients, thus eventually minimizing overestimation, costs, and potential complications of balloon sizing. (J Interven Cardiol 2012;25:628–634)     

Comparison of two transcatheter device strategies for occlusion of the patent ductus arteriosus

Objectives: The present study evaluates two transcatheter closure strategies utilized at a single center and makes recommendations for device selection when occluding the patent ductus arteriosus. Background: A variety of devices are available for transcatheter closure of the patent ductus arteriosus (PDA) but no guidelines exist to guide operator device choice. Methods: A total of 132 patients underwent attempted transcatheter PDA closure utilizing one of two consecutive closure strategies between January 2000 and June 2005. Strategy A (n = 64; January 2000–May 2003) utilized Gianturco coils only. Strategy B (n = 68; June 2003–June 2005) utilized a single Gianturco coil for the PDA with a minimal diameter ≤1 mm (n = 28) or an Amplatzer Duct Occluder (ADO) if the PDA diameter exceeded 1 mm (n = 40). Success was defined as complete occlusion on a follow up echocardiogram. Results: 58 of 64 (90.6%) patients treated utilizing strategy A had successful coil implantation. 68 of 68 (100%) patients treated utilizing strategy B had successful coil/device implantation. At follow up echocardiography, 32 of 44 (72.7%) strategy A patients had complete ductal closure, as compared with 57 of 58 (98.3%) strategy B patients (P < 0.0001). Stepwise logistic regression analysis identified closure strategy as the most powerful predictor of procedural success (OR = 85.9; CI 5.6–9.99). Conclusions: A transcatheter PDA closure strategy consisting of a single Gianturco coil for PDA ≤ 1 mm or an ADO for larger sized PDA (strategy B) achieves superior outcomes compared to the use of coils alone. © 2008 Wiley‐Liss, Inc.     

Long-term outcome comparison between rashkind umbrella and gianturco coils occlusion in native patent ductus arteriosus

Background: The Rashkind Umbrella device has proven effective in closing small to moderate size patent ductus arteriosus. A comparable early occlusion rate was also seen in PDA occlusion using Gianturco coils. This study addresses the long-term outcome of both techniques in a single centre. Methods: Review was undertaken of 522 patients with PDA who underwent transcatheter occlusion before January 1997; 244 patients (mean: age 8.0±6.7 years, weight 21.8±12.9 kg, PDA size 3.2±1.0 mm) were intended to receive the Rashkind Umbrella device and the remaining 278 patients (mean: age 6.4±5.6 years, weight 18.6±11.2 kg, PDA size 2.5±1.0 mm) would receive Gianturco coils. Deployment failure occurred in 8 patients (3%) and 6 (2%) during the initial learning curve of the Rashkind Umbrella and Gianturco coil, respectively. In the Rashkind Umbrella group, haemolysis occurred in 6, device embolisation in 3, and 1 patient died from anaesthetic sequelae. Peripheral pulmonary embolisation of coils occurred in 7 patients and all were successfully retrieved. Results: Results were analysed from 228 and 258 patients who had successful Rashkind Umbrella device and Gianturco coil deployment respectively. All had completed at least 1 year follow-up. They were evaluated clinically for residual ductal murmur and echocardiographically for a residual ductal shunt and presence of pulmonary artery or aortic obstruction. The Rashkind Umbrella group had significantly higher residual shunt compared to the Gianturco coil group at various stages of follow-up (p<0.05), 40% v 22% at 24 hours, 29% v 7% at 3 months, 25% v 4% at 6 months and 22% v 3% at 1 year. In 57 patients, a reocclusion procedure during the study period was undertaken to effect immediate complete occlusion. Mild left pulmonary artery stenosis (velocity<2 m/s) was noted in 6 patients who had multiple coils and one who had a 17 mm Rashkind Umbrella device. Conclusions: Transcatheter occlusion of PDA using the Gianturco coil is safer and more effective than the Rashkind Umbrella device. It has become the first choice for treating small to moderate size native PDA at our institution.     

