Transcatheter Closure of Multiple Defects of the Atrial Septum: Technique and Follow-Up
ABSTRACT
Introduction: Although multiple defects of the atrial septum are not uncommon, there remain limited data regarding the use of multiple devices in these patients. A variety of approaches to transcatheter closure have been used, and in this paper we describe the experience from two operators in a single centre. Methods: From September 2002 to September 2012, 673 transcatheter atrial septal defects (ASD) and patent foramen ovale (PFO) closure procedures were performed and retrospectively examined in a registry analysis. Results: Of these, 22 patients had multiple discrete defects, and four different approaches to closure were used. In 4 patients (18.2%) one device was used percutaneously to close multiple defects. Eleven patients (50%) had two devices inserted during the same procedure while two patients (9%) had two devices inserted as staged procedures. One patient (4.5%) had three devices inserted over two procedures. Four patients (18.2%) were found not to be suitable for percutaneous closure during the procedure and were referred for surgical closure. Conclusion: Our experience with the implant procedures, and clinical follow up of patients, shows that patients with multiple defects can be effectively treated with transcatheter device techniques including single device closure, multiple devices in one procedure and multiple devices in staged procedures and also with surgical repair.
Introduction: Although multiple defects of the atrial septum are not uncommon, there remain limited data regarding the use of multiple devices in these patients. A variety of approaches to transcatheter closure have been used, and in this paper we describe the experience from two operators in a single centre. Methods: From September 2002 to September 2012, 673 transcatheter atrial septal defects (ASD) and patent foramen ovale (PFO) closure procedures were performed and retrospectively examined in a registry analysis. Results: Of these, 22 patients had multiple discrete defects, and four different approaches to closure were used. In 4 patients (18.2%) one device was used percutaneously to close multiple defects. Eleven patients (50%) had two devices inserted during the same procedure while two patients (9%) had two devices inserted as staged procedures. One patient (4.5%) had three devices inserted over two procedures. Four patients (18.2%) were found not to be suitable for percutaneous closure during the procedure and were referred for surgical closure. Conclusion: Our experience with the implant procedures, and clinical follow up of patients, shows that patients with multiple defects can be effectively treated with transcatheter device techniques including single device closure, multiple devices in one procedure and multiple devices in staged procedures and also with surgical repair.
Cite this paper
Felice, H. , Chandran, S. , Bhamra-Ariza, P. and Brecker, S. (2015) Transcatheter Closure of Multiple Defects of the Atrial Septum: Technique and Follow-Up. International Journal of Clinical Medicine, 6, 591-596. doi: 10.4236/ijcm.2015.69079.
Felice, H. , Chandran, S. , Bhamra-Ariza, P. and Brecker, S. (2015) Transcatheter Closure of Multiple Defects of the Atrial Septum: Technique and Follow-Up. International Journal of Clinical Medicine, 6, 591-596. doi: 10.4236/ijcm.2015.69079.
References
[1] Teoh, K., Wilton, E., Brecker, S. and Jahangiri, M. (2006) Simultaneous Removal of an Amplatzer Device from an Atrial Septal Defect and the Descending Aorta. The Journal of Thoracic and Cardiovascular Surgery, 131, 909-910. [2] Butera, G., et al. (2006) Percutaneous versus Surgical Closure of Secundum Atrial Septal Defect: Comparison of Early Results and Complications. American Heart Journal, 151, 228-234.
http://dx.doi.org/10.1016/j.ahj.2005.02.051 [3] Butera, G., et al. (2010) Percutaneous Closure of Multiple Defects of the Atrial Septum: Procedural Results and Long-Term Follow-Up. Catheterization and Cardiovascular Interventions, 76, 121-128.
http://dx.doi.org/10.1002/ccd.22435 [4] Tillman, T., Mulingtapang, R. and Sullebarger, J.T. (2008) Approach to Percutaneous Closure in Patients with Multiple Atrial Septal Defects. Journal of Invasive Cardiology, 20, E167-E170. [5] Mahadevan, V.S., et al. (2009) Transcatheter Closure of Atrial Septal Defects with Multiple Devices in Adults: Procedural and Clinical Outcomes. International Journal of Cardiology, 133, 359-363.
http://dx.doi.org/10.1016/j.ijcard.2008.01.027 [6] Bramlet, M.T. and Hoyer, M.H. (2008) Single Pediatric Center Experience with Multiple Device Implantation for Complex Secundum Atrial Septal Defects. Catheterization and Cardiovascular Interventions, 72, 531-537.
http://dx.doi.org/10.1002/ccd.21668 [7] D Roy, R.S., Bunce, N., Ward, D. and Brecker, S.J. (2012) Selecting the Optimal Closure Device in Patients with Atrial Septal Defects and Patent Foramen Ovale. Interventional Cardiology, 4, 85-100.
http://dx.doi.org/10.2217/ica.11.90 [8] Roman, K.S., et al. (2002) Different Techniques for Closure of Multiple Interatrial Communications with the Amplatzer Septal Occluder. Journal of Interventional Cardiology, 15, 393-397.
