Transcatheter closure of ventricular septal defect using detachable steel coil

Transcatheter closure has been attempted in selected cases of ventricular septal defects using Lock clamshell device, Rashkind umbrella device, and Sideris buttoned device. A small perimembranous ventricular septal defect with aneurysm of membranous septum in a 12 year old girl was closed successfully with a detachable steel coil of 8 mm diameter with four loops, after failure of deployment of a Rashkind double umbrella device.


Keywords: transcatheter closure; ventricular septal defect; septal aneurysm; detachable coil; congenital heart defects     

Occlusion of Fontan fenestrations using the Amplatzer septal occluder

Objective—To evaluate the efficacy and safety of the Amplatzer septal occluder device for occlusion of Fontan fenestrations.
Subjects—Five children aged 5-10 years who had undergone a fenestrated Fontan operation.
Setting—Tertiary paediatric cardiology centre.
Methods—Each patient had right and left heart catheterisation to assess haemodynamic suitability for fenestration closure. Sizing of the defect was achieved with a balloon wedge catheter and transoesphageal echocardiography. Transcatheter occlusion of the fenestration was accomplished using a 4 mm device in three patients, and 5 mm or 9 mm devices in the other two patients. Residual shunting following occlusion was assessed using angiography and echocardiography.
Results—100% occlusion rate of the fenestration was achieved in all patients. No complications or device failures were seen during the three month follow up period.
Conclusion—The Amplatzer septal occluder device is safe, and effectively occludes the Fontan fenestration.

Keywords: Fontan circulation;  fenestration occlusion;  Amplatzer septal occluder device;  congenital heart disease     

Transcatheter closure of post-myocardial infarction ventricular septal defect with Amplatzer septal occluder.

Rupture of the interventricular septum is an uncommon but often fatal complication of acute myocardial infarction. Transcatheter closure is an established method of treating selected congenital defects but clinical experience on transcatheter closure of postinfarction ventricular septal defects (VSDs) is minimal. We report a case of successful transcatheter closure of postinfarction VSD using the Amplatzer septal occluder.     

Extending the limits of transcatheter closure of atrial septal defects with the double umbrella device (CardioSEAL)

Objective—To report initial findings from a selected group of patients with morphological variations of the atrial septal defect who underwent transcatheter closure with a second generation redesigned double umbrella device.
Patients—Two patients with abnormal location of the oval fossa and partial deficiency of the septal rim, three patients with multiple defects, and two patients with a multiperforated aneurysm of the interatrial septum (age range, 3.6-25.5 years).
Methods—Defects were closed with the double umbrella device (CardioSEAL) consisting of two sets of flexible arms (with central and two mid-arm hinges) covered with sewn Dacron patches. The implantation procedure was monitored by transoesophageal echocardiography.
Results—The diameter of the defect measured during transoesophageal echocardiography ranged from 7-18 mm and the balloon stretched diameter ranged from 13-21 mm. The size of the devices varied from 28-33 mm and the ratio of device size to defect size varied from 1.6-2.1. Two devices (23 and 28 mm) were chosen in a patient with two separated defects. No complications or serious arrhythmias were observed during implantation or follow up (median, 1.8 months). Residual shunting was trivial in three patients and mild in one patient (inferiorly located additional defect).
Conclusions—To extend the selection critera of an isolated central interatrial defect for transcatheter closure, some modifications of the implantation technique are needed. Using the redesigned double umbrella device, effective closure in patients with multiple or irregularly shaped atrial septal defects was achieved, indicating a broadening of the spectrum of transcatheter closure.

Keywords: atrial septal defects;  transcatheter closure;  congenital heart disorders;  double umbrella device;  CardioSEAL     

Transcatheter closure of perimembranous and intracristal ventricular septal defects with the SHSMA occluder

Objectives : The objective of this study was to evaluate the safety and efficacy of transcatheter closure of perimembranous ventricular septal defect (pmVSD) and intracristal VSD (icVSD) using the Shanghai Shape Memory Alloy (SHSMA) pmVSD occluder. Background : There is still limited experience with transcatheter closure of pmVSD and icVSD. Methods : Between January 2003 and September 2010, 348 patients with pmVSD and 47 patients with icVSD underwent transcatheter closure using a SHSMA pmVSD occluder. Results : The total successful closure rate in pmVSD and icVSD subjects was 97.4 and 78.7%, respectively. During the perioperative period, no death, major bleeding or hemolysis occurred in both groups. In pmVSD group, one case of occluder dislodgement, one case of pericardial tamponade, and two cases of thromboembolism occurred. None in icVSD group had these complications. During a median of 3.2 years of follow‐up, there was no evidence of significant residual shunt and device‐related valve regurgitation. None in icVSD group and 10 patients (2.9%) in pmVSD group had a persistent arrhythmia. Overall, only one patient (0.3%) with pmVSD acquired complete atrioventricular block requiring implantation of a permanent pacemaker. The rim from the tricuspid valve to the defect < 4 mm was the only predictor of arrhythmic complications after procedure (OR = 4.24; P = 0.021). Conclusions : Transcatheter closure of pmVSD in selected patients using the SHSMA occluder is effective and safe. Transcatheter closure of icVSD in experienced hands using this device is also feasible and safe. © 2011 Wiley Periodicals, Inc.     

