Combined percutaneous coronary intervention and atrial septal defect closure in an adult patient

A case of combined percutaneous coronary intervention and ostium secundum atrial septal defect closure in an elderly patient is reported. The procedure was successful and uneventful. The report demonstrates feasibility of combined percutaneous revascularization and intra‐ atrial shunt closure even in advanced age.     

Combined percutaneous coronary intervention and atrial septal defect closure in an adult patient

A case of combined percutaneous coronary intervention and ostium secundum atrial septal defect closure in an elderly patient is reported. The procedure was successful and uneventful. The report demonstrates feasibility of combined percutaneous revascularization and intra- atrial shunt closure even in advanced age.     

Jugular approach for percutaneous closure of atrial septal defect.

One hundred and forty-two consecutive procedures of percutaneous closure or atrial septal defect were approached by cannulation of the right femoral vein. In 3 of them, the internal jugular vein approach was also necessary because of azygos continuation or unsuccessful device implantation due to inadequate septal alignment. In all of them, device implantation was successfully performed through this alternative percutaneous vascular approach.     

Concurrent percutaneous atrial septal defect closure and pulmonary valvuloplasty

Severe pulmonary valve stenosis in association with a large atrial septal defect is uncommon. Simultaneous percutaneous closure of the atrial septal defect and pulmonary valvuloplasty appears to be an attractive modality when compared to patients with these two lesions being subjected to surgery or being treated percutaneously at different sittings. We encountered two cases, both with significant pulmonary valvular stenosis associated with atrial septal defect (fossa ovalis type). Both lesions were successfully treated percutaneously in the same sitting. Pulmonary valvuloplasty was done initially and the atrial septal defect closed later to minimize catheter manipulation after device implantation.     

Bioabsorbable atrial septal occluder for percutaneous closure of atrial septal defect in children

The BioSTAR bioabsorbable septal repair implant is a new transcatheter secundum atrial septal defect occlusion device that is absorbed and replaced by healthy native tissue. This retrospective analysis was designed to determine the most significant factors for its successful use in children. From October 2009 through December 2010, 33 children underwent catheterization to close secundum atrial septal defects by means of the BioSTAR. The mean age of the patients was 6.8 ± 3.4 years (range, 2.5-13 yr), and the mean body weight was 22.6 ± 11 kg (range, 11-55 kg). The device was successfully implanted in 91% of patients (30/33). In 2 patients, the attempt had to be abandoned because of deficient aortic rim. A 3rd patient had to be converted to surgery because the device embolized to the pulmonary artery. In 1 patient, 2 BioSTAR devices were used to occlude 2 separate holes. The mean maximum stretched diameter of the single-hole defects was 13.5 ± 2.5 mm (range, 8.5-18 mm). Twenty-five patients (76%) had a single-hole defect. The mean follow-up time was 7.7 ± 4.1 months (range, 0.8-15.6 mo). The occlusion rates were 77% after 24 hours and 97% at the end of follow-up. The BioSTAR septal occluder is best suited for small-to-moderate defects. Percutaneous closure of secundum atrial septal defects with the BioSTAR is safe and effective, yielding a high success rate at midterm outcome.     

Massive intravascular haemolysis after percutaneous atrial septal defect closure

We present a case of a 55 year-old female, who survived a complication of percutaneous closure of atrial septal defect never described before. Within the first day after treatment the device has dislodged and got stuck in the mitral valve apparatus. This has caused mitral insufficiency and massive haemolysis which resolved after interventional removal of the device.     

Echocardiographic aspects of percutaneous atrial septal defect closure in adults

Echocardiography plays an integral role in the diagnosis and management of atrial septal defects. With percutaneous closure of secundum defects becoming widespread, transoesophageal echocardiography in particular has assumed an important role in patient selection, as well as being central to the device deployment procedure, and an important tool in patient follow up.     

Electron beam angiography for the evaluation of percutaneous atrial septal defect closure.

Electron beam angiography (EBA) provides excellent anatomic imaging in patients with congenital heart disease and may be useful in the assessment of atrial septal defects (ASDs). We present four patients with an ASD who were considered for percutaneous closure and underwent EBA for measurement of defect size and assessment of rim adequacy, adjacent cardiac structures, and associated congenital anomalies.     

Chronotropic impairment after surgical or percutaneous closure of atrial septal defect

The “buddy‐in‐jail” technique is a novel method for increasing support during percutaneous coronary intervention. We report two case‐based examples of successful coronary stent delivery using the jailed buddy wire technique. © 2009 Wiley‐Liss, Inc.     

