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de Liyis BG, Kosasih AM, Jagannatha GNP, Dewangga MSY. Complications and Efficacies of Surgical Versus Transcatheter Closure for Pediatric Ostium Secundum Atrial Septal Defect: A Meta-Analysis. J Endovasc Ther 2024:15266028241245599. [PMID: 38597284 DOI: 10.1177/15266028241245599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
INTRODUCTION The optimal approach for pediatric ostium secundum atrial septal defect (ASD) closure remains uncertain. This study aims to assess complications and efficacies of surgical and transcatheter closures. METHODS Systematic search in Medline, Cochrane, and EMBASE databases identified cohort studies until July 2023. Complications, length of hospital stay, and efficacy outcomes were evaluated. Subgroup analyses considered ethnicity, ASD size, age, and rim deficiency involvement. RESULTS Fourteen cohort studies involving 9695 patients were comprehensively analyzed. Regarding complications, the pediatric patients in the surgery group exhibited higher occurrences of cardiac arrhythmia (odds ratio [OR]: 1.87, 95% confidence interval [CI]: 1.22-2.87, p=0.004), pericardial effusion (OR: 14.80, 95% CI: 6.97-31.43, p<0.00001), and pulmonary complications (OR: 2.58, 95% CI: 1.73-3.85, p<0.00001) compared with those in the transcatheter group. However, no significant difference in fever incidence was observed (OR: 2.57, 95% CI: 0.90-7.34, p=0.08). Furthermore, length of hospital stay was notably shorter in the pediatric transcatheter group (mean difference [MD]: 4.00, 95% CI: 1.71-6.29, p=0.0006). Regarding efficacies, both groups demonstrated similar rates of successful closure (OR: 1.97, 95% CI: 0.56-6.92, p=0.29) and residual shunting (OR: 0.55, 95% CI: 0.17-1.77, p=0.31) in the pediatric cohort. Subgroup analyses revealed that surgical residual shunting was notably lower in the European pediatric population (OR: 0.18, 95% CI: 0.07-0.45, p=0.0002), in cases with ASD size exceeding 15 mm (OR: 0.19, 95% CI: 0.08-0.49, p=0.0006), and in pediatric patients younger than 8 years (OR: 0.33, 95% CI: 0.12-0.92, p=0.03). Interestingly, residual shunting involving complex ASD with rim deficiency was more pronounced in the surgery group (OR: 2.66, 95% CI: 1.33-5.32, p=0.006). CONCLUSIONS Both surgical and transcatheter closures are equally effective, with transcatheter closure showing significantly fewer complications. CLINICAL IMPACT This meta-analysis offers pivotal insights for clinicians grappling with the optimal approach to pediatric ostium secundum ASD closure. The observed higher incidence of cardiac arrhythmias, pericardial effusions, and pulmonary complications in surgical closures underscores the challenges associated with this modality. In contrast, transcatheter closure, with its comparable efficacy and shorter hospital stays, emerges as an appealing and less invasive alternative. These findings equip clinicians with evidence to make informed decisions, optimizing patient outcomes. Subgroup analyses further refine recommendations, emphasizing tailored considerations for European pediatric patients, larger ASDs, and those under 8 years old, ultimately fostering personalized and improved care strategies.
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Affiliation(s)
- Bryan Gervais de Liyis
- Faculty of Medicine, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Universitas Udayana, Denpasar, Indonesia
| | - Anastasya Maria Kosasih
- Faculty of Medicine, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Universitas Udayana, Denpasar, Indonesia
| | | | - Made Satria Yudha Dewangga
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Universitas Udayana, Denpasar, Indonesia
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Cinteza E, Vasile CM, Busnatu S, Armat I, Spinu AD, Vatasescu R, Duica G, Nicolescu A. Can Artificial Intelligence Revolutionize the Diagnosis and Management of the Atrial Septal Defect in Children? Diagnostics (Basel) 2024; 14:132. [PMID: 38248009 PMCID: PMC10814919 DOI: 10.3390/diagnostics14020132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/26/2023] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
Atrial septal defects (ASDs) present a significant healthcare challenge, demanding accurate and timely diagnosis and precise management to ensure optimal patient outcomes. Artificial intelligence (AI) applications in healthcare are rapidly evolving, offering promise for enhanced medical decision-making and patient care. In the context of cardiology, the integration of AI promises to provide more efficient and accurate diagnosis and personalized treatment strategies for ASD patients. In interventional cardiology, sometimes the lack of precise measurement of the cardiac rims evaluated by transthoracic echocardiography combined with the floppy aspect of the rims can mislead and result in complications. AI software can be created to generate responses for difficult tasks, like which device is the most suitable for different shapes and dimensions to prevent embolization or erosion. This paper reviews the current state of AI in healthcare and its applications in cardiology, emphasizing the specific opportunities and challenges in applying AI to ASD diagnosis and management. By exploring the capabilities and limitations of AI in ASD diagnosis and management. This paper highlights the evolution of medical practice towards a more AI-augmented future, demonstrating the capacity of AI to unlock new possibilities for healthcare professionals and patients alike.
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Affiliation(s)
- Eliza Cinteza
- Department of Pediatrics, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (E.C.)
- Pediatric Cardiology Department, “Marie Skolodowska Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania; (I.A.); (A.N.)
| | - Corina Maria Vasile
- Department of Pediatric and Adult Congenital Cardiology, University Hospital of Bordeaux, F-33600 Bordeaux, France;
| | - Stefan Busnatu
- Cardio-Thoracic Department, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Cardiology Department, “Prof. Dr. Bagdasar Arseni” Clinical Hospital, 041915 Bucharest, Romania
| | - Ionel Armat
- Pediatric Cardiology Department, “Marie Skolodowska Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania; (I.A.); (A.N.)
| | - Arsenie Dan Spinu
- “Dr. Carol Davila” Central Emergency University Military Hospital, 010825 Bucharest, Romania;
- Department 3, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Radu Vatasescu
- Cardio-Thoracic Department, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Emergency Clinical Hospital, 014461 Bucharest, Romania
| | - Gabriela Duica
- Department of Pediatrics, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (E.C.)
- Pediatric Cardiology Department, “Marie Skolodowska Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania; (I.A.); (A.N.)
| | - Alin Nicolescu
- Pediatric Cardiology Department, “Marie Skolodowska Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania; (I.A.); (A.N.)
