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Kheiwa A, Hari P, Madabhushi P, Varadarajan P. Patent foramen ovale and atrial septal defect. Echocardiography 2020; 37:2172-2184. [PMID: 33368546 DOI: 10.1111/echo.14646] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 02/07/2020] [Indexed: 11/30/2022] Open
Abstract
Atrial septal defects (ASD) are among the most common congenital heart diseases encountered in adulthood. Patent foramen ovale (PFO) is present in up to 25% of the population. ASD could present as isolated lesion or in association with more complex congenital heart disease form as tetralogy of Fallot, or Ebstein's anomaly of tricuspid valve. There is a wide range of clinical presentation ranging from asymptomatic subjects surviving to adulthood undiagnosed to subjects presenting with right heart failure and severe pulmonary vascular disease (Eisenmenger syndrome). This manuscript is an in depth review of the complex atrial septation, the variable clinical presentation of ASD and PFO, and its clinical and therapeutic implications.
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Affiliation(s)
- Ahmed Kheiwa
- Division of Cardiology, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Pawan Hari
- Division of Cardiology, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Pranav Madabhushi
- Division of Cardiology, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Padmini Varadarajan
- Division of Cardiology, Loma Linda University Medical Center, Loma Linda, CA, USA
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Assaidi A, Sumian M, Mauri L, Mancini J, Ovaert C, Salaun E, Habib G, Fraisse A. Transcatheter closure of complex atrial septal defects is efficient under intracardiac echocardiographic guidance. Arch Cardiovasc Dis 2014; 107:646-53. [PMID: 25241222 DOI: 10.1016/j.acvd.2014.06.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 05/25/2014] [Accepted: 06/24/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND Studies on intracardiac echocardiography for transcatheter closure of secundum atrial septal defect (ASD) only include ASDs ≤38mm diameter without rim deficiency. AIMS To assess transcatheter closure of complex ASDs under intracardiac echocardiography guidance. METHODS Retrospective study from January 2006 to January 2012 in all consecutive adult patients referred to our centre for percutaneous device closure of ASD. Complex cases were defined as defect>38mm and/or defect with rim deficiency other than the anterior-superior rim. RESULTS Transcatheter closure was performed in 93 consecutive adult patients (59 women) with a median age of 48 (18-88) years. Complex cases comprised 17 patients (18%) with a median age of 54 (20-81) years and a median weight of 58 (45-99) kg. Thirteen cases had one or more deficient rims other than the anterior-superior rim, whereas nine had an ASD size>38mm. Transcatheter closure was successful in 14 cases, whereas three cases failed (18%). Minor complications occurred in three patients (18%). All the other non-complex ASDs were successfully closed percutaneously. Among the 93 patients, rim deficiency other than the anterior-superior rim tended to be associated with failure of transcatheter closure (P=0.058). CONCLUSION Transcatheter closure of complex ASDs is safe and effective under intracardiac echocardiographic guidance.
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Affiliation(s)
- Anass Assaidi
- Cardiologie pédiatrique et congénitale, hôpital de la Timone-Enfants, 264, rue Saint-Pierre, 13385 Marseille, France
| | - Marion Sumian
- Service de cardiologie B, hôpital de la Timone-Adultes, Marseille, France
| | - Lucia Mauri
- Cardiologie pédiatrique et congénitale, hôpital de la Timone-Enfants, 264, rue Saint-Pierre, 13385 Marseille, France
| | - Julien Mancini
- Biostatistiques et technologies de l'information et de la communication (BiosTIC), hôpital de la Timone, Aix Marseille Université, Inserm, IRD, UMR_S912, SESSTIM, Marseille, France
| | - Caroline Ovaert
- Cardiologie pédiatrique et congénitale, hôpital de la Timone-Enfants, 264, rue Saint-Pierre, 13385 Marseille, France
| | - Erwann Salaun
- Cardiologie pédiatrique et congénitale, hôpital de la Timone-Enfants, 264, rue Saint-Pierre, 13385 Marseille, France
| | - Gilbert Habib
- Service de cardiologie B, hôpital de la Timone-Adultes, Marseille, France
| | - Alain Fraisse
- Cardiologie pédiatrique et congénitale, hôpital de la Timone-Enfants, 264, rue Saint-Pierre, 13385 Marseille, France.