Five‐year Follow‐up of Intracardiac Echocardiography‐assisted Transcatheter Closure of Complex Ostium Secundum Atrial Septal Defect

Objective. We sought to prospectively evaluate long‐term follow‐up results of intracardiac echocardiography‐aided transcatheter closure of complex atrial septal defects (ASD) in the adults. Design and Settings. Prospective multicenter registry in tertiary care hospitals. Patients and Interventions. Over a 5‐year period, we prospectively enrolled 56 patients (mean age 49 ± 16.7 years, 24 females) who have been referred to our center for catheter‐based closure of complex secundum ASD (>25 mm diameter, deficiency of ≥1 rim, multiple secundum ASD, multiperforated ASD, associated incomplete floor of the fossa ovalis with or without aneurysm, embryonic remnants of incomplete atrial septation). All patients were screened by means of transesophageal echocardiography before the operation. Eligible patients underwent intracardiac echocardiography study and closure attempt. Results. Forty patients underwent a transcatheter closure attempt: transesophageal echocardiography‐planned device type and size were modified in 32 patients (64%). Rates of procedural success, predischarge occlusion, and major complications rate were 100%, 90%, and 2%, respectively. On mean follow‐up of 5.4 ± 1.8 years, the follow‐up occlusion rate was 98%. During follow‐up, only one case of permanent atrial fibrillation was observed. There were no cases of aortic/atrial erosion, device thrombosis, or new atrioventricular valve dysfunction. Conclusions. Intracardiac echocardiography‐guided complex secundum ASD transcatheter closure is safe and effective and appears to have excellent long‐term results, thus minimizing potential complications resulting from the complex anatomy.     

Left Ventricular Function by Pressure‐Volume Loop Analysis before and after Percutaneous Repair of Large Atrial Septal Defects

Aim

The intent of the present study was to evaluate changes in ventricular function with percutaneous closure of atrial septal defect (ASD), as it is associated with alterations in ventricular loading and function. Transcatheter occlusion of ASD imparts acute changes in volume loading of the left ventricle (LV) that obscures measurement of ventricular function by load‐dependent indices. To differentiate between changes in ventricular loading and function, load‐independent indices of ventricular function must be utilized.

Methods

During transcatheter occlusion of ASD, subjects underwent measurement of LV pressure and volume by the conductance catheter method. Load‐dependent indices of ventricular function included: systolic and diastolic pressures, +dP/dt_max, and ?dP/dt_max. Load‐independent indices included: elastance and tau, the preload‐independent time constant ofisovolumic relaxation. To obtain elastance, afterload was augmented by phenylephrine bolus pre‐ and post‐device occlusion.

Results

In total, 29 patients (age 2–79 years) underwent ASD device occlusion (device size 12–38 mm, median 28 mm). Load‐dependent indices were obtained in all, and satisfactory pressure‐volume loops in 11. At baseline, LV end‐diastolic pressure was 5–23 mmHg (13 ± 5 mmHg) and tau was 31 ± 6 ms. Postclosure of the ASD, LV systolic and diastolic pressures rose by 10 ± 11 mmHg and 5 ± 3 mmHg, respectively (P < 0.05), and +dP/dt_max rose from 1,288 ± 313 mmHg/sec to 1,415 ± 465 mmHg/sec (P < 0.05), but ?dP/dt_max was unchanged. Elastance significantly improved (9.4 ± 8.3 mmHg/mL vs. 13.0 ± 7.3 mmHg/mL, P < 0.05) and tau was unchanged.

Conclusions

Transcatheter occlusion of ASD is associated with acute improvement in load‐independent indices of systolic function in this cohort, without significant worsening of the preload‐independent index of diastolic function. (J Interven Cardiol 2014;27:204–211)

     

The impacts of transcatheter occlusion for congenital atrial septal defect on atrial volume, function, and synchronicity in children: a three-dimensional echocardiography study

Objective: To evaluate the impacts of transcatheter closure for atrial septal defect (ASD) on the atria. Methods: Thirty‐four patients with ASD undergoing transcatheter occlusion were recruited in the study, and 34 patients undergoing surgical operation and 34 healthy children were age‐matched as controls. A real time three‐dimensional (RT3DE) echocardiography was used to measure the volume, function, and synchronicity of the atria. Results: There was no difference in the atrial volume and function between the transcatheter occlusion group and healthy control group (P > 0.05). However, the parameters reflecting the atrial asynchrony were larger in the transcatheter occlusion group (P < 0.05). Compared to the surgical repair group, the transcatheter occlusion group had smaller maximum volume of the left atrium (21.0 ± 5.2 ml/m² vs 24.3 ± 5.8 ml/m², P = 0.01), smaller total emptying volume of the left atrium (12.7 ± 4.3 ml/m² vs 15.1 ± 3.8 ml/m², P = 0.014), smaller total emptying volume of the right atrium (13.5 ± 5.2 ml/m² vs 16.1 ± 4.7 ml/m², P = 0.029), and larger atrial systolic asynchrony indices. Conclusions: An atrial asynchrony is observed in patients with transcatheter closure of ASD, although little negative impacts on the atrial volume and function are demonstrated, which deserves more attention during follow‐up of this specific population.     