急性心肌梗死并发室间隔穿孔六例介入治疗

目的 评价Amplatzer肌部室间隔封堵器封堵室间隔穿孔(VSR)和同期经皮腔内冠状动脉成形术(PTCA)及冠脉支架术联合介入方法治疗急性心肌梗死(AMI)并发VSR的可行性及安全性.方法 6例患者术前均经超声心动图检查诊断为AMI并发心尖部VSR,出现心原性休克后均予主动脉球囊反搏(IABP)、机械通气支持.于3周后行室间隔封堵术,同期完成PTCA及支架术.结果 6例子Amplatzer肌部室间隔封堵器成功封堵VSR,2例有少量残余漏;同期冠状动脉造影3例患者为前降支中段及回旋支局限性狭窄,分别予植入1～2枚支架,另外3例患者为多支多段狭窄,未予以植入支架;3例并行支架的患者存活出院.结论 应用Amplatzer肌部室间隔封堵器封堵VSR同期行PTCA及冠状动脉支架术治疗AMI并发VSR是安全可行的.     

Transcatheter treatment of coronary artery disease and atrial septal defect with sequential implantation of coronary stent and Amplatzer septal occluder: preliminary results.

Coronary stent implantation had been established as a highly effective revascularization technique in patients with occlusive coronary artery disease. Transcatheter closure of atrial septal defects is becoming a definite alternative to surgery in properly selected patients. During a 19-month period, 6 patients (50% women; mean age, 58 +/- 17 years; range, 32-73 years) of a consecutive series of 176 prospective multicenter registry patients undergoing transcatheter atrial septal defect closure were treated with sequential percutaneous coronary revascularization and Amplatzer septal occluder implantation. Indication for revascularization was stable angina in four patients and unstable angina in two. Indication for defect closure was significant left-to-right shunt with right ventricular enlargement. Defect diameter ranged from 13 to 20 mm by transesophageal echocardiography, and the stretched diameter measured 13 to 25 mm. Procedural success of both interventions was achieved in all cases without in-hospital complications. A total of seven stents were successfully implanted in five coronary vessels. No stent was used in one patient after successful PTCA. Immediate total closure of the defect was obtained in five patients. Trivial residual shunting, observed in one patient, disappeared at 24 hr. No adverse cardiac events, recurrence of anginal symptoms, or evidence of residual shunt were observed at clinical and echocardiographic follow-up, which ranged from 60 to 390 days (mean, 258 +/- 150 days). These results suggest that sequential transcatheter therapy of coronary artery disease and atrial septal defect is safe and efficacious in selected patients.     

Transcatheter closure of perimembranous ventricular septal defects using umbrella devices.

There is only limited experience of interventional closure of perimembranous ventricular septal defects (pmVSDs), particularly on the long-term follow-up. This is a report on our long-term results after transcatheter closure of pmVSDs using the Cardioseal, Starflex, or Rashkind devices. PATIENTS: Between 1993 and 2005, we performed interventional occlusions of pmVSDs in 18 patients. The size of the defect ranged between 4 and 8.5 mm, Q(p)/Q(s) was calculated between 1.3 and 2.2. Except for two, the patients had no other structural heart defect. In the early days, we used the Rashkind PDA occluder (17 mm) in seven, followed by the Cardioseal device (17 mm) in nine, and the 23 mm Starflex device in two patients. RESULTS: Interventional closure of the defects was performed successfully in all patients without any complication during the procedure. Fluoroscopy times were 11.8-53.7 min (median 28.65 min). We achieved a complete closure in 13 patients, three patients with recently implanted devices still show minimal shunting. In two patients the occluder had to be removed surgically because of embolization into the pulmonary artery and significant residual shunting resulting in severe hemolysis in the second patient. In long- (mean 10.7 years) and short-term (mean 0.85 years) follow-up we have not observed any hemolysis, arrhythmias, device dislocations, or device-related aortic or tricuspid regurgitation. CONCLUSION: Transcatheter closure of small pmVSDs using non-selfcentering devices can be performed successfully. Long-term follow-up investigations show encouraging results. Complications like device-embolization and significant residual shunting occur in the presence of large defects and/or concomitant malformations.     

