Project description:An 86-year-old woman experienced hypoxia with right-to-left flow across an iatrogenic atrial septal defect after deployment of a left atrial appendage closure device. Emergent closure of the defect was performed with an atrial septal occluder device with resolution of hypoxia. (Level of Difficulty: Intermediate.).
Project description:Background Current guidelines recommend at least 6 months of antithrombotic therapy and antibiotic prophylaxis after septal-occluding device deployment in transcatheter closure of atrial septal defect. It has been estimated that it takes ≈6 months for complete neo-endothelialization; however, neo-endothelialization has not previously been assessed in vivo in humans. Methods and Results The neointimal coverage of septal occluder devices was evaluated 6 months after implantation in 15 patients by angioscopy from the right atrium. Each occluder surface was divided into 9 areas; the levels of endothelialization in each area were semiquantitatively assessed by 4-point grades. Device neo-endothelialization was sufficient in two thirds of patients, but insufficient in one third. In the comparison between patients with sufficiently endothelialized devices of average grade score ≥2 (good endothelialization group, n=10) and those with poorly endothelialized devices of average grade score <2 (poor endothelialization group, n=5), those in the poor endothelialization group had larger devices deployed (27.0 mm [25.0-31.5 mm] versus 17.0 mm [15.6-22.5 mm], respectively) and progressive right heart dilatation. The endothelialization was poorer around the central areas. Moreover, the prevalence of thrombus formation on the devices was higher in the poorly endothelialized areas than in the sufficiently endothelialized areas (Grade 0, 94.1%; Grade 1, 63.2%; Grade 2, 0%; Grade 3, 1.6%). Conclusions Neo-endothelialization on the closure devices varied 6 months after implantation. Notably, poor endothelialization and thrombus attachment were observed around the central areas and on the larger devices.
Project description:ObjectiveTranscatheter closure of atrial septal defect (ASD) has become an alternative treatment to surgical repair. One of the challenges is the prolapse of the left atrial disc during the procedure. Many techniques have been developed to prevent the prolapse but not reduce it. In this study, we present a novel technique, termed push back technique, that help reduce the prolapsed device.MethodsWe enrolled 24 patients (8 males, 16 females) between May 2008 and January 2023 who underwent the push back technique during transcatheter closure of ASD in Taichung Veterans General Hospital. We recorded the hemodynamic data, success rate and complications including device embolization/migration, valvular regurgitation, pericardial effusion, and residual shunt.ResultsThe median age was 6.3 years (1.2-70.5 years) and the median weight was 19.1 kg (7.8-90 kg). Fifteen (62.5%) patients had mild pulmonary hypertension. The median Qp/Qs was 2.54 (1.5-8.8). The median ASD stretched size was 21.2 mm (7.7-35.3 mm). The median device size was 22 mm (8-40 mm). The median fluoroscopy time was 14 min (5-23 min) and median procedure time was 47 min (25-78 min). The push back technique successfully reduced the prolapsed device in 21 (87.5%) patients. There was no complication in all patients.ConclusionWe present a novel push back technique that can successfully reduce the prolapsed device in 87.5% (21/24) patients without complications. It is feasible, safe and effective.
Project description:A 10-year-old girl underwent successful device closure of a 15-mm atrial septal defect with a short and thick retroaortic rim using a 16-mm atrial septal occluder from the conventional approach under transesophageal echocardiographic guidance. There were no periprocedural complications. The aortic valve was noted to be trileaflet and competent. Transthoracic echocardiography at a routine 2-year follow-up visit demonstrated new-onset moderate aortic regurgitation. There was no pericardial effusion.
Project description:BackgroundPatients >40 years with an atrial septal defect (ASD) may have atrial arrhythmia which warrants treatment. It is unclear whether preventive left atrial appendage (LAA) occlusion should be performed simultaneously during ASD closure in these patients.ObjectiveThis study aimed to examine the incidence of de novo atrial arrhythmia in patients >40 years old post transcatheter closure of ASD.MethodsThis was a single-center, retrospective study involving all consecutive patients who have undergone device closure of ASDs at age >40 years. Standard 12-lead ECGs were performed pre-procedure and during every clinic follow-up. Ambulatory monitors were applied when indicated.ResultsEighty-eight patients (mean age: 51.81 ± 8.01 years; male: 22.7%) were recruited and followed up over a median duration of 3.6 years (range: 1-6.5). Seven patients (8%) had documented atrial arrhythmia (AA) pre and post ASD closure. Two patients (2.5%) developed de novo atrial fibrillation and one patient (1.2%), ectopic atrial rhythm during follow-up. In univariate analyses, age >61.3 years (p < 0.001), a history of palpitation (p = 0.006), right atrial area >25.15cm2 pre-closure (p = 0.004); dilated right and left atrium immediately post ASD closure (p = 0.016 & 0.001) and pulmonary vascular resistance >1.31Woods unit (p = 0.036) were associated with increased risk of AA. However, on multivariate analyses, none were significantly associated with AA.ConclusionsDe novo atrial arrhythmia after ASD device closure is uncommon.
Project description:With increasing atrial septal defect (ASD) repairs, more women of childbearing age will have ASD closure devices. Current ASD closure trials have excluded women planning pregnancy, making their management challenging. We present a pregnant woman, with a repaired ASD, who presented with device-related infective endocarditis. (Level of Difficulty: Beginner.).