Atrial septal defect percutaneous closure: Difference between revisions
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Secundum defects are assessed via [[Atrial septal defect echocardiography|echocardiographic monitoring]] to determine the anatomic viability of percutaneous closure. The ideal secundum defect is less than 30mm in diameter with an accompanying rim of tissue around the defect of at least 5mm. This rim of tissue serves to prevent impingement upon the [[superior vena cava|superior vena cava (SVC)]], [[inferior vena cava|inferior vena cava (IVC)]], as well as the [[tricuspid valve|tricuspid]] or [[mitral valve|mitral]] valves.<ref name="pmid1389707">{{cite journal| author=Ferreira SM, Ho SY, Anderson RH| title=Morphological study of defects of the atrial septum within the oval fossa: implications for transcatheter closure of left-to-right shunt. | journal=Br Heart J | year= 1992 | volume= 67 | issue= 4 | pages= 316-20 | pmid=1389707 | doi= | pmc=PMC1024841 | url= }} </ref> | Secundum defects are assessed via [[Atrial septal defect echocardiography|echocardiographic monitoring]] to determine the anatomic viability of percutaneous closure. The ideal secundum defect is less than 30mm in diameter with an accompanying rim of tissue around the defect of at least 5mm. This rim of tissue serves to prevent impingement upon the [[superior vena cava|superior vena cava (SVC)]], [[inferior vena cava|inferior vena cava (IVC)]], as well as the [[tricuspid valve|tricuspid]] or [[mitral valve|mitral]] valves.<ref name="pmid1389707">{{cite journal| author=Ferreira SM, Ho SY, Anderson RH| title=Morphological study of defects of the atrial septum within the oval fossa: implications for transcatheter closure of left-to-right shunt. | journal=Br Heart J | year= 1992 | volume= 67 | issue= 4 | pages= 316-20 | pmid=1389707 | doi= | pmc=PMC1024841 | url= }} </ref> | ||
==Percutaneous closure benefits== | |||
==Percutaneous closure complications== | |||
==Supportive trial data== | ==Supportive trial data== | ||
Revision as of 18:11, 25 August 2011
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-In-Chief: Priyamvada Singh, MBBS [[2]]; Cafer Zorkun, M.D., Ph.D. [3]; Assistant Editor-In-Chief: Kristin Feeney, B.S. [[4]]
Overview
Percutaneous transcatheter closure is used in limited atrial septal defect cases. The Food and Drug Administration has only authorized the use of percutaneous closure in ostium secundum patients.
Percutaneous closure
Mechanisms of benefit
The Ampltazer septal occluder (ASO) is the most commonly used device as it allows closure of large cavities, is easy to implant, and boasts high success rates. As an instrument, the ASO consists of two self-expandable round discs connected to each other with a 4-mm waist, made up of 0.004–0.005´´ nitinol wire mesh filled with Dacron fabric. Implantation of the device is relatively easy. The prevalence of residual defect is low. The disadvantages are a thick profile of the device and concern related to a large amount of nitinol (a nickel-titanium compound) in the device and consequent potential for nickel toxicity.
Indication
Percutaneous transcatheter closure is currently only indicated for the closure of ostium secundum atrial septal defects. In patients with a secundum defect, there must be a sufficient rim of tissue around the septal defect.
Contra-indications
It should not be used in patients with sinus venosus, primum or patent foramen ovale atrial septal defects.
Types of occluders
The Food and Drug Administration has authorized the following percutaenous transcatheters for usage:[1]
- Amplatzer septal occluder
- CardioSEAL
- HELEX septal occluder
- Sideris patch
Pre-surgical considerations
Prior to undergoing percutaneous closure, eligible atrial septal defect patients must undergo pharmacologic preparation therapy. Most therapy regimens include antiplatelet drugs to protect patients against thrombus formation. Prior to percutaneous closure, ostium secundum atrial septal defect patients undergo antiplatelet therapy such as aspirin or clopidogrel for a minimum of six months. This antiplatelet therapy protects patients against thrombus formation.
Secundum defects are assessed via echocardiographic monitoring to determine the anatomic viability of percutaneous closure. The ideal secundum defect is less than 30mm in diameter with an accompanying rim of tissue around the defect of at least 5mm. This 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.[2]
Percutaneous closure benefits
Percutaneous closure complications
Supportive trial data
In a study done on 236 patients with secundum atrial septal defects (ASD), to evaluate the safety and efficacy of transcatheter closure with the amplatzer septal occlude, the device was found to be very efficient. It causes atrial septal defect closure in 84.7% of the treated patient population. During a median follow up of 2.3 years complete closure was documented in 94%, with a residual shunt only in 12 patients. Two of the treated patients were reported to have procedure related complications like retroperitoneal bleeding and air embolism.
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Evaluation
Benefits of percutaneous closure
Complications of percutaneous closure
Atrial septal defect occluders
References
- ↑ Schwetz BA (2002). "From the Food and Drug Administration". JAMA. 287 (5): 578. PMID 11829678.
- ↑ Ferreira SM, Ho SY, Anderson RH (1992). "Morphological study of defects of the atrial septum within the oval fossa: implications for transcatheter closure of left-to-right shunt". Br Heart J. 67 (4): 316–20. PMC 1024841. PMID 1389707.