Rosenthaltulip malformation of the left atrial disc in the lifetech cera asd device. Transcatheter closure of secundum atrial septal defect asd with amplatzer device is an alternative procedure to surgical repair, with some limitations. However, the percutaneous asd closure fully entered the clinical arena. The health care provider makes a tiny cut in the groin, then inserts the catheters into a blood vessel and up into the heart. Long term follow up is imperative to plan second stage closure of the fenestration. Complications in atrial septal defect device closure. Asd closure device dimension ranged from 8mm to 35mm mean 19. Percutaneous closure of atrial septal defect 3 rasheed ibdah. Closure devices for patent foramen ovale and atrial septal.
Selecting the optimal closure device in patients with. Atrial septal defect asd device transcatheter closure. Ostium secundum atrial septal defect asd, congenital heart defect, percutaneous device closure, older. Device closure of asd in children using the amplatzer devices. Tct685 high procedure success rate in device closure of. Complication rates in this group of smaller patients are not well described in the literature for either percutaneous or surgical approaches. Analysis of the therapeutic effect of transesophageal. Transesophageal echocardiography for device closure of atrial septal defects case selection, planning, and procedural guidance balu vaidyanathan, dm, john m. Asd closure is indicated in the presence of a significant lefttoright shunt, defined by a significant right heart enlargement due to volume overload, regardless of symptoms 3,4. Although surgical repair of interatrial defects is a safe, widely accepted procedure with negligible mortality, it is associated with morbidity, discomfort and thoracotomy scar. As little is known about the procedural completion in asd patients with multiple rim deficiencies, we aimed to evaluate the validity of device closure for these. Their device consisted of dacroncovered stainless steel umbrellas, but it required a large delivery sheath and.
Device closure of secundum atrial septal defects in children kg. Transcatheter closure of atrial septal defect journal of thoracic. Atrial septal defect asd is a common congenital cardiac anomaly. Secundum atrial septal defect asd is a common congenital heart. However, if the asd is in an unusual position within the heart, or if there are other heart defects such. Transcatheter closure of a secundum asd has been used for years with good results in both children and adults. Atrial septal defect transcatheter closure inpatient care.
Background there has been a trend over the years for referral of younger and smaller patients for elective closure of atrial septal defects asd. Most large atrial septal defects now can be closed either with openheart surgery or during a cardiac catheterization using a device inserted into the opening to plug it referred to as interventional or therapeutic catheterization pdf. Complications of transcatheter atrial septal defect closure. Even though surgery is the gold standard, percutaneous device closure is gaining popularity because of the short learning curve, cosmetic advantage and relative safety. The amplatzer septal occluder system summary of safety. Transcatheter and intraoperative device closures have been widely used in the treatment of secundum atrial septal defect asd. Post procedure echo studies check for a residual atrial shunt and unobstructed flow of pulmonary veins, coronary sinus, and venae cavae and proper function of the mitral and tricuspid valves. Adequate septal rim is an important factor for device closure of atrial septal defect asd. An atrial septal defect asd is a hole in the septum, or muscular wall, that separates the hearts two upper chambers atria. Minimally invasive cardiac surgery mics has been found safe and effective for asd closure with comparable mortalitymorbidity and superior cosmetic results compared to conventional median sternotomy. Management of large secundum asd and severe phtn has proven to be challenging.
Transcatheter closure of atrial septal defects coverage, coding and reimbursement overview physicianhospital 2016 edition all reimbursement amounts are listed at national medicare rates and do not include the 2% sequestration reduction physician rates effective january 1, 2016 through december 31, 2016. Having a transcatheter closure of your atrial septal defect this leaflet aims to answer your questions about having the hole in your heart known as an atrial septal defect or asd closed. Closure of atrial septal defect with amplatzer device. Without this procedure, your symptoms may get worse. Surgical closure of atrial septal defect asd has been the treatment of choice for decades, with excellent results, negligible mortality and limited morbidity. This study reports our clinical experience with transcatheter closure of secundum atrial septal defects asds in children, using the amplatzer, a new occlusion device. It has the advantages of cost savings, better cosmetic results, and less trauma than surgical. Only few cases of device closure of atrial septal defect in dextrocardia with situs inversus totalis has been reported previously.
It explains the benefits, risks and alternatives to the procedure, as well as what you can expect when you come to. Case 10 years old boy underwent successful transcather device closure of secundum asd in august 2011 with a 22 mm amplatzer septal occluder device. Minimally invasive atrial septal defect asd closure. Device closure of atrial septal defects with the amplatzer septal occluder. This means that your child will be asleep during the procedure. The device implant procedure was performed using standard tech. Having a transcatheter closure of your atrial septal defect. Indications and catheter preparations, technique, and. The procedure is performed while your child is under a general anaesthetic. After the procedure, you will need to take a bloodthinning medication to keep clots from forming on the device. Surgical patch closure of atrial septal defects the annals of. All patients had left atrial and ventricular volume overload documented by echocardiography. The procedure involves placing an asd closure device into the heart through tubes called catheters. Minimally invasive atrial septal defect asd closure ucsf offers a minimally invasive approaches for atrial septal defect asd closure.
We examined the efficacy and safety of the amplatzer, a new. This leads to a shorter recovery, less pain and a quicker return to normal activities. The procedure is very effective in closing atrial septal defects. The role of echocardiography indication rv volume load tte. Transcatheter device closure of asd has come a long way since the first experimental closure in dogs by kings and mills in 1972. Transcatheter device closure of asd has come a long. Current concept of transcatheter closure of atrial septal defect in adults. Three days after the procedure he developed severe migraines.