ASD closure with the Amplatzer device

We report the safety and efficacy of the Amplatzer device for transcatheter closure of ASD and fenestrated Fontan in children and adults. One hundred and two patients underwent transcatheter occlusion of the defect. The median age of the patients was 18.2 years, the median size of the ASDs by TEE was 17.6 mm, the median balloon-stretched diameter was 19.9 mm, and the median size of the device implanted was 20 mm. Immediately after the release of the device, color Doppler echocardiography revealed no residual shunt in 92 (90.19%) of 102 patients. At 24 hours all the patients 101/101 (100%) had complete closure. The minor complications encountered after the procedure were atrial arrhythmias in 4 patients. The only major complication we had was a baby who died. In conclusion, the ASO device is a safe and effective device for catheter closure of most secundum ASDs and fenestrated Fontan.     

Assessment of atrial septal defect size with 3D-transesophageal echocardiography: comparison with balloon method

BACKGROUND: Transcatheter closure of atrial septal defect (ASD) is an alternative approach to surgery in selected patients. Balloon stretched diameter (BSD) is considered as the standard way of measuring ASD size. Three-dimensional transesophageal echocardiography (3D-TEE) provides views of the ASD allowing its measurement and identifying its spatial relation with neighboring structures. Our aim was to compare the BSD and 3D-TEE methods to measure the ASD size before transcatheter closure. METHODS AND RESULTS: Seventy-six consecutive patients were enrolled for ASD device closure. Three-dimensional transesophageal echocardiography and balloon sizing were adequately performed in 70 patients before the defect closure. The mean maximal diameter measured by 3D-TEE was 20 +/- 15 mm (range 10-28) while the mean BSD was 22 +/- 4.8 mm (range 9-31). When comparing the 3D-TEE and transcatheter measurements, there was a good correlation between the two methods (y = 3.15 + 0.77x; r = 0.8). The defect as viewed by 3D-TEE was unique in 54 patients and multiple in 16 patients. In patients with a single defect, the correlation between the two methods was high (y = 1.74 + 0.84x; r = 0.85) while patients with multiple ASDs, the correlation was poor (y = 12.4 + 0.4x; r = 0.45). Transcatheter closure was performed successfully in 86%. The mean size of the Amplatzer device was 23 +/- 4.8 mm (range 4-32). The reference to choose the size of the device was the BSD in single defects and the 3D-TEE maximal diameter in multiple defects. CONCLUSION: Three-dimensional transesophageal echocardiography and transcatheter methods are two complementary techniques for the success of transcatheter ASDs closure.     

Transcatheter closure of patent ductus arteriosus and aorto‐pulmonary vessels using non‐ferromagnetic Inconel MReye embolization coils

Objectives . We report the use of non‐ferromagnetic embolization coils for transcatheter PDA closure. Background . Transcatheter patent ductus arteriosus (PDA) closure has been performed for 40 years. A number of devices have been used with varying degrees of success. Gianturco embolization coils have been used frequently since 1992 with excellent results. These coils are a stainless steel alloy, and create an artifact when subsequent MRI imaging is performed. Methods . Eight patients underwent right and left heart catheterization and transcatheter PDA closure. Angiography displayed a PDA with left to right shunting. The minimum PDA diameter was measured. An Inconel MReye coil was implanted using standard retrograde technique. A postimplant angiogram was performed. Evaluations were performed the following morning and after 2 months. Results . The median age was 5.5 years, median weight was 24 kg. The PDA minimum diameter was 1.7 mm (range 1.4–2.4 mm), with a median Qp:Qs=1.33:1. In all patients, the PDA was completely immediately closed using one Inconel coil. Two patients also had a small aorto‐pulmonary collateral vessel that was occluded using a separate Inconel coil. All patients had follow‐up evaluation the following day; the PDA remained completely occluded and there was no obstruction of the pulmonary artery branches or descending aorta. Seven patients had subsequent follow‐up and echocardiograms; the PDA remained completely occluded. There were no complications. Conclusion . The Inconel MReye coil is safe and effective for coil occlusion of small PDA and aorto‐pulmonary vessels. Additional studies are needed to define the maximum vessel diameter for Inconel coil occlusion. © 2008 Wiley‐Liss, Inc.     

