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Clinical Significance of Septal Malalignment for Transcatheter Closure of Atrial Septal Defect.

ABSTRACT: Background:Septal malalignment is related to erosion and device embolization in transcatheter closure of atrial septal defect (ASD), but limited information is available. Objectives:This study aimed to assess clinical significance of septal malalignment and to determine appropriate evaluation of ASD diameter, including the selection of device size. Methods:Four hundred and seventeen patients with ASD who underwent transcatheter closure were enrolled. Septal malalignment was defined as separation between the septum primum and the septum secundum on transesophageal echocardiography. Results:One hundred and eighty-four patients had septal malalignment. The frequency of septal malalignment increased with age reaching around 50% in adult patients. Septal malalignment was related to aortic rim deficiency. The distance of separation between the septum primum and the septum secundum was 5?±?2?mm (range, 1-11?mm). In patients with septal malalignment, the ASD diameter measured at the septum primum was 19?±?6?mm, while the ASD diameter measured at the septum secundum was 16?±?6?mm. There was a difference of 4?±?2?mm (range, 0-8?mm) between the ASD diameter measured at the septum primum and that measured at the septum secundum. For transcatheter closure, the Amplatzer Septal Occluder device size 2-3?mm larger and the Occlutech Figulla Flex II device size 4-7?mm larger than the ASD diameter measured at the septum primum were frequently used. During the study period, erosion or device embolization did not occur in all of the patients. Conclusions:Septal malalignment is highly prevalent in adult patients with aortic rim deficiency. The measurement of ASD diameter at the septum primum can be valuable for the selection of device size in patients with septal malalignment.

SUBMITTER: Takaya Y

PROVIDER: S-EPMC7072101 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Clinical Significance of Septal Malalignment for Transcatheter Closure of Atrial Septal Defect.

Takaya Yoichi Y Akagi Teiji T Nakagawa Koji K Nakayama Rie R Miki Takashi T Watanabe Nobuhisa N Toh Norihisa N Ito Hiroshi H

Journal of interventional cardiology 20200303

<h4>Background</h4>Septal malalignment is related to erosion and device embolization in transcatheter closure of atrial septal defect (ASD), but limited information is available.<h4>Objectives</h4>This study aimed to assess clinical significance of septal malalignment and to determine appropriate evaluation of ASD diameter, including the selection of device size.<h4>Methods</h4>Four hundred and seventeen patients with ASD who underwent transcatheter closure were enrolled. Septal malalignment was ...[more]

PMID: 32206044

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Project description:BackgroundTranscatheter atrial septal defect (ASD) and patent foramen ovale (PFO) closure might have opposite short- and long-term haemodynamic consequences compared with restricted interatrial shunt creation, which recently emerged as a potential treatment modality for patients with heart failure with preserved ejection fraction (HFpEF). Given the opposing approaches of ASD and PFO closure versus shunt creation, we investigated the early and sustained cardiac structural and functional changes following transcatheter ASD or PFO closure.MethodsIn this retrospective study, adult secundum-type ASD and PFO patients with complete echocardiography examinations at baseline and at 1‑day and 1‑year follow-up who also underwent transcatheter closure between 2013 and 2017 at the University Medical Centre Groningen, the Netherlands were included.ResultsThirty-nine patients (mean age 48 ± standard deviation 16 years, 61.5% women) were included. Transcatheter ASD/PFO closure resulted in an early and persistent decrease in right ventricular systolic and diastolic function. Additionally, transcatheter ASD/PFO closure resulted in an early and sustained favourable response of left ventricular (LV) systolic function, but also in deterioration of LV diastolic function with an increase in LV filling pressure (LVFP), as assessed by echocardiography. Age (β = 0.31, p = 0.009) and atrial fibrillation (AF; β = 0.24, p = 0.03) were associated with a sustained increase in LVFP after transcatheter ASD/PFO closure estimated by mean E/e' ratio (i.e. ratio of mitral peak velocity of early filling to diastolic mitral annular velocity). In subgroup analysis, this was similar for ASD and PFO closure.ConclusionOlder patients and patients with AF were predisposed to sustained increases in left-sided filling pressures resembling HFpEF following ASD or PFO closure. Consequently, these findings support the current concept that creating a restricted interatrial shunt might be beneficial, particularly in elderly HFpEF patients with AF.

Dataset Information

Clinical Significance of Septal Malalignment for Transcatheter Closure of Atrial Septal Defect.

Publications

Clinical Significance of Septal Malalignment for Transcatheter Closure of Atrial Septal Defect.

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