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Hascoet S, Baruteau AE, Jalal Z, Demkow M, de Winter R, Gaio G, Clerc JM, Sabiniewicz R, Eberli F, Santoro G, Dauphin C, Schubert S, Smolka G, Lutz M, Moreno R, Pan M, Gutierrez-Larraya F, Godart F, Carminati M, Ovaert C, Batteux C, Guerin P, Thambo JB, Ewert P. Safety and efficacy of the Amplatzer™ Trevisio™ intravascular delivery system: Post-approval study results. Arch Cardiovasc Dis 2023; 116:580-589. [PMID: 37951755 DOI: 10.1016/j.acvd.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND The Amplatzer™ Trevisio™ Intravascular Delivery System (Trevisio DS; Abbott Laboratories, Chicago, IL, USA) facilitates the delivery of Amplatzer™ Occluders and features an ultraflexible tip, which improves assessment of occluder position before release. AIMS To assess the safety and efficacy of the Trevisio DS for transcatheter closure of patent foramen ovale and atrial septal defect. METHODS The Amplatzer™ Trevisio™ Intravascular Delivery System Post-Approval Study was a prospective, postmarket, single-arm, multicentre, observational study of the Trevisio DS. Enrolled patients were indicated for transcatheter closure of patent foramen ovale or atrial septal defect. In all procedures, the Trevisio DS was used to deliver Amplatzer™ Occluders. Technical success was defined as successful deployment and release of at least one occluder. Device- or procedure-related serious adverse events were tracked until discharge or day 7, whichever occurred earlier. RESULTS The study enrolled 144 patients with patent foramen ovale and 107 patients with atrial septal defect at 22 European sites; 53 patients with atrial septal defect (49.6%) were aged<18years. The rate of technical success was 98.4% (97.2% for atrial septal defect, 99.3% for patent foramen ovale). There was one serious adverse event (0.4%), an acute periprocedural device embolization that occurred after occluder release in a patient with atrial septal defect; the device was retrieved percutaneously. This was determined by the implanter to be unrelated to the performance of the Trevisio DS. CONCLUSIONS The Trevisio DS exhibited a high rate of technical success and an excellent safety profile during transcatheter closure of patent foramen ovale and atrial septal defect.
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Affiliation(s)
- Sebastien Hascoet
- Hôpital Marie-Lannelongue, Groupe Hospitalier Paris Saint-Joseph, Faculté de Médecine Paris-Saclay, Université Paris-Saclay, Centre Constitutif Réseau Maladies Rares Cardiopathies Congénitales Complexes (M3C), BME Lab, 92350 Le Plessis-Robinson, France.
| | - Alban-Elouen Baruteau
- Nantes Université, CHU de Nantes, Department of Paediatric Cardiology and Paediatric Cardiac Surgery, FHU PRECICARE, 44000 Nantes, France; Nantes Université, CHU de Nantes, Inserm, CIC FEA 1413, 44000 Nantes, France; Nantes Université, CHU de Nantes, CNRS, Inserm, l'Institut du Thorax, 44000 Nantes, France
| | - Zakaria Jalal
- Department of Paediatric and Adult Congenital Cardiology, CHU de Bordeaux, 33000 Bordeaux, France; Centre Constitutif Réseau Maladies Rares Cardiopathies Congénitales Complexes (M3C), 92350 Le Plessis-Robinson, France; Electrophysiology and Heart Modelling Institute, IHU Liryc, Fondation Bordeaux Université, 33000 Bordeaux, France
| | - Marcin Demkow
- The Cardinal Stefan Wyszynski Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland
| | - Robbert de Winter
- Amsterdam Academic Medical Centre (AMC), 1105 AZ Amsterdam, The Netherlands
| | | | | | | | | | | | | | - Stephan Schubert
- Deutsches Herzzentrum Berlin, 13353 Berlin, Germany; Herz-und Diabetes Zentrum NRW, University Clinic of Ruhr-University Bochum, 32545 Bad Oeynhausen, Germany
| | | | - Matthias Lutz
- Universitätsklinikum Schleswig-Holstein Campus Kiel, 24105 Kiel, Germany
| | - Raul Moreno
- Hospital Universitario de la Paz, 28046 Madrid, Spain
| | - Manuel Pan
- Hospital Universitario Reina Sofia, 14004 Cordoba, Spain
| | | | | | | | | | - Clement Batteux
- Hôpital Marie-Lannelongue, Groupe Hospitalier Paris Saint-Joseph, Faculté de Médecine Paris-Saclay, Université Paris-Saclay, Centre Constitutif Réseau Maladies Rares Cardiopathies Congénitales Complexes (M3C), BME Lab, 92350 Le Plessis-Robinson, France
| | | | - Jean-Benoit Thambo
- Centre Constitutif Réseau Maladies Rares Cardiopathies Congénitales Complexes (M3C), 92350 Le Plessis-Robinson, France; Electrophysiology and Heart Modelling Institute, IHU Liryc, Fondation Bordeaux Université, 33000 Bordeaux, France
| | - Peter Ewert
- Deutsches Herzzentrum München des Freistaates Bayern, 80636 München, Germany
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Xie LF, Lin Y, Chen MF, Zhang GC. Complete Transthoracic Echocardiography for the Assessment and Guidance of Percutaneous Atrial Septal Defect Closure in Adults without Balloon Sizing: An Observed Study with a 10-Year Follow-Up. J Cardiovasc Dev Dis 2023; 10:321. [PMID: 37623334 PMCID: PMC10455240 DOI: 10.3390/jcdd10080321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/26/2023] Open
Abstract
OBJECTIVES This study aims to determine if complete transthoracic echocardiography (TTE)-guided percutaneous atrial septal defect (ASD) closure without balloon sizing could be safe and efficacious in adult patients. METHODS A total of 551 patients with ASDs were enrolled in this study, of which 438 patients underwent percutaneous ASD closure. Patients who received TTE-guided percutaneous ASD closure were classified into group T, and those who underwent a procedure that was guided by transesophageal echocardiography (TEE) were classified into group E. The clinical characteristics and the outcomes of the patients were analyzed. RESULTS The characteristics were comparable at baseline, except for the body mass index (BMI) (21.6 ± 5.3 vs. 23.8 ± 7.1, p < 0.001) between group T and group E. No significant difference was observed between the two groups regarding in-hospital outcomes, except for the duration of the procedure (29.8 ± 15.3 min vs. 41.5 ± 20.4 min), the length of stay in the hospital (2.1 ± 2.3 d vs. 2.9 ± 2.6 d), and hospital costs (USD 6233.3 ± 312.4 vs. USD 6673.7 ± 446.9). There were no significant differences in the incidences of long-term complications, cardiac chamber sizes, and tricuspid regurgitation severity between the patients in the two groups during the 10-year follow-up period. CONCLUSION TTE may be as safe and efficacious as TEE for the assessment and guidance of percutaneous ASD closure without balloon sizing in adult patients with lower BMIs who are commonly found in East Asia.