Analysis of P Wave and P Dispersion in Children with Secundum Atrial Septal Defect

Background: P maximum and P dispersion are evaluated as predictors of paroxysmal atrial fibrillation in adults. In this study, these variables are being investigated in children with secundum ASD in comparison with that of normal controls and in relation to size of ASD and the presence or absence of atrial dilation. Methods: Ninety‐four children with isolated secundum ASD (33 boys, 60 girls; mean ± SD age at diagnosis 2.9 ± 4.1 years) and 65 age‐matched controls (mean ± SD age 4.2 ± 4.2 years) were evaluated. Resting 12‐lead ECG was used to measure P waves from which P maximum and P dispersion (difference between maximum and minimum P‐wave duration) were derived. ASD children were arbitrarily subgrouped according to ASD sizes (small: 1–3 mm, moderate: 4–7 mm, large: 8 mm). The presence of right atrial dilation was noted from echocardiography. Results: Children with ASD had significantly longer mean P dispersion compared to controls (P dispersion: 30.2 ± 11.1 vs 26.4 ± 6.6 ms, P = 0.008). Mean P maximum and P dispersion were significantly prolonged with increasing ASD size (P < 0.001). Children with right atrial dilation had significantly longer P maximum (102.3 ± 15.2 vs 82.8 ‐13.4 ms, P < 0.001) and larger P dispersion (36.1 ± 12.5 vs 27.6 ± 9.4 ms, P = 0.003) compared to those without right atrial dilation. Conclusion: Prolonged atrial conduction time and inhomogeneity of atrial conduction may possibly be present in children with moderate to large sized ASD and in those with atrial dilation. A.N.E. 2001;6(4):305–309     

Evaluation of right ventricular function in early period following transcatheter closure of atrial septal defect

Aims: There is limited data on alterations in novel right ventricular (RV) function indices like tricuspid annular plane systolic excursion (TAPSE) and tricuspid annular systolic velocity (TASV) after transcatheter atrial septal defect (ASD) closure. We aimed to evaluate RV function by echocardiography (ECG) with these novel indices in early period in patients with secundum‐type ASD that was closed percutaneously. Methods: Patients were enrolled to study if they had secundum‐type ASD that was suitable for percutaneous closure. Patient population consisted of 4 men and 16 women. Echocardiography was performed before and 1 month after closure. Results: Mean age was 37 ± 16. Mean diameter of ASD and total atrial septum length measured by ECG were 19 ± 6 mm and 49 ± 7 mm, respectively. Mean diameter of defect in transesophageal echocardiography was 20 ± 6 mm. Stretched mean diameter in catheterization was 23 ± 6 mm. One month after closure, there were statistically significant decreases in RV end‐diastolic diameters (43.3 ± 10.7 mm vs. 34.9 ± 5.5 mm; P < 0.001), RV/left ventricular (LV) end‐diastolic diameter ratio (1.1 ± 0.3 vs. 0.87 ± 0.1; P < 0.001), TASV (16.9 ± 3.2 cm/sec vs. 14.3 ± 3.3 cm/sec; P < 0.05), early diastolic tricuspid annular velocity (15.3 ± 3.1 cm/sec vs. 13.4 ± 2.4 cm/sec P <0.05), late diastolic tricuspid annular velocity (16.2 ± 5.4 cm/sec vs. 14.3 ± 6.3 cm/sec; P < 0.05), and TAPSE (29.9 ± 6.2 mm vs. 22.4 ± 7.4 mm; P < 0.001). LV end‐diastolic diameter (38.0 ± 6.9 mm and 40.0 ± 4.5 P < 0.05) was increased, whereas there was no change in LV ejection fraction. Conclusion: Closure of ASD by using Amplatzer devices led to decrease in right heart chamber size, tissue Doppler–derived tricuspid annular velocities and TAPSE in early period. (Echocardiography 2012;29:358‐362)     