Transcatheter closure of postinfarction ventricular septal defects using Amplatzer devices

We carried out transcatheter procedures to close postinfarction ventricular septal defects (PIVSDs) in 19 patients: two had recanalization after surgical closure, and 17 had a primary PIVSD. In three of the latter patients, who had acute PIVSDs, the procedure was carried out in the first 3 weeks after infarction; in the 13 patients with subacute PIVSD, it was carried out 3.5-12 weeks after infarction. There was another procedure in one patient with chronic PIVSD. In total, 22 procedures were completed: 17 using an Amplatzer atrial septal occluder, two using an Amplatzer postinfarction ventricular septal defect occluder, and two using an Amplatzer muscular ventricular septal defect occluder. The procedure was successful in 14 patients: in 11 with subacute PIVSD, one with chronic PIVSD, and two with postsurgical PIVSD. Transcatheter closure of PIVSDs using an Amplatzer atrial septal occluder is probably the treatment of choice in patients undergoing surgery more than 3.5 weeks after myocardial infarction and in those with recanalization after previous surgical closure.     

应用Amplatzer偏心性封堵器介入治疗膜部室间隔缺损

目的　应用Amplatzer偏心性封堵器治疗膜部室间隔缺损 (perimembraneventicularseptaldefect,PMVSD)并对近期疗效进行观察。方法　 6例PMVSD患者均经胸超声心动图确诊 ,术中经左心室造影明确缺损直径为 3～ 9mm ,平均 5 5mm ;经左心系统、室间隔缺损处、右心系统建立导丝轨迹 ,沿导丝经传送鞘管送直径 6～ 12mm(平均 8mm)的Amplatzer封堵器至缺损处行封堵 ;术后 2 4h、1月、3月分别行经胸超声及X线检查观察临床疗效。结果　全组技术成功率 10 0 % ,术中未发生任何重要并发症。全部患者封堵后无一例存在残余分流 ,术后即刻完全封堵率 10 0 % ;术后 2 4h、1月及 3月经胸超声心动图检查无残余分流 ,X线检查全部显示肺血减少 ,心胸比例不同程度缩小。 1例患者术后出现完全性左束支传导阻滞 ,1月随访时消失。结论　经导管置入Amplatzer偏心性膜部室间隔缺损封堵器治疗PMVSD是一种成功率高、近期疗效可靠的介入方法 ,其远期疗效需进一步观察。     

国产封堵器介入治疗房间隔缺损后心功能变化的研究

目的探讨国产封堵器介入治疗房间隔缺损(ASD)后心脏形态和功能的变化规律。方法全组60例,年龄5～35(16.10±10.71)岁,体重17～7(243.91±13.21)kg,经胸超声心动图(TTE)示ASD最大径7～3(618.3±7.2)mm,选用封堵器型号为10～4(026±3)mm。术后3d、3个月、6个月和12个月行TTE追踪测量。采用心尖四腔切面面积-长度法计算左右心室容积及射血分数。结果术后3d,右心房上下径、左右径,右心室舒张末期前后径、左右径均逐渐减小(与术前比较,P<0.05);右室舒张末期容积(RVEDV),右室收缩末期容积(RVESV),及右室射血分数(RVEF)均逐渐减小(与术前比较,P<0.05)。3～6个月随访,右心功能进一步改善。至12个月随访时,右心房、右心室大小及右心功能恢复正常(与术前比较,P<0.01)。术后3d,左室舒张末期前后径(LVEDD),左室舒张末期容积(LVEDV)均逐渐增大(与术前比较,P<0.05);左室收缩末期容积(LVESV),左室每搏量(LVSV)及左室射血分数(LVEF)均逐渐增大(与术前比较,P<0.05)。3～6个月随访,左心功能进一步改善。至12个月随访时,左心房、左心室大小及左心室功能恢复正常(与术前比较,P<0.01)。结论国产封堵器介入封堵ASD,既阻断了异常分流,又改善了左心室及右心系统功能及其几何构型。     

Effect of atrial septal mobility on transcatheter closure of interatrial communications