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Affiliation(s)
- Lin-Feng Xie
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou 350000, China; (L.-F.X.); (Y.L.); (M.-F.C.)
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou 350000, China
- Fujian Provincial Center for Cardiovascular Medicine, Fuzhou 350000, China
| | - Yong Lin
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou 350000, China; (L.-F.X.); (Y.L.); (M.-F.C.)
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou 350000, China
- Fujian Provincial Center for Cardiovascular Medicine, Fuzhou 350000, China
| | - Mei-Fang Chen
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou 350000, China; (L.-F.X.); (Y.L.); (M.-F.C.)
- Fujian Provincial Center for Cardiovascular Medicine, Fuzhou 350000, China
| | - Gui-Can Zhang
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou 350000, China; (L.-F.X.); (Y.L.); (M.-F.C.)
- Fujian Provincial Center for Cardiovascular Medicine, Fuzhou 350000, China
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Ebuoka N, Asai H, Arai Y, Oba J, Sakai W, Tachibana T. Cosmetic and shoulder functional outcomes in posterolateral minithoracotomy atrial septal defect closure: A retrospective study. J Card Surg 2022; 37:4797-4802. [PMID: 36335627 DOI: 10.1111/jocs.17131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 10/24/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND AIM Transcatheter device closure has become the first treatment option for atrial septal defects (ASD). Surgical ASD closure, although still implemented, is cosmetically inferior to transcatheter closure. This study aimed to evaluate the feasibility as well as short- and long-term clinical outcomes of the right posterolateral minithoracotomy approach for surgical ASD closure. METHODS In total, 102 consecutive patients underwent posterolateral minithoracotomy for ASD between January 2014 and December 2021 at our center. Early surgical outcomes, cosmetic findings, and skin perception were evaluated over 1 year of postoperative follow-up using a self-satisfaction survey (1: very good, 2: good, 3: normal, 4: not good, 5: bad), Cavendish score, and shoulder joint function (angles of flexion, extension, and abduction). RESULTS No patient required conversion to median sternotomy. Only one patient required reoperation due to bleeding. Postoperative echocardiography revealed no residual shunt at discharge in all patients. The mean follow-up period was 3.7 years (range: 0.3-7.1 years), during which the questionnaire was answered by 69 of 98 patients who were evaluated after more than 1 year. The mean self-satisfaction survey scores for cosmetic findings and skin perception were 1.3 ± 0.6 and 1.2 ± 0.5, respectively. The Cavendish score was under Grade 1 in all patients. Shoulder flexion and abduction were normal at 180° in all patients, except one, while extension was normal at 50° in all patients, except three. CONCLUSIONS Our procedure achieved not only good early surgical outcomes but also excellent long-term cosmetic and shoulder function results.
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Affiliation(s)
- Noriyoshi Ebuoka
- Department of Cardiovascular and Thoracic Surgery, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Japan
| | - Hidetsugu Asai
- Department of Cardiovascular and Thoracic Surgery, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Japan
| | - Yosuke Arai
- Department of Cardiovascular and Thoracic Surgery, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Japan
| | - Junichi Oba
- Department of Cardiovascular and Thoracic Surgery, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Japan
| | - Wataru Sakai
- Department of Pediatric Intensive Care Unit, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Japan
| | - Tsuyoshi Tachibana
- Department of Cardiovascular Surgery, Kanagawa Children's Medical Center, Yokohama, Japan
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Limitations of Percutaneous Closure of a Complex Secundum Atrial Septal Defect. CASE 2022; 6:233-236. [PMID: 35832827 PMCID: PMC9271411 DOI: 10.1016/j.case.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Percutaneous closure of ASDs can be limited by size or shape of the defect. A 3D evaluation of ASDs is essential for proper sizing and procedural planning. Balloon sizing may help for large or irregularly shaped ASDs.
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Big, bigger and biggest – The management of large atrial septal defects. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 42:34-35. [DOI: 10.1016/j.carrev.2022.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 06/13/2022] [Indexed: 11/18/2022]
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An Up-to-Date Narrative Review on Congenital Heart Disease Percutaneous Treatment in Children Using Contemporary Devices. Diagnostics (Basel) 2022; 12:diagnostics12051189. [PMID: 35626343 PMCID: PMC9139868 DOI: 10.3390/diagnostics12051189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/05/2022] [Accepted: 05/07/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Congenital heart pathology has a significant burden regarding morbidity and mortality in the pediatric population. Several transcatheter interventions and devices have been designed as an alternative to surgical repair. Percutaneous interventions have been proven to yield good results in most cases but with less stress and trauma than that attributed to surgical treatment, especially in frail pediatric patients. We aimed to review the literature and to investigate the feasibility and efficacy of transcatheter interventions and implantable devices for congenital heart disease management in children. Methods: We performed a search in Scopus and MEDLINE databases using prespecified keywords to retrieve clinical studies published between 2000 and 2021. Results: This article provides an up-to-date review regarding the applicability of interventional techniques in simple inter-atrial or inter-ventricular defects, and in challenging congenital defects, such as hypoplastic left heart syndrome, tetralogy of Fallot, or coronary artery fistula. Furthermore, we reviewed recent indications for defibrillator and cardiac resynchronization therapy, and new and promising devices currently being tested. Conclusion: Transcatheter treatment represents a feasible and efficient alternative to surgical repair of congenital heart defects. Novel devices could extend the indications and possibilities of percutaneous interventions in pediatric patients with congenital heart diseases.
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Malzahn L, Bertog S, Sievert K, Reinhartz M, Schnelle N, Grunwald I, Franke J, Gafoor SA, Jovanovic B, Vogel A, Ilioska-Damkoehler P, Galeru N, Sievert H. Transcatheter closure of large atrial septal defects in adults. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 42:28-33. [DOI: 10.1016/j.carrev.2022.03.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 03/12/2022] [Accepted: 03/21/2022] [Indexed: 11/03/2022]
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Avesani M, Kang SL, Jalal Z, Thambo JB, Iriart X. Renaissance of Cardiac Imaging to Assist Percutaneous Interventions in Congenital Heart Diseases:The Role of Three-Dimensional Echocardiography and Multimodality Imaging. Front Pediatr 2022; 10:894472. [PMID: 35664875 PMCID: PMC9160663 DOI: 10.3389/fped.2022.894472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 04/12/2022] [Indexed: 11/20/2022] Open
Abstract
Percutaneous interventions have completely refashioned the management of children with congenital heart diseases (CHD) and the use of non-invasive imaging has become the gold standard to plan and guide these procedures in the modern era. We are now facing a dual challenge to improve the standard of care in low-risk patients, and to shift our strategies from the classic open chest surgery to imaging-guided percutaneous interventions in high-risk patients. Such rapid evolution of ultrasound technologies over the last 20 years have permitted the integration of transthoracic, transesophageal and intracardiac echocardiography into the interventional workflow to improve image guidance and reduce radiation burden from fluoroscopy and angiography. Specifically, miniaturization of transesophageal probe and advances in three-dimensional (3D) imaging techniques have enabled real-time 3D image guidance during complex interventional procedure, In addition, multimodality and fusion imaging techniques harness the strengths of different modalities to enhance understanding of anatomical and spatial relationship between different structures, improving communication and coordination between interventionalists and imaging specialists. In this review, we aim to provide an overview of 3D imaging modalities and multimodal fusion in procedural planning and live guidance of percutaneous interventions. At the present times, 3D imaging can no longer be considered a luxury but a routine clinical tool to improve procedural success and patient outcomes.