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Silvestry FE, Kadakia MB, Willhide J, Herrmann HC. Initial Experience with a Novel Real-Time Three-Dimensional Intracardiac Ultrasound System to Guide Percutaneous Cardiac Structural Interventions: A Phase 1 Feasibility Study of Volume Intracardiac Echocardiography in the Assessment of Patients with Structural Heart Disease Undergoing Percutaneous Transcatheter Therapy. J Am Soc Echocardiogr 2014; 27:978-83. [DOI: 10.1016/j.echo.2014.04.022] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Indexed: 10/25/2022]
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Medford BA, Taggart NW, Cabalka AK, Cetta F, Reeder GS, Hagler DJ, Johnson JN. Intracardiac echocardiography during atrial septal defect and patent foramen ovale device closure in pediatric and adolescent patients. J Am Soc Echocardiogr 2014; 27:984-90. [PMID: 24998516 DOI: 10.1016/j.echo.2014.05.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND Intracardiac echocardiography (ICE) is commonly used during interventional cardiac catheterization in adults, but data regarding the use of ICE in children are limited. There are no data available comparing the effectiveness of preprocedural transthoracic echocardiography (TTE) with that of intraprocedural ICE in predicting atrial septal defect (ASD) size and rim adequacy for percutaneous closure in a pediatric population. The objectives of this study were to describe the investigators' experience using ICE in pediatric and adolescent patients and to compare the effectiveness of preprocedural TTE with that of ICE in predicting ASD size and rim adequacy for percutaneous closure. METHODS In this retrospective study, all cases in which ICE was used during ASD or patent foramen ovale closure in patients ≤21 years of age at a single institution from January 2002 through October 2013 were reviewed. All studies were performed using the Acuson AcuNav ICE system. RESULTS One hundred fifteen patients (65 female; mean age, 12 ± 6 years; range, 10 months to 21 years) were included. All intracardiac echocardiographic studies were performed by the interventional cardiologist performing the catheterization. ICE was used to facilitate ASD closure in 92 patients (81%) and patent foramen ovale closure in 23 (19%). Thirty-eight patients (34%) underwent cardiac catheterization and ICE without general anesthesia. ICE was correlated highly with preprocedural TTE in predicting ASD size (r(2) = 0.76, P < .0001). In nine of 92 patients (9.8%) with ASDs, ICE identified deficient septal rims (n = 8) or complex or multiple ASDs (n = 1) that necessitated surgical closure. There were no major complications. CONCLUSIONS ICE can be performed safely and effectively in a large cohort of children and adolescents undergoing percutaneous device closure. ICE may obviate the need for general anesthesia in some patients and is a reasonable alternative to transesophageal echocardiography for this catheter-based procedure in children. ASD measurements with ICE correlate well with preprocedural measurements on TTE; however, ICE more accurately identifies the absence or deficiency of critical septal rims before device closure.
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Affiliation(s)
- Beth A Medford
- Department of Pediatrics, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota.