http://dx.doi.org/10.1111/j.1540-8183.2002.tb01073.x [9] Hu, Z., et al. (2015) Comparison of the Effectiveness and Safety of Single versus Dual Occluders for the Closure of Multiple Atrial Septal Defects. Journal of Interventional Cardiology, 27, E90-E97. [10] Cao, Q., et al. (2000) Transcatheter Closure of Multiple Atrial Septal Defects. Initial Results and Value of Two- and Three-Dimensional Transoesophageal Echocardiography. European Heart Journal, 21, 941-947.
http://dx.doi.org/10.1053/euhj.1999.1909 [11] Szkutnik, M., et al. (2004) Transcatheter Closure of Double Atrial Septal Defects with a Single Amplatzer Device. Catheterization and Cardiovascular Interventions, 61, 237-41.
http://dx.doi.org/10.1002/ccd.10753 [12] Masseli, J., et al. (2013) Transcatheter Closure of Multiple Interatrial Communications. Catheterization and Cardiovascular Interventions, 81, 825-836. [13] Song, Z.-Y., et al. (2009) Clinical Efficiency and Safety Analysis of Transcatheter Closure of Multiple Atrial Septal Defects in Adults. Clinical Cardiology, 32, 130-134.
http://dx.doi.org/10.1002/clc.20450 [14] Kuo, B.T., et al. (2011) Double Atrial Septal Defect: Diagnosis and Closure Guidance with 3D Transesophageal Echocardi-Ography. Echocardiography, 28, E115-E117.
http://dx.doi.org/10.1111/j.1540-8175.2010.01347.x
[1] Teoh, K., Wilton, E., Brecker, S. and Jahangiri, M. (2006) Simultaneous Removal of an Amplatzer Device from an Atrial Septal Defect and the Descending Aorta. The Journal of Thoracic and Cardiovascular Surgery, 131, 909-910. [2] Butera, G., et al. (2006) Percutaneous versus Surgical Closure of Secundum Atrial Septal Defect: Comparison of Early Results and Complications. American Heart Journal, 151, 228-234.
http://dx.doi.org/10.1016/j.ahj.2005.02.051 [3] Butera, G., et al. (2010) Percutaneous Closure of Multiple Defects of the Atrial Septum: Procedural Results and Long-Term Follow-Up. Catheterization and Cardiovascular Interventions, 76, 121-128.
http://dx.doi.org/10.1002/ccd.22435 [4] Tillman, T., Mulingtapang, R. and Sullebarger, J.T. (2008) Approach to Percutaneous Closure in Patients with Multiple Atrial Septal Defects. Journal of Invasive Cardiology, 20, E167-E170. [5] Mahadevan, V.S., et al. (2009) Transcatheter Closure of Atrial Septal Defects with Multiple Devices in Adults: Procedural and Clinical Outcomes. International Journal of Cardiology, 133, 359-363.
http://dx.doi.org/10.1016/j.ijcard.2008.01.027 [6] Bramlet, M.T. and Hoyer, M.H. (2008) Single Pediatric Center Experience with Multiple Device Implantation for Complex Secundum Atrial Septal Defects. Catheterization and Cardiovascular Interventions, 72, 531-537.
http://dx.doi.org/10.1002/ccd.21668 [7] D Roy, R.S., Bunce, N., Ward, D. and Brecker, S.J. (2012) Selecting the Optimal Closure Device in Patients with Atrial Septal Defects and Patent Foramen Ovale. Interventional Cardiology, 4, 85-100.
http://dx.doi.org/10.2217/ica.11.90 [8] Roman, K.S., et al. (2002) Different Techniques for Closure of Multiple Interatrial Communications with the Amplatzer Septal Occluder. Journal of Interventional Cardiology, 15, 393-397.
http://dx.doi.org/10.1111/j.1540-8183.2002.tb01073.x [9] Hu, Z., et al. (2015) Comparison of the Effectiveness and Safety of Single versus Dual Occluders for the Closure of Multiple Atrial Septal Defects. Journal of Interventional Cardiology, 27, E90-E97. [10] Cao, Q., et al. (2000) Transcatheter Closure of Multiple Atrial Septal Defects. Initial Results and Value of Two- and Three-Dimensional Transoesophageal Echocardiography. European Heart Journal, 21, 941-947.
http://dx.doi.org/10.1053/euhj.1999.1909 [11] Szkutnik, M., et al. (2004) Transcatheter Closure of Double Atrial Septal Defects with a Single Amplatzer Device. Catheterization and Cardiovascular Interventions, 61, 237-41.
http://dx.doi.org/10.1002/ccd.10753 [12] Masseli, J., et al. (2013) Transcatheter Closure of Multiple Interatrial Communications. Catheterization and Cardiovascular Interventions, 81, 825-836. [13] Song, Z.-Y., et al. (2009) Clinical Efficiency and Safety Analysis of Transcatheter Closure of Multiple Atrial Septal Defects in Adults. Clinical Cardiology, 32, 130-134.
http://dx.doi.org/10.1002/clc.20450 [14] Kuo, B.T., et al. (2011) Double Atrial Septal Defect: Diagnosis and Closure Guidance with 3D Transesophageal Echocardi-Ography. Echocardiography, 28, E115-E117.
http://dx.doi.org/10.1111/j.1540-8175.2010.01347.x