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Affiliation(s)
- Martina Avesani
- Department of Pediatric and Congenital Cardiology, M3C National Reference Centre, Bordeaux University Hospital, Bordeaux, France
| | - Sok-Leng Kang
- Department of Pediatric Cardiology, Alder Hey Children's Hospital, Liverpool, United Kingdom
| | - Zakaria Jalal
- Department of Pediatric and Congenital Cardiology, M3C National Reference Centre, Bordeaux University Hospital, Bordeaux, France.,Institut Hospitalo-Universitaire (IHU) Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Foundation, Pessac, France
| | - Jean-Benoit Thambo
- Department of Pediatric and Congenital Cardiology, M3C National Reference Centre, Bordeaux University Hospital, Bordeaux, France.,Institut Hospitalo-Universitaire (IHU) Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Foundation, Pessac, France
| | - Xavier Iriart
- Department of Pediatric and Congenital Cardiology, M3C National Reference Centre, Bordeaux University Hospital, Bordeaux, France.,Institut Hospitalo-Universitaire (IHU) Liryc, Electrophysiology and Heart Modeling Institute, Bordeaux University Foundation, Pessac, France
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Hahn RT, Saric M, Faletra FF, Garg R, Gillam LD, Horton K, Khalique OK, Little SH, Mackensen GB, Oh J, Quader N, Safi L, Scalia GM, Lang RM. Recommended Standards for the Performance of Transesophageal Echocardiographic Screening for Structural Heart Intervention: From the American Society of Echocardiography. J Am Soc Echocardiogr 2022; 35:1-76. [PMID: 34280494 DOI: 10.1016/j.echo.2021.07.006] [Citation(s) in RCA: 78] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Rebecca T Hahn
- Columbia University Irving College of Medicine, New York, New York
| | - Muhamed Saric
- New York University Langone Health, New York, New York
| | | | - Ruchira Garg
- Cedars-Sinai Medical Center, Los Angeles, California
| | | | | | - Omar K Khalique
- Columbia University Irving College of Medicine, New York, New York
| | - Stephen H Little
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | | | - Jae Oh
- Mayo Clinic, Rochester, Minnesota
| | | | - Lucy Safi
- Hackensack University Medical Center, Hackensack, New Jersey
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Nakayama R, Takaya Y, Akagi T, Watanabe N, Miki T, Nakagawa K, Toh N, Ito H. Efficacy and safety of atrial septal defect closure using Occlutech Figulla Flex II compared with Amplatzer Septal Occluder. Heart Vessels 2021; 36:704-709. [PMID: 33386412 DOI: 10.1007/s00380-020-01739-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/20/2020] [Indexed: 11/25/2022]
Abstract
Few studies have reported the efficacy of Occlutech Figulla Flex II (FFII) device compared with Amplatzer Septal Occluder (ASO) device. The aim of this study was to examine the efficacy and safety of FFII compared with ASO for transcatheter atrial septal defect (ASD) closure. We retrospectively evaluated 190 patients using FFII and 190 patients using ASO who underwent transcatheter ASD closure. ASD characteristics were evaluated by transesophageal echocardiography. The prevalence of procedural complications, including erosion, device embolization, stroke, and new-onset atrial arrhythmia, and the presence of a residual shunt were evaluated between the two groups during 12-month follow-up. FFII was used more frequently than ASO in patients with a deficient aortic rim or septal malalignment (P = 0.02, P < 0.01, respectively). The procedural complications of erosion, device embolization, and stroke did not occur in any patients. New-onset atrial arrhythmia occurred in 3 patients of the FFII group and 4 patients of the ASO group, and the difference between the two groups was not significant (P = 0.70). A large residual shunt (≥ 3 mm) was observed in 6 patients of the FFII group and 5 patients of the ASO group, and the difference between the two groups was not significant (P = 0.76). FFII was used frequently in patients with high-risk ASD morphology; however, there was no difference in the prevalence of procedural complications or efficacy between patients using FFII and those using ASO.
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Affiliation(s)
- Rie Nakayama
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Yoichi Takaya
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
| | - Teiji Akagi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Nobuhisa Watanabe
- Division of Medical Support, Okayama University Hospital, Okayama, Japan
| | - Takashi Miki
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Koji Nakagawa
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Norihisa Toh
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
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Takaya Y, Akagi T, Nakagawa K, Nakayama R, Miki T, Toh N, Ito H. Morphological assessments of deficient posterior-inferior rim for transcatheter closure of atrial septal defect. Catheter Cardiovasc Interv 2021; 97:135-141. [PMID: 32790128 DOI: 10.1002/ccd.29182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/26/2020] [Accepted: 07/19/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES This study aimed to determine morphological characteristics of deficient posterior-inferior rim for transcatheter atrial septal defect (ASD) closure success. BACKGROUND The feasibility of transcatheter closure of ASD with deficient posterior-inferior rim remains unclear. METHODS Of 869 patients with ASD who were scheduled transcatheter closure, 121 with posterior-inferior rim of <5 mm were included. Posterior-inferior rim morphologies were evaluated by transesophageal echocardiography. RESULTS One hundred six patients successfully underwent transcatheter closure, while 15 patients failed. These 15 patients had complete deficient posterior-inferior rim of 0 mm and/or a large defect of ≥38 mm. Multivariate logistic regression analysis showed that transcatheter closure failure was independently related to complete deficient posterior-inferior rim and a large defect of ≥38 mm. Incomplete deficient posterior-inferior rim of >0 to <5 mm was observed in 84 patients. All these patients successfully underwent transcatheter closure, except two patients with a large defect of ≥38 mm. Complete deficient posterior-inferior rim was observed in 37 patients. The frequency of complete deficient posterior-inferior rim was higher in patients who failed transcatheter closure (87% vs. 23%, p < .01), but transcatheter closure was performed successfully if the range of complete deficient rim was ≤30°. After the procedure, no adverse events occurred during a median follow-up of 24 months. CONCLUSIONS Most patients with deficient posterior-inferior rim successfully underwent transcatheter closure. Transcatheter closure could be performed even in patients with complete deficient posterior-inferior rim if the range was partial. Our findings can help to identify candidates for transcatheter closure.