| | - Nathaniel W Taggart
- Department of Pediatrics, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota
| | - Allison K Cabalka
- Department of Pediatrics, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota
| | - Frank Cetta
- Department of Pediatrics, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota; Department of Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Guy S Reeder
- Department of Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Donald J Hagler
- Department of Pediatrics, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota; Department of Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Jonathan N Johnson
- Department of Pediatrics, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota
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Yetkin U, Yurekli I, Akyildiz ZI, Gokalp O, Tetik O, Lafci B, Ergene O, Gurbuz A. Emergency surgical approach to device emboli due to migration of the atrial septal defect occluder. Arch Med Sci 2014; 10:464-9. [PMID: 25097575 PMCID: PMC4107253 DOI: 10.5114/aoms.2014.43741] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Revised: 05/28/2012] [Accepted: 07/18/2012] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Atrial septal defect (ASD) transcatheter occlusion techniques are now established as the preferred method and have become an alternative to surgery under extracorporeal circulation. In this study, we aimed to present our emergency surgical approach to cases of device embolization due to migration of the atrial septal defect occluder. MATERIAL AND METHODS Between June 2009 and June 2011, 6 patients underwent emergency operations due to device emboli secondary to migration of the transcatheter atrial septal defect occluder during the early period. Mean age was 25.5 years (15-45) and 3 of the patients were female (50%). The diagnosis was made via transthoracic echocardiography (TTE) preoperatively. RESULTS All of these 6 patients underwent emergency operations. Mean postoperative intensive care unit (ICU) stay was 2.2 days and mean hospital stay was 6 days. No early or late postoperative mortality was seen. Mean postoperative follow-up time was 19.3 months (range: 5-28 months). Early- and late-period TTE examinations showed no residual interatrial shunting. One patient developed a right atrial thrombus in the postoperative 22(nd) month as a complication of long-term follow-up. He was treated with anticoagulant therapy for 6 months with complete resolution at the TTE. CONCLUSIONS Transcatheter occlusion of secundum type ASD provides prominent clinical improvement, as well as a regression in dimensions of cardiac chambers. Nevertheless, this technique has drawbacks such as distal migration and residual shunts. Consequently, we think that unfavorable anatomy and device diameter are major issues in device migration. Oversizing also increases the migration risk.
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Affiliation(s)
- Ufuk Yetkin
- Department of Cardiovascular Surgery, Izmir Ataturk Education and Research Hospital, Izmir, Turkey
| | - Ismail Yurekli
- Department of Cardiovascular Surgery, Izmir Ataturk Education and Research Hospital, Izmir, Turkey
| | - Zehra Ilke Akyildiz
- Department of Cardiology, Izmir Ataturk Education and Research Hospital, Izmir, Turkey
| | - Orhan Gokalp
- Department of Cardiovascular Surgery, Izmir Ataturk Education and Research Hospital, Izmir, Turkey
| | - Omer Tetik
- Department of Cardiovascular Surgery, Bursa Yuksek Ihtisas Hospital, Bursa, Turkey
| | - Banu Lafci
- Department of Cardiovascular Surgery, Izmir Ataturk Education and Research Hospital, Izmir, Turkey
| | - Oktay Ergene
- Department of Cardiology, Izmir Ataturk Education and Research Hospital, Izmir, Turkey
| | - Ali Gurbuz
- Department of Cardiovascular Surgery, Izmir Ataturk Education and Research Hospital, Izmir, Turkey
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Hari P, Pai RG, Varadarajan P. Echocardiographic Evaluation of Patent Foramen Ovale and Atrial Septal Defect. Echocardiography 2014; 32 Suppl 2:S110-24. [DOI: 10.1111/echo.12625] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Pawan Hari
- Division of Cardiology; Loma Linda University Medical Center; Loma Linda California
| | - Ramdas G. Pai
- Division of Cardiology; Loma Linda University Medical Center; Loma Linda California
| | - Padmini Varadarajan
- Division of Cardiology; Loma Linda University Medical Center; Loma Linda California