BACKGROUND: Transcatheter techniques have evolved as alternatives to surgical closure of interatrial communications due to its less invasive nature and low morbidity. The technique may be limited by the inability to deploy the device and, thus, may be complicated by significant residual shunting. Mobile or redundant septal tissue has been implicated as a possible cause of unsuccessful closure. METHODS: To determine if atrial septal hypermobility precludes successful transcatheter device closure of interatrial communications, 69 patients (mean age 46.4 +/- 17.5 years [male:female ratio 34:35]) with periprocedural transesophageal echocardiograms were reviewed. Septal excursion was defined as the maximal transit of the interatrial septum between either side of the plane connecting the superior and inferior attachment points. Unsuccessful closure was defined as subsequent cardiac surgery to close the defect, inability to deploy the device, recurrent attempts at closure, device malalignment, residual shunting greater than mild in degree on follow-up transthoracic study, and procedural complications. RESULTS: Reasons for closure were the following: embolic events (n = 48); platypnea/orthodeoxia (n = 15); atrial septal defect with right ventricular dilatation and paroxysmal atrial tachycardia (n = 2); atrial septal defect (n = 3); and prophylactic patent foramen ovale closure in a scuba diver (n = 1). Successful closure occurred in 76% of patients (n = 53). Compared with those patients with successful transcatheter closure, the mean septal excursion in patients with failed closure was 0.66 +/- 0.56 cm versus 0.76 +/- 0.47 cm (P = not significant [NS]). CONCLUSION: Our results do not support the concern that exaggerated septal mobility compromises successful device closure of interatrial communications.     

封堵器介入治疗室间隔缺损失败原因影像学分析

目的 用影像学方法分析封堵器介入治疗室间隔缺损的失败病例,以提高介入治疗室间隔缺损手术成功率。方法 未能成功行室间隔缺损堵闭术47例（47/774）,男27例,女20例,年龄2～30岁。对比其手术前后左心室和主动脉造影影像资料。结果 膜部瘤破裂15例,其中8例有多个破口,堵闭主要破口后仍有其他的破口分流,2例术前造影只显示单个破口,堵闭破口后出现新的破口,5例封闭基底部后仍存在大量分流;放置堵闭器后出现了中度以上的主动脉瓣反流28例,7例高位嵴下型室间隔缺损,室间隔缺损上缘到主动脉瓣距离小于适应证标准。21例伴有主动脉瓣脱垂,封堵器影响主动脉瓣从而造成主动脉关闭不全;封堵器移位2例;2例术后出现溶血。结论 封堵器介入治疗室间隔缺损是安全可靠的治疗方法,但是应该严格把握适应证,恰当地选择堵闭方式和堵闭器,避免治疗失败及术后并发症。     

Retrograde use of the Cardioseal/Starflex occluder device.

The Cardioseal/Starflex septal occluder is usually deployed through a long transvenous sheath for closure of atrial septal defects, persistent foramen ovale, and, less commonly, ventricular septal defects. We describe two patients with residual left-to-right shunting after surgical palliation of congenital heart defects and illustrate the successful use of the double-umbrella device in these situations using a retrograde transarterial approach. This is exemplified by two previously not described interventions: retrograde closure of a large muscular ventricular septal defect in a patient after a palliative Mustard operation and a transcatheter closure of a Waterston-Cooley anastomosis. Effective and safe closure of left-to-right shunting can be achieved by retrograde use of the Cardioseal/Starflex device in selected adolescents and grown-ups with congenital heart disease.     

Persistence of the eustachian valve in secundum atrial septal defects: possible implications for cerebral embolism and transcatheter closure procedures

Transcatheter closure of large secundum atrial septal defects is now accepted clinical practice. With the introduction of easily applicable closure devices the indications for this procedure have been expanded to include the closure of patent foramen ovale after cerebral stroke of unknown origin. In some of these patients a persistent eustachian valve is present. The clinical relevance of this finding is still unclear. A 36 year old patient with a brainstem stroke of unknown origin and a secundum atrial septal defect in combination with a persisting prominent eustachian valve is reported. The potential role of the eustachian valve in the genesis of the stroke and the difficulties during transcatheter closure of the defect because of the persisting valve are discussed.


Keywords: atrial septal defect; eustachian valve; stroke; transcatheter closure     

Combined catheter ventricular septal defect closure and multivessel coronary stenting to treat postmyocardial infarction ventricular septal defect and triple-vessel coronary artery disease: a case report.

Ventricular septal defect following acute myocardial infarction is a rare but life-threatening complication. Early surgical closure improves survival but carries a considerable risk. Percutaneous transcatheter closure is an alternative but experience to date is limited. We report a case of successful transcatheter closure of postmyocardial infarction ventricular septal defect (VSD) in a 55-year-old male with the Amplatzer muscular VSD occluder device and complete percutaneous revascularization with successful multivessel coronary stenting for three-vessel disease as a staged procedure. The technique and its potential use as an alternative to surgical approach for treatment of acute myocardial infarction and its complication (VSD) are discussed.     