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Affiliation(s)
- Yoichi Takaya
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Teiji Akagi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Koji Nakagawa
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Rie Nakayama
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Takashi Miki
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Norihisa Toh
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Aggeli C, Apostolou I, Dimitroglou Y, Toutouzas K, Vavuranakis M, Latsios G, Tsiamis E, Lerakis S, Tousoulis D. The role of ‘halo sign’ for the accurate quantification of atrial septal defect size with 3D TEE. Int J Cardiovasc Imaging 2020; 36:873-881. [DOI: 10.1007/s10554-020-01786-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 01/31/2020] [Indexed: 11/29/2022]
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Long-Term Follow-Up of Transthoracic Echocardiography-Guided Transcatheter Closure of Large Atrial Septal Defects (≥ 30 mm) Using the SHSMA Occluder. Pediatr Cardiol 2020; 41:716-723. [PMID: 32006083 DOI: 10.1007/s00246-020-02288-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 01/17/2020] [Indexed: 10/25/2022]
Abstract
Transcatheter closure of large atrial septal defects (ASDs) remains controversial. The aim of this study was to evaluate the feasibility and safety of transthoracic echocardiography (TTE)-guided transcatheter closure of large ASDs. Patients with large secundum ASDs (≥ 30 mm) who underwent device closure were retrospectively reviewed. TTE was performed to guide ASD occluder positioning and assess the immediate and long-term outcomes. A total of 60 patients (median age 43.5 years, range 15-78 years) were enrolled in the study. The median ASD size was 35 mm (range 30-42 mm). Mild to moderate pulmonary hypertension was observed in 36 patients (60%). Thirty-one patients (51.7%) had one short rim, and 18 patients (30.0%) had two deficient rims. Placement of the device was successful in 57 patients (95%), and the median device size was 42 mm (range 40-50 mm). Dislodgement of the device occurred in three patients with two deficient rims: a larger device was redeployed in one case, and two patients required surgical repair. During a median follow-up of 37 months (range 6-83 months), no residual shunts, erosion, or embolization were noted, and pulmonary hypertension resolved in 75% of the patients. Thus t vast majority (95%) of large ASDs can be successfully closed percutaneously using the Chinese-made Shanghai Shape Memory Alloy (SHSMA) occluder under TTE guidance. Long-term follow-up showed that transcatheter closure could become a safe and effective alternative to surgery in select large ASDs.
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16
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Tan W, Aboulhosn J. Echocardiographic guidance of interventions in adults with congenital heart defects. Cardiovasc Diagn Ther 2019; 9:S346-S359. [PMID: 31737541 DOI: 10.21037/cdt.2018.09.10] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cardiac catheterization procedures have revolutionized the treatment of adults with congenital heart disease over the past six decades. Patients who previously would have required open heart surgery for various conditions can now undergo percutaneous cardiac catheter-based procedures to close intracardiac shunts, relieve obstructive valvular lesions, stent stenotic vessels, or even replace and repair dysfunctional valves. As the complexity of percutaneous cardiac catheterization procedures has increased, so has the use of echocardiography for interventional guidance in adults with congenital heart disease. Transthoracic, transesophageal, intracardiac, and three-dimensional echocardiography have all become part and parcel of the catheterization laboratory experience. In this review, we aim to describe the different echocardiographic techniques and their role in various cardiac catheterization interventions specific to adults with congenital heart disease.
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Affiliation(s)
- Weiyi Tan
- University of California, Los Angeles, USA
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17
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Abe N, Go M, Nakai K, Kato M, Tanaka K. The repeating dislodgement of an Amplatzer Septal Occluder device during recovery from general anesthesia in an adult undergoing transcatheter closure of atrial septal defect : a case report. THE JOURNAL OF MEDICAL INVESTIGATION 2019; 66:194-198. [PMID: 31064940 DOI: 10.2152/jmi.66.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Transcatheter closure with an Amplatzer Septal Occluder (ASO) has become the standard treatment for secundum atrial septal defect (ASD). However, this procedure is associated with complications, such as device dislodgement. A 52-year-old woman was admitted with exertional dyspnea. Transesophageal echocardiography showed an ASD involving a 29 mm defect. Calculated Qp/Qs was 5.6 and all the rims were ?5 mm, with the exception of the posterior rim, which was 3 mm. Transcatheter ASD closure with an ASO was performed under general anesthesia. During emergence from anesthesia, tachycardia developed and the ASO device became dislodged. Hemodynamic changes associated with the end of anesthetic administration were believed to have led to device dislodgement. In a second transcatheter ASD closure, a low dose of propofol and remifentanil was maintained during emergence from anesthesia to reduce hemodynamic changes. However, device dislodgement occurred with nonsustained ventricular tachycardia. Finally, surgical ASD closure was performed. The large defect size, high Qp/Qs, and rim deficiency may have predisposed to device dislodgement after transcatheter ASD closure with ASO. The risk of device dislodgement should be considered in advance of surgery and, in high-risk cases, the patient's cardiovascular status should be closely monitored. J. Med. Invest. 66 : 194-198, February, 2019.