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Marchese N, Pacilli MA, Inchingolo V, Fanelli R, Loperfido F, Vigna C. Residual shunt after percutaneous closure of patent foramen ovale with AMPLATZER occluder devices - influence of anatomic features: a transcranial Doppler and intracardiac echocardiography study. EUROINTERVENTION 2014; 9:382-8. [PMID: 23872652 DOI: 10.4244/eijv9i3a61] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS To evaluate the relationship between the anatomic features of the fossa ovalis (FO) and residual right-to-left shunt (RLS) after percutaneous patent foramen ovale (PFO) closure with AMPLATZER PFO occluder devices. METHODS AND RESULTS FO anatomic features were assessed by intracardiac echocardiography in 127 patients with large RLS at contrast-enhanced transcranial colour Doppler (TCCD) undergoing percutaneous PFO closure with an AMPLATZER device. Residual RLS was evaluated by TCCD three and 12 months after the procedure. PFO closure was successful in all but two patients. At TCCD, a significant residual RLS (grade ≥2) was observed in 27 (21.6%) and 17 (13.6%) patients at three and 12 months, respectively. Larger baseline RLS, presence of atrial septal aneurysm, greater longitudinal and transverse FO dimensions, and use of larger devices were associated with significant residual RLS. At multivariate analysis, the presence of atrial septal aneurysm (OR 7.6; 95% CI: 1.38-42.35; p=0.02) and longitudinal FO dimension >20.8 mm (OR 8.5; 95% CI: 1.55-46.95; p=0.014) were identified as independent predictors of significant residual RLS at 12 months. CONCLUSIONS Our study suggests that a large FO and the presence of atrial septal aneurysm are independent predictors of persistent residual RLS after PFO closure with AMPLATZER devices.
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Affiliation(s)
- Nicola Marchese
- Department of Cardiology, Casa Sollievo della Sofferenza Hospital IRCCS, San Giovanni Rotondo, Italy.
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RIGATELLI GIANLUCA, DELL'AVVOCATA FABIO, DAGGUBATI RAMESH, DUNG HOTHUONG, NGHIA NGUYENTHUONG, NANJIUNDAPPA ARAVINDA, GIORDAN MASSIMO, CARDAIOLI PAOLO. Impact of Interatrial Septum Anatomic Features on Short- and Long-Term Outcomes After Transcatheter Closure of Patent Foramen Ovale: Single Device Type Versus Anatomic-Driven Device Selection Strategy. J Interv Cardiol 2013; 26:392-8. [PMID: 23941654 DOI: 10.1111/joic.12048] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- GIANLUCA RIGATELLI
- Section of Adult Congenital and Adult Heart Disease; Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital; Rovigo Italy
| | - FABIO DELL'AVVOCATA
- Section of Adult Congenital and Adult Heart Disease; Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital; Rovigo Italy
| | - RAMESH DAGGUBATI
- Brody School of Medicine at East Carolina University; Greenville North Carolina
| | - HO THUONG DUNG
- Interventional Cardiology Department; Thong Nhat Hospital; Ho Chi Minh Vietnam
| | - NGUYEN THUONG NGHIA
- Interventional Cardiology Department; Cho Rey Hospital; Ho Chi Min City Vietnam
| | - ARAVINDA NANJIUNDAPPA
- CAMC Vascular Center of Excellence; West Virginia University; Charleston West Virginia
| | - MASSIMO GIORDAN
- Section of Adult Congenital and Adult Heart Disease; Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital; Rovigo Italy
| | - PAOLO CARDAIOLI
- Section of Adult Congenital and Adult Heart Disease; Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital; Rovigo Italy
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RIGATELLI GIANLUCA, DELL'AVVOCATA FABIO, CARDAIOLI PAOLO, GIORDAN MASSIMO, DUNG HOTHUONG, NGHIA NGUYENTHUONG, DAGGUBATI RAMESH, NANJIUNDAPPA ARAVINDA. Safety and Long-Term Outcome of Modified Intracardiac Echocardiography-Assisted “No-Balloon” Sizing Technique for Transcatheter Closure of Ostium Secundum Atrial Septal Defect. J Interv Cardiol 2012; 25:628-34. [DOI: 10.1111/j.1540-8183.2012.00755.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Vigna C, Marchese N, Zanchetta M, Chessa M, Inchingolo V, Pacilli MA, Amico C, Fanelli M, Fanelli R, Loperfido F. Echocardiographic Guidance of Percutaneous Patent Foramen Ovale Closure: Head-to-Head Comparison of Transesophageal versus Rotational Intracardiac Echocardiography. Echocardiography 2012; 29:1103-10. [DOI: 10.1111/j.1540-8175.2012.01750.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Crawford GB, Brindis RG, Krucoff MW, Mansalis BP, Carroll JD. Percutaneous atrial Septal Occluder devices and cardiac erosion: A review of the literature. Catheter Cardiovasc Interv 2012; 80:157-67. [DOI: 10.1002/ccd.24347] [Citation(s) in RCA: 103] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Accepted: 01/16/2012] [Indexed: 11/06/2022]
