Page 24 - Journal of Structural Heart Disease Volume 2, Issue 1

Original Research Report
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Advantages:
1. No reported incidence of device erosion or cardiac perforation.
2. Even after locking the device in position after optimal position is con rmed, it can still be re- trieved with the help of retrieval cord attached to the right atrial disc.
3. The HELEXR Septal Occluder is a non-self-centering device having a narrow mid portion that makes it suitable for closure of multifenestrated defects.
4. The device can easily be seen on uoroscopy and echocardiography.
Disadvantages:
1. Defects larger than 18 mm cannot be closed with this device.
2. Wire frame fracture has been reported with the HELEXR Septal Occluder, especially the larger sizes, occurring in 6.4–8.0% after 1 year [12].
3. In a United States multicentre study of the HELEXR Septal Occluder, used in 143 patients for closure of ASDs, there was a rate of residual leaks of 25.7% at 12 months [13].
Advantages:
1. There is a 50% reduction of meshwork material on the left atrial side along with elimination of the left atrial disc microsrew, minimizing both the risk of thrombus formation and damage to the distal wall of the left atrium during implantation.
2. The delivery cable mechanism is di erent and allows pivoting of the device (up to 500), which facilitates positioning across the septum; an ad- vantageous feature especially in large defects and borderline length of rims (right gure).
3. Thedeviceisfullyrecapturableandrepositionable.
Slide # 28:
The Amplatzer Septal Occluder device (St. Jude, Plymouth, Minnesota, USA) is a self-expandable double-disk device made of a nitinol (55% nickel; 45% titanium) wire mesh. The ASO device is constructed from a 0.004–0.0075-inch nitinol wire mesh that is tightly woven into two at disks. There is a 3–4-mm connectingwaistbetweenthetwodisks,correspond- ing to the thickness of the atrial septum.
Slide # 29:
*This will be in context of Amplatzer Septal Occluder (St. Jude, Plymouth, Minnesota, USA).
Slide # 30:
These sheath sizes are recommended by the man- ufacturer depending on the size of the device. Our practice is to use a sheath 1 Fr larger than the recom- mended size excepting in children weighing less than 15 kg in whom we use the same size as per the recom- mendations.
*A 40-mm device is not available in the US.
Slide # 31:
A. Loader – used to introduce the Amplatzer Septal Occluder into the delivery sheath.
B. Hemostatic valve with extension tube and stop- cock – allows ushing the delivery system and controls back-bleeding.
C. Delivery sheath – provides a pathway through which a device is delivered.
4. There is a xed right angle between the tip of the delivery catheter and the device. In some cases, especially in children, this distorts the anatomy and orientation of the atrial septum, making it di cult to decide whether the occluder position is optimal. With release of the device there is a pronounced repositioning when the force from the delivery system is taken away from the sep- tum.
Slide # 27:
The Occlutech Figulla Flex II (Occlutech GmbH, Jena, Germany) is a self-expanding nitinol wire mesh, very similar to the Amplatzer device in shape, but with a dif- ferent design that eliminates the left atrial microscrew (left gure). The device, developed using a unique patented braiding technique, consists of a nitinol wire mesh to create a smooth and exible outer layer. Two retention discs allow for a single central pin on the right atrial side. Two polyethylene terephthalate (PET) patches assure complete closure after implantation. Available sizes range between 4 to 40 mms.
Journal of Structural Heart Disease, February 2016
Volume 2, Issue 1:15-32