Atrial septal defect video showing percutaneous repair: Difference between revisions
New page: {{Atrial septal defect}} {{CMG}}; '''Associate Editor(s)-In-Chief:''' Priyamvada Singh, M.B.B.S. [mailto:psingh@perfuse.org]; {{CZ}} '''Assistant Editor(s)-In-Chief:''... |
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==Overview== | ==Overview== | ||
==Pre-surgical considerations== | |||
Prior to undergoing [[Atrial septal defect percutaneous|percutaneous closure]], eligible [[atrial septal defect]] patients must undergo pharmacologic preparation therapy. Most therapy regimens include [[Antiplatelet Therapy to Support PCI (patient information)|antiplatelet drugs]] to protect patients against [[thrombus]] formation. Prior to [[percutaneous closure]], [[Ostium secundum atrial septal defect|ostium secundum atrial septal defect]] patients are started on [[Antiplatelet Therapy to Support PCI (patient information)|antiplatelet drugs]] such as [[aspirin]] or [[clopidogrel]] for a minimum of six months. | |||
[[Ostium secundum atrial septal defect|Secundum defects]] are assessed via [[Atrial septal defect echocardiography|echocardiographic monitoring]] to determine the anatomic viability of percutaneous closure. The ideal [[Ostium secundum atrial septal defect|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> | |||
==Per-cutaneous closure== | |||
The salient feature of the [[Atrial septal defect percutaneous closure | percutaneous closure]] are- | |||
* Device is placed via [[femoral vein]]. | |||
* Best results are for centrally located [[Ostium secundum atrial septal defect|secundum defects]]. | |||
* Static diameter of the defect is assessed by using [[transesophageal echocardiography]]. | |||
* [[Transesophageal echocardiography]] used for determining the device size, position, and deployment | |||
* A ''' 'stop-flow' ''' is used to select the proper diameter of the device. | |||
* In the stop flow technique, the sizing balloon is inflated until no flow is visible through the defect using [[transesophageal echocardiography]]. | |||
* The margins of the defect must be '''≤5 mm''' to accommodate the edges of the device. | |||
<youtube v=Gros-u7YCTk/> | <youtube v=Gros-u7YCTk/> | ||
Revision as of 00:43, 12 September 2011
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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
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 are started on antiplatelet drugs such as aspirin or clopidogrel for a minimum of six months.
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.[1]
Per-cutaneous closure
The salient feature of the percutaneous closure are-
- Device is placed via femoral vein.
- Best results are for centrally located secundum defects.
- Static diameter of the defect is assessed by using transesophageal echocardiography.
- Transesophageal echocardiography used for determining the device size, position, and deployment
- A 'stop-flow' is used to select the proper diameter of the device.
- In the stop flow technique, the sizing balloon is inflated until no flow is visible through the defect using transesophageal echocardiography.
- The margins of the defect must be ≤5 mm to accommodate the edges of the device.
<youtube v=Gros-u7YCTk/>