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.     

实时三维超声心动图在房缺封堵术中的应用

目的探讨实时三维超声心动图(RT3DE)技术在经导管房间隔缺损(ASD)封堵术中的应用价值。方法57例连续先心病ASD行介入封堵治疗患者术前、术中及术后行经胸超声心动图(TTE)、经食管超声心动图(TEE)及RT3DE,测定ASD部位、大小、形态、以及与二尖瓣、三尖瓣的关系,术后封堵器的位置、形态、和残余漏。结果RT3DE显示ASD大多为不规则椭圆状。与TTE比较,RT3DE测得ASD最大径(P<0.05),ASD边缘与二尖瓣距离(P<0.01)及三尖瓣距离(P<0.05)差异有统计学意义。RT3DE在检测封堵后残余分流、封堵器对瓣膜活动影响及封堵器微脱位都优于TTE。结论RT3DE可准确测定ASD部位、大小、形态、以及与邻近解剖结构的关系,对封堵器选择、手术过程指导及术后疗效评价都非常有价值。     

Intracardiac echocardiography guided device closure of atrial septal defects

OBJECTIVES: This study was designed to determine the feasibility and accuracy of intracardiac echocardiography (ICE) in guiding percutaneous closure of atrial septal defects (ASD). BACKGROUND: Intracardiac echocardiography is a novel imaging technique that might be used to guide interventional procedures. The sensitivity and specificity of ICE, compared to standard imaging techniques, in detecting potentially adverse procedural events and guiding remedial action will be an important consideration in its use. METHODS: In a prospective study, 24 patients underwent device closure of ASD using ICE as the primary echocardiographic imaging modality. Feasibility was expressed as proportion of cases in which complete diagnostic ICE imaging was achieved. Accuracy was expressed as the percent agreement between ICE and simultaneously performed transesophageal echocardiography (TEE). RESULTS: High-quality ICE images were acquired in all patients, though images were limited in two patients with aneurysmal septa. Intracardiac echocardiography successfully guided closure of 24 out of 25 ASDs (96%) in 23 patients. There was close agreement between ICE and TEE in their assessment of device position and the adequacy of septal capture before device release (98%) and in identifying the presence of significant residual shunts. Intracardiac echocardiography detected all potentially adverse events, including four malpositions, and guided appropriate remedial action. CONCLUSIONS: Intracardiac echocardiography guided device closure of secundum ASDs is feasible in the majority of patients and provides diagnostic data comparable to TEE. These data indicate that ICE may be used to guide routine closure of ASDs in adults without the need for TEE and general anesthesia.     

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.     

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.     

Intracardiac echocardiography using the AcuNav ultrasound catheter during percutaneous closure of multiple atrial septal defects.

Transesophageal echocardiography is routinely used in catheterization laboratories to guide the percutaneous closure of ostium secundum atrial septal defects. The patient is under general anesthesia, and the interatrial septum anatomy is usually well defined. Multiple atrial septal defects are, in some cases, a challenge for both the interventional echocardiographer and the interventional cardiologist, when trying to evaluate the anatomy of the defects, the strategy of closure and the correct choice of the device. We describe the usefulness of a new phased-array ultrasound-tipped catheter for intracardiac echocardiography in a case of percutaneous closure of multiple ostium secundum atrial septal defects.     

Comparison of intracardiac echocardiography versus transesophageal echocardiography guidance for percutaneous transcatheter closure of atrial septal defect