经胸超声心动图和χ线透视下行膜部室间隔缺损封堵术

目的:探讨Am p latzer封堵器和国产封堵器的临床疗效以及经胸超声心动图和χ线透视下行膜部室间隔缺损(V SD)封堵术的安全性和有效性。方法:在经胸超声心动图和χ线指导下,对15例膜部(膜周)室缺患者行室缺封堵术,术后1 d,1月,3月,6月随访心电图和超声心动图检查。结果:左室造影测量室缺的大小为3~11 mm,经胸超声心动图测量V SD大小为3~10 mm,封堵器的大小为6~14 mm。15例患儿手术成功,其中8例选择Am p latzer封堵器,7例选择国产封堵器,二者在手术时间,手术即刻和随访的成功率无显著性差异(P>0.05),二组均无严重并发症发生。患儿住院时间为5~7 d,术后复查超声心动图未见主动脉瓣,三尖瓣的关闭不全,无残余分流,心电图无房室传导阻滞。结论:(1)Am p latzer封堵器和国产封堵器性能相同;(2)膜部室间隔缺损封堵术安全,有效。     

Transcatheter closure of atrial septal defects in adults with the Amplatzer septal occluder

OBJECTIVE—To assess the efficacy and complications of device occlusion of atrial septal defects in adults, using the Amplatzer septal occluder (ASO).
DESIGN—A prospective interventional study.
SETTING—Paediatric cardiology departments in two European teaching hospitals.
PATIENTS—The first 20 patients accepted for atrial septal defect device occlusion, on the basis of transoesophageal echocardiography. Sixteen patients had larger defects with right heart dilatation, while the primary indication for closure in four was a history of early paradoxical embolism.
INTERVENTIONS—Transcatheter atrial septal defect occlusions performed under transoesophageal echocardiography and fluoroscopic guidance between December 1996 and June 1998.
OUTCOME MEASURES—Success of deployment of ASO devices, procedure and fluoroscopic times, complications, and symptoms.
RESULTS—The ASO device was successfully implanted in all 20 patients (14 female), median age 44.2 years, with no complications. Of the 16 patients with right heart dilatation, the median Qp:Qs was 2.5:1. Defects measured 11-22 mm (median 18) on transoesophageal echocardiography, with balloon sized diameter (and device size) of 13-28 mm (median 20). For all 20 patients, the procedure time ranged from 38-78 minutes (median 61), and fluoroscopy 8.4-24.7 minutes (median 15.2). There were residual shunts in three patients at the end of the procedure, which were trivial ( 1 mm) as assessed by transoesophageal echocardiography, and persisted for more than six months in only one patient. Follow up ranged from 0.1-1.5 years (median 0.7). There have been no late complications.
CONCLUSIONS—The ASO device can be used successfully to close selected oval fossa defects in adults, with minimal procedural morbidity and excellent early results.


Keywords: atrial septal defect; interventional cardiac catheterisation; Amplatzer septal occluder     

Transcatheter closure of muscular ventricular septal defect using the Amplatzer devices

TECHNIQUE: From November 1997 to June 2002, percutaneous transcatheter closure of muscular ventricular septal defects was attempted in seven patients. Four patients had single and three had multiple defects. Surgical closure was performed in two patients in an attempt to close a perimembranous defect, leaving behind a large apical muscular defect, which was successfully closed using a device in one patient, whilst the second patient succumbed to septicemia/endocarditis 3 weeks after failure of device implantation. One patient had previous pulmonary artery banding and in another intraoperative placement of two Clamshell devices followed by additional transcatheter closure using Gianturco coils in two different sessions was performed. RESULTS: Transcatheter closure of ventricular septal defect was successful in six patients. Three patients underwent closure of their ventricular septal defects using the Amplatzer Septal Occluder and in the remaining three patients. Amplatzer Muscular Ventricular Septal Defect Occluder was used. The median age was 15 months (range 14 months to 10 years) and the median weight was 7.8 kg (range 7-16 kg). The devices were deployed antegradely in all patients. Immediate complete closure was obtained in three patients while two patients had small and one had a large residual following the procedure. The later was due to another multiple muscular septal defect. Transient heart block occurred in one patient during the procedure and another patient developed heart block on day 3 post-procedure. The latter required temporary pacemaker. During the follow up, one patient who had residual multiple muscular defects underwent a successful redo transcatheter closure using two Amplatzer Muscular Ventricular Septal Occluder devices. CONCLUSIONS: We conclude that transcatheter closure of muscular ventricular septal defect using Amplatzer devices is feasible and effective.