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Affiliation(s)
- Natsuki Abe
- Department of Anesthesiology, Tokushima Prefectural Central Hospital, Tokushima, Japan
| | - Masanori Go
- Department of Anesthesiology, Tokushima RedCross Hospital, Tokushima, Japan
| | - Kaori Nakai
- Department of Anesthesiology, Tokushima RedCross Hospital, Tokushima, Japan
| | - Michihisa Kato
- Department of Anesthesiology, Tokushima RedCross Hospital, Tokushima, Japan
| | - Katsuya Tanaka
- Department of Anesthesiology, Tokushima University, Tokushima, Japan
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18
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Jung SY, Kim AY, Jung JW, Choi JY. Procedural, Early and Long-term Outcomes after Percutaneous Closure of Atrial Septal Defect: Comparison between Large and Very Large Atrial Septal Defect Groups. Korean Circ J 2019; 49:975-986. [PMID: 31165594 PMCID: PMC6753025 DOI: 10.4070/kcj.2018.0391] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 03/13/2019] [Accepted: 04/10/2019] [Indexed: 12/03/2022] Open
Abstract
Background This study aimed to compare procedural, early and long-term outcome of device closure of atrial septal defect (ASD) between large ASD patients and very large ASD patients. Methods We carried a retrospective study of adult large ASD (defined as ≥25 mm) treated by percutaneous closure using Amplatzer septal occluder during 12-year period (May 2003–February 2015) at a single tertiary center. A total of 269 patients were divided into 2 groups, according to the pre-procedural maximal ASD diameter; 25 mm≤ASD<35mm, group 1 (n=216) and 35 mm≤ASD, group 2 (n=53). We compared procedural parameters, early complications and long-term follow-up results between 2 groups. Results The need of modified implantation techniques (MITs) was higher group 2 (23.6% vs. 37.7%, p=0.034). Procedural success rate was considerably high in both groups (99.1% in group 1 vs. 100% in group 2, p=0.620). Major complications were occurred in 4 (1.5%) patients (1.4% vs. 1.9%, p=0.804). Minor complication rate was not different between 2 groups. During long-term follow-up (47.2±32.0 months, range, 6.0–135.5), there was one major complication (0.4%) of stroke. Most common long-term minor event was migraine headache (3.9%) followed by arrhythmias (1.9%) without statistical difference between 2 groups. Conclusions Although MIT was more frequently required in very large ASD groups, the procedural, early and long-term outcomes after percutaneous ASD closure were similar in both groups. This suggested that percutaneous ASD closure for very large ASD could be considered a good treatment option.
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Affiliation(s)
- Se Yong Jung
- Division of Pediatric Cardiology, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Ah Young Kim
- Division of Pediatric Cardiology, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Jo Won Jung
- Division of Pediatric Cardiology, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Young Choi
- Division of Pediatric Cardiology, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.
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Amedro P, Bayburt S, Assaidi A, Kreitmann B, Habib G, Fouilloux V, Fraisse A. Should transcatheter closure of atrial septal defects with inferior-posterior deficient rim still be attempted? J Thorac Dis 2019; 11:708-716. [PMID: 31019758 DOI: 10.21037/jtd.2019.02.89] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Transcatheter closure for atrial septal defect (ASD) with inferior-posterior rim deficiency has been scarcely reported with proper identification of the indications and limits. We aimed to assess the safety and feasibility of transcatheter closure of ASDs with deficient rims, paying particular attention to cases with inferior-posterior rim deficiency. Methods From January 2008 to January 2013, 241 patients underwent transcatheter ASD closure, including 50 cases (20.7%) with deficient rims, other than the anterior-superior one. Eighteen patients (12 females) presented inferior-posterior rim deficiency. Their median age was 8 (1.4-85) years and their median weight was 24 [9-97] kg. Transcatheter closure was performed in all cases under transesophageal echocardiography (TEE) guidance in children and intracardiac echocardiography (ICE) guidance in adults. Results Out of 18 patients with inferior-posterior rim deficiency, only 8 underwent successful immediate transcatheter closure. Four cases failed to be closed. Major complications occurred in 6 patients, including 4 device embolizations, 1 pericardial effusion and 1 complete atrioventricular block that resolved after surgical removal of the device. During a median follow up of 54±13 months, a residual right-to-left shunt was documented in 2 more cases, requiring surgery in one case because of cyanosis. Transcatheter closure was successfully performed in the rest of the 223 patients, including in the 32 cases with deficient rims other than inferior-posterior. Conclusions Transcatheter closure of ASDs with inferior-posterior rim deficiency cannot be recommended.
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Affiliation(s)
- Pascal Amedro
- PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France.,Pediatric and Congenital Cardiology Department, M3C Regional Reference Centre, Montpellier University Hospital, Montpellier, France
| | - Selin Bayburt
- School of Medicine, Acibadem University, Istanbul, Turkey
| | - Anass Assaidi
- Pediatric and Congenital Cardiology Department, M3C Reference Regional Centre, La Timone University Hospital, Marseille, France
| | - Bernard Kreitmann
- Department of Cardiovascular Surgery, Bordeaux University Hospital, Bordeaux, France
| | | | | | - Alain Fraisse
- Pediatric Cardiology Service, Royal Brompton and Harefield Hospital Trust, London, UK
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20
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Sivakumar K, Viswambaran B, Bhattacharjya S. Feasibility, safety and midterm follow-up of patients after nonsurgical closure of atrial septal defects using very large 40-46 mm nitinol septal occluders. Catheter Cardiovasc Interv 2019; 93:466-473. [PMID: 30419611 DOI: 10.1002/ccd.27957] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 10/07/2018] [Accepted: 10/11/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To study the feasibility of closure of large atrial septal defects (ASDs) using occluder devices >38 mm and assess the midterm complications. BACKGROUND Feasibility and safety of large occluders >38 mm and their follow-up are largely unknown. METHODS All patients with ASDs closed using devices >38 mm were retrospectively analyzed. Since outcome of patients receiving 40 mm devices were known before, patients receiving 40 mm devices were compared with those receiving 42-46 mm devices on demographic, hemodynamic parameters and procedural characteristics. RESULTS A total of 17 patients with 40-mm device and 31 patients with >40-mm device formed the cohort. The mean echocardiographic defect size was 36.3 ± 3.7 mm. In total 19 patients had deficient retroaortic margin; inferior margin was deficient in one. Larger defects needed special deployment techniques more often. There was acute technical success in all patients. Two procedures failed; one device embolization next day in a patient with deficient inferior margin needed surgery. Another elderly patient with restrictive left ventricular physiology died of multiorgan dysfunction. Two late deaths on follow-up were unrelated to the procedure. All other patients had symptom improvement. There were no erosions, thromboembolism or valvar regurgitation at a median follow-up of 39 (1-60) months. Apart from late-onset atrial flutter in one, there were no arrhythmias on follow-up. CONCLUSIONS Occluders larger than 38 mm in appropriately selected patients are feasible, successful and safe in majority and often require special deployment techniques. Complications during and after the procedure were infrequent. Very large defects with any deficient margin except retroaortic rim should be excluded from device closure.