Transcatheter closure of interatrial septal defects is guided by transesophageal echocardiography (TEE), which requires general anesthesia in most cases. Using a new intracardiac echocardiographic (ICE) catheter may avoid endotracheal and esophageal intubation while using only local anesthesia. Forty-two patients underwent transcatheter interatrial septal defect closure; half of them underwent TEE guidance with general anesthesia and the other half underwent ICE guidance with local anesthesia. Device deployment success rate, adequate 2-dimensional and Doppler visualization of the defect and deployment steps, interatrial communication closure at 24 hours, and at 3 and 6 months, procedure time length, complications, fluoroscopic time, and length of hospitalization were compared between both methods. All interventions were completed successfully with no complications, except for 1 patient in the TEE group who had a minor oral trauma. Echocardiographic visualization of the septal defect and deployment was adequate by both methods. Catheterization laboratory time (92 +/- 18 vs 50 +/- 12 minutes, p <0.001) and interventional procedure length (47 +/- 8 vs 35 +/- 6 minutes, p <0.001) were shortened using ICE. There was no difference in the rate of closure after 6-month follow-up by either method. ICE guidance offers equivalent echocardiographic views compared with TEE and similar rates of closure. ICE is associated with decreased procedure length while eliminating the risks of endotracheal or esophageal intubation and general anesthesia.     

Comparison of costs of intracardiac echocardiography and transesophageal echocardiography in monitoring percutaneous device closure of atrial septal defect in children and adults

The cost of percutaneous device closure of atrial septal defect in children and adults using the Amplatzer Septal Occluder under intracardiac echocardiographic guidance was compared with that of transesophageal echocardiographic guidance. Hospital and physician charges incurred by 20 patients who had intracardiac echocardiographic guidance and 20 patients who had transesophageal echocardiographic guidance during atrial septal defect closure were compared.     

Thrombus formation during percutaneous closure of an atrial septal defect with an Amplatzer septal occluder

Percutaneous closure of an ostium secundum-type atrial septal defect is typically a safe and effective therapeutic option in the presence of significant shunting or paradoxical embolism. Infrequently, however, periprocedural sequelae occur.Herein, we report the cases of 2 patients, each of whom underwent transcatheter closure of an atrial septal defect with the use of an Amplatzer Septal Occluder under transesophageal echocardiographic guidance. In both patients, acute thrombi formed periprocedurally, despite preprocedural anticoagulation. In patient 1, the infusion of unfractionated heparin for 24 hours prevented the recurrence of thrombus; in patient 2, the thrombus was isolated under the arm of the occluder, and unfractionated heparin was infused. Both patients were asymptomatic and without detectable thrombus after the procedure and at follow-up. These reports highlight a rare early sequela and the importance of transesophageal echocardiographic monitoring during the percutaneous closure of an atrial septal defect.     

Staged percutaneous atrial septal defect closure and pulmonic balloon valvuloplasty in an adult with congenital heart disease

Combined atrial septal defect and pulmonic stenosis, while a common occurrence in children, is relatively uncommon in adults. There is no widely accepted order in which the defects should be corrected. We report a case that highlights the hemodynamics and the technical dilemma of deciding which lesion to correct first. © 2008 Wiley‐Liss, Inc.     

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.     

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.     

Simultaneous percutaneous atrial septal defect closure and percutaneous coronary intervention.

OBJECTIVE: To evaluate the possibility to perform both percutaneous coronary interventions (PCI) and atrial septal defect (ASD) transcatheter treatment during the same session. Transcatheter ASD closure is a well-established alternative to surgery and the treatment of choice for single vessel coronary artery disease (CAD) is accepted to be PCI. METHODS: From January 2000 to December 2005, 985 patients were referred to our center for ASD closure. One hundred thirty four patients (59 males, mean age 58 +/- 4 years, range 45-72 years) were included in a prospective protocol of ASD transcatheter closure and coronary angiography. RESULTS: In 7 patients we found a coronary artery disease. A combined single setting definitive percutaneous approach (ASD closure and PCI) was performed in 6 patients. The patient number 4 was judged unsuitable for PCI and then was referred for surgery. There was no acute intra-procedural complication in all patients; renal functions pre and post procedure showed no change despite the increase in the amount of contrast used. CONCLUSION: Our report showed the feasibility of both PCI and ASD transcatheter treatment during the same session.     

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.