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Rigatelli G, Dell' Avvocata F, Cardaioli P, Giordan M, Vassiliev D, Nghia NT, Chen JP. Five-year Follow-up of Intracardiac Echocardiography-assisted Transcatheter Closure of Complex Ostium Secundum Atrial Septal Defect. CONGENIT HEART DIS 2011; 7:103-10. [DOI: 10.1111/j.1747-0803.2011.00567.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Five-year follow-up of transcatheter intracardiac echocardiography-assisted closure of interatrial shunts. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2011; 12:355-61. [PMID: 21715232 DOI: 10.1016/j.carrev.2011.04.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Revised: 04/18/2011] [Accepted: 04/22/2011] [Indexed: 11/23/2022]
Abstract
OBJECTIVE We sought to prospectively evaluate long-term follow-up results of intracardiac echocardiography-aided transcatheter closure of interatrial shunts in adults. BACKGROUND Intracardiac echocardiography improves the safety and effectiveness of transcatheter device-based closure of interatrial shunts, but its impact on long-term follow-up is unknown. METHODS Over a 5-year period, we prospectively enrolled 258 consecutive patients (mean age 48 ± 19.1 years, 169 females) who had been referred to our centre for catheter-based closure of interatrial shunts. All patients were screened with transesophageal echocardiography before the operation. Eligible patients underwent intracardiac echocardiography study and attempted closure. RESULTS After intracardiac echocardiography study and measurements, 18 patients did not proceed to transcatheter closure due to unsuitable rims, atrial myxoma not diagnosed by preoperative transesophageal echocardiography or inaccurate transesophageal echocardiography measurement of defects more than 40 mm. The remaining 240 patients underwent transcatheter closure: transesophageal echocardiography-planned device type and size were modified in 108 patients (45%). Rates of procedural success, predischarge occlusion and complication were 100%, 94.2% and 5%, respectively. On mean follow-up of 65 ± 15.3 months, the follow-up occlusion rate was 96.5%. There were no cases of aortic/atrial erosion, device thrombosis or atrioventricular valve inferences. CONCLUSIONS Intracardiac echocardiography-guided interatrial shunt transcatheter closure is safe and effective and appears to have excellent long-term results, potentially minimizing the complications resulting from incorrect device selection and sizing.
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Abstract
PURPOSE OF REVIEW To provide an overview of the various modalities that have emerged in the last years as adjunctive tools to provide detailed imaging of the cardiovascular system in the catheterization laboratory. RECENT FINDINGS Completion angiography after cardiac surgery for congenital heart disease using a dedicated hybrid operating cardiac suite may aid in early diagnosis and therapy of postsurgical abnormalities. The application of three-dimensional rotational digital angiography results in a more precise delineation of the three-dimensional anatomy of vascular structures outside the heart with rapid image processing and reduction of the amount of contrast used and ionizing radiation dose. Combined catheterization/magnetic resonance (MR) hybrid laboratories have the potential to accurately assess changes in the anatomy and physiology pretranscatheter and posttranscatheter interventions. Fully MR-guided transcatheter procedures have become possible in animal models. Real-time three-dimensional transesophageal echocardiography (TEE) has helped to guide transcatheter procedures in septal and valvar structures. Miniaturization of probes has expanded the applications of TEE for smaller neonates. The use of intravascular ultrasound has helped to better understand the mechanisms of vascular diseases and transcatheter treatments. SUMMARY Knowledge and proper application of new imaging modalities during interventions in the catheterization laboratory may improve the outcomes of patients with congenital and acquired structural heart disease.