老年房间隔缺损患者经导管封堵治疗的可行性及疗效

目的　探讨经导管封堵治疗老年房间隔缺损患者的可行性及疗效。方法　 19例年龄≥ 6 0岁的老年房间隔缺损患者 ,术前经胸超声测量房间隔缺损直径为 10～ 34(2 4 .4± 8.2 )mm ,其中 3例患者为双孔型房间隔缺损。 11例患者合并心房颤动或阵发性心房颤动。X线胸片示心胸比例均 >0 .5 (0 .5 2～ 0 .70 )。术前心功能 (NYHA分级 )Ⅱ级8例 ,Ⅲ级 9例 ,Ⅳ级 2例。所有患者均在局麻下 ,应用X线透视和经胸心脏超声引导行房间隔缺损封堵术。结果术中测肺动脉平均压力 2 1～ 4 7mmHg(1mmHg=0 .133kPa) ,其中肺动脉平均压力 >2 5mmHg者 16例。所有患者均用Amplatzer房间隔缺损封堵器或国产双盘状封堵器一次封堵治疗成功。所用封堵器直径为 14～ 38mm。 3例双孔型缺损 ,2例用 2 8mm和 32mm封堵器一并封堵 ,另 1例用直径 14mm和直径 2 6mm的封堵器封堵成功。所有患者于术后 5～ 7d行经胸心脏超声检查 ,无残余分流。术后患者心功能明显改善 ,随访 1～ 30个月 ,无封堵器相关的并发症。结论　经导管封堵治疗老年房间隔缺损患者是一种安全有效的方法。     

介入封堵术在老年继发孔型房间隔缺损患者中的临床应用

目的观察老年继发孔型房间隔缺损(ASD)患者进行介入封堵术的中、远期疗效和安全性。方法老年继发孔型ASD患者206例,缺损8～38(26.5±8.1)mm。封堵术前、术后行右心导管检测肺动脉压、右心室压,随访6个月,评价心功能(NYHA)改善情况。结果成功封堵203例,成功率98.5%。封堵器直径12～42(31.5±7.3)mm。与封堵术前比较,患者封堵术后肺动脉收缩压、右心室平均压明显下降(P<0.05,P<0.01);3～6个月随访时,患者右心室容积缩小、LVEF升高、心功能改善明显。术后心包积液1例(0.5%);即刻残余分流10例(4.9%);术后出现心律失常30例(14.8%)、出现急性心功能不全16例(7.9%)。6个月随访,患者均未发现有残余分流、脱落、栓塞。结论老年继发孔型ASD患者行介入封堵治疗中、远期相对安全、有效。     

The Amplatzer duct occluder: experience in 209 patients

OBJECTIVES: The aim of the study was to assess the safety and efficacy of the Amplatzer ductal occluder (ADO) in transcatheter occlusion of patent ductus arteriosus (PDA). BACKGROUND: Transcatheter closure of small to moderate sized PDAs is an established procedure. The ADO is a self-expandable device with a number of salutary features, notably its retrievability, ease of delivery via small 5F to 7F catheters and a range of sizes suitable even for the larger PDAs. METHODS: Between November 1997 and August 1999, the ADO was successfully implanted in 205 of 209 patients with PDA. The inclusion criteria for this device occlusion method were patients with clinical and echocardiographic features of moderate to large PDA, weighing > or =3.5 kg as well as asymptomatic adolescents and adults with PDA measuring > or =5.0 mm on two-dimensional (2D) echocardiogram. Occlusion was achieved via the antegrade venous approach. Follow-up evaluations were performed with 2D echocardiogram, color-flow mapping and Doppler measurement of the descending aorta and left pulmonary artery velocity at 24 h and 1, 3, 6 and 12 months after implantation. RESULTS: Two hundred and five patients had successful PDA occlusion using this device. The patients were between two months and 50 years (median 1.9) and weighed between 3.4 kg and 63.2 (median 8.4). Infants made up 26% of the total patients. The PDA measured from 1.8 to 12.5 mm (mean 4.9) at the narrowest diameter. Forty-four percent of patients achieved immediate complete occlusion. On color Doppler the closure rates at 24 h and 1 month after implant were 66% and 97%, respectively. At 6 and 12 months all except one patient attained complete occlusion. Device embolization occurred in three patients; in two this was spontaneous, and in the other it was due to catheter manipulation during postimplant hemodynamic measurement. Mild aortic narrowing was seen in an infant. CONCLUSIONS: Patent ductus arteriosus occlusion using ADO is safe and efficacious. It is particularly useful in symptomatic infants and small children with relatively large PDA. Embolization can be minimized by selection of appropriate sized devices, and caution should be exercised in infants <5 kg.