Atrial septal defect video showing percutaneous repair
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [2]; Cafer Zorkun, M.D., Ph.D. [3] Assistant Editor(s)-In-Chief: Kristin Feeney, B.S. [4]
Overview
Percutaneous device closure of atrial septal defect, is currently approved only for secundum defects. Prior to the procedure, the patient is started on antiplatelet therapy for 6 months to prevent thrombus formation. Transesophageal echocardiography along with stop-flow technique is used for determining the device size, position, and deployment.
Pre-surgical considerations
1) Prior to undergoing percutaneous closure, eligible atrial septal defect patients must undergo pharmacologic preparation therapy.
2) Most therapy regimens include antiplatelet drugs such as aspirin or clopidogrel for a minimum of six months to protect patients against thrombus formation.
3) Secundum defects are assessed via echocardiographic monitoring to determine the anatomic viability of percutaneous closure.
4) The ideal secundum defect is less than 30mm in diameter with an accompanying rim of tissue around the defect of at least 5mm.
5) The rim of tissue serves to prevent impingement upon the superior vena cava (SVC), inferior vena cava (IVC), as well as the tricuspid or mitral valves.[1]
Steps during per-cutaneous closure
The salient feature of the percutaneous closure are-
1) Device is placed via femoral vein
2) Best results are for centrally located secundum defects.
3) Static diameter of the defect is assessed by using transesophageal echocardiography
4) Transesophageal echocardiography used for determining the device size, position, and deployment
5) A 'stop-flow' technique is used to select the proper diameter of the device
6) In the stop flow technique, the sizing balloon is inflated until no flow is visible through the defect using transesophageal echocardiography.
7) The margins of the defect must be ≤5 mm to accommodate the edges of the device.
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