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Affiliation(s)
- Kothandam Sivakumar
- Department of Pediatric Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, India
| | - Bijesh Viswambaran
- Department of Pediatric Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, India
| | - Sudipta Bhattacharjya
- Department of Pediatric Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, India
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21
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Fraisse A, Latchman M, Sharma SR, Bayburt S, Amedro P, di Salvo G, Baruteau AE. Atrial septal defect closure: indications and contra-indications. J Thorac Dis 2018; 10:S2874-S2881. [PMID: 30305947 DOI: 10.21037/jtd.2018.08.111] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Transcatheter closure has become an accepted alternative to surgical repair for ostium secundum atrial septal defects (ASD). However, large ASDs (>38 mm) and defects with deficient rims are usually not offered transcatheter closure but are referred for surgical closure. Transcatheter closure also remains controversial for other complicated ASDs with comorbidities, additional cardiac features and in small children. This article not only provides a comprehensive, up-to-date description of the current indications and contra-indications for ASD device closure, but also further explores the current limits for transcatheter closure in controversial cases. With the devices and technology currently available, several cohort studies have reported successful percutaneous closure in the above-mentioned complex cases. However the feasibility and safety of transcatheter technique needs to be confirmed through larger studies and longer follow-up.
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Affiliation(s)
- Alain Fraisse
- Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | | | | | - Selin Bayburt
- Acibadem University, School of Medicine, Acıbadem Universitesi Kerem AydınlarKampüsü, Ataşehir, Istanbul, Turkey
| | - Pascal Amedro
- Department of Paediatric Cardiology, CHU de Montpellier, Montpellier, France
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22
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Faccini A, Butera G. Atrial septal defect (ASD) device trans-catheter closure: limitations. J Thorac Dis 2018; 10:S2923-S2930. [PMID: 30305952 DOI: 10.21037/jtd.2018.07.128] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Transcatheter closure is a widespread technique used to treat secundum atrial septal defects (ASDs). When compared to surgery, it provides a less invasive approach with quicker recovery and reduced physical and psychological impact. Nowadays, almost 85-90% of all secundum ASD can be closed by using a transcatheter approach. However, several limitations may have a significant impact on the feasibility and success of percutaneous ASD closure. Limitations can be grouped as: (I) anatomical; (II) device-related; (III) associated defects and natural history associated issues; (IV) physiological; (V) complications. Physician should be aware of potential limits of percutaneous ASD closure.
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Affiliation(s)
- Alessia Faccini
- Department of Congenital Cardiology and Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Gianfranco Butera
- Department of Congenital Cardiology and Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
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23
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Jalal Z, Hascoët S, Gronier C, Godart F, Mauri L, Dauphin C, Lefort B, Lachaud M, Piot D, Dinet ML, Levy Y, Fraisse A, Ovaert C, Pillois X, Lusson JR, Petit J, Baruteau AE, Thambo JB. Long-Term Outcomes After Percutaneous Closure of Ostium Secundum Atrial Septal Defect in the Young. JACC Cardiovasc Interv 2018; 11:795-804. [DOI: 10.1016/j.jcin.2018.01.262] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 01/16/2018] [Accepted: 01/23/2018] [Indexed: 11/24/2022]
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Guedeney P, Hammoudi N, Duthoit G, Yan Y, Silvain J, Pousset F, Isnard R, Redheuil A, Kerneis M, Collet JP, Montalescot G. Intravenous enoxaparin anticoagulation in percutaneous left atrial cardiac procedures. EUROINTERVENTION 2017; 13:1226-1233. [DOI: 10.4244/eij-d-17-00518] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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25
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Baruteau AE, Hascoët S, Fraisse A. Transthoracic echocardiography is a safe alternative for assessment and guidance of transcatheter closure of secundum atrial septal defect in children. J Thorac Dis 2017; 9:1247-1256. [PMID: 28616275 DOI: 10.21037/jtd.2017.04.47] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND 2D-transesophageal echocardiography (TEE) is routinely performed to guide percutaneous ASD closure in children. We aimed to assess whether two-dimensional (2D)-transthoracic echocardiography (TTE) is a safe alternative for assessment and guidance of atrial septal defect (ASD) closure in unselected children. METHODS We performed a retrospective single-center study including 389 consecutive children aged less than 15-year-old who underwent percutaneous ASD closure under 2D-TEE (1998-2005, n=133) or 2D-TTE (2005-2014, n=256). A balloon calibration was performed in all cases for the Amplatz Septal Occluder choice. RESULTS ASDs were larger and rims deficiencies were more frequent in the TTE-guided group. The procedure was successful in 376 patients [96.7%; 95% confidence interval (CI), 94.4-98.2%]. The success rate tended to be higher in the TTE- versus TEE-guided group (98.0% versus 94.0%, P=0.069). Device migration occurred in 4 patients (1.0%; 95% CI: 0.3-1.6%), all after TEE-guided procedure (P=0.013). Early major adverse events were observed in 5 patients (1.3%; 95% CI: 0.4-3.0%), all in the TEE group (P=0.004). Fluroroscopic time and irradiation dose were not different among the 2 groups (P=0.450 and P=0.130 respectively). After a median follow-up of 7 years (range, 1-16 years), no adverse events was reported. One (0.3%, 95% CI: 0-1.4%) 12-year-old patient developed atrial fibrillation 5 years after the procedure. Pregnancies were uneventful in 72 cases. CONCLUSIONS When a balloon sizing is performed, 2D-TTE imaging is as efficient as 2D-TEE to guide percutaneous ASD closure in children. The procedure can safely be done in spontaneously breathing children under TTE guidance alone in experienced centers.
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Affiliation(s)
- Alban-Elouen Baruteau
- Department of Congenital Cardiology, Evelina London Children's Hospital, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Sébastien Hascoët
- Department of Paediatric Cardiac Surgery, Marie-Lannelongue Hospital, Paris Sud University, Paris, France
| | - Alain Fraisse
- Department of Paediatric Cardiology, Royal Brompton Hospital and Harefield NHS Foundation Trust, Imperial College London, London, UK
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26
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Deficient Surrounding Rims in Patients Undergoing Transcatheter Atrial Septal Defect Closure. J Am Soc Echocardiogr 2016; 29:768-776. [DOI: 10.1016/j.echo.2016.04.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Indexed: 11/22/2022]
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27
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Shunt Lesions Part I: Patent Ductus Arteriosus, Atrial Septal Defect, Ventricular Septal Defect, and Atrioventricular Septal Defect. Pediatr Crit Care Med 2016; 17:S302-9. [PMID: 27490614 DOI: 10.1097/pcc.0000000000000786] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES This review summarizes the current understanding of the pathophysiology and perioperative management of patent ductus arteriosus, atrial septal defect, ventricular septal defect, and atrioventricular septal defect. DATA SOURCE MEDLINE and PubMed. CONCLUSIONS The four congenital cardiac lesions that are the subject of this review, patent ductus arteriosus, atrial septal defect, ventricular septal defect, and atrioventricular septal defect, are the most commonly found defects causing a left-to-right shunt. These defects frequently warrant transcatheter or surgical intervention. Although the perioperative care is relatively straightforward for many of these patients, there are a number of management strategies and complications associated with each intervention. The treatment outcomes for all of these lesions are very good in the current era.