Closure of atrial septal defects with the amplatzer. In the past the only way of doing this involved openheart surgery. Transcatheter and intraoperative device closure of atrial. In general, the risks associated with asd device closure are believed and reported to be relatively low. Simultaneous transcatheter device closure of asd, vsd and. The aim of this study was to assess the initial and midterm results of the treatment of asd with amplatzer septal occluder in children and adolescents. The operation is performed using a small 46 cm incision through the small space between the ribs. When compared to surgery, it provides a less invasive approach with quicker recovery and reduced physical and psychological impact. Intraoperative device closure of atrial septal defect is a safe and feasible technique for infants. Longterm followup after transcatheter closure of atrial septal defect in children. Your doctor will talk to you about the right type of medication for you and how long you need to take it. Their device consisted of dacroncovered stainless steel umbrellas, but it required a large delivery sheath and complicated maneuvering during deployment. Selection of device size for atrial septal defect closure.
Not every asd can be closed with heart catheterization. King and mills, in 1974, originally described and subsequently demonstrated feasibility of closing asd using a device. Transcatheter closure of atrial septal defect with amplatzer device. Device closure of secundum atrial septal defects is sometimes needed in young children. Learn more information about atrial septal defect from the no. Pa pressures of patient reduced significantly after the procedure and possible postoperative.
The catheter enters from the groin, continues into the heart, and goes across the asd to deploy the. Intraoperative device closure of atrial septal defect in. Complications related to the procedure were minimal 16 patients. We present a case of a 36 years old male, who had secundum type. Minimally invasive surgery vs device closure for atrial. Contraindications to device closure asd closure procedures. However, if the asd is in an unusual position within the heart, or if there are other heart defects such as abnormal connections of the veins bringing blood from the lungs back to the heart pulmonary veins, the asd cannot be closed with the catheter. Atrial septal defect sizing and transcatheter closure fulltext.
Dear parent, you have already been informed that your child has an atrial septal defect asd which needs to be repaired. Closure of secundum atrial septal defects with the. Robert frankeldirector of the cardiac catheterization lab at maimonides medical centerexplains the use of the amplatzer septal occluder device. An asd occurs when part of the atrial septum does not form properly. The society of thoracic surgeons adult cardiac surgery. Alternative practices or procedures the only alternative to device closure of an asd is openheart surgery. Skeptics went up in arms damning the device and the procedure many radicals suffered most conservatives survived what almost killed the procedure overenthusiasm.
However, unlike earlier devices, the current generation is easier to deploy and retrieve. Shortterm and midterm followup of transthoracic device closure. An animation of a cardia pfo closure device being implanted in the human heart. View enhanced pdf access article on wiley online library html view. Atrial septal defect asd is a common congenital lesion in adults.
Review article percutaneous device closure of secundum. Indications and catheter preparations, technique, and outcome 15 scai fellow course fall 2014 ralf j holzer md msc fscai medical director. Descriptions of percutaneous device closure of a secundum asd have been extensively reported in other articles and will therefore not be detailed in this paper. Atrial septal defect asd american heart association. Therefore, we first need to measure the asd to make sure it can be closed with a device in the. Device closure is the firstline treatment for most atrial septal defects asds.
Device closure of atrial septal defects with the amplatzer. The patients are administered aspirin 5 mgkgday for 6 months. If this happens, you may need open heart surgery to remove the device and repair the hole with a patch or stitches. None of the devices previously used for transcatheter closure of interatrial communications has gained wide acceptance. Pdf transcatheter device closure of atrial septal defect. Device closure of secundum atrial septal defects in. Surgery is relatively safe with a mortality of less. Cardiac surgery that is required for closure of such defects is a major procedure that requires cardiopulmonary bypass. Amplatzer device closure of atrial septal defects and. However, for young infants with asd, device closure remains controversial, and such treatment features limited data. Sanotranscatheter closure of atrial septal defect in a geriatric population. The closure device is then placed across the asd and the defect is closed. Figure 1 amplatzer septal occluder device and delivery system 6.
The amplatzer device is the most advanced device of its type available in the united states. It explains the benefits, risks and alternatives to the procedure, as well as what you can expect when you come to hospital. We compared the clinical data and followup results of percutaneous and intraoperative device closure for asd to evaluate the feasibility, safety, and. Transesophageal echocardiography for device closure of. Surgicaldevice closure indicated see above discussion under management o chf present o defect not spontaneously closed by 24 years of age two treatment options surgical or device o choice depends on. Partial closure using a custom made fenestrated device is a safe and feasible treatment option to reduce the magnitude of the shunt and rv overlad. Using a catheterbased procedure, we are able to avoid surgery. Advances in percutaneous transcatheter device closure of secundum atrial septal defect asd have resulted in high success rates. Simpson, md, raman krishna kumar, dm transcatheter closure is an effective alternative to surgery in most patients with atrial septal defects asds of the secundum type 1,2.
872 526 1418 973 822 679 823 963 14 1303 1349 802 1194 509 176 76 594 566 412 242 308 924 141 895 1261 766 332 618 1233 332 370 543 264 525 361 292 582 329 134 658 1023 1259 132 730 512 1059 513 1059