Year 2020, Volume 6 , Issue 5, Pages 485 - 491 2020-09-04

Streamlined percutaneous atrial septal defect closure in adults

Selma ARI [1] , Hasan ARİ [2] , Veysi CAN [3] , Sencer ÇAMCI [4] , Mehmet MELEK [5]


Objectives: The aim of the study to evaluate the safety and efficacy of the transthoracic echocardiography (TTE) guided secundum atrial septal defect (ASD) closure without balloon sizing, sedation or general anesthesia in adults.

Methods: We retrospectively evaluated 200 secundum ASD closure patients in the tertiary cardiology center. Transesophageal echocardiography (TEE) was performed to all the patients at least one day before the intervention by the procedure operators. The patients who were closed with a cribriform device, using more than one device, with insufficient rim (<5 mm) (other than the anterior superior rim (aortic rim)), totally flail, and complex interatrial septum anatomy were excluded from the analysis.The size of the ASD closure device was chosen according to the largest diameter measured by TEE. ASD device was selected as 4 mm larger in patients without anterior superior rim and 2 mm larger in other patients than the largest diameter measured in 2D-TEE.

Results: In the remaining 166 patients, the procedure was performed with TTE and fluoroscopy guidance without balloon sizing, sedation or general anesthesia. The procedure was performed through right femoral vein. The patients age: 38.56 ± 14.72, gender: 57 male, 109 female, ASD size: 18.88 ± 5.99 mm, anterior superior rim: 5.30 ± 4.04 mm, anterior inferior rim: 14.22 ± 6.46 mm, posterior superior rim: 17.16 ± 4.96 mm, posterior inferior rim: 16.67 ± 7.48 mm. ASD device size: 23.74 ± 6.59 mm. The procedure success rate was 98.1% (163 patients). The complications; 1 patient device embolised, 2 patients device was not placed in the correct position by TTE.

Conclusions: TTE and fluoroscopy-guided secundum ASD closure without balloon sizing, sedation or general anesthesia by experienced operators is a safe and effective procedure. 

Atrial septal defect, transthoracic echocardiography, transesophageal echocardiography, , closure, sedation
  • 1. King TD, Milk NL. Nonoperative closure of atrial septal defects. Surgery 1974;75:383-8.
  • 2. Abaci A, Unlu S, Alsancak Y, Kaya U, Sezenoz B. Short and long term complications of device closure of atrial septal defect and patent foramen ovale: meta‐analysis of 28,142 patients from 203 studies. Catheter Cardiovasc Interv 2013;82:1123-38.
  • 3. Ding C, Chang JK, Lin CC, Wu YJ, Hsieh KS. Efficacy and safety of transthoracic echocardiography alone in transcatheter closure of secundum‐type atrial septal defects in adults. Echocardiography 2016;33:579-85.
  • 4. Zaqout M, Suys B, De Wilde H, De Wolf D. Transthoracic echocardiography guidance of transcatheter atrial septal defect closure in children. Pediatr Cardiol 2009;30:992-4.
  • 5. Yang M-C, Wu J-R. Recent review of transcatheter closure of atrial septal defect. Kaohsiung J Med Sci 2018;34:363-9.
  • 6. Jin M, Ding W-H, Wang X-F, Guo B-J, Liang Y-M, Xiao Y-Y, et al. Value of the ratio of occluder versus atrial septal length for predicting arrhythmia occurrence after transcatheter closure in children with ostium secundum atrial septal defect. Chin Med J 2015;128:1574-8.
  • 7. Bissessor N. Current perspectives in percutaneous atrial septal defect closure devices. Med Devices (Auckl) 2015;8:297-303.
  • 8. Silvestry FE, Cohen MS, Armsby LB, Burkule NJ, Fleishman CE, Hijazi ZM, et al. Guidelines for the echocardiographic assessment of atrial septal defect and patent foramen ovale: from the American Society of Echocardiography and Society for Cardiac Angiography and Interventions. J Am Soc Echocardiogr 2015;28:910-58.
  • 9. Dalvi B, Jain S. Atrial septal defect: step-by-step catheter closure. J Struct Heart Dis 2016;2:15-32.
  • 10. Thanopoulos BD, Dardas P, Ninios V, Eleftherakis N, Karanasios E. Transcatheter closure of large atrial septal defects with deficient aortic or posterior rims using the “Greek maneuver”. A multicenter study. Int J Cardiol 2013;168:3643-6.
  • 11. Hijazi ZM, Feldman T, Sievert H, Al-Qbandi MHA. Transcatheter closure of ASDs and PFOs: a comprehensive assessment: Cardiotext Publishing, 2010.
  • 12. Kutty S, Asnes JD, Srinath G, Preminger TJ, Prieto LR, Latson LA. Use of a straight, side‐hole delivery sheath for improved delivery of Amplatzer ASD occluder. Catheter Cardiovasc Interv 2007;69:15-20.
  • 13. Spies C, Boosfeld C, Schräder R. A modified cook sheath for closure of a large secundum atrial septal defect. Catheter Cardiovasc Interv 2007;70:286-9.
  • 14. Chiam PT, Cohen HA, Ruiz CE. The parallel wire technique for septal defect closure. Catheter Cardiovasc Interv 2008;71:564-7.
  • 15. Wahab HA, Bairam AR, Cao QL, Hijazi ZM. Novel technique to prevent prolapse of the Amplatzer septal occluder through large atrial septal defect. Catheter Cardiovasc Interv 2003;60:543-5.
  • 16. Dalvi BV, Pinto RJ, Gupta A. New technique for device closure of large atrial septal defects. Catheter Cardiovasc Interv 2005;64:102-7.
  • 17. Nounou M, Harrison A, Kern M. A novel technique using a steerable guide catheter to successfully deliver an Amplatzer septal occluder to close an atrial septal defect. Catheter Cardiovasc Interv 2008;72:994-7.
Primary Language en
Subjects Cardiac and Cardiovascular Systems
Journal Section Original Articles
Authors

Orcid: 0000-0001-8669-8750
Author: Selma ARI
Institution: Department of Cardiology, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
Country: Turkey


Orcid: 0000-0002-9681-2374
Author: Hasan ARİ (Primary Author)
Institution: Department of Cardiology, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
Country: Turkey


Orcid: 0000-0002-4731-4061
Author: Veysi CAN
Institution: Department of Cardiology, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
Country: Turkey


Orcid: 0000-0003-2152-0470
Author: Sencer ÇAMCI
Institution: Department of Cardiology, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
Country: Turkey


Orcid: 0000-0003-1787-0187
Author: Mehmet MELEK
Institution: Department of Cardiology, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
Country: Turkey


Supporting Institution Yok
Dates

Application Date : April 28, 2020
Acceptance Date : July 20, 2020
Publication Date : September 4, 2020

EndNote %0 The European Research Journal Streamlined percutaneous atrial septal defect closure in adults %A Selma Arı , Hasan Ari̇ , Veysi Can , Sencer Çamcı , Mehmet Melek %T Streamlined percutaneous atrial septal defect closure in adults %D 2020 %J The European Research Journal %P -2149-3189 %V 6 %N 5 %R doi: 10.18621/eurj.728060 %U 10.18621/eurj.728060