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28
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O'Byrne ML, Gillespie MJ, Kennedy KF, Dori Y, Rome JJ, Glatz AC. The influence of deficient retro-aortic rim on technical success and early adverse events following device closure of secundum atrial septal defects: An Analysis of the IMPACT Registry ®. Catheter Cardiovasc Interv 2016; 89:102-111. [PMID: 27189502 DOI: 10.1002/ccd.26585] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 04/21/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND Concern regarding aortic erosion has focused attention on the retro-aortic rim in patients undergoing device closure of atrial septal defects (ASD), but its effect on early outcomes is not well studied. METHODS A multicenter retrospective cohort study of patients undergoing device occlusion of ASD between 1/2011-10/2014 was performed, using data from the IMproving Pediatric and Adult Congenital Treatment Registry. Subjects were divided between those with retro-aortic rim <5 and ≥5 mm. Primary outcomes were technical failure and major early adverse events. Case times were measured as surrogates of technical complexity. The effect of deficient retro-aortic rim on primary outcomes was assessed using hierarchical logistic regression, adjusting for other suspected covariates and assessing whether they represent independent risk factors RESULTS: 1,564 subjects (from 77 centers) were included, with deficient retro-aortic rim present in 40%. Technical failure occurred in 91 subjects (5.8%) and a major early adverse event in 64 subjects (4.1%). Adjusting for known covariates, the presence of a deficient retro-aortic rim was not significantly associated with technical failure (OR: 1.3, 95% CI: 0.9-2.1) or major early adverse event (OR: 0.7, 95% CI: 0.4-1. 2). Total case (P = 0.01) and fluoroscopy time (P = 0.02) were greater in subjects with deficient rim, but sheath time was not significantly different (P = 0.07). Additional covariates independently associated with these outcomes were identified. CONCLUSION Deficient retro-aortic rim was highly prevalent but not associated with increased risk of technical failure or early adverse events. Studies with longer follow-up are necessary to assess other outcomes, including device erosion. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Michael L O'Byrne
- Division of Cardiology, Children's National Medical Center, George Washington University School of Medicine and Health Sciences.,Department of Pediatrics, George Washington University School of Medicine and Health Sciences
| | - Matthew J Gillespie
- Division of Cardiology, The Children's Hospital of Philadelphia.,Department of Pediatrics, Perelman School of Medicine, The University of Pennsylvania, Philadelphia
| | | | - Yoav Dori
- Division of Cardiology, The Children's Hospital of Philadelphia.,Department of Pediatrics, Perelman School of Medicine, The University of Pennsylvania, Philadelphia
| | - Jonathan J Rome
- Division of Cardiology, The Children's Hospital of Philadelphia.,Department of Pediatrics, Perelman School of Medicine, The University of Pennsylvania, Philadelphia
| | - Andrew C Glatz
- Division of Cardiology, The Children's Hospital of Philadelphia.,Department of Pediatrics, Perelman School of Medicine, The University of Pennsylvania, Philadelphia.,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania
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29
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Nassif M, Abdelghani M, Bouma BJ, Straver B, Blom NA, Koch KT, Tijssen JGP, Mulder BJM, de Winter RJ. Historical developments of atrial septal defect closure devices: what we learn from the past. Expert Rev Med Devices 2016; 13:555-68. [PMID: 27112301 DOI: 10.1080/17434440.2016.1182860] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Since King and Mills' pioneering work in percutaneous closure devices of secundum atrial septal defects (ASD) four decades ago, developments in device shape, material and implantation technique led to adoption of percutaneous ASD closure as current treatment of choice. Not only was the feasibility of such a percutaneous procedure tested altogether, but pursuing the ideal device in terms of safety and efficacy became priority. AREAS COVERED In this review we present the historical development of ASD devices in design, material and technique with clinical data, and provide the future perspectives in percutaneous ASD closures. EXPERT OPINION An 'ideal device' requires complete defect closure with negligible risk of complications using a safe, straightforward delivery technique with repositioning and retrieving properties. Some of the devices currently at hand come close to fulfilling these criteria, however none seem to provide those prerequisites completely. By understanding how challenges in device development were overcome in the past, new insights into future improvements are given.
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Affiliation(s)
- Martina Nassif
- a Department of Cardiology, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
| | - Mohammad Abdelghani
- a Department of Cardiology, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
| | - Berto J Bouma
- a Department of Cardiology, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
| | - Bart Straver
- b Department of Pediatric Cardiology, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
| | - Nico A Blom
- b Department of Pediatric Cardiology, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
| | - Karel T Koch
- a Department of Cardiology, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
| | - Jan G P Tijssen
- a Department of Cardiology, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
| | - Barbara J M Mulder
- a Department of Cardiology, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands.,c Interuniversity Cardiology Institute of the Netherlands (ICIN) , Utrecht , The Netherlands
| | - Robbert J de Winter
- a Department of Cardiology, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
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30
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Hascoët S, Warin-Fresse K, Baruteau AE, Hadeed K, Karsenty C, Petit J, Guérin P, Fraisse A, Acar P. Cardiac imaging of congenital heart diseases during interventional procedures continues to evolve: Pros and cons of the main techniques. Arch Cardiovasc Dis 2016; 109:128-42. [DOI: 10.1016/j.acvd.2015.11.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 11/09/2015] [Accepted: 11/13/2015] [Indexed: 12/22/2022]
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31
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Gossett JG, Mansfield L, Acevedo J, Lay AS, Rychlik K, Wax DF. Growth of the atrial septum after amplatzer device closure of atrial septal defects in young children. Catheter Cardiovasc Interv 2015; 86:1041-7. [DOI: 10.1002/ccd.26041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 05/05/2015] [Accepted: 05/08/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Jeffrey G. Gossett
- Division of Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago; Northwestern University's Feinberg School of Medicine; Chicago Illinois
| | - Laura Mansfield
- Division of Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago; Northwestern University's Feinberg School of Medicine; Chicago Illinois
| | - Jennifer Acevedo
- Division of Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago; Northwestern University's Feinberg School of Medicine; Chicago Illinois
| | - Amy S. Lay
- Division of Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago; Northwestern University's Feinberg School of Medicine; Chicago Illinois
| | - Karen Rychlik
- Division of Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago; Northwestern University's Feinberg School of Medicine; Chicago Illinois
| | - David F. Wax
- Division of Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago; Northwestern University's Feinberg School of Medicine; Chicago Illinois
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