Combined percutaneous pulmonary valvuloplasty and atrial septal defect closure for pulmonary valvular stenosis and associated secundum atrial septal defect in an adult.

Percutaneous balloon valvuloplasty is the treatment of choice for congenital pulmonary valve stenosis, and percutaneous closure of secundum atrial septal defects has become a promising alternative to surgery in selected patients. We report a case of combined percutaneous pulmonary valvuloplasty and secundum atrial septal defect occlusion in an adult patient.     

Right ventricular form and function after percutaneous atrial septal defect device closure

OBJECTIVES

We sought to assess the right heart’s response to percutaneous device closure of moderate sized atrial septal defects (ASDs) in adults over a one-year follow-up period.

BACKGROUND

Percutaneous ASD device closure is a safe and effective means of reducing or eliminating interatrial shunting. The response of the adult’s right heart to device closure is incompletely understood.

METHODS

Forty consecutive patients had 40 device implantations (32 with the CardioSeal implant and 8 with the Amplatzer device). The patients were assessed with echocardiography, chest radiography and electrocardiography before the procedure and at 1, 6 and 12 months.

RESULTS

The mean ASD size was 13 ± 4 mm, and the device size ranged from 33 to 40 mm for CardioSeal and 12 to 36 mm for Amplatzer. At one month, heart size (49% vs. 46%), four-chamber right ventricular (RV) size (45 vs. 41 mm), paradoxical septal motion (60% vs. 5%), QRS duration (125 vs. 119 ms), PR interval (181 vs. 155 ms) and echocardiographically determined pulmonary artery systolic pressure decreased significantly and was maintained at 12-month follow-up. At six months, right atrial length decreased from 50 to 47 mm. At one year, 29% of patients had persistent RV enlargement.

CONCLUSIONS

Right heart morphology undergoes rapid improvement within one month of defect closure, with associated mechanoelectrical benefit. A small number of patients had persistent RV enlargement or pulmonary hypertension, or both, at one year. Our data support the application of transcatheter methods in achieving excellent hemodynamic and anatomic outcomes.     

Migraine with aura related to the percutaneous closure of an atrial septal defect.

We report a case of a 31-year-old woman who presented migraine attacks with aura within the 48 hr after transcatheter closure of an atrial septal defect with the Amplatzer septal occluder device. The migraine attacks persisted for 3 months, and all examinations performed to rule out a thromboembolic origin of migraine were negative.     

The influence of percutaneous atrial septal defect closure on the occurrence of migraine.

AIMS: Percutaneous patent foramen ovale closure seems to influence migraine. We wanted to observe the effect of percutaneous atrial septal defect (ASD) closure on migraine. METHODS AND RESULTS: All patients (>16 years of age) with a percutaneous ASD closure were selected from our database (n=114). A questionnaire about headache before and after closure was sent. According to the criteria of the International Headache Society, two neurologists diagnosed migraine with and without aura (MA+ and MA-, respectively). McNemar paired chi(2) and Wilcoxon signed rank tests were used where applicable. Seventy-five patients (66%, 59 females, mean age 51+/-19 years) responded and were included in the study. An Amplatzer ASD occluder was used in all. Median follow-up time was 29 months (IQ1 and IQ3, 18 and 39 months, respectively). The prevalence of MA- and MA+ changed from 19 (14/75) and 11% (8/75), respectively, before closure to 12 (9/75) and 15% (11/75), respectively, after closure (P=0.18 and P=0.55, respectively, vs. before closure). In 12 patients who suffered from migraine before closure (n=4 and 8, MA+ and MA-, respectively), migraine disappeared. In this subgroup, the frequency of migraine attacks decreased significantly (P=0.01). New-onset migraine was noted in 10 patients (n=7 and 3, MA+ and MA-, respectively). CONCLUSION: Percutaneous ASD closure was not related to a decrease in prevalence of migraine. In a subgroup, patients who suffered from typical migraine before ASD closure, the frequency of migraine attacks decreased significantly. The reason for the new-onset migraine remains unexplained. A larger study sample will be necessary to determine these findings.     

Late free atrial wall rupture after percutaneous atrial septal defect closure and transvenous pacemaker implantation

We report a remarkable case of right atrial rupture, 3 years after transcatheter closure of a secundum atrial septal defect, and 7 months after permanent transvenous two‐chamber pacemaker implantation. The etiology of the rupture remains unclear, but the presence of the two intracardiac devices is probably not coincidental. © 2008 Wiley‐Liss, Inc.