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Abstract
PURPOSE OF REVIEW A comprehensive review of the main concepts about patent foramen ovale (PFO) management is offered. RECENT FINDINGS PFO is a common, usually benign, anatomical variant that in the presence of a discrete right-to-left shunt and other predisposing factors (Eustachian valve/Chiari network, atrial septal aneurysm, and coagulation cascade abnormalities) may play an important role in the patho-physiology of paradoxical embolism at different levels (cryptogenic stroke, peripheral embolism, coronary embolism, etc.). Therapy is a controversial issue, since data on these patients are variable and accepted guidelines are missing. Recurrent strokes are the most diffuse and accepted indication for transcatheter closure of PFO, but severe refractory migraine with aura, unexplained oxygen desaturation, orthodeoxia-platypnea, and other conditions have been suggested to benefit from PFO closure. Different devices and techniques have been proposed for this procedure, mainly depending on operator experience and preferences, which have contributed to this intervention becoming a well tolerated and effective procedure with very low morbidity and virtually absent mortality. SUMMARY PFO management is still a debated field: indications, pathophysiology and ideal closure techniques remain to be fully clarified and investigated before considering PFO closure a routine procedure.
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Rigatelli G, Ronco F, Cardaioli P, Dell'avvocata F, Braggion G, Giordan M, Aggio S. Incomplete aneurysm coverage after patent foramen ovale closure in patients with huge atrial septal aneurysm: effects on left atrial functional remodeling. J Interv Cardiol 2010; 23:362-7. [PMID: 20718907 DOI: 10.1111/j.1540-8183.2010.00586.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Large devices are often implanted to treat patent foramen ovale (PFO) and atrial septal aneurysm (ASA) with increase risk of erosion and thrombosis. Our study is aimed to assess the impact on left atrium functional remodeling and clinical outcomes of partial coverage of the approach using moderately small Amplatzer ASD Cribriform Occluder in patients with large PFO and ASA. METHODS We prospectively enrolled 30 consecutive patients with previous stroke (mean age 36 +/- 9.5 years, 19 females), significant PFO, and large ASA referred to our center for catheter-based PFO closure. Left atrium (LA) passive and active emptying, LA conduit function, and LA ejection fraction were computed before and after 6 months from the procedure by echocardiography. The preclosure values were compared to values of a normal healthy population of sex and heart rate matched 30 patients. RESULTS Preclosure values demonstrated significantly greater reservoir function as well as passive and active emptying, with significantly reduced conduit function and LA ejection fraction, when compared normal healthy subjects. All patients underwent successful transcatheter closure (25 mm device in 15 patients, 30 mm device in 6 patients, mean ratio device/diameter of the interatrial septum = 0.74). Incomplete ASA coverage in both orthogonal views was observed in 21 patients. Compared to patients with complete coverage, there were no differences in LA functional parameters and occlusion rates. CONCLUSIONS This study confirmed that large ASAs are associated with LA dysfunction. The use of relatively small Amplatzer ASD Cribriform Occluder devices is probably effective enough to promote functional remodeling of the left atrium.
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Affiliation(s)
- Gianluca Rigatelli
- Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy.
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Rigatelli G, Aggio S, Cardaioli P, Braggion G, Giordan M, Dell'avvocata F, Chinaglia M, Rigatelli G, Roncon L, Chen JP. Left Atrial Dysfunction in Patients With Patent Foramen Ovale and Atrial Septal Aneurysm. JACC Cardiovasc Interv 2009; 2:655-62. [DOI: 10.1016/j.jcin.2009.05.010] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Revised: 04/24/2009] [Accepted: 05/03/2009] [Indexed: 11/15/2022]
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