Page 22 - Journal of Structural Heart Disease Volume 3, Issue 1

Original Scienti c Article
Journal of Structural Heart Disease, February 2017, Volume 3, Issue 1:15-27
DOI: http://dx.doi.org/10.12945/j.jshd.2017.16.005
Received: April 18, 2016 Accepted: June 10, 2016 Published online: February 2017
Challenges in Atrial Septal Defect Occlusion
Roie Tal, MD1, Moshe Dotan, MD2, Yitzhack Schwartz, MD1, Avraham Lorber, MD1*
1 Pediatric Cardiology and Adults with Congenital Heart Disease Institute, Rappaport Children’s Hospital, Rambam Health Care Campus, Haifa, Israel
2 Pediatric Cardiology, Ziv Medical Center, Safed, Israel
Abstract
We present 11 cases of percutaneous transcatheter oc- clusion of atrial septal defects (ASDs) in adults, includ- ing multi-fenestrated ASD, balloon-assisted deploy- ment of ASD occlude, dilator-assisted deployment of ASD occlude, “cobra”-shaped dis guration of the left disc, ASD with de cient aortic rim, pulmonary vein-as- sisted deployment of ASD occlude, “high” ASD, large Chiari network, double interatrial septum, snaring a runaway occluder, and right ventricular diastolic dys- function causing cyanosis. Each case is followed by a practical discussion of the special dilemmas, complica- tions, and challenges that may occur during common procedures.
Copyright © 2017 Science International Corp.
Key Words
Atrial septal defect • Percutaneous occlusion • Challenge • Technique
Introduction
Atrial septal defects (ASDs) account for 10–17% of congenital cardiac anomalies. Percutaneous clo- sure of ostium secundum ASD is a safe and e ective alternative to surgery [1]. Nevertheless, as with any interventional procedure, some ASD closures pose challenges and dilemmas to the interventional cardi- ologist. We report a variety of 11 representative cases, highlighting challenging morphological and clinical considerations that are of educational and practical value and suggesting ways to avoid pitfalls and com-
plications. These observations were collected over an 18-year period during which we have implanted over 1,000 interatrial shunts using the percutaneous approach.
Multi-Fenestrated ASD
A 45-year-old patient was evaluated after a cere- brovascular attack. Transthoracic echocardiography (TTE) revealed a oppy interatrial septum (IAS) with four fenestrations (Figure 1). A spontaneous left-to- right ow was noted as well as free right-to-left mi- cro-bubble ow during the Valsalva maneuver. We decided to close the fenestrations with a single de- vice. A rst attempt with a 15-mm device deployed in
Figure 1. Transesophageal echocardiogram demonstrating a multifenestrated atrial septal defect with four openings.
* Corresponding Author:
Avraham Lorber
Pediatric Cardiology and Adults with Congenital Heart Disease Institute
Rappaport Children’s Hospital, Rambam Health Care Campus
HaAliya HaShniya St 8, Haifa, 3109601, Israel
Tel. +1 972 4 7774630, Fax: +1 972 4 7774690, E-Mail: a_lorber@rambam.health.gov.il
Fax +1 203 785 3346
E-Mail: jshd@scienceinternational.org http://structuralheartdisease.org/
© 2017 Journal of Structural Heart Disease Published by Science International Corp. ISSN 2326-4004
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